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Articles by Robin E Ferner
Re: Rising fatalities, injuries, and NHS costs: dog bites as a public health problem
Rapid Response: Dear Editor The news [1] that another person has been mauled to death by a large dog underlines the warnings in Waters’s feature [2] that dog bites constitute a serious hazard to health. We have identified through news reports at least 48 inquests since 2013 in which deaths have been related to dog bites, either through trauma or sepsis, or in one case, strangulation by dogs’ leads.[3] Fourteen victims were under 5 years old.
Effectiveness of biosimilar adoption within a UK tertiary hospital: 6‐year follow‐up
CONFLICT OF INTEREST STATEMENT The authors have no conflicts of interest to declare. REFERENCES 1 European Medicines Agency. Biosimilar medicines: overview. Accessed November 13, 2022. https://www.ema.europa.eu/en/human-regulatory/overview/biosimilar-medicines-overview 2 NHS England, NHS Improvement, NHS Clinical Commissioners. Commissioning framework for biological medicines (including biosimilar medicines). Version 1. Gateway reference: 06924. Published online September 2017.
Drug shortages. Part 1. Definitions and harms
1 INTRODUCTION Drug shortages are often in the news1 and are often looked on as a recent phenomenon. However, drug shortages have been with us for a long time.
Drug shortages. Part 2: Trends, causes and solutions
1 INTRODUCTION In the first part of this two-part review on drug shortages, we discussed how drug shortages are defined and the harms, including medication errors, that can result. In this second part, we shall discuss the trends in drug shortages, their causes and potential solutions.
How to assess pharmacogenomic tests for implementation in the NHS in England
What is already known about this subject Pharmacogenomic testing has the potential to target medicines more effectively towards those who will benefit and avoid use in individuals at risk of harm. Health economies are actively considering how pharmacogenomic tests can be implemented into healthcare systems to make better use of medicines. One of the barriers for implementation is evaluation of the evidence including clinical usefulness, cost-effectiveness and operational requirements.
1455 A 10-year review of insulin-related enquiries to the UK National Poisons Information Service (NPIS)
Abstract Aims, Objectives and Background More than 4.9 million people in the UK have diabetes, and sufferers are at increased risk of depression.1 We reviewed enquiries to the NPIS about insulin overdose. Method and Design Retrospective analysis of enquiries between 1 November 2011 and 31 October 2021. Results and Conclusion We received 1195 enquiries involving insulin. Further analysis was limited to the 169 enquiries involving insulin only (90.5% via injection).
We need reliable evidence to guide treatment choices for the many, not the few
News & Views We need reliable...
Re: Pregnant women should be included in clinical trials to improve outcomes, says commission
Rapid Response: Re: Pregnant women should be included in clinical trials to improve outcomes, says commission Dear Editor, The BMJ is right to highlight the Healthy Mum, Healthy Baby, Healthy Future report on the need to include pregnant women in studies of new treatments, especially of drugs and vaccines.(1,2) Clinical trials under-represent many groups of people.(3) Countless patients fall into one or more of the 'overlooked' categories.
Re: Thrombosis after covid-19 vaccination
Dear Editor Is tozinameran (the Pfizer/BioNTech vaccine) safer than ChAdOx1 (the Oxford-AstraZeneca vaccine)? The Oxford-AstraZeneca vaccine may cause an extremely rare and very distinctive syndrome of cerebral venous sinus thrombosis, thrombocytopenia, and antibodies against platelet factor 4, as Professor Hunter suggests, but we need to know the aggregate risks of harm from the vaccines, not this specific risk.
Harms and the Xmas factor
News & Views Harms and the Xmas factor Harms and the Xmas factor Feature Christmas 2020: The Citadel BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4067 (Published 16 December 2020) Cite this as: BMJ 2020;371:m4067 Robin E Ferner, honorary professor of clinical pharmacology1, Jeffrey K Aronson, consultant physician and clinical pharmacologist2 1University of Birmingham, UK 2Centre for Evidence Based Medicine, University of Oxford, Oxford, UK Correspondence to R Ferner...
Study confirms reduced efficacy of hormonal contraceptives with antibiotic use
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Establishing a service to tackle problematic polypharmacy
ABSTRACT Introduction Polypharmacy is increasingly common and can increase the risk of adverse drug reactions (ADRs), accounting for a significant proportion of hospital admissions. It may also impair functional status and quality of life. Current efforts to improve polypharmacy take place largely in primary care, but there may be a role for increased support from medicines specialists in the secondary care setting.
Painful perianal ulcers with nicorandil
Education Painful perianal...
Analysis of reports of unintended pregnancies associated with the combined use of non-enzyme-inducing antibiotics and hormonal contraceptives
Analysis of reports of unintended pregnancies associated with the combined use of non-enzyme-inducing antibiotics and hormonal contraceptives Free http://orcid.org/0000-0003-1139-655XJeffrey K Aronson1, Robin E Ferner2 1Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford OX2 6GG, Oxfordshire, UK 2Institute of Clinical Sciences, University of Birmingham, Birmingham, UK Correspondence to Dr Jeffrey K Aronson, Centre for Evidence...
