The doctors, even the most conscientious, often have difficulty regarding the drug interactions. In spite of a high prevalence of significant interactions, there is a real problem of denial: a study (Glassman, 2002) on 263 physicians of every specialty tells us that in 40% of cases drug interactions are ignored, even in severe clinical situations, potentially lethal. For this reason somebody talks of “silent epidemic.”
It isn’t solely neglect: there an issue of complexity that appears unmanageable.
The controlled clinical trials cover a very small portion of the potential interactions: usually they involve only pairs of drugs, whereas patients rarely take so few active ingredients (drug and other): So you are moving in a land that is not one of “evidence based medicine.”
It is impossible, if you want to address the problem, not to refer to databases. Many clinicians supporting softwares have some limitations, that Interactions Explorer tried to overcome: but the professionals are requested to adopt an active approach.
Most of interactions softwares generate “alarms” when pairs of drugs are not compatible: this mode has not proved particularly effective even in simple situations (pairs of drugs) because after a while doctors tend to ignore the “alarms”. Our opinion is that this mode induces the doctors to be too passive: we thought that from this point of view it was much better to provide professionals with all the useful data enabling them to take a decision on the basis of “clinical judgment.”
Another gross limitation is the absence of support when the drugs or active ingredients are more than two. Interactions Explorer allows you to speculate about situations with many active ingredients used together.
Finally, non-pharmacological active principles are almost never considered, while in the real life patients take non-traditional medicines, supplements, herbals, drugs of abuse, and so on, or have eating habits that strongly interfere with the therapies.
The innovativeness of Interactions Explorer is therefore both in encouraging the interest of the physician in the interactions mechanisms, and in covering the complexity of the possible situations.