The New Straits Times, September 5, 1997
Q: Could you please explain what is meant by "rational use of drugs"?
A: "Rational use of drugs" means ensuring that the use of medicines meets the criteria of clinical and scientific objectivity. This is to safeguard the safety of patients and prevent exposure to the harmful effects inherent in all medicines.
As such, it is an important part of policy framework. This policy element is now being accepted as an international norm among health professionals because it is increasingly becoming evident that "good" drugs can be badly used even in legitimate medical settings.
In other words, drugs that are of good quality and standard are not being used appropriately, leading to "irrational" use which is not only dangerous but also wasteful. It is therefore closely intertwned with the Essential Drugs Concept discussed last week (Life & Times, Aug 28).
According to experts, there are at least five levels of rational drug use. The first level concerns the question of whether the use of a drug is at all necessary. Oftentimes there is no necessity to use drugs for treating minor self-limiting ailments.
In such cases, relief and "cure" could be obtained by having plenty of good rest, a nutritious and well-balanced diet, or other non-drug interventions including exercise. Discussing some of these points with health professional could be of great assistance and will go a long way towards exploding the myth that there is "a pill for every ill".
If drug therapy is deemed necessary, then the next question to ask would be "what drug action is required?" This is important because it direct one's attention to the mechanism(s) of the drug required that matches most appropriately to the disease to be "cured". Mismatch between drug action and disease diagnosed can cause the disease to worsen, or cause some unwarranted and avoidable side-effects.
In other word, the treatment is not only inappropriate but also irrational. Some drugs only relieve the signs and symptoms without providing any cure, that is, they will alleviate the signs and symptoms but the underlying cause remains untreated. In this case, the symptoms are bound to recur sooner or later.
Hence, it is important to know what the drug actually does and the limits of its action. Sound decisions in this respect will also have to consider many other factors that could influence the fate of the drug one taken into the human body.
After deciding the most appropriate drug action, one would then be able to choose the right rug for not only the intended disease but also the person. There is a proliferation of drugs on the market for us to chose from. Yet there are factors that could be used to make a decision more rational.
All being equal, the cost or price factor ought to be given due consideration. To choose the more expensive drug in the belief that it is necessarily the best is indeed a fallacy. Many cheaper generic equivalents (especially if already registered in the country) are just as good and are thus a more rational choice in this context.
This where the Essential Drugs Concept is of assistance, whereby the preferred items are narrowed down to a handful. And one need not succumb to "industrial pressure" to use any particular branded item. In other instance, standard treatment guidelines and drug policies are designed to provide further support in recommending the most appropriate choice.
The fourth level in rational use of drugs is related to dosage. Here again, a particular drug can come in various doses or strength. There is also the question of dosage forms - injections, capsules, creams and so on. In trying to achieve rational use of drugs, the choice of strength and form must be given careful consideration before the drug can be prescribed and dispensed.
This is because closely related to this is the matter of compliance, that is, the relative ease with which the patient can optimally use the medication as directed. This is to ensure that the patient experiences the most desired therapeutic effects while avoiding unwanted effects. Choosing the wrong dose and dosage form often hampers compliance, rendering treatment ineffective, if not risky. Here again the use of standard therapeutic guidelines and policies are relevant as a decision-making tool.
So far, the above principles of rational drug use could be summarised as "the selection of the right drug for the right disease, given to the right patient at the right dose, in the right dosage forms at the right time, and at the right price." This principle is also known as the Rule Of Right; and if any of these parameters is not "right", it will render the use of the drug irrational.
The fifth level in rational use of drugs is patient information. Keeping information away from the patient about his/her medication is tantamount to an irrational practice. This is because in principle all medicine are of two components - the chemical entity or the active ingredient and the information about it. One without the other does not constitute a medicine. Giving away the so-called "medicines" with the accompanying information, which is often the practice, would be incomplete. The patient is getting no more than just a chemical substance, and not a medicine.
To make it a medicine one must know many important information. For example: the name of the chemicals that constitute the medicine, how it will act to produce its effect in achieving the desired results, how and when it must be used, for the side.
In addition, what the side-effects are, what to do if undesirable effects occur, or if there is any specific attention that must be paid in cases of pregnant or lactating women or the elderly or children. What about in cases of a concurrent ailment? AL these are important to make the medicine work better. It is the patient's right to know.
It is the practice today for patients to undergo a drug counselling session so that they can fully comprehend the medication accorded to them, or at the very least be given an explanation when they are dispensed. It is preferable that accompanying written information be given together with the medication, apart from it being correctly and adequately labelled, in lay language.
Many Government hospitals are giving drug information to patients unlike the practice in the private sector. Rational use of drugs should not discriminate between the public and private sector, but must be a benchmark for all practitioners. It is in the interest of all parties that medicine is practised rationally.
