Inclusion of Black Box Warnings in the Curriculum: A Topic of Global Significance in Patient Care and Management

To the Editor. In a recent issue of the Journal, an interesting research article that evaluated the awareness of black box warnings among pharmacy undergraduates was published.¹ While it is important to have such a knowledge base about black box warnings built into the curriculum, given the importance of these warnings in clinical practice, the idea of conducting a survey to get a feedback is indeed commendable. This may help to better administer the course and build an interesting curriculum on a topic that has such a tremendous impact in the prescribing of medicines and therapeutics.

The cross-sectional survey was performed meticulously and without bias by incorporation of sound statistical analysis following the ratings on the questionnaire by 2 independent judges. Overall, it was suggested that third-year doctor of pharmacy students are more knowledgeable on black box warnings than first- or second-year students. Familiarity with black box warnings on drugs such as paroxetine and estrogen was evident, while familiarity with other black box warnings such as stavudine and enoxaparin was generally lacking.¹ One interesting thought process: would a personal background or family history of depression or anxiety disorder have resulted in some of the pharmacy students being more familiar with paroxetine? Likewise, would knowledge of hormone replacement therapy and associated women's health disorders have made some students more knowledgeable about estrogen? In addition, prescriptions for chronic disorders such as depression, cancer, and cardiovascular disease may have helped students to understand the significance of black box warnings as opposed to medicines for acute use or short-term prescriptions. This exercise in particular, of conducting an awareness survey, is significant in the context of preparing future pharmacists for practice in the real world and ties into the objectives of this letter to the editor.

Pharmacy students in the United States are privileged to be able to study interesting topics such as black box warnings as part of the curriculum. Their knowledge on black box warnings assumes universal significance as it is applicable in clinical care and clinical practice across various geographies, not just in the United States. It prepares pharmacy students to face real world challenges, regardless of the professional path they choose (ie, research, pharmacy practice, industrial position, etc). Unfortunately, pharmacy students in many other countries and developing regions are not exposed to this subject matter and their familiarity with black box warnings would be very limited or, perhaps, non-existent. Hence, this topic would be extremely beneficial to pharmacy students in other regions to be exposed to since black box warnings and prescription implications along with other co-medications may have serious safety consequences in patient care and disease management. Also, the conduct of an unbiased survey to ensure the awareness of black box warnings is a progressive way to ensure the spread of knowledge. Such practices should also be readily adopted in the developing regions when they introduce topic(s) of public health in the pharmacy curriculum. After all, the well preparedness of pharmacy students post curriculum would enable implementation of such public health practices.

It is the suggestion of the author that as part of Journal development, some special topics are chosen that may have universal applicability. Although the aim of the Journal may be to reach out to pharmacy professionals/educators and other health care professionals/researchers in the United States, such an endeavor to cover certain universally important topics would bode well in developing the community of pharmacists across the globe. Some of these topics include: (a) case studies of fatalities, if any, as a consequence of serious drug-drug interactions; (b) case studies of unsuspected drug-drug interactions; (c) patient care in certain critical medical conditions; (d) recent drug withdrawals due to serious clinical safety issues; (e) approvals of some innovative medicines. It is not the intention of the author to suggest original research publications in the suggested topics. However, introduction of a forum within the journal that caters to the review of published clinical pharmacology, safety, and/or medical information on the above topics, with expert opinion of the presenter and its implications to pharmacy professionals would add significant benefit to the Journal's readership.

• © 2011 American Association of Colleges of Pharmacy