Image: Roxana Selagea, a Publix Supermarket pharmacy manager
Joe Raedle  /  Getty Images file
Roxana Selagea, a Publix Supermarket pharmacy manager, retrieves bottles of antibiotics from the shelf. The grocery chain began offering the drugs for free in 2007. Since then, several other chains have followed suit, sparking concerns from health experts worried about rising drug resistance.
By JoNel Aleccia Health writer
msnbc.com
updated 3/5/2009 8:42:40 AM ET 2009-03-05T13:42:40

Offering free antibiotics to cash-strapped customers may have seemed like a good idea this dire winter, but supermarket chains are fielding a backlash from health experts who say the promotions may do more harm than good.

Five large retailers have received letters from the federal Centers for Disease Control and Prevention and the Infectious Diseases Society of America cautioning that giving away antibiotics contributes to misuse of medication and the rise of increasingly drug-resistant bugs.

“We were a little alarmed, especially when they suggested they’d be doing it during cold and flu season,” said Dr. Lauri Hicks, medical director of the CDC’s program on appropriate antibiotic use.

“We know that antibiotics aren’t effective for cold and flu. We don’t want to perpetuate the idea that they are.”

But the stores, which include Wegmans, ShopRite, Stop and Shop and Giant Food, contend they’re only filling valid prescriptions written by doctors — and trying to save shoppers a little money in the process.

“We feel like it’s a way to help our customers out during tough economic times,” said Jamie Miller, a spokesman for Giant Food, a 182-store chain based in Landover, Md.

However, offering free antibiotics likely will prompt more patients to ask their doctors for the drugs, experts said. Repeated research shows that doctors often prescribe antibiotics just because a patient asks. A study published last fall in the British Medical Journal showed that some doctors use antibiotics as placebos for patients who insist on medication.

“It’s much easier to give someone an antibiotic than it is to explain to someone why they don’t need it,” said Dr. Ed Septimus, an internist who helped write the letters sent by the IDSA.

Giant Food is one of several retailers that launched free-drug giveaways this winter, providing up to two weeks of the most frequently prescribed antibiotics, including amoxicillin, erythromycin, ciprofloxacin and penicillin. The offer is available to anyone with a prescription whether they have health insurance or not.

A typical round of antibiotics costs $10 to $20, though many stores have started offering $4 generic prescriptions.

Most of the stores planned to continue offering the drugs through the end of this month, if not longer. Some grocery chains, such as Meijer Inc. of Grand Rapids, Mich., and Publix Super Markets Inc. of Lakeland, Fla., have offered the free meds year-round for several years.

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Well-intentioned but obviously ill-advised’
That worries many infectious disease specialists, who say they’ve been fighting for years to reduce demand for the drugs.

How germs spread“I was actually driving to work and saw this huge billboard that said ‘Come to Wegmans for free antibiotics,’” said Ann Marie Pettis, director of infection prevention at the University of Rochester Medical Center in Rochester, NY.

“Here we are all working so hard to control the use of antibiotics and then to see something that’s well-intentioned but obviously ill-advised was surprising,” she said.

Other experts contend that the stores’ motives aren’t completely altruistic because they’re using the free drugs as so-called “loss leaders” to attract new customers.

“They’re buying these drugs for pennies and they’re getting people into the store to buy things they can make money on,” said Septimus.

If the stores really wanted want to help, they’d give away free flu shots or free blood pressure medications, services that save shoppers money and don’t compromise their health, he added.

Even when they do need the drugs, the free programs may influence patient demand. When Lisa Samples’ husband, James, needed an antibiotic for a bad case of bronchitis this week, the 42-year-old Dallas, Ga., woman asked the doctor to prescribe something from the free list at her local Publix supermarket.

“It makes a difference right now, definitely, especially because we’re both not working,” said Samples, who called the free drugs “a great marketing strategy.”

“I ended up going in and spending money,” she said, noting that she picked up eggs, milk, bread and lunchmeat.

Stores say they aren't prescription police
But the stores counter that the problem isn’t that they’re providing free drugs, it’s that doctors aren’t prescribing them correctly, said Frank Guglielmi, a spokesman for Meijer Inc., which operates 180 stores in five states.

“The premise that we’re responsible for policing prescriptions? That’s not what a pharmacy does,” he said.

Whatever the source, however, health experts say easy access to antibiotics is at the core of the growing problem of drug resistance. Overuse of the drugs has allowed many bacteria to become increasingly immune to the medications. That has fueled the rise of potentially deadly superbugs such as MRSA or methicillin-resistant Staphylococcus aureus, and C. diff, or Clostridium difficile.

C. diff , a severe intestinal illness that can lead to removal of the colon or even death, often is sparked by recent use of antibiotics such as ciprofloxacin, which is on the free lists.

Even when the problem isn’t life-threatening, antibiotics can cause harm. About 142,000 emergency department visits each year are tied to antibiotic use, mostly allergic reactions, according to a recent study in the journal Clinical Infectious Diseases.

“The fact is that antibiotics are not harmless,” said Hicks, the CDC specialist. “There’s a perception that antibiotics are like candy.”

She has urged stores to help raise awareness of proper antibiotic use by providing information from the CDC’s program, “Get Smart: Know When Antibiotics Work.”

That’s why the agency tried to be diplomatic in the recent letters. “We were concerned if we took a very aggressive approach with them, we would lose any opportunity to get our message out there,” said Hicks.

Stores surprised by strong reaction
That has worked with Wegmans, which may soon stock the CDC literature along with the free drugs. Spokeswoman Jo Natale said the company was surprised at the strong reaction from many health experts after the program began. Some doctors called the company to protest the program.

“Did we go to public health officials and ask their advice? We did not,” she said. “We should have had those conversations.”

As it was, the retailer acknowledged health officials’ concerns by sending out tips to their customers on the proper use of antibiotics.

“Without meaning to,” Natale said, “we did initiate a dialogue about this very topic.”

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