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Sideways looks (Editorial)

Sideways looks (Editorial)

What interesting questions Bandolier readers ask. This month the whole issue is taken with finding answers (of a sort, perhaps) to questions we have been asked over the last few months. For most there is some evidence, though the more perceptive will have guessed that where there is no evidence (nada, zero, none) we duck the answers.

Bandolier was recently called eclectic in its choice of subjects. Well, maybe, but much of that eclecticism reflects the real need for information that you, the readers and users of evidence, have. Your demand for information illuminates our ignorance, and though the light may be dim at first, we soon want to turn up the watts and find out more. So keep the questions coming.

One question for which Bandolier has found a hint of an answer is the old chestnut about compliance and the number of times a day we have to take the tablets. A solid, if ageing, review confirms that. But it raises lots of other questions, and the Bandolier view is that there are a few theses begging to be written by aspiring pharmacists.

It then begs other questions. If Bandolier can't find answers to obvious questions like those about prescribing and compliance and safety, how do prescribing leads or advisors give sensible advice? The likelihood of unintended consequences is huge.

Sideways looks

Moreover, what we may be looking at is a massive waste of resources, with a very large proportion of prescribed drugs not being taken (and there is a whole issue of the BMJ given over to the subject in October 2003). Now we don't know how much this is unfilled prescriptions, and how much drugs from filled prescriptions not being taken. But with primary care prescribing costs in England in 2002 being some £7 billion, the scope for untreated illness or waste (or both) is massive.

If it were 10%, that would be £700 million. If it were 30%, that would be £2 billion. Just think of the good that could come from judicious use of those piles of cash.

Someone, somewhere, must have thought of that, so there must, somewhere, be a plan to deal with it. There must be some more, or better evidence. Or is there? So far Bandolier has failed to find it. But our readers will know better, so a plea to those of you who know where the evidence is on prescribing waste and how to deal with it, please get in touch.

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