Published online by Cambridge University Press: 30 October 2009
A pharmacist at a drug store has been presented with prescriptions for two drugs that the pharmacist knows are being prescribed “off-label” or “off-list” (meaning, for a non-approved use) for obesity. The patient presenting the prescription appears to be somewhat overweight but not obese. The pharmacist knows that the medical literature has recently contained reports that patients on this drug combination have developed severe cardiac problems and some have died from the condition. Since the reports are anecdotal in nature and not supported by scientifically controlled research studies, the consensus opinion among healthcare providers is that there is no proof that the drugs cause cardiac problems but there is cause to be alarmed about the risk. For this reason, some physicians have stopped prescribing the combination for their overweight patients. When the pharmacist asks the patient about the prescriptions, he learns that the patient has been on the drugs for months and has lost a considerable amount of weight, a fact that he says has “turned his life around.” He reports, improved blood lipid chemistries, better mobility, and a tremendous boost in his self-esteem. The patient also discloses that his usual physician has stopped prescribing the drugs because of the side effect reports, forcing the patient to locate another willing prescriber. In the midst of this prescription intake session with the patient, the pharmacy supervisor calls the pharmacist aside and tells him that there is a backlog of prescriptions that need filling immediately.
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