The ethics of rational prescribing
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Editor, – Regarding Dr Max Kamien's letter to the Editor (Aust Prescr 2000;23:96) and the response from the Pharmaceutical Society, it seems to me that industry marketing to physicians and pharmacists continues to play a greater part in prescribing than evidence. The 'evidence' used by industry to push new drugs in general and in this case COX-2 inhibitors specifically, is often far from clinically relevant. Statistical significance and clinical relevance are often totally unrelated.
Regarding the pharmacist pushing new drugs (of the same class) onto patients, there is a case in Canada that is possibly on its way to the courts. The doctor prescribed a well-tested non-steroidal anti-inflammatory drug and the pharmacist replaced it with the newer, so-called miracle drug, but the patient did not do well.
Dr Kamien's conclusion is absolutely on the mark. It is neither socially responsive nor ethical for pharmacists to push new drugs. Our patients deserve better.
Department of Family Practice
University of British Columbia