Adverse drug reactions
Adverse drug reactions (ADRs) are important but often difficult to diagnose. They should be considered in the differential diagnosis of a wide range of conditions. Estimates of the proportion of acute hospital admissions caused by ADRs range from 0.5% to 12.8%. They can be classified according to dose-relatedness, time course and susceptibility. Toxic effects are caused by high doses, for example nephrotoxicity with aminoglycosides.
Remdesivir in covid-19
News & Views Remdesivir in covid-19 Remdesivir in covid-19 Editorials BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1610 (Published 22 April 2020) Cite this as: BMJ 2020;369:m1610 Read our latest coverage of the coronavirus pandemic Robin E Ferner, honorary professor of clinical pharmacology1, Jeffrey K Aronson, clinical pharmacologist2 1Institute of Clinical Sciences, University of Birmingham, Birmingham, UK 2Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health...
Chloroquine and hydroxychloroquine in covid-19
News & Views Chloroquine and...
Drugs and the renin-angiotensin system in covid-19
Intended for healthcare professionals Toggle navigation The BMJ logo Toggle top menu News & Views Drugs and the renin...
The patient who reports a drug allergy
Intended for healthcare professionals Toggle navigation The BMJ logo Toggle top menu Education The patient who...
A licence to cure
Intended for healthcare professionals Toggle navigation The BMJ logo Toggle top menu News & Views A licence to cure A licence to cure Editorials BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1723 (Published 01 April 2015) Cite this as: BMJ 2015;350:h1723 Jeffrey K Aronson, honorary consultant physician1, Robin E Ferner, director2 1Nuffield Department of Primary Care Health Sciences, Oxford OX2 6GG, UK 2West Midlands Centre for Adverse Drug Reactions, City Hospital, Birmingham, UK...
Adverse drug reactions
No medicine is entirely safe, so the therapeutic benefit needs to be balanced against the risk of an adverse drug reaction. The pharmacovigilance environment has changed in the past two decades, with biological therapies, complex multidrug regimens, genetic testing, “big data,” and new regulation for drug safety.1 In this clinical update we describe some principles that guide prevention, recognition, and response to adverse drug reactions.
Preventing Future Deaths from Medicines: Responses to Coroners’ Concerns in England and Wales
Coroners inquire into sudden, unexpected, or unnatural deaths. We have previously established 99 cases (100 deaths) in England and Wales in which medicines or part of the medication process or both were mentioned in coroners’ ‘Regulation 28 Reports to Prevent Future Deaths’ (coroners’ reports). We wished to see what responses were made by National Health Service (NHS) organizations and others to these 99 coroners’ reports.
Prescribing biosimilars
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Patient Safety and the Law of Gross Negligence
The safety of patients depends on recognition of an error when it occurs, and concerted efforts to prevent its recurrence. The recent highly publicised prosecutions of healthcare professionals for gross negligence manslaughter (GNM) has increased fears that they will make patients less safe by eroding staff morale and resulting in the practice of defensive medicine – making clinicians more reluctant to disclose their errors for fear of criminal sanction.
Manslaughter trials ignore systemic failures
Robin E Ferner, consultant clinical pharmacologistUniversity of Birmingham, City Hospital, Birmingham B18 7QH, UKr.e.ferner{at}bham.ac.ukDonaldson’s important editorial describes the haphazard way in which doctors come to face charges of gross negligence manslaughter.1 Police investigation can be triggered by complaints from relatives, hospital authorities, or coroners.2 We do not know the true numbers of cases that are investigated by the police, referred to the Crown Prosecution Service, or...
Nominal ISOMERs (Incorrect Spellings Of Medicines Eluding Researchers)-variants in the spellings of drug names in PubMed: a database review
Results The 30 standard names of drugs in the test set gave 325 979 hits in total, and 160 hidden reference variants gave 3872 hits (1.17%). The standard names of the control set gave 470 064 hits, and 79 hidden reference variants gave 766 hits (0.16%). Letter substitutions (particularly i to y and vice versa) and omissions together accounted for 2924 (74%) of the variants. Amitriptyline (8530 hits) yielded 18 hidden reference variants (179 (2.1%) hits).
How similar are biosimilars?
The United Kingdom has lagged behind other European countries in adopting biosimilars, said a recent article in the Financial Times,1 and a British Biosimilars Association has been launched “to promote medicines that could shave a third off NHS prices.”2 The UK’s chief pharmaceutical officer was quoted as saying that “biosimilar medicines have enormous potential to deliver increased patient access, as well as savings to the NHS, which can be reinvested elsewhere.”2 Biological products...
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