ADRs: Is the patient voice loud enough?

I attended the 1st International Conference on patient reporting of suspected Adverse Drug Reactions

in London in June, organised by PRIMM (Prescribing and Research in Medicines Management) and the DSRU (Drug Safety Research Unit).   It was very well organised, if not well attended.  Up to million Britons are hospitalised by prescription medicines every year, costing the NHS £2 Billion, and ADRs are the 5th leading cause of death in Europe causing £79 billion.  Tony Avery was one of dozens of professors who had written an open letter to David Cameron warning him of an epidemic of ADRs.

My eyes were opened to the vast possible life threatening and debilitating side effects from drugs whose testing is not thorough, monitoring in the Community phase 5 is poor and patient reporting is little known about.  For example, pathological gambling effect from a Parkinson medication, and suicide from an acne medication.  Prof Simon Maxwell reminded us that “All drugs are poisons depending on the dose”… may I add and dependent on the patient.

GPs have only 2-3 hours training in recognising ADRs, Pharmacology was removed by the BMA, and often GPs will just change the dose or prescribe another drug before stopping the problem drug.   Thankfully Pharmacists spot many errors in prescribing and are in the highest group of health professionals is reporting ADRs to the MHRA (Medicines & Healthcare Regulatory Agency.)

7,000 prescriptions are written daily so with an error rate of 5-10% so that equates to hundreds of mistakes every day.  My personal issue is that GPs often do not follow up their prescribing and so can not effectively reflect or evaluate their professional practice.  Patients do not always cash in the prescription, or even use the drug even though taken, may have a problem with the drug but may not share this information or may share it with another GP.  Unless GPs see patients through a illness period, how can they monitor their practice?

Shelley Gandi from the MHRA told us that only 10% of ADRs are reported to them and everyone agreed that Patient Reporting is vital.  The patient was found to write a more detailed and accurate report, especially about the psychological effect and the reduced quality of life, compared to the health professional who will pick up on the life threatening effects.  Patients can of course use the Yellow Card, available on line and in most pharmacists, but less than 10% of the population is aware of this.  Promoting the Yellow Card is vital of course, but we need to share our experiences with our GPs to reduce the incidence in the first place.

My question:

“It is common for today’s babies and toddlers to be regularly ill with colds and infections, and have allergies and atopic conditions, but more worrying is that everyone thinks that this is normal.   However, parents who use few pharmaceutical products find that their children are rarely ill or immune compromised, and so are not ‘normal’.   If ill health is a side effect of combinations of vaccines, antibiotics and anti pyretics, then how can the side effects be even suspected as a result, let alone be assigned to each product?”

My Question was not answered at the conference, but was followed up with a possibility of a study by a Prof of Pharmacy and Chemistry “I do acknowledge that a combination of products makes it difficult to identify which product caused an ADR and that is the next area on which I wish to work.  It is possible that we could consider doing some epidemiological research in this area..”

That’s good.

The patients were so respected here, that’s good too.
Please see this very good site for more about ADRs http://www.april.org.uk
APRIL was founded by the amazing Millie Kieve who began researching for information about adverse drug reactions (ADR’s) after the tragic death of her daughter Karen in 1995.

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