E-DRUG: Rational versus Appropriate Medicines Use
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Dear E-druggers
The ongoing debate on the Make Medicines Child Size slogan and the
various proposed better alternatives has stimulated me to put forward a
case for consideration of changing from Rational Medicines Use to
Appropriate Medicines Use.
According to definitions gleaned from the numerous online dictionaries
available the adjective rational is associated with reasonable, sensible
and logical. Thus it would be rational for a patient to only buy a
single days treatment of an antibiotic rather than a full 5-day course
if that was all they could afford. It would also be rational for them to
stop taking a medicine if they appeared to be cured or if they
experienced unpleasant adverse effects. However in these cases it would
certainly not be appropriate for them to behave this way in terms of
obtaining the required and expected therapeutic benefit of the medicine.
On the other hand the word appropriate is associated with suitability
and fitness for purpose or circumstances. This would therefore seem to
be indeed much a more appropriate adjective when applied to medicines
use.
The word could equally well be applied to the WHO childrens medicines
campaign as in >>>Make Medicines Appropriate for Children<<<
Best regards
Chris Forshaw
Pharmaceutical Adviser
Ministry of Health, Kenya
c/o Royal Danish Embassy
Box 40412-00100, Nairobi, Kenya
Mobile: +254 724 253 202
Tel/fax (home): +254 20 206 2156
Office direct: +254 20 272 4944
forshaw@hsps.or.ke
E-DRUG: Rational versus Appropriate Medicines Use (2)
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Dear E-druggers,
I agree with Chris Forshaw that "appropriate" is a more appropriate word than "rational". One of my reasons is that
whilst many decisions are bad, few are irrational. Usually the logic is valid but based on information that is flawed,
irrelevant and/or incomplete.
Another reason is that the word used can make a big difference to discussions about treatment choices that we disagree
with. If we suggest that a treatment choice is irrational then we are suggesting that the person who made the choice is
mentally deficient. This is not a good way to win friends and influence people! By contrast, if we suggest that a
treatment choice is inappropriate then we are focusing on disagreements about aspects of the drug. The latter is more
likely to be successful.
This is why in 1983 I named my organisation the Medical Lobby for Appropriate Marketing. Our name has been changed to
Healthy Skepticism but we still work for appropriate medicines use.
regards,
Peter
Dr Peter R Mansfield OAM BMBS
GP
Director, Healthy Skepticism Inc
www.healthyskepticism.org
Lecturer, Discipline of General Practice, University of Adelaide
www.adelaide.edu.au/directory/peter.mansfield
peter.mansfield@adelaide.edu.au
E-DRUG: Rational versus Appropriate Medicines Use (3)
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A suggested intepretation of the differences between rational and appropriate. First point to bear in mind is that 'use' often refers to the prescriber, not just the patient.
Second is the question of Standards. When standard treatment guidelines are
developed based on efficacy, and clinical data, there is an assumption about a standard rational patient (i.e. generic). This is the starting point.
However, people and circumstances differ. When these differences are taken into consideration, when making assumptions about patient behaviour, prescribing becomes appropriate. i.e. it becomes more cost effective.
cheers, Billy
Billy Futter
Associate Professor
Faculty of Pharmacy
Rhodes University, Grahamstown, South Africa
email B.Futter@ru.ac.za
phone 046 603 8494
fax 046 636 1205
E-DRUG: Rational versus Appropriate Medicines Use (4)
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Appropriate or Rational Use of medicines ?
Appropriate means correct or suitable, convenient, and correct means without mistake.
Does the prescription of the the right medicine to the right patient at the right dose is always without mistake ? I do not think so!
Rational means to do something according to the reason or to do something in one way able to reason (logical) or to persuade by a fair argument and more comprehensible mean. If you try to do something only with unbiased judgement, logically, rational is better than appropriate who is equivalent to correct, but in rational use all is not always correct. Consequently, keep rational use of medicines in your agenda.
A. Helali
Clinical pharmacologist
Director
Centre National de Pharmacovigilance et de Matériovigilance
BP. 247, Bab El Oued
16009 Algiers
Fone/fax : 213 21 36 36 71
CNPM <pharmacomateriovigilancedz@hotmail.com>