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A call for a radical shift in physicians’ prescribing attitudes and behaviors

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Researchers from Harvard and the University of Illinois at Chicago have published “Principles of Conservative Prescribing” in the Archives of Internal Medicine. They write:

The concept sums up lessons from past experience as well as from recent studies demonstrating that medications are commonly used inappropriately, overused, and associated with significant harm–suggesting the need to more thoughtfully weigh claims for drugs, especially new drugs.

These principles urge clinicians to (1) think beyond drugs (consider nondrug therapy, treatable underlying causes, and prevention); (2) practice more strategic prescribing (defer nonurgent drug treatment; avoid unwarranted drug switching; be circumspect about unproven drug uses; and start treatment with only 1 new drug at a time); (3) maintain heightened vigilance regarding adverse effects (suspect drug reactions; be aware of withdrawal syndromes; and educate patients to anticipate reactions); (4) exercise caution and skepticism regarding new drugs (seek out unbiased information; wait until drugs have sufficient time on the market; be skeptical about surrogate rather than true clinical outcomes; avoid stretching indications; avoid seduction by elegant molecular pharmacology; beware of selective drug trial reporting); (5) work with patients for a shared agenda (do not automatically accede to drug requests; consider nonadherence before adding drugs to regimen; avoid restarting previously unsuccessful drug treatment; discontinue treatment with unneeded medications; and respect patients’ reservations about drugs); and (6) consider long-term, broader impacts (weigh long-term outcomes, and recognize that improved systems may outweigh marginal benefits of new drugs).

Reuters Health reported on the paper with some additional perspectives.

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