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Healthy Skepticism Library item: 8559

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.


Publication type: Journal Article

Kunin CM.
Problem of antibiotic usage. Definitions, causes, and proposed solutions
Ann Intern Med. 1978 Nov; 89:(5):802-5.


Methods used to measure the extent of antimicrobial use and to evaluate the quality of the diagnostic process and therapeutic judgement used by physicians in prescribing antibiotics are discussed. These include use of data from the hospitai pharmacy and review of routine orders for prophylaxis in surgery and for specific infectious diseases. Audits of individual agents should be based on standardized guidelines for use. Attempts to improve the quality of use of antimicrobial agents require understanding of the constraints of medical practice that affect use of drugs to solve problems. These include the practice setting, cost and availability of laboratory support, and patient expectation. Promotion by the pharmaceutical industry capitalizes on the motivation of the physician to help his patient, often in settings in which diagnosis and management are uncertain. The overall solution to inappropriate antibiotic use requires more than educational programs. There should also be well structured hospital programs regulating pharmaceutical representatives, the formulary, antimicrobial susceptibility tests, justification for high cost agents, and development of mutually agreed on guidelines for use.

Anti-Bacterial Agents/therapeutic use* Drug Industry Drug Utilization* Hospitals Humans Quality of Health Care


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Cases of wilful misrepresentation are a rarity in medical advertising. For every advertisement in which nonexistent doctors are called on to testify or deliberately irrelevant references are bunched up in [fine print], you will find a hundred or more whose greatest offenses are unquestioning enthusiasm and the skill to communicate it.

The best defence the physician can muster against this kind of advertising is a healthy skepticism and a willingness, not always apparent in the past, to do his homework. He must cultivate a flair for spotting the logical loophole, the invalid clinical trial, the unreliable or meaningless testimonial, the unneeded improvement and the unlikely claim. Above all, he must develop greater resistance to the lure of the fashionable and the new.
- Pierre R. Garai (advertising executive) 1963