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Rational use of drugs: in practice drugs are not always prescribed in strict indications and conditions of their authorization for placing on the market. They are often used at high doses (antibiotics, sedatives, hypnotics, antihypertensives in the elderly by example) or too low (antidepressants ...) multiple and associated requirements lead to drug interactions poorly controlled and sometimes unpredictable. Drugs are often over-consumed (benzodiazepines, non-steroidal anti-inflammatory ...), and others remain under-consumed because their real interest is not brought to the attention of doctors.

Relationship between the use, benefit and risk : Many doctors agree
immediately to prescribe new drugs without proof of their real innovation, without systematic, efficient, relevant studies and often too early for their severe side effects control, which demonstrates the importance and the need for post-marketing surveillance.

Patients compliance : adherence to prescription is very difficult to obtain,
and very difficult to control, especially during long-term treatment or medication.

Plasmatic drug dosage : lithium, vitamin K antagonists, antidepressants, digitalis, theophylline, anticonvulsants and antipsychotics drugs. The debate is still wide open, and there are few clear and independent opinions based on the comparison of the relative variability of the concentration-effect relationship,
or dose-concentration.

Research and clinical trials : The improvement of these tests has an important epidemiological interest. The cost-benefit ratio, categorical imperative, is extremely difficult to establish. The more expensive drug is not necessarily the most effective and the least toxic. The cheapest drug is not necessarily as effective as its more expensive counterparts. The misuse of cheap drug can weigh costs through longer hospital stays or disability-related adverse effects.

The influence of non-pharmacological and non-commercial factors on the prescription: industry plays an exclusive and predominant role in the pharmacological information provided to doctors.This dominant role also extends to the choice of tests (organization and strategy are generally conducted by the manufacturer to promote the drug to doctors).
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