Rational drug use and pharmaceutical industry

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Uluoğlu C.

LEUKEMIA RESEARCH, vol.39, no.2, pp.16-17, 2015 (SCI-Expanded)

  • Publication Type: Article / Review
  • Volume: 39 Issue: 2
  • Publication Date: 2015
  • Doi Number: 10.1016/s0145-2126(15)30397-0
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.16-17
  • Gazi University Affiliated: Yes


Irrational drug use is not only our country’s

problem, but also a global public health problem.

As a result of irrational use of drugs all around the

world, the concept of rational use of medicine for

the first time has been introduced by World Health

Organization (WHO) conference of experts in

Nairobi 1985 (1). The rational use of drugs has been

described as patients should receive medications

in compliance with their clinical needs, in doses

that meet their own individual requirements for an adequate period of

time, and at the lowest cost to them and their community.

When rational use of medicine cannot be achieved, increased mortality

and morbidity, increased adverse drug reactions and hospitalization,

drug wastage, drug resistance, environmental pollution and wasted

economical resources will occur.

According to WHO, physicians should follow the 6 steps to improve

rational drug prescribing. (I) Identify the patient’s real problem. This may

be a specific problem as in infectious diseases or non specific or a drug’s

adverse effect, (II) determine the target of treatment such as to relieve

pain, to eradicate bacteria or to improve quality of life (III) list possible

intervention or treatment. This may be a non drug treatment or drug

treatment. Drug must be chosen taking into account the parameters of

efficacy, safety, suitability (high risk group of patients, contraindications,

the diversity of the formulation etc.) and costs. Current diagnostic and

treatment guidelines should be based. Special groups (children, elderly,

pregnancy, breastfeeding women, patients with kidney and liver failure,

history of drug/OTC/herbal or food allergies) should be interpreted with

caution, (IV) (if necessary) start the treatment by writing an accurate

and complete prescription e.g. name of drugs with dosage forms, dosage

schedule. It is thought that common prescription errors are missing

information, inappropriate choice of drug, incompatibility among drugs

in prescription (drug –drug interactions), unreadable handwriting (if

it is not e-prescription), (V) Given suitable information instruction and

warning regarding the treatment such as total duration of the treatment,

adverse effects of drug, dosage schedule, risk of stopping the therapy

suddenly, drug storage conditions, contraception when using drug and

cost of treatment, (VI) monitor the treatment, if necessary stop or change

the treatment.

Although all these steps are the responsibility of the physician, physicians

are only one of the responsible parties for rational use of drugs.

Responsible parties are physicians, pharmacists, nurses, other medical

staff, patients and patients’ relatives, pharmaceutical industry, regulatory

authorities and others (media, academia, the educational system etc.) for

rational use of drugs.

Because so many parties responsible for the rational drug use, WHO

suggests 12 national strategies to promote rational use of medicines (2).

1. A mandated multi-disciplinary national body to coordinate medicine

use policies

2. Clinical guidelines

3. Essential medicines list based on treatments of choice

4. Drugs and therapeutics committees in districts and hospitals

5. Problem-based pharmacotherapy training in undergraduate curricula6. Continuing in-service medical education as a licensure requirement

7. Supervision, audit and feedback

8. Independent information on medicines

9. Public education about medicines

10. Avoidance of perverse financial incentives

11. Appropriate and enforced regulation

12. Sufficient government expenditure to ensure availability of medicines

and staff

On the other hand, things that need to be done to improve the rational

use of medicines in 27 EU member states are summarized in six key title

according to the “Rational Use of Medicine in Europe Executive Summary

Report” published in February 2010 (3).

1. INN prescribing (International Nonproprietary Name NN)

2. Prescription guidelines

3. Pharmaceutical budgets for doctors

4. Promoting the use of generic drugs

5. Prescription monitoring

6. Information activities targeted at the general public.

In Turkey, people can buy drugs without prescription (except for

controlled drugs), and so self-medication rates have been reported

to be high, and can be the cause of wasted resources, the emergence

of resistant strains of microorganisms, and serious adverse reactions.

World Health Organization refers that at least half of the antibiotics

consumed by humans is unnecessary (2). Overuse and misuse of

antimicrobials contributes to antimicrobial resistance. A major issue of

concern to hematologists is the intensive use of antibiotic in patients

with immune suppressed, receiving chemotherapy, or undergoing bone

marrow transplantation. For the first time, in a study including Turkey,

validated data on antibiotic use in seven newly independent states

(Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Moldova, Tajikistan),

five southern and eastern European countries (Bosnia and Herzegovina,

Croatia, Montenegro, Serbia, Turkey), and Kosovo, have been collected

and analysed. This study provided publicly available total antibiotic-use

data for 13 non-EU countries and areas of the WHO European region. (4).

In this study, Turkey had the highest antibiotic use in Europe, and on the

basis of this finding, the Turkish government already published a Rational

Drug Use National Action plan 2013–2017, with quantitative targets to

reduce antibiotic use. In fact, although positive developments accelerated

in recent years, applications within the context rational drug use started

at after 1990 in Turkey (5). Prescription monitoring and evaluation

process is one of the interesting title among these activities. Physicians’

prescriptions can be analyzed and evaluated and the feedback related

them can be given by way of “Prescription Information System” which was

developed to promote rational use of medicine in our country (6).

The pharmaceutical industry can contribute to rational drug use before

prescribing process. It is important to creation and the implementation

of marketing strategies and, appropriately storing and distributing of

the drug. The responsibilities of pharmaceutical companies concerning

rational use of drugs are also to provide clear and understandable drug

leaflet, drug formulations in accordance with treatment guidelines and

rational drug use, appropriate drug containers. On the other hand, some

factors related to pharmaceutical companies can influence compliance

of patients. Advertisements for OTC drugs can result in the patient

stopping taking the “real” medication, or promotional activities of the

pharmaceutical manufacturers may affect rational prescribing.

On the other hand, non-rational usage of drugs enhance the percent of

medical cost in the health funds. Different methods are recommended to

control the drug expenditure

all around the world:

• Implementation the principles of rational drug use

• Regulations relating to prescription writing

• Awareness for preventive and protective treatment

• Promoting the use of generic drugs (While original drugs offer a new,

effective, and safe treatment to humanity, generic drugs constitute an

economical alternative) In conclusion, irrational use of medicines is a serious global public health

problem. But, as stated by the World Health Organization “Irrational

prescribing is a difficult disease to cure, but prevention is possible”.