E-DRUG: The terms compliance and concordance (cont)
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In response to David Dickinson's comments on terminology ...
I think that it is important that we keep in mind the fact that the
quality of the scientific support for recommended drug regimens is very
uneven. One reflection of that fact is the large number of drugs whose
recommended regimens have undergone downward revision in the months to
years after the drug first entered the market. These changes were a
topic of discussion at the European Drug Utilization Research Group
meeting this past weekend in Israel (Oct 1-3), and it has been variously
expressed, but usually piecemeal, in field-specific review articles.
One recommendation made at the Drug Utilization meeting was that the WHO
Collaborating Ctr in Oslo publish on their website a list of drugs whose
defined daily doses (DDDs) have undergone downward revision, as a
quantitative indicator of the phenomenon in question.
Of course "that's history", as they say. But this problem also
illustrates Santayana's Dictum that 'those who ignore the lessons of
history are condemned to repeat it'. With that in mind, a potentially
useful research topic, perhaps suitable for the Cochrane Collaboration,
would be to develop some kind of quality ranking to assess the
scientific robustness of currently recommended drug regimens.
There are two key questions in respect to the quality of execution of
prescribed drug regimens (which is perhaps a neutral term for the matter
in question): (a) the quality of the recommendation, and (b) the
permissible margin for deviation from that recommendation, without
incurring risk of lost effectiveness and/or increased hazard due to,
e.g., rebound effects.
John Urquhart, MD, FRCP(Edin)
Professor of Pharmaco-epidemiology, Maastricht University, Maastricht,
NL
Chief Scientist, AARDEX Ltd/APREX Corp. Zug, CH and Union City, CA, USA
Professor of Biopharmaceutical Sciences, UCSF, San Francisco
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