Drug Information Specialists

All pharmacists provide some level of drug information, whether to other clinicians or to patients. In fact, a exact survey found that 96.4% of 491 hospitals have staff pharmacists who routinely answer drug information questions,[1] and a separate survey of colleges of pharmacy showed that 89% of first professional pharmacy degree programs require at least one didactic course in drug information.[2] While most pharmacists are equipped with knowledge regarding the practice of drug information, the ever-expanding list of pharmaceuticals, as well as the overwhelming amount of clinical data, makes it difficult for practitioners to stay current with exact developments. This also results in the need for more advanced problem-solving skills in order to answer the more complex questions that challenge practitioners today.

Drug information specialists are pharmacists whose primary responsibility is the provision of drug information. As with any specialty, formalized training beyond that received in pharmacy school is not required; however, this focused training does Strengthen the practitioner's clinical credibility and ability to compete with others for employment opportunities. These two intangible attributes may also be obtained with time and experience.

The American Society of Health-System Pharmacists (ASHP) provides residency accreditation in drug information. There are currently 31 ASHP-accredited drug information specialty residencies located throughout the United States. These residency programs are housed in community, academic, and industrial settings and offer a variety of learning opportunities. Although there are additional drug information residency programs that are not ASHP accredited, the standards and objectives for such accreditation may be used to describe the clinical skills set of the drug information specialist which go beyond the minimum standards required of all pharmacists.[3]

Most drug information residency programs provide the resident with 12 months of directed, postgraduate practical experience in the provision of comprehensive drug information. During this 12-month period, the resident is exposed to various aspects of drug information practice that range in scope and complexity, with the ultimate goal of training the resident to become a competent drug information specialist. Many of the competencies required of a drug information resident are specific to executive issues, such as the development and management of a drug information center, but there are many more competencies that construct the foundation of a drug information specialist's clinical practice. Drug information specialists must be up-to-date with relevant drug-related literature in order to provide the most current information. They are often tasked as a pharmacy representative to pharmacy and therapeutics (P&T) committees. Responsibilities may include preparing medication-use policies and procedures, improving a health system's adverse-drug-reaction reporting and medication-use evaluation programs, and creating and distributing newsletters containing pertinent medication-use information. The drug information specialist must have advanced literature search and test skills to develop drug monographs. Additional responsibilities often include developing patient safety initiatives, ensuring compliance with Joint Commission on Accreditation of Healthcare Organizations's standards, and appropriately utilizing drug-contracting opportunities to decrease drug expenditures. Drug information specialists may also work in pharmacy informatics.

As previously mentioned, drug information specialists work in a variety of settings, each with its own unique scope of practice. Academic drug information centers staffed by drug information specialists offer pharmacy students practical experience in utilizing available medical media and developing literature-search strategies. Of 88 colleges of pharmacy surveyed, 20% require a drug information practice experience and 70% offer the experience as an elective.[2] These centers are often located within colleges of pharmacy or university hospitals. Most offer their services to a limited range of health care professionals, such as those within certain facilities or within the region or state. Others offer their services to community pharmacists and patients. Many health maintenance organizations (HMOs) and group purchasing organizations (GPOs) have contractual relationships with academic drug information centers, which in turn offer their services to the respective members of the organizations. In addition, HMOs, GPOs, and pharmacy benefit management companies (PBMs) have internal drug information departments that assist their members on a grander scale by providing many of the items utilized by P&T committees in making medication-use decisions. Many PBMs also provide consumer-based drug information via the Internet that is prepared by drug information specialists.

Proprietary and generic drug manufacturers are staffed with pharmacists who provide drug information specifically for the drugs manufactured by the respective companies. Although there is some information they cannot legally share and all information received should be critically evaluated, they do maintain a database of clinical studies, both published and unpublished, that provides hard-to-find information. These drug information specialists are available to health care professionals and the public and should be contacted if a patient has an unexpected adverse drug reaction. In addition, drug information specialists have practical knowledge of clinical trial design and often provide valuable insight as medical writers and in governmental agencies analyzing drug efficacy and safety claims.

