Drug Prescribing — Can Traditions Be Overcome?

Abstract

A survey published in 1986 showed a very strong negative correlation between the time since a physician graduated and the currency of his or her knowledge concerning the care of patients with hypertension [6]. In other words, physicians seem to treat disorders much in the way in which they were taught in formal training. If this is the sense that we want to give to the word “tradition”, some corollaries follow: First, the need to overcome tradition is directly proportional to the rate of real innovation in a field. The rate of real innovation in pharmacotherapeutics is not exceedingly fast, since most new drugs are actually “me-toos” that do not add much to what pre-existing drugs already offered. As an example, Table 1 shows the rate of relevant innovation in the drug market as assessed by three independent sources in recent years [1,2,5]. This observation is even truer if we restrict the field to general practice, where many time-honored remedies are still unexcelled (penicillin, thiazide, aspirin etc.). In this respect the need to overcome tradition does not seem to be that strong and the decision of many British general practitioners (GPs) not to include in their formularies drugs that have been on the market for less than five years seems wise and not backward.