Starting or Strengthening a Drug Bulletin - A Practical Manual
(2005; 165 pages) View the PDF document
Table of Contents
View the documentPreface
View the documentHow the manual was produced
View the documentAbout ISDB
View the documentExecutive summary
Open this folder and view contents1. Introduction
Close this folder2. Rational use of medicines
View the document2.1 The relationship between evidence and rational use
View the document2.2 Other influences on the choice of medicines
View the document2.3 Sources of information for prescribers
View the document2.4 The special role of drug bulletins
View the document2.5 Specific ways in which bulletins can help
View the document2.6 Bulletins as part of wider initiatives for promoting rational use of medicines
View the document2.7 Summary
Open this folder and view contents3. What are drug bulletins?
Open this folder and view contents4. Defining aims, target and type of bulletin
Open this folder and view contents5. Planning resources
Open this folder and view contents6. Planning bulletin production: schedules and timing
Open this folder and view contents7. The editorial process
Open this folder and view contents8. Reviewing a new drug: is it a therapeutic advance?
Open this folder and view contentsAnnexe to Chapter 8: Evaluating harm
Open this folder and view contents9. Design and production
Open this folder and view contents10. Dissemination
Open this folder and view contents11. Organizational and legal issues
Open this folder and view contents12. Evaluating quality and usefulness
Open this folder and view contents13. Partnership and collaboration
Open this folder and view contents14. Keeping records and creating a memory
Open this folder and view contentsAppendix: Electronic sources of information

2.1 The relationship between evidence and rational use

Conventionally, the best evidence for an intervention is that for which there is scientific support, which means that evidence of its efficacy and safety is derived from well-controlled clinical trials. Using such evidence as the basis for making rational decisions about medicine use is logical and seems straightforward. Yet, there are several problems with relying on formal evidence alone.

Problems with evidence as a basis for rational use

• Evidence may not be available. In reality, much of what is done in medicine is not based on evidence, simply because it is not available. This is often the case for cheaper non-drug interventions. Most clinical trial ‘evidence’ relates to drugs and is mainly generated by pharmaceutical companies (e.g. there are thousands of published clinical trials of nonsteroidal anti-inflammatory drugs (NSAIDs) in osteoarthritis but hardly any on the use of walking sticks).

• Clinical trials are often focused on proving efficacy for drug registration instead of drug effectiveness for actual ‘real life’ use (see Chapter 8).

• There may be poor access to evidence and a lack of openness from regulatory authorities and pharmaceutical companies who hold such information.

• Promotion of medicines to health professionals and consumers by pharmaceutical companies is often misleading.

• Patients included in trials that make up the evidence may not be representative of ‘real’ patients, for example, because the trials were carried out in a different country, or the patients in the trial had no co-morbidities.

• Health professionals and patients do not necessarily behave like those involved in the trials. For example, they might be less likely to give patients detailed and motivating instructions, or to perform the specified regular checks on whether the treatment is being effective (e.g. blood pressure measurements) or causing adverse effects (e.g. liver function tests).

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