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Practical tips
Dr Raman-Wilms suggests you
keep these questions in mind when looking at research
on new drugs:
- Where does the drug
fit in with other therapeutic options?
- What are the contraindications
for this drug?
- What are the reported side
effects?
- What is the original study
that got the drug approved?
- She also suggests taking
into consideration the cost of the drug, especially
with elderly or low-income patients. Not all
new drugs are covered by the provincial formularies.
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It takes a certain kind of doctor
to jump on the latest meds. Family practitioners tend
to get most of their information about new drugs from
marketing brochures, advertisements or the familiar
knock of a pharmaceutical rep on their office door.
But physicians shouldn't decide whether to give a new
drug a shot on the basis of that information alone,
according to a study published March 2 in the online
edition of BMC Family Practice.
"[Marketing material] may give
them some information but rather than relying on it
they should go to evidence-based resources," says Dr
Mitchell Levine, director for the Centre of Evaluation
of Medicines at McMaster.
Dr John Maxted, a health and public
policy director with the College of Family Physicians
of Canada (CFPC), says that drug companies have a lot
invested in new drugs. "We have to recognize that the
companies are marketing a product," he says. "But,"
he adds, "that's not to say they're trying to put one
over on us." Even if you're not the adventurous type,
you can safely give new drugs a try. You just have to
know where to go for the information you need to make
an educated decision.
EVIDENCE-BASED
INFO
"More objective forms of scientific information from
clinical journals and even clinical practice guidelines
can be a benefit," says Dr Maxted. "Many of us also
find CME helpful."
Odds are you don't have much time
to pore over journals, so you might want to try picking
your specialist colleagues' brain for the latest new
drug information. "Specialists are traditionally the
first to adopt new drugs," says Dr Robyn Tamblyn, PhD,
a professor at McGill University. One of the few Canadians
to have studied how physicians go about trying new drugs,
she says specialists see a higher percentage of patients
who fail conventional treatment, and so are more likely
to try something new. "The specialist may also be more
aware of the studies behind the marketing information,"
adds Dr Levine. But he warns that not everything a specialist
considers appropriate translates to primary care. "Often
new drugs may be appropriate for use as a second or
third line agent," says Dr Levine. "So it's really about
what the indication is and who is the ideal patient."
Much of the exchange between GP
and specialist is very casual, what Dr Maxted calls
"hallway consultations." But he suggests more formal
ways of approaching a colleague. "What we [the CFPC]
promote is to have the consultant return a letter to
the FP that outlines the investigation, diagnoses and
includes some background information on the drug."
The pharmacist is another helpful
but oft-overlooked resource. "They are an important
member of the healthcare team," says Dr Maxted. "It's
quite easy to talk to them about the dose and availability
of certain drugs."
Dr Lalitha Raman-Wilms, director
of pharmacy practice at the University of Toronto, espouses
the value of the doctor and druggist relationship. "The
common way that physicians find out [about new drugs]
is through pharmaceutical representatives and brochures,"
she says. "That's a good place to start but then they
should be able to tap into other resources." She explains
that pharmacists can access drug information centres,
a service that provides pharmacists with up-to-date
evidence-based information on new therapies, and pass
that information along.
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