[Racemic therapeutic agents; problems concerning medical ethics and registration].
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Drugs are currently released for general use without substantial knowledge of their minimum and maximum effective dose and their dose-related side effects. There are several plausible explanations for this situation, but in some cases this has resulted in patients receiving larger than necessary or smaller than effective doses and experiencing adverse reactions. A concurrent problem with drug evaluation is the rising concern with the use of placebo controls and the growing pressure to utilize positive-control studies. Such studies have many problems, however, some of which are subtle but nonetheless counterproductive in terms of proving efficacy through rigorous scientific investigation. The use of dose-ranging in clinical trials provides more information regarding a drug's TI and can circumvent some of the problems of placebo- and positive-controlled studies. Thus, such dose-ranging studies should be a feature of the development of most new drugs.
Important ethical, economic, and professional issues in home health care (HHC) are identified and discussed. Patient services issues in HHC involve the ethics of providing high-technology feeding therapies to terminally ill patients and the controversies surrounding drug products, such as the appropriate amount of drug to be dispensed, the appropriate individual to compound home-care drug products, acceptable types of product packaging, and the impact of a switch in venders on the drug products supplied to patients. Economic issues include reasonable profit for HHC services, methods used to charge for products and services, payments to physicians for patient referrals, and pharmacies owned and operated by the HHC industry. Pharmacy relations issues center on the influence of nonpharmacists on pharmacy-based HHC services and the effect of HHC services on intraprofessional relations. How pharmacists resolve the many ethical, economic, and professional issues in HHC will determine the quality of services provided to patients, the nature of the working relationships between pharmacists and other health professionals, and the direction that pharmacy HHC services will take in the future.
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