Most patients trust their physicians to select just the right medication for them. Unfortunately, the fact is many physicians prescribe medications for an assortment of less appropriate reasons. Sometimes it is the medication with which they are most familiar, or for which they have been provided the most information. I have known physicians over the years who would prescribe one medication over others because it had the shortest name, or which they had taken personally with positive results. The fact that pharmaceutical companies invest billions of dollars for direct to consumer advertising is proof that physicians often accommodate a patient’s request for a specific brand name. So it came as no surprise when Glaxo Smith Kline (GSK) was recently fined three billion dollars for promoting two drugs for unapproved uses and failing to report safety data about a diabetes drug to the Food and Drug Administration (FDA). Treating an illness with a medication that has not been approved specifically for that condition is called “off label use”. Although it is not illegal, it is considered by many physicians to be an irresponsible practice. Failure to report adverse side effects, or to misrepresent the frequency of side effects, is also a common and inexcusable practice by drug manufacturers. Nonetheless, pharmaceutical companies will sometimes weigh the fines and bad publicity against the financial advantage of selling a drug until it is pulled off the market by regulatory agencies. These scenarios are potentially more dangerous for travelers and ex-pats in countries where regulations are lax and new medications are sometimes prescribed before being fully scrutinized by the U.S. Food and Drug Administration. That’s why HTH Worldwide strongly encourages patients receiving unfamiliar medications outside the United States to check with our global health team to make sure that an FDA approved equivalent is available stateside and is being appropriately prescribed. As the GSK behavior reveals, FDA approval does not mean that the medication is being recommended according to guidelines, or that adverse side effects have been fully disclosed. HTH Worldwide makes every effort to encourage the use of well known, time tested medications by everyone, particularly those abroad. Photo by


About The Author

Frank Gillingham, M.D. serves as Chief Medical Director for HTH Worldwide. Frank has led HTH Worldwide's international business development efforts in Europe and Canada and has been a guest speaker at international business conferences and has authored a series of articles on travel medicine, including pieces on travel information available on the Internet and the role of physicians working with travel insurers. Frank is a Board-Certified Internist and Emergency Medicine Specialist. He is also a private emergency physician in Southern California and a former emergency department director and member of the UCLA emergency department staff. Frank completed residency training at Los Angeles County/USC Medical Center, received his M.D. from Albert Einstein College of Medicine and his B.A. from the University of Pennsylvania .

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