a tribute to caring - Western University of Health Sciences

NEWS &VIEWSA COMMENTARY ON DRUG-INDUCEDDISEASEby Max D. Ray, PharmD, M.S.Dean of the College of PharmacyA colleague of mine sent me a copy of anarticle that appeared in the AARP Bulletinregarding inappropriately managed drug therapyin the elderly. The article pointed out somethingI have known for years: drug-induced diseasehas become epidemic and we seem to have nogrip on the problem. Up until now, we've seenonly the tip of the iceberg.As an educator, I instill in my students,the pharmacists of the future, the belief thatsomething must be done. But before this can becorrected, a number of contributing factors mustbe identified.There are more elderly people than ever before,which means there is a burgeoning need for drugsto manage chronic disease. We don’t have goodscience establishing what the correct dose is forthe elderly and, often times, do not adjustdosages. With respect to drug therapy, we all needto keep in mind that drugs are approved for themarket based on studies done primarily in healthyadults (mostly young adults); we have no clinicaldata regarding safety and appropriate dosing forelderly people whose liver enzymes and renalfunction have begun to slow down.Polypharmacy—the practice of over-prescribing— is a huge national problem in which pharmacistsacross the country can easily corroborate. If everyphysician and pharmacist were to do a better jobin keeping up with what patients are alreadytaking, before adding another drug to the regimen,we would begin to bring this problem undercontrol. Part of the problem of polypharmacy, ofcourse, arises from the fact that many patientssee more than one physician, with few beingaware of what the other is prescribing.Patient monitoring after a prescription isfilled is a huge unmet need in our society. Pharmacists have amajor role to play in following up. Once a patient has a newprescription filled, there is usually no provision for follow-upmonitoring until the patient's next appointment with his/herphysician, which could be several months. In the meantime,the patient could have experienced a toxic reaction or atreatment failure that goes undetected. And often the toxicreaction is viewed as another symptom to be treated withmedication, rather than as a drug-induced disease for whichthe appropriate treatment is discontinuation of the drug.Physicians and pharmacists need to keep their guard upevery time a drug is prescribed. I tell our students thatwhenever a drug is used by a patient for the first time, we'redealing with experimental pharmacology. In other words, wereally don't know what will happen. We, therefore, need toprovide for close monitoring of the patient until we knowthat the drug is producing the desired effect without causingany clinically significant toxicity.There is one other contributing factor: the huge "disconnect"between medicine and pharmacy (or between physiciansand pharmacists). There are some settings in which physiciansand pharmacists function in a highly collaborative manner,such as in some hospitals and in many managed-careorganizations. But the majority of pharmacists are based inretail pharmacy settings, with no formal relationship with anyspecific physician or group of physicians. It is not enough toteach the pharmacists of the future; current pharmacistsneed to be educated now.10 Winter 2006 www.westernu.edu