2006 Rho Chi Lecture: Unparalleled opportunities for improving medication-related health outcomes.

It is a tremendous honor to be chosen to present the 2006 Rho Chi Lecture at the annual meeting of the Society, which ‘‘encourages and recognizes excellence in intellectual achievement and advocates critical inquiry in all aspects of pharmacy. ’’ It brings back fond memories of my induction into the Society as a graduate student. I am grateful for all the opportunities I have had in pharmacy education, practice and research over the past 30 years. None of this would have happened without the support of my colleagues and administration at Ohio State, the hard work of my students and fellows, and a sense of community I have felt with my pharmacy friends across the country. I have been fortunate to be associated with the most advanced system of pharmacy practice, education, and research in the world. The reason we excel is because we are always pushing the frontiers and asking ourselves how we could do better. In that spirit, for this presentation, I have chosen to briefly describe the current health care needs in our society, within the context of pharmacotherapy, and discuss the role pharmacy must play to enhance medication-related health outcomes and quality of life of our citizens. Enormous progress has occurred in clinical medicine during the past century. Just during my career, advances in pharmacotherapy, in part have led to increased life expectancy, decreased infant mortality, effective vaccines and antibiotics for the prevention and treatment of many deadly infectious diseases, and lower morbidity and mortality from cardiovascular disease by treating hypertension, hyperlipidemia, and heart failure. AIDS was fatal in nearly all patients two decades ago; now this disease has become a chronic illness in most patients due to the use of highly active antiretroviral therapy. Improved pharmacotherapy of benign prostatic hyperplasia has reduced the need for prostatectomies, disease modifying drugs have improved the course of rheumatoid arthritis, and aromatase inhibitors and herceptin have advanced the treatment of breast cancer. Despite all the progress in pharmacotherapy, we face many challenges. The evidence presented in the 1999 Institute of Medicine (IOM) report demonstrated that thousands of patients receiving medications in our country were being harmed due to errors. 1 However, a much bigger problem is when adverse events occur despite the use of drugs under FDA approved indications. Within the past year, rofecoxib (Vioxx) and valdecoxib (Bextra) were withdrawn from the market due to safety concerns; we also learned that antidepressants may be associated with suicidal ideation, that pseudoephedrine may be used to produce a drug of abuse, and that phenylpropanolamine may cause hypertension and hemorrhagic stroke. The 2001 IOM report found that the nation’s healthcare system was fragmented and uncoordinated, and far too many were not receiving optimal pharmacotherapy: antibiotics were overused and vaccines underutilized, and many patients with mental illnesses received suboptimal therapies. 2 Three years later, the Rand Corporation reported that recommended care was being provided to only 39% of pneumonia patients, 45% of diabetes patients, 53% of asthma patients, 54% of patients with colorectal cancer, 63% of patients with congestive heart failure, and 65% of patients with hypertension. 3 The 2005 State of Health Care Quality report from the National Committee for Quality Assurance (NCQA) showed areas where improvements in the treatment of chronic diseases are still needed. The combined data from Medicare, Medicaid, and certain commercial health plans showed that the appropriate care was provided to only 19% of women treated for osteoporosis after fracture, 32% of patients treated for alcohol and other drug dependence treatment, 52% of patients managing their cholesterol after a heart attack, 60% of diabetics trying to control their hemoglobin A1c, 64% of patients trying to control their high blood pressure, and 69% of patients who used medications for asthma; it was good to know that 90% of patients received a beta-blocker after a heart attack. 4 The aggregate data suggest that health care including pharmacotherapy is still in need of marked improvement. I believe that the problems with the quality in health care may not be so much related to a lack of knowledge but rather in its application to get the right results. We have done