The value of establishing baselines.

the authors’ explanation is enlightening: there are more prescriptions written for narcotics but for a small number of patients from the general population. The database for Che and colleagues is a representative statewide sample of patients, rather than a list from a practice. Their study emphasizes the value of looking at total populations as a starting point, rather than simply our own practices. Their study shows things that should not come as a surprise: that we take more pills as we age, that women take more pills than men, and smokers need more medication than nonsmokers. But their data also show that education, race, and family income are correlated with increased medication use. Social deterThe old saw about not knowing where you are going means that any road will get you there has a corollary— you can’t get to a destination unless you know where you are starting. This issue of the WMJ includes two articles that help understand the starting point—and trends—for two important Wisconsin-focused clinical issues. The first, from Che and colleagues1 looks at prescription use by patients statewide, and the second, from Ablove and colleagues,2 describes the changes in the increased use of a shoulder surgery over a relatively short period of time We are a pill-using nation, and pressure from society, pharma, and the press tries to identify every social ill from the cold to sleeplessness to erectile dysfunction as a problem that will respond to a pill. Direct-to-consumer advertising, which used to be direct-to-prescriber advertising in medical journals, has increased the likelihood of patients seeking something pharmaceutical for their problems.3 I remember a patient contacting me about a new drug for obesity that was going to be released by the Food and Drug Administration (FDA) the next day and wondering if he could get a prescription for it. Patients often more closely follow the FDA than clinicians do. We can’t begin to change our prescribing behaviors until we understand the starting point—the baseline—for our practices. Electronic health records should help understand what we do in practice, but health systems rarely report prescribing patterns except when they are a problem—such as narcotic use—and the individual variability in a group is IN THIS ISSUE