Letters
More trials from general practice are needed
EDITOR,--As the medical prescribing adviser to Highland Health Board, I have a responsibility to encourage cost effective prescribing. Nick Freemantle and colleagues rightly emphasise the need for adequate data from good trials, but they miss one major point. Much of the 85% of prescribing that takes place in general practice is necessarily based on a presumptive diagnosis (for example, heartburn) rather than proved disease (for example, reflux oesophagitis)--but drug trials are generally limited to selected groups of patients with proved disease (for example, endoscopically proved oesophagitis). Thus, while a proton pump inhibitor may be shown to be the most cost effective treatment for endoscopically proved erosive oesophagitis, this does not necessarily mean that it is the best treatment for patients with dyspepsia presenting to general practitioners.
The prescription of proton pump inhibitors has increased by about 160% over the past two years in Scotland, and these drugs alone account for
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- Promoting cost effective prescribing
- Nick Freemantle, David Henry, Alan Maynard, and George Torrance
BMJ 1995 310: 955-956.[Extract] [Full Text]
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