Right Drug, Wrong Patient 药对了，病人错了(Andrea Rock 安德里亚·洛克)
摘自：英语泛读教程四
As a rule, the pharmacy's proficiency and authority is little doubted. But the rate of pharmacy errors is much higher than people think. Imagine what would happen if the drug dispensed to you were not the proper one. The following article tells us more about pharmacy errors.
通常，药房的职业水平和权威是很少受到怀疑的。然而，药房的出错率比人们所想的要高得多。想一想，要是药房给你开错了药会出现什么后果？下面这篇文章将会告诉我们更多有关药房错误的事情。
At breakfast, seven-year-old Gabrielle Hundley took the first of two pills that would change her life. The new prescription that her mother, Peggie, had gotten filled at the Rite Aid in Rock Hill, S.C., was for Ritalin, a drug used to treat attention deficit- hyperactivity disorder.
在吃早餐时，7岁的加布里埃尔·亨德黎服下了将会改变她一生的两粒药中的第一粒。新处方上开的药是利他林，这是她母亲佩吉在南卡罗来纳州洛克山的日特爱德药店配的药，一种用来注意力缺失/过动症的药。
In an emergency room later that day, February 21, 1995, doctors discovered that the little girl hadn't ta
ken Ritalin at all, but a high dose of Glynase, a diabetes medication. In court the next year, the Hundleys' attorney argued that the pills were incorrectly dispensed, and contained 16 times the normal starting dose for adult diabetics, causing Gabrielle's blood-sugar level to plummet so severely that she suffered permanent brain damage. The jury awarded the Hundley family $16 million. Rite Aid is appealing the verdict.
当天，即1995年2月21日的晚些时候，在急救室里，医生们发现小女孩服用的根本不是利他林，而是大剂量的格里纳斯，一种糖尿病的药。次年在法庭上，亨德黎的律师论证说，药物没有正确配发，其剂量比成人正常初服量高出16倍，使得加布里埃尔血糖急遽攀高，从而导致她脑部永久性损伤。陪审团判决赔偿亨德黎家１600万美元。日特爱德药店提出了上诉。
Pharmacy transactions seem so straightforward. How often could they go awry?
药房交易看上去非常简单明了。它们的出错率有多高呢？
While there are no definitive national statistics, there is evidence suggesting that drug-dispensing mistakes are more common than you think. In a 1997 nationwide survey conducted by the trade publication Drug Topics, 53 percent of pharmacists admitted having made errors in the preceding two months. A June 1996 survey of 3361 pharmacists in California and Oregon revealed that errors occurr
ed at an annual rate of 324 per pharmacy －nearly one a day.
尽管没有确定的全国性统计数据，还是有证据表明配药错误比人们想象的要更常见。1997年，行业刊物《药学信息》在全国范围内进行的一次调查表明，53%的药剂师承认在前两月里发生过差错。1996年6月对3361位加利福尼亚和俄勒冈的药剂师的调查显示，出错率为每家药店每年324次——将近每天1次。
“Ten years ago, an acceptable error rate was considered one per year per pharmacy,” says Ralph Vogel, president of the Guild For Professional Pharmacists, a union representing 2000 pharmacists. “What we're seeing today is the chaos that comes from understaffing and other new stresses in the pharmacy. “
“十年前，可接受的出错率为每家药店每年1次，”拉尔夫·沃格尔说。他是专业药剂师协会的主席，这家协会拥有2000名药剂师。“我们今天看到的却是由于人员配备不足以及配药业出现的一些新的压力所造成的混乱局面。”
The pharmacy industry insists that worries over error rates are overblown. Nevertheless, many state regulators, consumer advocates and pharmacists contend that a revolution in the retail drug business is causing problems by increasing workloads.reaction to a book or an article
配药业坚决认为，对出错率的担忧被过分渲染。不过，有许多州的管理者、消费者权益维护者和药剂师们认为，由于工作量增加，一场零售药业的革命正在引起诸多问题。
They point to two factors: First, overall prescription volume keeps rising －up 30 percent between 1992 and 1997, according to IMS Health, a health care information company. Second, the percentage of prescriptions paid for by insurance or HMOs3 has risen from 28 percent in 1991 to 60 percent in 1997. These third-party payers are imposing ever-lower reimbursement rates on pharmacies, which must churn out a high volume of prescriptions to keep profit margins up. Even the Big Four chains －Rite Aid, CVS, Eckerd and Walgreens －are affected.
他们指出了两点：一、处方总量在不断增长——1992年到1997年增长了30%，这是卫生保健信息公司“IMS Health”所调查的结果。二、由保险公司或卫生维护组织支付的处方百分比已由1991年的28%增长到1997年的60%。这些第三方付款者使配药业得到的付还率持续走低，这必然造成为保持利润增长而大量配药。甚至四大连锁药房——日特爱德公司，CVS，爱克德以及沃尔格林斯——也受到了影响。
Against this backdrop, too many people are taking the prescription transaction for granted. Indeed, for the past nine years, Americans responding to Gallup Polls have ranked pharmacists as the country's most honest and ethical professionals ahead of clergy mem bers. No wonder so many people assume nothing can go wrong. “I had blind faith,” says Peggie Hundley.