Drug information specialists are trained to provide clear, concise, and accurate drug information in a variety of settings. Not only do they provide quality service, but pharmacist-provided drug information, adverse-drug-reaction monitoring, and formulary management have been associated with significant reductions in the total cost of care in hospital settings, as well as reductions in patient deaths.[4] The presence of a drug information center providing these services in 232 hospitals reduced total cost of care per hospital by $5,226,128.22 (p = 0.003), including a $391,604.94 reduction in drug costs per hospital, and was associated with a total of 10,463 fewer deaths.[4] Disappointingly, an online survey of health care professionals showed that only 1% of respondents contact a drug information center when the need arises.[5] Another exact survey found that only 5.9% of 491 hospitals have a staff position dedicated to the provision of drug information and 4.1% have a formal drug information center.[1] Granted, contacting a drug information specialist may not be the fastest way to obtain drug information in an emergency situation; nonetheless, this underutilization raises several questions.

Today, the Internet provides a plethora of information for both health care professionals and their patients. Many practitioners probably use the Internet when seeking answers to questions. However, at least one study judged significantly more responses obtained from a drug information center as accurate when compared with those received from a Usenet newsgroup (p = 0.001).[6] Also, there is no quality control for these types of newsgroup services and other similar medical information sources housed on the Internet, and practitioners may be jeopardizing their own credibility when using these resources. Another source of information is facility-housed references, including print and electronic products. Electronic drug information products are becoming increasingly popular. A exact survey showed that 60.4% of 491 hospitals subscribed to some sort of electronic product.[1] Two interesting surveys on drug information references have been conducted.[7,8] In one survey, 40.9% of 22 respondents said they were not satisfied with the drug information resources to which their pharmacy currently subscribed.[7] In another survey, 38% of 71 respondents said they used a drug information reference at least 10 times a day, and another 35.2% used such a reference 3-5 times daily.[8] This discrepancy shows that practitioners regularly use some sort of drug information reference, even though they are not always satisfied with the information obtained.

With so many pharmacists retrieving information from drug information references, the underutilization of drug information specialists as a resource cannot be attributed to a lack in the number of questions that need to be answered. Perhaps practitioners do not know how to find drug information specialists. Industry-based specialists can be contacted via the manufacturer's Web site, and the Physicians' Desk Reference provides a listing of contact information for drug manufacturers.[9] Drug Topics's Red Book contains a list of academic drug information centers, and many colleges of pharmacy provide these services to the pharmacies in their respective states.[10] It is also worth contacting HMOs or GPOs, where applicable, to learn about the services they provide.

Drug information specialists are a valuable resource available to support appropriate drug use and Strengthen quality of patient care. New practitioners are urged to take advantage of the expertise of drug information specialists, either within or outside of their own institutions.

Does Information Affect Their Beliefs?

It was the social-science equivalent of Barbenheimer weekend: four blockbuster academic papers, published in two of the world’s leading journals on the same day. Written by elite researchers from universities across the United States, the papers in Nature and Science each examined different aspects of one of the most compelling public-policy issues of their time: how social media is shaping their knowledge, beliefs and behaviors.

Relying on data collected from hundreds of millions of Facebook users over several months, the researchers found that, unsurprisingly, the platform and its algorithms wielded considerable influence over what information people saw, how much time they spent scrolling and tapping online, and their knowledge about news events. Facebook also tended to show users information from sources they already agreed with, creating political “filter bubbles” that reinforced people’s worldviews, and was a vector for misinformation, primarily for politically conservative users.

But the biggest news came from what the studies didn’t find: despite Facebook’s influence on the spread of information, there was no evidence that the platform had a significant effect on people’s underlying beliefs, or on levels of political polarization.

These are just the latest findings to suggest that the relationship between the information they consume and the beliefs they hold is far more complex than is commonly understood.

Sometimes the dangerous effects of social media are clear. In 2018, when I went to Sri Lanka to report on anti-Muslim pogroms, I found that Facebook’s newsfeed had been a vector for the rumors that formed a pretext for vigilante violence, and that WhatsApp groups had become platforms for organizing and carrying out the genuine attacks. In Brazil last January, supporters of former President Jair Bolsonaro used social media to spread false claims that fraud had cost him the election, and then turned to WhatsApp and Telegram groups to plan a mob attack on federal buildings in the capital, Brasília. It was a similar playbook to that used in the United States on Jan. 6, 2021, when supporters of Donald Trump stormed the Capitol.

