McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 6  Challenges to effective drug therapy

the best position to listen, teach and explain some of this confusing information to people and to facilitate the care of the person in the health system.

use of these drugs. Even if the words are legible, they frequently don’t have any meaning for the reader. The paediatrician or nurse may spend a great deal of time explaining why a particular drug is not indicated for a particular child and may actually experience resistance on the part of the parent who wants the drug for their child. As the marketing power for prescription drugs continues to grow, the healthcare provider must be con- stantly aware of what people are seeing, what the ads are promising and the real data behind the indications and contraindications for these “hot” drugs. It is a con- tinuing challenge to stay up-to-date and knowledgeable about drug therapy. The media also look for headlines in current medical research or reports. It is not unusual for the media to take a headline or research title and make it into news. Sometimes the interpretation of the medical report is not accurate, and this can influence a person’s response to suggested therapy or provide a whole new set of demands or requests for the healthcare provider. Many television talk shows include a medical segment that presents just a tiny bit of information, frequently out of context, which opens a whole new area of interest for the viewer. Some healthcare providers have learned to deal with the “disease of the week” as seen on these shows; others can be unprepared to deal with what was presented and may lose credibility. The Internet The Internet , the worldwide digital information system accessed through computer systems, and World Wide Web are now readily accessible for most consumers. People who do not have Internet access at home can find it readily available at the local library, at work or even in cafés that allow community access. The information available over the Internet is completely overwhelm- ing to most people. A person can spend hours looking up information on a drug—including pharmaceuti- cal company information sites, chat rooms with other people who are taking the drug, online pharmacies, lists of government regulations, and research reports about the drug and its effectiveness. Many people do not know how to evaluate the information that they can access. Is it accurate or anecdotal? People often come into the healthcare system with pages of information down- loaded from the Internet that they think pertains to their particular situation. The nurse, midwife, doctor or other health professional can spend a tremendous amount of time deciphering and interpreting the information and then explaining it. Some tips that might be helpful in determining the usefulness or accuracy of information found on the Internet are given in Box 6.1.

CONSUMER AWARENESS Access to information has become so broad over the last decade that consumers are often overwhelmed with details, facts and choices that affect their healthcare. Gone is the era when the healthcare provider was seen as omniscient and always right. The person now comes into the healthcare system burdened with the influence of advertising, the Internet and a growing alternative therapy industry. Many people no longer calmly accept whatever medication is selected for them. They often come with requests and demands, and they partake of a complex array of over-the-counter (OTC) and alter- native medicines that further complicate the safety and efficacy of standard drug therapy. Media influence The last 20 years have seen an explosion of drug adver- tising in the mass media. It became legal to advertise prescription drugs directly to the public in the US in the 1990s, and it is now impossible to watch television, listen to the radio or flip through a magazine without encountering numerous drug advertisements. This is more restricted in Australia and New Zealand. Legis- lation, in both countries, determines what can be said in an advertisement, but in some cases this further confuses the issue for many consumers. Because, in many cases, listing the possible adverse effects is not a good selling point, many advertisements are pure business ploys intended to interest consumers in the drug and to have them request it from their healthcare providers (even if it is unclear what the drug is used for). It is not unusual to see an ad featuring a smiling, healthy-looking person romping through a field of beau- tiful flowers on a sunny day with a cute baby or puppy in tow. The ad might simply state how wonderful it is to be outside on a day like today—contact your healthcare provider if you too would like to take drug X. Although most people now know what the erectile dysfunction drug Viagra is used for, some of the ads for this drug simply show a happy older couple smiling and dancing the night away and then encourage viewers to ask their healthcare providers about Viagra. What older person wouldn’t want a drug that makes him or her feel young, happy and energetic? Parenting magazines, which are often found in paediatricians’ offices, are full of advertisements for medications that can improve the health of children. These ads picture smiling, cute children and encour- age readers to check with their paediatricians about the