在这种背景下，有太多的人想当然地看待配药交易。实际上，在过去的九年里，美国人在回答盖洛普民意测验时，都将药剂师列为本国最诚实最有职业道德的专业人员，位于牧师之前。难怪为数众多的人以为，根本不会出什么差错。佩吉·亨德黎说：“我盲目地信任了他们。”
Here's what you need to know to protect your family:
为了保护您的家人，您需要了解以下知识：
You can't rely solely on your doctor. Most physicians get only one year of formal training in medical school on the use of prescription drugs. And, generally, continuing education on medications is not required.
不可完全依赖您的医生。大多数医生在医学院只接受过一年的有关配方药使用的正式培训。
而且，一般说来，不要求他们再接受药学方面的继续教育。
In contrast, many states require pharmacists to complete an average 15 hours of continuing education each year. And there's no dearth of homework: new drugs are pouring into the market, stimulated by a 1992 program shortening the FDA's5 drug-approval times. In the past two years, 92 new drugs hit the market －compared with 125 approved for the previous five years.
相对而言，许多州政府要求药剂师每年平均完成15小时的继续教育。而且，额外的准备工作也不会少：1992年，由于美国食品和药物管理局缩减了药品批准时间，新的药品就如洪水般涌入了市场。在过去的两年里，92种新药涌进市场，而在此之前的五年里只批准了125种。
So don't assume you would never leave your doctor's office with a problem prescription. Ruth Paxton, 44, of Dayton, Nev., trusted her doctor implicitly when she sought treatment for a sinus infection in July 1992.
因此，不要以为自己从不会拿着有问题的配方离开医生的办公室。来自内华达州达顿的44岁的路斯·帕克斯顿，在1992年7月请自己的医生窦炎，当时，她对他信任无疑。
Years earlier, Paxton had experienced severe allergic reactions to the antibiotics penicillin and Keflex. Unaware of the severity of her past reactions, her doctor prescribed the antibiotic Ceftin, which can cause life-threatening allergic responses in people with extreme sensitivities to either of the other two drugs.
此前几年，帕克斯顿曾经因为使用抗生素盘尼西林和基弗莱克斯而发生过严重的过敏反应。在对她的过敏史不了解的情况下，医生开出了抗生素西福辛。对于使用以上两种药中的任何一种都极度敏感的患者来说，这种药可以引起致命的过敏反应。
Within 20 minutes of taking Ceftin, Paxton's throat began to swell, making it difficult to breathe. Swift self-treatment with an anti-histamine stopped the reaction.
在服用西福辛二十分钟之后，帕克斯顿的咽喉肿胀起来，并随之呼吸困难。由于迅速用抗组胺药自救才中止了这种反应。
Nevada's board of pharmacy reprimanded Paxton's pharmacist, saying he should have warned her of the potential for allergic reaction.
内华达配药业委员会对帕克斯顿的药剂师进行了批评，认为他应该警告病人此药有可能导致过敏反应。
A white coat does not a pharmacist make. The burden of knowing about potentially dangerous drug reactions is one reason pharmacists must complete five or six years of academic training. Yet increasingly, the white-coated person who dispenses medicine isn't a pharmacist at all but a pharmacy technician. Depending on the state, such techs may have nothing more than a high school degree and on-the-job training.
穿白大褂的未必是药剂师。了解药物潜在的危险反应这项重任，是药剂师们必须完成五或六年专业培训的原因之一。不过，越来越常见的现象是，穿着白大褂配药的人根本不是药剂师，而是药店的技工。根据各州的情况，这样的技工或许只有高中学历，仅仅受过在职训练。
As pharmacy chains face squeezes on profit margins, the use of techs is growing. Why? Techs typically earn $5 to $12 an hour －compared with the average of $30 to $39 an hour for registered pharmacists.
配药连锁店由于利润幅度紧缩，使用的技工越来越多。为什么会这样呢？技工每小时的酬金为5-12美金，比较而言，注册药剂师每小时的酬金则达30～39美金。
Of course, pharmacists are supposed to check technicians' work. Failure to do so was cited as a major cause of dispensing errors by nearly a third of pharmacists in the Drug Topics survey.
当然，药剂师应当核查技工的工作。《药学信息》的调查认为，将近三分之一的药剂师犯配药错误主要是由于没有核查。
You could get the right drug, but the wrong dose. Hazel Van Hattem of Crete, Ill., says there were two pharmacists and three technicians on duty on May 30,1995, when she picked up a refill of Coumadin, a powerful blood-thinning medication, for her husband, Ernest. “At the trial, they said they couldn't be sure who filled the prescription,” says Hazel, referring to her lawsuit against Kmart. Her attorney argued that whoever filled the prescription did so with pills containing 5 mg. of Counmadin rather than Ernest's usual 2 mg. －an overdose that caused massive bleeding and led to his death. A jury levied a
n $810 000 judgment against the pharmacy. A Kmart spokesperson says the company is appealing.
