Message from abroad------DR. Andrew Herxheimer

Welcome to the first Japanese drug bulletin for consumers and professionals!
 I am delighted that the new Japan Institute of Pharmacovigilance for Evidence-Based Healthcare is taking such an important initiative.

Good conversations and mutual understanding between patiants and doctors and other health professionals continues to be the exception. Until recently medical students have not been taught communication skills, and mostdoctors have either learnt them on their own, or never discovered that they donot communicate well. That remains a major problem in most countries, andit is good to know that it is now getting more attention in Japan.

In order to be able to talk with a doctor or pahrmacist, a patient needs some basic understanding of illness, symptoms and medicines. When one is ill, it istoo late to study medicine---there is so much to learn and to understand. Butfortunately it is not difficult to learn a few important questions that the patient can ask the doctor, and that cannot be called `stupid questions'.

For example, it is often reasonable to ask the doctor about the diagnosis, and how certain it is. When the doctor suggests a drug, the patient needs to knowwhat can be expected from it---whether it is aimed at one or more symptoms, or can be a cure, and how likely it is to be effetive, and how long it will take to work. For example, if it works in fewer than half the people who take it, or can cause unpleasant effects, then the patient may prefer to accept the symptoms and wait for them to disappear on their own. Of course once the patient has obtained the medicine, she or he also has to know when and how to take it, what to look out for, whether to avoid particular activities or foods, and so on.

For most people who need drug treatment, or are uncertain whether they need it, it is difficult to distinguish good pills from bad ones. The reason is that many pharmaceutical companies, and also some authorities, make greatly exaggerated claims that a product is effective and safe. You will find that the bulletin will help you to distinguish them, because it evaluates the scientific evidence according to international standards and takes specialcare to eliminate or minimise biases.

I hope that the bulletin will give various examples of informative and helpful conversations between doctors and patients, as well as of unsuccessful encounters and misunderstandings. Both patients and doctors can learn a lot from such stories.

I wish the new bulletin every success, and look forward to staying in touch with it.

Andrew Herxheimer 

Former editor, Drug & Therapeutics Bulletin  
Former chairman, ISDB  
Emeritus Fellow, UK Cochrane Centre 


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