E-drug: Advertising in national formularies (cont)
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Joel Lexchin has pointed out some of the shortcomings in
Canada's CPS, and I'd like to make some additional comments.
This publication is promoted - by practice - as the "last word" for
health professionals in Canada - physicians, nurses, and
pharmacists. I've gotten countless queries from ward nurses along
the lines of "but I can't find that in the CPS" if I've left a consult note
about a patient or a physician orders something that doesn't follow
the straight and narrow. There are some amazing omissions (and
commissions) in the monographs - some of which fly in the face of
a solid body of literature, eg, for the use of a medication for a
particular purpose or for administering a medication via a particular
route.
There is no mention of croup as an indication for dexamethasone or
any other steroid - but the monograph for Actifed (one of the
irrational *cold* preps referred to by Joel) does list croup as an
indication. Neuropathic pain is not an approved indication for
amitriptylline. Bipolar disorder is not an approved indication for
lamotrigine. There is no information about giving ketorolac IV.
There is still the claim in the monograph for Synthroid that it is not
interchangeable with other brands of levothyroxine. Ischemic
stroke has now been included as an indication for alteplase even
though the results of the original NINDS study have not been
consistently replicated.
I do not consider the CPS monographs to be scientific documents
at all - and yet these are the "official" statements about the proper
use of medications in Canada. And the provincial licensing bodies
for pharmacists promote the use of the CPS as *the* source that
pharmacists must consult when dispensing. Licensing exams are
based on the CPS - not on the literature.
And this rant of mine is going far from the original thread about ads
in print versions of national formularies. But maybe it's not really
that far at all. Manufacturers can submit monographs that do
nothing but promote the use of a particular product. The
monograph for ciprofloxacin - for example - can blithely promote
Cipro as appropriate for community-acquired pneumonia - even in
the face of evidence that it's not a very good choice at all. There is
no requirement for any monograph to include any critical evaluation
of real-life effectiveness for any product.
And which monographs are the *meatiest*? The ones promoting
the newest products. (And when was the last time you saw the
streptokinase rep?)
My short message to the physicians and nurses where I work is
that the CPS is one of the most unreliable sources of drug
information on the planet.
hmmmmph!