How will a certain drug impact a certain patient? What behavior and lifestyle factors affect risky or inconsistent medication use? These are the questions behind pharmacoepidemiology, the multidisciplinary field that uses data points to discover how medications affect our health. They’re questions that Brigham and Women’s Hospital physician Jerry Avorn, MD, was asking long before data science became ubiquitous. As a practicing intern in the 1980s, Dr. Avorn realized that electronic patient data could reveal how people use medications to manage chronic health conditions over time.
This realization spurred pioneering research, led by Dr. Avorn, to analyze Medicaid claims for prescription drug trends—which uncovered suboptimal prescribing patterns, with concurrent suboptimal outcomes. These findings, then formed the basis for Dr. Avorn’s 1998 creation of the Brigham’s Division of Pharmacoepidemiology and Pharmacoeconomics.
Today the world’s largest academic research center of its kind, the Division is home to a multidisciplinary team led by Sebastian Schneeweiss, MD, ScD, who works to foster personalized medicine by analyzing claims data on diagnoses, emergency department visits, hospitalizations, and lab reports. The data is applied to help clinicians identify root causes of risky or ineffective medication use, drug safety issues, and the impact of drugs and drug combinations on public health issues such as chronic disease.
“Our responsibility is to probe questions about effectiveness, safety, access, and cost that cannot be answered within the realm of clinical trials,” Dr. Schneeweiss says. “These are multibillion-dollar questions with real lives at stake. It’s a huge responsibility and a massive opportunity.”
In one such initiative, the Division was asked by the Food and Drug Administration to build the analytics component of Sentinel, the nation’s first systematic program to mine health care data for signs of serious risks associated with any drug on the market. “If you look at data that exist from 300 million patients, you can zoom in until you get to 10,000 patients 70 years and older using warfarin or a new anticoagulant to treat atrial fibrillation who are characteristically similar and see what happens with them over time,” notes Dr. Schneeweiss.
Dr. Schneeweiss is proud of the strides the Division has made to spread evidence about medication safety, particularly for chronic diseases. As more conditions transform from virtual death sentences to manageable conditions, he hopes the Division will help people with complex illnesses live longer with more confidence in their treatment choices. “This isn’t just how we learn what is harmful—it is also the path to understanding the range of uses a drug can have,” he says. “The potential for improving human health is limitless.”
More on the Division’s work here.