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Wise words

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Earlier this year, DTB's founding editor, Andrew Herxheimer, died aged 90 years. Andrew established DTB's reputation for producing succinct, accurate, impartial and independent reviews on the use of drugs and the management of diseases.1 In addition, he recognised the importance of involving patients in making treatment decisions and the need to help patients weigh up the pros and cons of treatments.2,3 Through his work with the Cochrane Collaboration, he raised awareness of the adverse effects of interventions. As prescribing of medicines is increasingly determined by guidelines and protocols, it is timely to reflect on some of his principles. Andrew believed that effective communication about benefits and harms is an essential element of the consultation, and that it is the responsibility of healthcare professionals to ensure that patients can play their part in coming to an informed decision about treatment.3 Every prescribing decision should be accompanied by a discussion with the patient on how the benefit of treatment can be maximised and the harms prevented or minimised. The nature and time course of benefits and harms should be outlined and patients encouraged to think about their attitude to both.3 Although it is often easier to describe the potential benefit of drug treatment rather than the complexity of possible harms, it is important that patients decide for themselves where the balance lies.4 In 2008, Andrew outlined a series of key issues to consider before prescribing a drug.5,6 We believe that these themes are timeless and still relevant for patients and prescribers.

What could you do instead of using a medicine?

▸ How do non-drug interventions compare with drug treatment?

Unless you have a special reason, avoid new medicines.

▸ Bad news about medicines often takes years to emerge.

If a medicine is necessary, get to know as much about it as you can.

▸ What are the benefits and what problems have people had with it?

Be clear what the medicine is being used for.

▸ Is it for curing or preventing a disease, or for symptom control?

Be clear what benefits and harms can be expected.

▸ What impact will they have and when will they occur?

Encourage patients to keep a record of how they respond to a medicine.

▸ Is it helping, what problems does it cause?

If something bad happens with a medicine: investigate, analyse, learn and report.

How many of us would be confident that we address such issues with our patients every time we prescribe or supply a medicine?

Visit to watch an interview with Andrew Herxheimer.

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