[How to prevent drug therapy risk].
OBJECTIVE
Therapeutic risk is largely foreseeable and can also largely be avoided. The art of prescription consists of favoring the beneficial effect of the medicament while taking all useful precautions to minimize undesirable effects.


BACKGROUND
The appropriate method is correct use of the medicament at the collective and individual level. This is based on respect of reference systems and firstly on the particulars of the marketing license and the summary of the characteristics of the product, which provide validated knowledge concerning the medication. However, these may also be gray areas, insufficient updating, and insufficiently clear and concrete information on the expected therapeutic benefit as opposed to the pernicious effects feared. It is also based on opposing medical references, which attract attention to dangerous prescription practices. Moreover, for an individualized prescription it is necessary to take into account the actual patient, here and now, and not only the standard patient of clinical trials. Prescription priority must also be organized to favor indispensable medications only. In some cases drug monitoring based on personalized pharmacokinetics should be performed. Monitoring and informing of the patient must be strict for maximum safety; however, this is never complete. In this connection, lack of hindsight, premature enthusiasm, and falsely reassuring surveillance should be taken into account, particularly where undesirable effects not dependent on dosage are concerned.


CONCLUSIONS
Health education for the public, improved training of health staff as concerns iatrogenic effects and, shortly, computerized risk prevention with suitable software and data banks, systematic reviews and meta-analyses of therapeutic safety will help provide the patient with improved protection. This constitutes a major scientific, economic and ethical challenge for our societies.
Bouvenot
G
G
Laboratoire de thérapeutique, faculté de médecine de Marseille, 13385 Marseille, France. gbouvenot@ap-hm.fr
D016903:Drug Monitoring; D011307:Drug Prescriptions; D064420:Drug-Related Side Effects and Adverse Reactions; D006266:Health Education; D006801:Humans; D007049:Iatrogenic Disease; D010353:Patient Education as Topic; D012307:Risk Factors