A recent article published in the New York Times caught my attention. The article -- "In Reporting Symptoms, Don’t Patients Know Best?" (find it here) -- suggested that doctors tend to "downgrade symptoms" (ie, adverse effects of drugs) reported to them by their patients because of "wishful thinking" or, worse, because they do not want to document problems they failed to act on for fear of being sued.
That being the case, there is little hope that widespread use of electronic medical records will capture useful adverse events that the FDA can analyze. Garbage in, garbage out as they say.
Speaking of garbage, the article criticized FDA's MedWatch program that allows doctors and patients to report problems that they think are adverse events from drugs already on the market. "But it’s a passive system that waits for reports instead of actively surveying patients," says the article. "Many people don’t know about it, and it has failed to catch some important adverse events," said Dr. Ethan Basch, an oncologist who treats men with prostate cancer and does research at Memorial Sloan-Kettering Cancer Center in New York.
"A better approach," says Basch, "would be to have large numbers of patients filling out questionnaires before and after drugs are marketed. For example, in the postmarket setting we could ask 5,000 selected patients starting Bextra to report monthly."
Of course, Bextra has been taken off the market by the FDA. Dr. Bach's point is that if post marketing surveys of patients were done soon after Bextra entered the market, the problems may have been noticed much earlier.
Meanwhile, Dr. Basch is working on his idea: "Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events" is National Cancer Institute funded outcomes Research project that began in October 2008 (see here). As part of that research, Dr. Basch and his co-investigators initiated development of an electronic patient-reported system for monitoring and reporting symptomatic AEs that patients may experience during treatment.
I imagine that this system would be pretty expensive to implement on a large scale across many different drug treatments. But there is a cheap (ie, FREE) electronic system already available for capturing adverse events from patients: patient-focused social media sites such as PatientsLikeMe (PLM) and others.
PLM found that 7% of 500 randomly selected posts from the 364,000 posts contributed by patients within the PatientsLikeMe Forum during 2009 incorporated all four elements required for reporting an adverse event (an identifiable patient, a specific medication, an identifiable reporter and a reaction). This is 35 times the rate in the frequently cited Nielson study, which found only one such message in its random sample of 500 posts. (See "PatientsLikeMe Reports High Rate of Adverse Event Reporting Among Its Members".)
I'm not sure how Dr. Basch is getting his questionnaire out to patients, but he might look to social media sites like PatientsLikeMe to perform a public service and place the form on its site so that patients can easily access it. Just a thought on how social media can help expedite outcomes research!
NOTE: I will be speaking on this topic next week at the World Drug Safety Congress. The title of my presentation is "Web based AE reporting; is it the future?" I will specifically address how social media can be incorporated into a drug’s safety strategy and the challenges involved. If you have any solutions, ideas, or comments I can incorporate into my presentation, please tell me about them (you can email me at firstname.lastname@example.org).