Andrew Herxheimer’s Golden Rules of Using Medicines

Today is the final day of the MHRA‘s contribution to a Europe wide social media campaign from the Strengthening Collaboration for Operating Pharmacovigilance in Europe (SCOPE) programme to improve the reporting of adverse drug reactions (ADRs) to schemes like the Yellow Card Scheme. Perhaps ironic, given this is occurring in the week we hear EMEA will be moving to Amsterdam.

It reminded me that I should share Andrew Herxheimer‘s golden rules on using medicines. Andrew was a sad loss to the drug safety community in 2016. I was lucky enough to have met Andrew at several drug safety conferences over the years, and worked on the odd committee with him. The first conference I ever presented at (European Society of Pharmacovigilance Verona, 2000), I cautiously presented some work on coding of ADRs. The first comment from the audience? Andrew with “Yes, very interesting, but what are are you going to do about it.” His emphasis. That was the first time I met him.

Reporting adverse drug reactions was in his Golden Rules of prescribing, which Jeff Aronson skillfully paraphrased in the BMJ.

Andrew Herxheimer’s Golden Rules on using medicines.

  1. Think what you could do instead of using a medicine.
  2. Unless you have a special reason, avoid new medicines. Stick to those about which a lot is known from many sources and which have been used for over 10 years; bad news about a drug often takes years to emerge.
  3. Before deciding to use a medicine be clear whether it is to relieve a symptom, to cure a disease, to remedy some deficiency, or to prevent something. It doesn’t make any sense at all to prevent something in the future if it’s going to cause you some problem now.
  4. Ask a doctor or pharmacist you trust, someone who understands it a bit better than you do, how well the medicine works, what problems people have had with it, and what happened.
  5. If you have to take medicines, get to know as much as you can about those that help you.
  6. Everybody is different and you must learn how your own body reacts to medicines.
  7. Keep a diary of your experiences with a medicine: why you took it, how much for how long, what happened and when, how well it worked, and anything you didn’t like.
  8. If something bad happens that you suspect may have been caused by a medicine, report it on a yellow card; ask a doctor, pharmacist, or nurse to help you do that or to do it for you.
  9. When you have a problem about an adverse reaction or something difficult to discuss with your doctor, take someone with you to the consultation, because four ears are better than two; there are too many things to think about and an independent opinion is well worth having.