拿到正确的药，但剂量不对。伊利诺斯州克雷特的海泽尔·凡·哈特姆说，1995年5月30日，她去为丈夫恩尼斯特配强效血管收缩的药香豆定时，有两位药剂师和三名技工当班。“在审讯时，他们说拿不准是谁配的这张药方，”海泽尔在谈到诉讼卡马特的案件时说。她的律师论证说，无论是谁配的这张药方，他确实配了含5毫克香豆定的药剂，而不是恩尼斯特的正常用量2毫克——剂量过大引起大出血而导致了他的死亡。陪审团判决药店赔偿81万美金。卡马特的发言人说公司将提起上述。
Some dispensing errors can be attributed to unreasonable workloads. Three med ical studies conducted over an 11-year period found a correlation between pharmacists' workloads and error rates :”There does appear to be a greater risk of errors when a pharmacist is expected to fill more than 24 prescriptions per hour,” says Elizabeth A llan Flynn of Auburn University's School of Pharmacy. Increasingly, pharmacists say, pushing beyond that rate is not unusual.
某些配药错误可归咎于不合理的工作量。三项持续11年之久的医学研究，发现了药剂师的工作量与错误率之间的关系：“在人们想让药剂师每小时配的药方超过24张时，发生错误率的风险确实要高，”奥本大学配药学院的伊丽萨白·艾伦·福林说。药剂师们说，配药超过那个速度越来越常见，并不是什么稀奇事。
The safety net has holes. Most pharmacies rely on computer setups that are supposed to be updated regularly with information about new drugs or new risks for existing drugs. But these systems don't always work.
安全网络有漏洞。多数药剂师依靠电脑装置，他们以为有关新药或现有药品的新危险的内容
会被定期更新。然而这些系统并非总是发挥作用。
In a study reported in the Journal of the American Medical Association in 1996, Raymond Woosley, chairman of the department of pharmacology at Georgetown University Medical Center, and his colleagues presented two prescriptions for the same patient to 50 pharmacists in the Washington, D.C., area. One was for the antihistamine Seldane; the other was for the antibiotic erythromycin.
1996年《美国医学会杂志》报道了一项研究，乔治镇大学医学中心配药学系的主任雷蒙德·伍丝尔利和他的同事们向华盛顿市区的50位药剂师展示了为同一病人开出的两张药方。一张是抗组胺药塞尔岱，另一张是抗生素红霉素。
Since 1992 the FDA and the drug manufacturers have issued warnings that mixing the two drugs could be fatal. Still, 32 percent of the pharmacies filled the prescriptions. Of the 48 pharmacies using comput
ers to flag adverse interactions, 29 percent had programs that failed to issue an alert. In some cases, Woosley says, pharmacists had shut down the systems or overridden them.
从1992年起，美国食品及药物管理局与药品制造商就已经发布警告说，将这两种药混用会产生致命的后果。但仍然有32%的药剂师配发了这两张药方。在48家使用计算机指明副作用的药店中，有29%的药店的程序没能给予警告。伍丝尔利说，在有些情况下，是药剂师关闭了系统或者使它们失效。
And what about the patient information leaflets stapled to prescription bags at most pharmacies? These are also designed to give added protection against drug interactions or side effects. They usually aren't prepared by pharmacists or physicians －but by commercial vendors. And they're often vague or out-of-date.
那大多数药店里钉在处方袋上的病人须知单又是怎样的呢？这些单子同样是为了进一步防止药物的相互作用或副作用而设计的。一般它们不是由药剂师或医生——而是由商贩们提供的。而且，往往要么是含糊不清要么就是已经过时。
Little watchdog oversight exists. Most state boards don't require pharmacies to report dispensing errors. And national error-reporting programs such as one run by U.S. Pharmacopeia (a nonprofit group that sets drug-manufacturing quality standards) are voluntary.
存在小的监督疏漏。多数州政府委员会不要求药店汇报配药错误。而象美国药典会（制定药物生产质量标准的非营利性组织）主持的国家错误汇报项目，也只是自愿执行的。
Drug chains, however, usually require pharmacists to submit error reports to management. But even those internal reports don't always prevent future errors.
不过，连锁药店通常要求药剂师向管理者呈交错误报告。然而，即使内部报告也不总是能避免将来的失误。
Malvina Holloway, 59, of Mobile, Ala., received a bottle filled with Tambocor, a dangerous heart- rhythm-altering medication, rather than the breast-cancer drug Tamoxifen that her oncologist had prescribed. Holloway didn't discover the mistake until five months and two

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