But aside from discrete events like these, there have also been concerns that social media, and particularly the algorithms used to suggest content to users, might be contributing to the more general spread of misinformation and polarization.

The theory, roughly, goes something like this: unlike in the past, when most people got their information from the same few mainstream sources, social media now makes it possible for people to filter news around their own interests and biases. As a result, they mostly share and see stories from people on their own side of the political spectrum. That “filter bubble” of information supposedly exposes users to increasingly skewed versions of reality, undermining consensus and reducing their understanding of people on the opposing side.

The theory gained mainstream attention after Trump was elected in 2016. “The ‘Filter Bubble’ Explains Why Trump Won and You Didn’t See It Coming,” announced a New York Magazine article a few days after the election. “Your Echo Chamber is Destroying Democracy,” Wired Magazine claimed a few weeks later.

But without rigorous testing, it’s been hard to figure out whether the filter bubble effect was real. The four new studies are the first in a series of 16 peer-reviewed papers that arose from a collaboration between Meta, the company that owns Facebook and Instagram, and a group of researchers from universities including Princeton, Dartmouth, the University of Pennsylvania, Stanford and others.

Meta gave unprecedented access to the researchers during the three-month period before the 2020 U.S. election, allowing them to analyze data from more than 200 million users and also conduct randomized controlled experiments on large groups of users who agreed to participate. It’s worth noting that the social media giant spent $20 million on work from NORC at the University of Chicago (previously the National Opinion Research Center), a nonpartisan research organization that helped collect some of the data. And while Meta did not pay the researchers itself, some of its employees worked with the academics, and a few of the authors had received funding from the company in the past. But the researchers took steps to protect the independence of their work, including pre-registering their research questions in advance, and Meta was only able to veto requests that would violate users’ privacy.

The studies, taken together, suggest that there is evidence for the first part of the “filter bubble” theory: Facebook users did tend to see posts from like-minded sources, and there were high degrees of “ideological segregation” with little overlap between what liberal and conservative users saw, clicked and shared. Most misinformation was concentrated in a conservative corner of the social network, making right-wing users far more likely to encounter political lies on the platform.

“I think it’s a matter of supply and demand,” said Sandra González-Bailón, the lead author on the paper that studied misinformation. Facebook users skew conservative, making the potential market for partisan misinformation larger on the right. And online curation, amplified by algorithms that prioritize the most emotive content, could reinforce those market effects, she added.

When it came to the second part of the theory — that this filtered content would shape people’s beliefs and worldviews, often in harmful ways — the papers found little support. One experiment deliberately reduced content from like-minded sources, so that users saw more varied information, but found no effect on polarization or political attitudes. Removing the algorithm’s influence on people’s feeds, so that they just saw content in chronological order, “did not significantly alter levels of issue polarization, affective polarization, political knowledge, or other key attitudes,” the researchers found. Nor did removing content shared by other users.

Algorithms have been in lawmakers’ cross hairs for years, but many of the arguments for regulating them have presumed that they have real-world influence. This research complicates that narrative.

But it also has implications that are far broader than social media itself, reaching some of the core assumptions around how they form their beliefs and political views. Brendan Nyhan, who researches political misperceptions and was a lead author of one of the studies, said the results were striking because they suggested an even looser link between information and beliefs than had been shown in previous research. “From the area that I do my research in, the finding that has emerged as the field has developed is that factual information often changes people’s factual views, but those changes don’t always translate into different attitudes,” he said. But the new studies suggested an even weaker relationship. “We’re seeing null effects on both factual views and attitudes.”

As a journalist, I confess a certain personal investment in the idea that presenting people with information will affect their beliefs and decisions. But if that is not true, then the potential effects would reach beyond my own profession. If new information does not change beliefs or political support, for instance, then that will affect not just voters’ view of the world, but their ability to hold democratic leaders to account.

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