The patientís responsibility

Editor’s Note:  This story, first published in 2005, has been updated.

Bill Snyder
Published: July, 2005

Advice for consumers: “Kick the tires” before taking new medication
Photo illustration by Don Button
Today’s scientists are hurtling into the future, discovering new targets for drugs, new compounds with drug-like activity and new tools with which to test them.

Will their efforts lead to improved drug safety and lower costs? Perhaps… but a lot will depend on us—as patients and physicians.

There is growing concern, for example, that Americans are overmedicated. As a result, we may suffer inordinately from adverse drug reactions.

“And that’s why safe drugs have to be taken off the market, not because they’re unsafe but because their use is unsafe,” says Raymond L. Woosley, M.D., Ph.D., a nationally known clinical pharmacologist and president of the Critical Path Institute in Tucson, Ariz.

Some observers point their fingers at direct-to-consumer advertising, but banning the practice alone won’t solve the problem. After all, physicians prescribe drugs, and—Woosley believes—many prescribe inappropriately.

“Every school has a six-hour or one-semester course in pharmacology that talks about the actions of drugs, but how to use those safely and how to address drug interactions and how to use drugs in the proper way is not taught in 90 percent of the medical schools in this country,” he says. “Medical education has to take a major responsibility for the failures of pharmaceuticals.”

Patient education is equally important, says Peter J. Neumann, Sc.D., who directs the Center for the Evaluation of Value and Risk in Health at the Tufts Institute for Clinical Research and Health Policy Studies.

“We hear a lot about the cost of drugs. But it’s the wrong question, really. It should be about the value,” says Neumann, whose cost-benefit evaluations have included drug treatments for asthma, lung cancer and other diseases.

“When you go out and buy a car, you get information about the value of the car and the attributes that you care about—the safety, the way it looks, the zero-to-60 power of the engine and so forth.

“When you buy a drug, you might get information about different attributes of value—how convenient is it to take, what are the side effects, what are the benefits, and so forth, and what’s the price.”

Consumer Reports provides that kind of information through its Web site, which compares prescription drugs on price, effectiveness and safety, Neumann notes.

But while better education of physicians and patients may help improve drug safety, “at the end of the day, we’re probably going to be paying more for our health care,” he cautions.

“That’s probably not a bad thing… research shows in a very general sense we’re getting more health—we’re living longer, we’re alleviating symptom, we have less disability, and we’re paying more for that…

“I’d much rather live today with today’s medicine,” Neumann says, “even with today’s prices, than 30 years ago with 1970s medicine and 1970s prices.”

The key is getting the rules right. “You can swing the pendulum too far either direction,” he says. Too much regulation stifles innovation. “On the other hand, if you had no scrutiny or too little, then you’d have too many bad outcomes.

“So what’s the right mix? I don’t know, but I think that’s the right question.”

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