While there is no dispute about the need for sound government policy to support optimal drug prescribing, there is nonetheless an awareness that relevant policies are being made in an environment that provides very limited research support. Although we have a clear understanding of what constitutes an authoritative study on the impact of formulary policy decisions , we also recognize that studies that would be universally acceptable are difficult to execute and likely to prove expensive. Little wonder that decisions continue to be made on a largely intuitive basis and that outcomes are rarely evaluated after the implementation of new drug policies . It is of further concern that politicians may grasp at the frequent oversimplifications of evidence-based medicine and translate these into short term savings obtainable from ‘evidence-based rationing’. In this environment, it is doubly encouraging to see the commitment of Ms Lindberg to a more careful process of planning, experimentation and evaluation in Ontario.
A major feature of the past and forthcoming debate about optimal drug therapy is the discussion of what constitutes appropriate or inappropriate drug therapy. Understandably, there is a tendency to assume that ‘inappropriate’ use refers to the overprescribing or overuse of medication. The underuse of certain drugs is also a major problem. Numerous studies show that, even when there is ample evidence of benefit, recommended drug therapy is often denied to large segments of the population . This is a problem of particular concern among seniors, for whom failure to provide optimal preventive treatments may pose a threat to the maintenance of independence and the ability to live outside of an institution. buy asthma inhaler