1. ARN14 Feb. 2002 JSPS visit Showa University RUD useful references; Rational Drug Use: Consumer Education and Information Estimating Drug Requirements: A Practical Manual Public Education in Rational Drug Use Report of an Informal Consultation. Geneva, 23-26 November 1993 Rational Use of Drugs in the South-East Asia Region Report of an Intercountry Consultative Meeting. New Delhi, 7-11 June 1993 Producing National Drug and Therapeutic Information -- The Malawi Approach to Developing Standard Treatment Guidelines Producing National Drug and Therapeutic Information -- The Malawi Approach to Developing Standard Treatment Guidelines Clinical Pharmacology. The European Challenge The Rational Use of Drugs. Report of the Conference of Experts. Nairobi, 25-29 November 1985 The Use of Essential Drugs. Eighth Report of the WHO Expert Committee (including the Tenth Model List of Essential Drugs) WHO Drug Information International Nonproprietary Names (INN) for Pharmaceutical Substances Lists 1-73 of Proposed INN and Lists 1-35 of Recommended INN Cumulative List No. 9 International Nonproprietary Names (INN) for Pharmaceutical Substances: Names for Radicals and Groups, Comprehensive List July 1997 Guidelines on the Use of International Nonproprietary Names (INN) for Pharmaceutical Substances

2. ARN14 Feb. 2002 JSPS visit Showa University RUD useful references; (cont.) The Use of Common Stems in the Selection of International Nonproprietary Names (INN) for Pharmaceutical Substances, March 1999 WHO Model Prescribing Information Series WHO Model Prescribing Information: Drugs Used in the Treatment of Streptococcal Pharyngitis and Prevention of Rheumatic Fever WHO Model Prescribing Information: Drugs Used in the Treatment of Streptococcal Pharyngitis and Prevention of Rheumatic Fever WHO Model Prescribing Information: Drugs Used in HIV-Related Infections WHO Model Prescribing Information: Drugs Used in HIV-Related Infections WHO Model Prescribing Information: Drugs Used in Leprosy WHO Model Prescribing Information: Drugs Used in Skin Diseases WHO Model Prescribing Information: Drugs Used in Parasitic Diseases Second edition WHO Model Prescribing Information: Drugs Used in Sexually Transmitted Diseases and HIV Infection WHO Model Prescribing Information: Drugs Used in Anaesthesia

3. ARN14 Feb. 2002 JSPS visit Showa University Challenges Despite the growing body of knowledge on rational use interventions, numerous studies have documented the continuing widespread irrational prescribing of drugs. injection therapy can also be an example of irrational drug use. knowledge alone is not enough to change behaviour, and that complex and multifaceted solutions are needed. Many new drugs and second-line drugs are very expensive and accordingly unaffordable for many governments and consumers.

4. ARN14 Feb. 2002 JSPS visit Showa University Challenges (cont.) Drugs and therapeutics committees may have difficulty to run in situations where Medical and pharmacy training is still very traditional; with much emphasis on drug knowledge and very little on public health, prescribing skills, drug management and patient care. Influence of pharmaceutical representatives Doctors often gets visits from these representatives introducing new drugs or reminding doctors of their products. Doctors should stick to the principles of rational prescribing.

5. ARN14 Feb. 2002 JSPS visit Showa University Expected outcomes for 2000-2003 Development of national standard treatment guidelines and essential drugs lists Support for problem-based and skill-based in- service training programmes Drugs and therapeutics committees established and operating effectively International technical guidelines and standards on traditional medicine expanded

6. ARN14 Feb. 2002 JSPS visit Showa University Rational Drug Use by Consumers Establishing effective drug information systems to provide independent and unbiased drug information -- including on traditional medicine -- to the general public and to improve drug use by consumers

7. ARN14 Feb. 2002 JSPS visit Showa University Progress An extensive review by WHO of public education on drugs provided valuable insight into strategies used, and their strengths and weaknesses (Public Education in Rational Drug Use: A Global Survey).Public Education in Rational Drug Use: A Global Survey WHO guide to investigating drug use in the community has contributed to a growing body of knowledge on consumer understanding, attitudes and practices regarding drug use. (How to Investigate Drug Use in Communities).How to Investigate Drug Use in Communities Support independent sources of drug information. Experiences with independent drug bulletins are being shared with developing countries through networks such as the International Society of Drug Bulletins. International Society of Drug Bulletins Development of drug information centres. These are important source of independent drug information. Linking these centres electronically contributes to sharing of information and experience.

8. ARN14 Feb. 2002 JSPS visit Showa University Challenges The consumer takes the final decision about whether and where to seek health care, what medicine is actually taken, how much and when, and from what source. These decisions are influenced by knowledge, culture, drug promotion and personal finances. Independent drug information and public education about drug use are complicated and costly and have always been underserved and underfunded. They also tend to be organized by NGOs thus with informal networks and objective evaluation of interventions and publication of the results are not easily arranged. Lack of independent drug information and advice. Worldwide, some 50% of people fail to take their medicines correctly. Part of the problem is that self-medication is widespread. Purchases of drugs in certain localities take place in the private sector, where prescribing and selling functions are often combined. Profit motives and pressure to please the patient can lead to over- treatment of mild illnesses, overuse of injections and misuse of anti- infective drugs.

9. ARN14 Feb. 2002 JSPS visit Showa University Expected outcomes for 2000-2003 Effective systems of drug information that are accessible to all health workers and the general public, through provision of training material and regional and national training courses, and technical support to international networks of drug information centres. Public education in rational drug use and consumer empowerment through operational research, and development and provision of new training materials and courses.

