I read an interesting opinion piece in the Wall Street Journal recently titled Of Ferguson and Fallujah. In his essay Bret Stephens (@StephensWSJ) intends to compare President Obama’s foreign policy to the police response to the extremely unfortunate events that have been, and continue to be unfolding in Ferguson, MO. His view is that both are “disastrously reactive”.
To support his opinion, he uses the broken windows theory. Developed by George Kelling and James Q. Wilson, and written about in a 1982 Atlantic Monthly article. The title comes from the following example:
Consider a building with a few broken windows. If the windows are not repaired, the tendency is for vandals to break a few more windows. Eventually, they may even break into the building, and if it's unoccupied, perhaps become squatters or light fires inside.
Or consider a pavement. Some litter accumulates. Soon, more litter accumulates. Eventually, people even start leaving bags of refuse from take-out restaurants there or even break into cars.
Without getting into his conclusions regarding Ferguson or Fallujah, weighing in on his argument, or debating the controversy that surrounds the theory, I wanted to use broken windows to make an additional analogy. An analogy to… yep you guessed it… drug safety.
My view is that the majority of Pharmacy Directors and the P&T Committees that they sit on, both on the payer and provider side of the healthcare spectrum, are being “disastrously reactive” when it comes to the safety of the medications that they are placing on their formularies. By relying solely on FDA action to make safety related decisions, they are creating a broken windows environment. One that will further perpetuate the unfortunate status quo that leads to an increasing deterioration of patient outcomes and an increase in healthcare costs.
To be fair, in large part this is not the fault of the Pharmacy Director. The data needed to make more educated decisions have been kept under the lock-and-key of drug manufacturers and the FDA. Luckily the data is now being liberated. Furthermore, in order for change to be accepted, prescribers need to embrace data-driven, evidence based metrics in order for the Pharmacy Directors’ recommendations to take hold. Luckily, we have long since entered the age of big data, and the use of statistics and analytics by non-pharmacovigilance experts is catching on.
Proactive maintenance and independent post approval safety surveillance of drug formularies by payer and provider organizations fixes broken windows and creates an environment that does not accept unsafe drugs.
What broken windows do you want to see cleaned up in drug safety? Share your thoughts in the comments below.
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Executive Vice President