The use of medications is a central part of health care. Certainly, when used wisely, medicines can contribute much to the prevention or treatment of disease. Few of us would want to live in a community which did not have doctors and medicines. If they are to be effective, however, medicines must be used properly. This means that the patient and health care provider have to understand when and how the medicine should be taken.

Patients in some countries receive much more medication than patients in other countries - for example, Japanese patients receive about three times as much as the average American patient for the same complaint. In most other countries, the physician does not actually sell the medication. The doctor will write a prescription which is filled by an independent pharmacy. In Japan, the doctor often sells the medication to the patient, and the price is subsidized by health insurance. This has led to widespread abuse by doctors, and over-prescription of drugs. Also, drug companies may try to influence doctors to use a particular medicine which is not necessarily most appropriate.

The improper and excessive use of medicines leads to serious disease and many deaths every year. This is because virtually all drugs have potentially harmful effects. Also, drugs which are effective by themselves, may become ineffective or even harmful when used in combination with other medications. This is especially important in older people who may be receiving treatment for a number of different diseases.

Therefore, like many other forms of treatment or diagnosis, medication has both risks and benefits. Drugs should only be given when there is a clear need. Also, it is important to check for contraindications such as allergies. As with any other form of treatment, and especially where there is a well-recognized risk, informed consent should be obtained. However, most patients know very little about pharmacology, and so rely completely on the advice of their health care provider. This places a great responsibility on health care providers to consider the best interests of the patient.

Situation 1: A pharmacist is explaining to a patient about the medication which she has received.

Pharmacist: Mrs. Johnson, here is your prescription.

Mrs. Johnson: Thanks very much. When should I take them? (referring to the packages of medication she has received.)

Pharmacist: This is your antibiotic. You should take one pill three times a day, with your meals.

Mrs. Johnson: Do you mean I should take them before I eat or after I eat?

Pharmacist: You must have some food in your stomach when you take these. Otherwise, you will get an upset stomach. You should take them while you are eating, or just after you have finished eating. Okay?

Mrs. Johnson: Okay. Now, what is the other pill?

Pharmacist: The blue tablets are for your fever and pain.

Mrs. Johnson: When should I be taking them?

Pharmacist: You have to take one of these tablets twice a day - when you wake up in the morning, and just before bedtime.

Mrs. Johnson: Can I take them on an empty stomach?

Pharmacist: Sure, you should just take a little fluid to help you swallow. Okay?

Mrs. Johnson: Okay. I take the antibiotic three times a day with meals, and the other tablet twice a day, once in the morning and once at night.

Pharmacist: Good. Now, there is enough medication for one week. You must finish all of it. Even if you feel better, you have to take all of the antibiotic. Otherwise, the infection might come back.

Mrs. Johnson: Thanks very much. Now, what do I owe you for this?

Pharmacist: Here`s the bill. You should send the receipt to your insurance company. You should be able to get something back from them.

Patterns:

* When should
...I take them
... I be taking them

* Should I take them before I eat or after I eat
* Can I take them on an empty stomach

* You should
... take one pill three times a day
... take them while you are eating
... take a little fluid
... send the receipt to your insurance company
... be able to get something back from them

* You have to
... take one of these tablets twice a day
... take all of the antibiotic

* You must
... have some food in your stomach when you take these
... finish all of it

Discussion:

1. Why do Japanese patients receive more medication than patients with the same complaints in other countries?

2. How do you think the average Japanese patient feels when they receive a lot of medication for their illness?

3. Why are elderly people more susceptible to the harmful effects of medication?

4. What are some of the harmful effects of antibiotics?

5. What is the professional responsibility of the pharmacist towards the patient?