Crowdpleasers: Breaking the Rules

Posted by Mark Abramowicz, M.D.

The most recent issue of The Medical Letter (August 6th) included an update of a topic that always seems to interest our readers: splitting tablets. We remind them that when 2 tablet strengths cost the same, splitting the higher strength saves money. Some are horrified; others applaud. Of course, we elaborate a little. Some kinds of tablets, some kinds of drugs, and some kinds of patients are more suitable than others. But it all feels a little naughty, because we are telling prescribers that they can break the rules, at least some of the time.

Another rule-breaking article that we have published from time to time in The Medical Letter, and my own personal favorite, is on the use of drugs past their expiration date. That article came about in an odd way. A physician working in a war zone asked us whether he could use some outdated antibiotics that he had come across, and added that he had no others. I asked the only pharmacist on our advisory board at the time, and he told me, to my astonishment, that the only adverse effect ever reported from outdated systemic drugs was renal toxicity from a single formulation of tetracycline that was no longer available. He also told me that the US Department of Defense and the FDA had sponsored a joint program that stored drugs for years and even decades under various conditions of heat and humidity and then evaluated their potency. Many retained substantial activity even after long exposure to unfavorable conditions. We wrote all about it in The Medical Letter 2009; 51:100.

Breaking the rules is always interesting, and sometimes it can be the right thing to do.

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