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