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Rational Pharmacotherapy
And
Drug Information
Rational Pharmacotherapy
The best medical treatment
under the present
circumstances
Best from the viewpoint of
the patient and society
'The right pill
in
the right mouth'
Drug information:
All facts and evidence on
drug, in particular its
therapeutic use
In contrast to:
Drug advertisement
Chain of events:
Sources of information
Decision on rational pharmacotherapy
Creation of information
Dissemination
Sources of information
Randomized clinical trials
Epidemiological studies
Other studies
If no studies: Extrapolation
Extrapolation is a necessity!
When and how to do it ?
Examples:
Gender – age – race
Diseases – drugs
(synonymous/analogues)
Rules for extrapolation
between drugs:
'Analogous' chemistry
Same mode of action
Comparable chemistry
Studies have – in some
respects – shown similar
efficacy and adverse reactions
The Life Study
atenolol versus losartan
losartan,
better than atenolol
Press Release:
COZAAR,
better than ß-blockers
All doctors and agencies have
to take a greater responsibility
in demanding and supporting
needed studies
(important head-to-head studies)
Decision on rationality
Effect
Adverse Reactions x Price
Parameter of efficacy:
Qualitatively correct
Real versus surrogate
Quantitatively correct
Reduction:
per cent or per cent point
How large should
the effect be ?
It depends on:
The disease
Other treatments
Adverse reactions
Price
Have to solve the problem ?
Ask the patients
Statistics
Significant
Almost significan
Trends towards significant
difference
Numerial difference
And much more
Drug Information should be
Correct
Complete
Comparative
Comprehensible
Implementation
The most difficult part !
Many studies:
written feed-back is easy
but not very effective
Academic detailing is
time-consuming and difficult,
but more effective
Development in the use of antibiotics
(from 1999-2 to 2000-2)
J01
intervention: - 6,1 %
control:
+ 4,8 %
Macrolides
(J01FA)
intervention: - 18,5 %
control:
- 3,1 %
Pivmecillinam
(J01CA08)
intervention: - 15,7 %
control:
+ 3,7 %
Disturbing factor (barriers)
Aggressive advertising
The press creating dramatic stories
Doctors indolence
Patients unrealistic and selfish
demands
Legal views versus biology
Complacent and bureaucratic
administration
Politicians:
Industrial
versus
Health Polities
Wishes for the day
What is rational pharmacotherapy ?
How it is created and implemented ?
Why so many differences in EU ?
Mutual benefit ?
Honesty and
sincerity
without
Hypocrisy