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If I can agree with the authors’ purpose pointing out the number of adverse drug events due to lack of observance (Abilio C de Almeida Neto et al. : http://www.bmj.com/cgi/content/full/339/aug20_1/b3282), I am convinced that the major problems of drug prescribing are more obviously over prescribing, wrong prescribing and ignorance of drug interactions. Modern medicine is polluted by the famous disease mongering process, whose final aims are to prescribe inadequate and dangerous drugs (including placebos) to non-ill patients for paternalistic reasons.
Doctors are always prompt to denounce patients’ dealings but are reluctant to stress their own dealings that are linked to medical arrogance. Underreporting of adverse effects is more important than underreporting lack of observance and it would be more effective to change doctors’ attitudes than to plan programmes to enhance patients’ adherence. One of the major reforms of modern medicine is to prescribe less and better in hospital or in ambulatory care (Tejal K Gandhi et al. http://content.nejm.org/cgi/content/abstract/348/16/1556).
Finally, to paraphrase the authors, I write : "Overprescribing drugs can cause treatment failure, mortality and increase healthcare costs."
No competing interests
24 September 2009
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