Tag: pharma

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Guidelines Follow-up

The are many professional organisations which agree after thorough discussions on guidelines how to conduct professional services. As long as we have such guidelines, the adherence to the guidelines is an issue as well. This is part of a research program of organisational sociology, but there is a rather strange paradox in this field of compliance with guidelines. In the most highly educated professions like medical doctors, the rate of compliance to guidelines is below average. A study of 20+ years ago published in the JAMA Journal: Cabana et al. (1999) “Why Don’t Physicians Follow Clinical Practice Guidelines?” highlighted this paradox among medical doctors. The lack of awareness of existing or changed guidelines is one of the major reasons mentioned in this respect. Self-efficacy is also an issue, but mentioned less frequently for not following guidelines.
Besides a professional bias, related to the above average educational attainment of physicians, (believed) superior coping mechanisms compared to the average population might be at work. Mastering advanced technology might lead to a behavior that assumes to be able to handle higher risks as well.
For a profession that is used to confront issues of life and death on a regular basis some adherence to a very specific medical guideline might appear a negligible risk. However, maybe comparable to some cases among politicians or priests a logic: “rules or guidelines are for others to follow” rather than the physicians bear obvious risks to these persons themselves, but even to others in specific circumstances like the spreading of infectious diseases.
Drug or substance abuse has been evidenced before in relationship with specific professions or in historical time periods. We should take care to repeat similar studies (Cabana et al. (1999) every now and again.

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Law and Legality

Some persons consider themselves to stand above the law or push all interpretations of regulations beyond usual understanding of it. Even after a person has been dealing with pharmaceuticals or drugs used also for doping purposes, the conviction of such a person may take several years if not decades. In France, Mr Bernard Sainz seems to be a good example of such a relentless case of practicing para-medical consultations to assist mainly cyclists in endeavors to win championships or professional status. Le Monde  and Cash investigation have raised awareness of the public for such dubious practices. The “French Federation du cyclisme” and medical doctors association fight a continued legal battle against this persons exercising illegally such doping assistance. 

With apparently 56 legal procedures in connection with this person, the legal system has to bear the majority of costs of such illegal practices.

The reach of such dubious practices might be extended if the systems beyond doping, but for assisted euthanasia cannot be controlled effectively. Hence, the precursor cases of positive stimuli like doping pose similar challenges to the legal system as “negative stimuli” weakening persons as assistance to die. The end of a life course is not only a medical issue. Society-wide debates need to take place in order to organize a large consensus on the implications more liberal practices shall entail. 

(Image: Palais de Justice, Paris 2025)

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Synthetic opioids

Across the globe there are many tough lessons to be learned about synthetic opioids. These psychoactive substances fall under special legislation and can only be used with medical prescriptions. The strength of these substances is usually compared to heroin and the risk of addiction to these substances is very high.
A recent paper in International Review of the Armed Forces Medical Services (2024) has highlighted also “the abuse of the synthetic opioid U-47700” at times of military conflict. The power of these drugs to suppress the feeling of pain is helpful for medical operations. The abuse, however, may consist in the use of the drug to “keep fighting whilst pain is suppressed”. Such use of synthetic opioids increases the risk for addition and the fatal consequences of overdoses. The reporting of such occurrences in a specialized medical journal is an important warning against the conscious and willingness to abuse the drugs for war purposes.
The finding reminds us of the abuse that was already widely spread during the Nazi led 2nd World War (“Der totale Rausch“). The addictive potential was experiences even after the war time in terms of active combat was over. The costs to society of such abuse as well as use of supply chains of provision of opioids during peace times remain a problem for many years after the war. After a war, the war on drug abuse continues. Fighting addiction is a lengthy and painful process.

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Investment Disinvestment

Asume we live in a world of fixed amounts of investments. The option to invest in a new project or product will automatically reduce the amount of investment in another product. The investment decision, therefore, is subject to opportunity costs. A recent study by Naci et al. (2025) applies this rationale to the investment in new drugs compared to financing other traditional treatments. The results for the U.K between 2000 and 2020 revealed that the „quality-adjusted life-years (QALYs)“ is not in favor of the investment in new drugs. The relatively small numbers of beneficiaries of the new drugs is compared to the many other persons who could have benefited from the less costly previous treatment. Investment in one new drug causes disinvestment in other ones. The overall balance for the UK turned out to be negative. Particularly the disinvestment in prevention of diseases appears to have very detrimental effects in view of the results based on this study. Preventative measures are relatively cheap compared to the estimated 20.000 pounds for one additional quality adjusted year of life for a new drug. The message is: choose your health investments wisely to avoid ever rising health costs and health insurance. (Image: rest room Belgium)

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Shorter is better

Contrary to a lot of received previous recommendations, the shorter duration of antibiotics prescription and use (3-5) days is overall better than the prolonged use of durations between 7-14 days (JAMA Link).  A so-called narrative review of medical studies (Lee et al.2023) reports more precise results separate for medical indications (pneumonia, sinusitis etc.), which tend to go in the same direction for the majority of indications. In view of the serious issue of antimicrobial resistance, a consequence of overconsumption and too widespread use of antibiotics (also in animal health and food production), the slogan of shorter is better should receive serious attention.
It is not only a medical, pharmaceutical or public health issue. The topic has become an issue of nutrition as well. The food chain contains largely unknown amounts of antibiotics as well, especially if larger amounts of animal or fish products are part of it.
The knowledge from these sciences has still to filter through to the broader public. This means it has become a social science topic as well. The transmission of knowledge and patient expectations on prescriptions, which is also linked to regulations concerning sick leave, make it more difficult to shorten prescriptions of antibiotics. There is a steep challenge to change behaviour according to the new mantra “shorter is better” with respect to antibiotics, even if we know that it is better for all of us in the medium or long term.
(Image: Jan Harmensz. Muller, De keuze van de rechte levensweg 1571-1628, MRBAB, Brussels)

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Science Fraud

It is a big issue if publications in science in high reputation journals have managed to pass a rather lengthy and thorough peer review process and still contain evidence based on fraudulent data. The worst case scenario that based on this wrong evidence tests of useless drugs are performed on patients in hope of an honest concern for their health. In fact the financial rewards and even academic rewards have been achieved only through the successful publication of a bias introduced into the data and/or analyses of the data. The fraudulent researcher became subsequently Director of the institute of agingwhoch is part of the American National Institute of Health (NIH) and an academic reference in health sciences far beyond the USA. It is the merit of Charles Piller and his team to persist in challenging the treatment recommendations which were concerning Alzheimer and Parkinson diseases. The checks and balances in the academic research have failed and a serious reconsideration of the procedures should follow, not just business as usual. The reputation of scientific research is at stake beyond the natural sciences and medicine, although the normal way of proceeding is just to qualify such events as singularity and specific to a single discipline. Aging is also not just treated by one single discipline. Hence, there is a need to review the review process and publication practices. The Boeing airplane control failures were also indicating that reviews of technology are subject to high risks. Independent checks and control are hard to ensure in advanced subject matters, but sufficient time and resources have to be devoted to the process. (Image Repair Lab Deutsches Technikmuseum DTM2024).