The Clinical Value of Drugs: Sources of Evidence

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Abstract
Physicians prescribe drugs about 4 times as often as they did 20 years ago. A large fraction of the preparations used are of relatively recent origin, Acceleration has occurred both in the rate of acceptance of new drugs and in their rate of obsolescence. Too frequently drugs are introduced into the market and put into extensive use after inadequate clinical investigation and without justification by medical need. Organized efforts to evaluate drugs and to inform physicians about their advantages and disavantages, while valuable and of increasing scope, do not as yet promise to deal with all aspects of the problem. For a rational, scientific and ethical program of clinical evaluation of drugs in patients and of their subsequent utilization in practice, it seems essential that the development, production and trial of new drugs should be governed primarily by medical need and scientifically established criteria. Important progress in this direction will be possible only when evidence regarding the value of drugs is subjected to the rigorous criteria applied to other scientific problems. The general adoption of such standards depends on the leadership of medical educators, and on the organized efforts of hospital staffs and of medical care programs. Widespread adoption of criterial standards by which to judge proffered evidence of clinical value can result not only in financial savings but in an appreciable and salubrious improvement in the standard of medical care given to the American people.