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Ronny Jackson’s VA Nomination Debacle Highlights America’s Drug Overprescribing Problem

White House doctor and Rear Admiral Ronny Jackson’s tumultuous nomination by President Donald Trump to lead the Department of Veterans Affairs (VA) came to an abrupt end Thursday. Jackson withdrew his VA nomination—which had already taken some by surprise given his lack of government and leadership experience—amid mounting allegations of misconduct. Those allegations, vehemently denied by Jackson, included claims that the White House physician was drunk while on duty, fostered a hostile work environment, and overprescribed prescription drugs.

That last point, which reportedly earned Jackson the moniker “Candyman” (among the allegations disputed by Jackson as “baseless and anonymous attacks on my character and integrity”), is worth exploring from a broader perspective. Unnamed accusers say Jackson was readily willing to hand out pills like Ambien and Provigil while taking very little in the way of patient histories. But regardless of what Jackson did or did not do, overprescribing medicine is a common element of American health care, according to multiple independent studies.

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Overprescribing is often labeled one of the central villains in the opioid epidemic, to cite just one example. A study led by Mayo Clinic researchers found that one of out of every three patients prescribed opioid painkillers after surgery don’t even take a single pill. Not one. Nada. That in and of itself presents a danger for prescription abuse since the pills are just laying around the house, available for non-medical use at a moment’s notice.

“Fewer than 10% of patients disposed of their leftover opioids,” the Mayo Clinic’s scientific director for surgical outcomes, Elizabeth Habermann, told WebMD earlier this month while discussing the study. “We know from the literature that many individuals who are taking heroin actually started their use of narcotics with leftover prescription opioids prescribed to others. So this is a huge risk to our community.”

Elderly Americans are also a regular target of overprescribing and what some argue is excess medical intervention. Last year, studies published in JAMA Internal Medicine and the New England Journal of Medicine found that many older people are routinely prescribed powerful, mind-altering psychotropic drugs even if they’ve never been diagnosed with a condition that calls for the treatments.

Financial incentives may well play a part in this culture of overprescribing. After all, the U.S. medical regimen largely rewards doctors, hospitals, and other stakeholders on the bulk of services they provide (whether those services be diagnostic tests, medical procedures, or prescription drugs) rather than those services’ broader value. And, in the drug industry specifically, physicians who receive significant money from pharmaceutical companies tend to prescribe more pricey brand name prescriptions.

Jackson’s case—if the allegations about his prescription practices are true—is admittedly different from what’s experienced by everyday Americans given his perch at the White House. But the underlying trend may not be all that rare.