We must not take prescribing for granted
I find clinical pharmacology fascinating and always take an active interest in therapeutic issues. Although this is very much a personal interest of mine, I do feel that clinical pharmacology and therapeutics is an important topic for all doctors, irrespective of our specific clinical disciplines. Prescribing encompasses a huge range of issues including costs, safety, knowledge and evidence-based effectiveness to name but a few.
In modern medicine, we tend to follow protocols and pathways, and although we aim to encourage lifestyle interventions, more often than not we reach for the keyboard to print out a prescription. While there is nothing wrong in prescribing a drug as part of a rational, cost-effective and well-thought-out process, we must continuously monitor prescribing and therapeutic drug use, not least because unexpected findings with profound safety implications occasionally arise.
A good example of this was highlighted in the univadis GP News service, which reported that "use of multiple prescription drugs puts younger, working-aged adults, as well as older people, at increased risk of injury from falling" (click here). According to the article, the authors believe this "signals a need for greater awareness of the association, whether due to the medications, underlying conditions, or a combination of both".
These findings need to be verified in further research, but if confirmed the results should be widely distributed.
While front-line clinicians may not be able to contribute actively to original research in the ongoing surveillance of prescription drugs and adverse events, it is important for them to provide data (with appropriate consent) and to co-operate with independent scientists. Just as important is the dissemination of proven research data, which has a direct influence on prescribing. Not only does that research need to reach the busy clinician, it must also make them act and change their behaviour - something that is not always easy to achieve.
This particular finding that multiple prescription drugs can cause falls in younger people is an interesting proposition, which of course will have to be verified, but without doubt raises a number of points. It certainly should remind all prescribers to be cautious, questioning and aware of what is going on. Keep reading!
Dr Harry Brown, editor-in-chief univadis
By Dr Harry Brown