The Pharmaceutical Journal
Vol 269 No 7214 p306
7 September 2002

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Difficult doses [more]
Will advertising do the trick? [more]

Difficult doses

Determining the right dose of a pharmaceutical product for a patient is not easy either for pharmacists or for pharmaceutical companies. Striking a balance between maximum efficacy and minimum adverse effects is always a problem.

This balancing act is illustrated by work carried out by pharmacists from the Queen's University of Belfast who found that children were often underdosed with analgesics after surgery (see p308). Because so many drugs are not licensed for children little research is carried out on them, so it is difficult to know what dosages are appropriate. As a result, prescribers are likely to be conservative and give inadequate doses. Many children in the Belfast study did not experience the side effects normally associated with analgesics, suggesting underdosing, and some children experienced insufficient pain relief.

More needs to be done to stimulate research and data collection on the use of medicines in children. At a national level, a scheme similar to that in the United States, where patents are extended in return for undertaking appropriate research, could be introduced. This is already being discussed at a European level (PJ, 16 March, p349). At an individual level, prescribers using medicines off-licence could have to submit case reports for collation into a larger database. The support of pharmacists in ensuring that they did so would be crucial to building up an evidence base.

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Will advertising do the trick?

In the past, lay members of the Council of the Royal Pharmaceutical Society were discovered and selected by the time-honoured method of asking the Great and the Good to suggest candidates, whose names were then put forward by health ministers for approval by the Privy Council.

Now that the Government demands that this process should be open and transparent, vacancies are advertised in the national press, starting with a replacement for Dr John Evans who retires in October after 15 years' service.

Few people can argue with the advantages of open competition for these posts, but the profession should fervently hope that the Great and the Good's network still operates. How else will individuals of the calibre of Dr Evans (who has always added intelligent comment and thoughtful opinion to debates, however unacceptable to other members of Council) and who might not choose to respond to an advertisement, be persuaded to apply. The danger of open competition is that it could appeal to those seeking status, but without the nous to realise the responsibilities it carries.

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