Association Perspective
Michael D. Hogue, PharmD, FAPhA, FNAP, FFIP, Executive vice president and CEO of APhA
When I was in pharmacy school, I enrolled in stand-alone coursework and a clinical rotation in drug information. Domingo Martinez was in his final year of teaching at Samford University, and a new professor, Mike Kendrach, had started. I distinctly remember the exercise that Martinez and Kendrach put us through during our PharmD training. We had to review literally dozens of journal articles in a systematic process to determine the validity of the science.
As I recall, the worksheet had 37 evaluative items (lettered A through KK) against which we judged the validity of the study design, enrollment criteria, length of the study, and even the bias that might be present in the researchers through grant funding and employment. We’d join journal club sessions to discuss our evaluations with our fellow students and preceptors. We did this nonstop. In fact, it’s hard to remember a single week during my PharmD program that didn’t involve going through this process for two to six articles a week during our final year of the Bachelor of Science program and our track in clinicals.
In my experience, Samford wasn’t the only institution that took this approach. I’m pleased to see that nearly every PharmD program still follows a very similar intensity to the rigor of evaluating the science of the literature. It’s why institutions depend on pharmacists to direct pharmacy and therapeutics committees and make clinical recommendations bedside. We know how to look critically at the literature and determine what is in a patient’s best interest.
It is with that foundation that I’m now concerned about what’s happening in the public sphere. Politicians are using “studies” and “evidence” in an attempt to prove a point they wish to make. This isn’t a new phenomenon; it’s been happening for years. People often use personal experiences to leverage their opinion by finding some aspect of science to prove their case. But not every study is designed appropriately. Not every case report has a definitive and direct causal association which can be inferred. In fact, rarely is there a definitive, direct causal association between a medical observation and the event that led to the observation.
For example, let’s say a 65 year old develops a speech impediment. He has hypertension, hyperlipdemia, and obesity. He just had his flu shot 2 weeks ago. He got a pedicure last evening. He smoked a pack per day of cigarettes for the past 30 years. Why did this gentleman develop a speech impediment? I won’t answer this question, but as pharmacists, you are likely thinking through the process of evaluating a cause. But could we determine a definitive cause? Sure. It’s absolutely possible that with appropriate laboratory testing, physical examination, and monitoring, we might discover he had a stroke or a transient ischemic attack. We might learn that he has developed some new onset neurologic issue such as Parkinson’s. However, this hypothetical case simply doesn’t provide enough information. There are some people who will read this case and conclude that the flu shot must have been the cause. Others may decide it was the pedicure, no matter how silly that might seem to me and you.
It’s more important than ever that we stand behind the science. Not emotion. Not gut sense. Not the pressure of public opinion. Not politics—science.
We are pharmacists, with our own opinions, convictions, and beliefs that shape us. Ultimately, the systematic review of the literature, the evidence, and the science must be our guiding star. When that literature changes over time, then we must be willing to change our determinations. If that body of evidence does not change, we must, with the same conviction, stand behind the science we have. That’s what it means to be a health care provider standing on the firm foundation of evidence-based science.
For every pharmacist. For all of pharmacy. ■