From Dr H. S. Boardman, FFPM
SIR,-I am most grateful to Mr Hands and Miss Grant (PJ, February 19, p297) for confirming that it is official Royal Pharmaceutical Society policy for drug information pharmacists to preserve the confidentiality of their inquirers. In their letter, they acknowledge that this can cause problems in following up drug safety matters but suggest that alternative solutions should be sought to circumvent these. It was to initiate just such a discussion that I wrote my original letter illustrating the problem with an anonymised example drawn from real life. Poor communication is certainly the enemy of drug safety, but my story had a positive outcome.
The solution to the communication problem was to write a "Dear Doctor" letter for the drug information pharmacist to hand to the consultant physician caring for the patient with the suspected adverse drug reaction. As soon as he was informed about my reasons for requesting more information he contacted me and explained the lengths to which he had gone to investigate what turned out to be a very complicated case. He had been taking all of the appropriate steps but was not sure that the problem was due to the drug in question - hence his reluctance to supply information prematurely. Clearly he was not a lazy physician hiding behind the convenient cloak of confidentiality, rather he was a busy specialist who had been doing his best to investigate his patient's problem properly. My initial assumptions about the reasons for the lack of communication turned out to be entirely false. Fortunately, the follow-up of the case has now been completed successfully.
What lessons can be learnt from this example? First, it is most important for physicians, pharmacists and pharmaceutical companies to communicate openly about drug safety matters. Secondly, it is important not to jump to conclusions about the reasons behind delays in obtaining answers to requests for clinical information about suspected side effects. Thirdly, it can be counterproductive to attempt to obtain clinical information prematurely for the purposes of meeting tight drug regulatory reporting timelines: side effects may be attributed inappropriately to drugs which have not caused them.
Hugh Boardman
London SW20