10. ARN14 Feb. 2002 JSPS visit Showa University

11. ARN14 Feb. 2002 JSPS visit Showa University Activities in Japan April 1998: Japanese version of P-Drug manual 28 Oct. 98: 13th Fujigoko Clinical Pharmacological Conference 10 Oct. 98: P-Drug Network (P-Net-J) founded 15 Oct. 98: P-Net-J website founded (http://p-drug.UMIN.ac.jp).UMIN.ac.jp 6 Dec. 98: 1st P-Drug Workshop – Hamamatsu, Shizuoka (Facilitator Hans Hogerzeil) 1 Apr. 99: P-Net-J Regulation 27-29 Aug. 99: 2nd P- Drug Workshop, Hieizan, Shiga (Facilitator K. Kafle) 9-11 Aug. 99: 3rd P-Drug Workshop, Machida, Tokyo (Facilitator K. Barnes) 30 Sep. 2000: 7th Course for Certified Clinical Pharmacologist by J- CPT 11 Nov. 2000: 6th Meeting of Japanese Society for Pharmacoepidemiology (Symposium) 16 Nov. 2000: 10th Meeting of Japanese Society for Clinical Psychopharmacology (Plenary lecture) 18th Feb. 2001 20th Meeting of Japanese Society of Oral Therapeutics and Pharmacology (Plenary lecture) ? 2001: 4th P-Drug Workshop

12. ARN14 Feb. 2002 JSPS visit Showa University RUD in Malaysia: Drug regulation (MOH/Pharmaceutical division/NPCB/DCA) RUD meeting in Sarawak 1995 with WHO involvement (?first) Bi-Regional Working Group Meeting on Hospital Pharmaceutical & Therapeutic Committee and Drug Information Service13 - 15 October 1999, Penang, Malaysia PRUD workshop in Kuala Lumpur – August 2001 Scientific meetings of professional Societies and Associations; MSPP USM - National Poison Centre (and Drug information) - RUD teaching in School of Medical Sciences USM. - Research and Ethical Committee - Pharmacy and Therapeutics Committee - DIU/DUC - Clinical Trial Unit - Regular Therapeutic Update Seminars

13. ARN14 Feb. 2002 JSPS visit Showa University Examples of regional activities by NGOs incl. associations First Asian CPT Conference, Yokyakarta, Indonesia, 1993 ICIUM- 1-4 April 1997, Chiengmai, Thailand Padang, Indonesia 9-21 Oct. 2000 – Training Course on Promoting Rational Drug Use Kuala Lumpur, August 2001- Workshop on Rational Pharmacotherapy Manila, Philippines 19-28 Oct. 2001-1 st Asian Course in Problem-based Pharmacotherapy Teaching

14. ARN14 Feb. 2002 JSPS visit Showa University Other Centres of activity worldwide Newcastle – Australia Boston – USA Gronigen – Netherlands Cape Town – South Africa Individual efforts in respective countries N.B: It is important that the educational activities are conducted to the right target group, eg. Medical teachers, prescribers, decision makers in family. School children has been shown to be effective in dissemination of information.

15. ARN14 Feb. 2002 JSPS visit Showa University Specify the Therapeutic objective Verify whether your P-Treatment is suitable for this patient Start the Treatment Give information, instructions and warnings Monitor and stop treatment Define the patient’s problem WHO model (Guide to Good Prescribing) Process of Rational Prescribing

16. ARN14 Feb. 2002 JSPS visit Showa University Specify the Therapeutic objective Choose and verify P-Drug Execute Treatment Give information, instructions and warnings Monitor and stop treatment Define the patient’s problem (after careful evaluation) WHO model (Guide to Good Prescribing) Process of Rational Prescribing – Rahman’s modification Management Plan (Pharmacological and Non-pharmacological) Write Prescription Cont./stop treatment Review treatment

17. ARN14 Feb. 2002 JSPS visit Showa University Do The right things right (K-action) 5 `rights' of medication: right patient right drug right dose right route right frequency

18. ARN14 Feb. 2002 JSPS visit Showa University In conclusion; It is our duty to provide health care for mankind through rational approach and providing rational management as part of overall rational patient care.

19. ARN14 Feb. 2002 JSPS visit Showa University Doctors must not say; Don’t tell me what to do

20. ARN14 Feb. 2002 JSPS visit Showa University No. of physicians in the U.S. = 70,000 Accidental death caused by physicians per year = 120,000  accidental death per physicians = 0.171 (source: U.S. Dept. of Health and Human Services) cf. No. of gun owners in the U.S. = 80,000,000 No. of accidental gun death per year = 1500 No. of accidental gun death per gun owner = 0.0000188 Statistically doctors are approximately 9000 more dangerous than gun owners.

21. ARN14 Feb. 2002 JSPS visit Showa University Summary Drugs need to be used rationally Irrational use of drugs is occurring Definition of rational use of drugs need to consider national, economic and socio-cultural background in respective community Efforts to promote RUD is worldwide Focus of activities should be at international, national, prescribers and consumers level There are many challenges in tackling irrational use of drugs Cooperation among parties involved in promotion of RUD including pharmaceutical industry should be strengthened Doctors must maintain the noble status of their profession

22. ARN14 Feb. 2002 JSPS visit Showa University

23. ARN14 Feb. 2002 JSPS visit Showa University ARIGATO GOZAIMAS