E-drug: Essential Drugs Monitor: Evidence based medicine)
---------------------------------------------
It is indeed a nice thing to be able to move from Experience based to
evidence based drug selection. In my over 10 years of experience in
teaching and training on drug management and rational drug use, I
have increasingly moved away from "experience based" to 'evidence
based" approaches to rational drug selection.
However, in my practice as a hospital pharmacist, and secretary to
the Drugs and Therapeutics Committee (DTC) of my hospital, I
constantly ask myself the question "whose evidence??" MY DTC has made
great leaps to use Evidence as the primary guide to drug selection.
This has meant that I, as the secretary, comb through a myriad of
publications (Primary and secondary sources) to gather some
evidence-(No access to Cochrane and SIGN I must admit). Local
evidence is scarce because locals do not seem to publish (Even local
unpublished evidence is scarce). I rely heavily on FDA, MCA, MCC
evidence-Is this acceptable to our local practitioners?
At the end of our DTC drug selection meetings, we pat ourselves on
the back for a job well done based on "someone's evidence"
I am stimulating discussion on "Whose evidence??" Please bear in mind
that, at the end of the day, we have to be practical and not generate
formularies and guidelines that are not used or not usable.
On a more positive angle, I am at least happy that we are doing some
form of "evaluation" when selecting drugs and it is not based on Gut
feeling. We have a check list of what to look out for and how to go
about it. A recent example of one member of our DTC committee saying
that drugs from a particular generic manufacturer do not work were
met with a chorus of "Where is your evidence?" and all they could say
is that it is in their previous experience in the past two years-This
was deemed unacceptable by the Committee members
So, "Where is the evidence?" and "Whose evidence is it?"
Dr Atieno Ojoo
Chief Pharmacist
Gertrudes Garden Children's Hospital
Nairobi , Kenya
Atieno Ojoo <atisojoo@yahoo.co.uk>
Access Essential Drugs Monitor #32 at http://www.who.int/medicines/mon/mon32.shtml
--
To send a message to E-Drug, write to: e-drug@healthnet.org
To subscribe or unsubscribe, write to: majordomo@healthnet.org
in the body of the message type: subscribe e-drug OR unsubscribe e-drug
To contact a person, send a message to: e-drug-help@healthnet.org
Information and archives: http://www.essentialdrugs.org/edrug