Information about medicines can be obtained from various sources. If your only source of information about usage of medicines is from the drug industry representative or from industry sponsored programs, do find an alternative source of drug information like textbooks and medical journals.
When using medicines promoted by industry, and you are unsure of the source, try these guide questions:
• Is the company reputation good and what is the track record in terms of drug quality violations.
• Does the company have compliance to Good Manufacturing Practices (cGMP)
• Does the generic drug have bio-availability or bio-equivalence studies
• Can the drug industry representative provide you with medical literature or studies demonstrating efficacy and safety.
• Do the drug company representatives or materials only emphasize the good points about the medicines and gloss over the risk profile.
When a doctor informs the drug industry of an adverse drug event, the industry may not always accept that that is the case primarily because they will stick to the legal definition of ADR as any noxious, unintended, unexpected reaction to a drug when used in its normal way (normal dosage and administration). But we, as health professionals is after drug product and usage safety, and even if the reaction falls outside of the normal pattern of usage, adverse events may and can develop. The culture of safety for our patients and for our own professional protection occupies a higher moral ground because it is for public good and not a simplistic issue of legality.
It was highlighted recently in a WHO meeting (2007) that doctors and patients must disabuse their thinking that all medicines work (this is a myth). In the same meeting, a recent Uppsala Monitoring Center (WHO Collaborating Center for drug monitoring) report showed data from 2005 revealed that unexpected ineffective medicines were the 7th highest ranking adverse event and medication errors ranked 11th highest ranking adverse event reported.
In our view a drug that does not work as intended is an unsafe drug. Not all products licensed by BFAD is considered good quality and we need to raise the bar for quality standards ourselves within PCP.
A doctor needs to spend some time educating patients about usage of medicines and in particular, to source their drugs from drug outlets that are licensed by the government. This is of particular importance to us because of the maldistribution of doctors in the Philippines where the doctors to patients ratio makes it extremely difficult for us to spend much time educating our patients during each clinical consultation. However, we cannot be remised with our obligation to patients. Perhaps it is time to revisit PCP Covenant.
Incomplete knowledge about drugs and how to use these drugs during patient self-medication can also be a serious safety concern.
Lastly, because we work within a hospital system, human nature tells us that no health professional will willingly report medication errors if the hospital is perceived as punitive and not nurturing or protective. These hospitals might find it to their best interest to put in place patient safety protocols to study how best to improve systems and not pinpoint personal errors.
There are four myths in medicine that we must remember:
• All medicines work.
• Medicines in the market are 100% safe.
• There is a pill for every ill.
• People will use drug rationally as intended.