Pharmaceutical use and outcomes: always a need for a sober second look.

P HARMACEUTICALS ARE UNDENIABLY ONE OF THE CORNERSTONES OF MODern medicine. Appropriately used, many pharmaceutical agents can provide powerful health improvements and tremendous value for money in the health-care system. Despite this remarkable promise, pharmaceuticals have important characteristics that necessitate careful appraisal of their safety, effectiveness and economic value, both before market entry and after. The paper by O'Reilly et al. in this issue illustrates the need to monitor pharmaceutical use and the related impacts on patient health and the healthcare system. Under an unrestricted-access policy, utilization of relatively expensive treatment options (atypical antipsychotic agents) generated a more than 17-fold increase in provincial expenditure on antipsychotic medication for the Newfoundland and Labrador Prescription Drug Program. The pharmacoeconomic models that manufacturers use to justify the higher costs of atypical antipsychotic agents promise significant reductions in hospital expenditure. Yet, data reported by O'Reilly et al. indicate that the extra $3.5 million spent as a result of unrestricted access to atypical antipsychotics