Should medical students be taught rational prescribing?
Robin Ferner argues why this is important
The famous 19th century pathologist Virchow dismissed therapeutics contemptuously, saying that only by combination with physiology could it rise to be a science, ‘which today it is not.’1 A J Clark, a professor in Edinburgh, after the first world war, wrote that, ‘The vital information as to what a drug does when given in therapeutic doses in disease is scanty in most cases, and absent in very many.’1 We are gradually making progress, but many medical schools no longer teach the skills, knowledge, and attitudes needed to make good prescribing decisions.
The first skill for a rational prescriber is to decide the aim of prescribing. Is it palliation of symptoms, cure of a disease, or the prevention of some adverse consequence? For sore throats, antibiotic treatment might reduce the incidence of quinsy but is unlikely to be as effective as aspirin for pain relief.2 Reconciling the prescribers view with the