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Clinical Decision Making
Clinical Decision Making
Prescription drugs are prescribed during clinical encounters. Thorough and effective patient-provider communication about the benefits, risks, costs and alternatives to prescription medicines is a vital part of clinical care. The Center supports research and advocacy to identify and overcome barriers to patient-provider communication to improve safe medication use and to maximize adherence.
Comparative Effectiveness
Comparative Effectiveness
For stakeholders to make informed decisions about prescription drug use, they need timely evidence about the comparative effectiveness of therapies and their alternatives, including their risks and benefits. Incomplete evidence contributes to overuse of some therapies, underuse of others and risky prescribing. The Center supports innovative research into these topics.
Global Medicines
Global Medicines
Ensuring adequate access and affordability of prescription medicines poses major and unique challenges for countries around the world. These challenges are particularly salient in emerging economies that account for an increasing proportion of the world's population and pharmaceutical expenditures. Center investigators focus on how public policy can be optimized to maximize global drug availability and access.
Medication Safety
Medication Safety
Some adverse effects of medicines only come to light after medications have been on the market and widely used. Center investigators are working to develop new methods for identifying risk, to predict the likelihood of high-risk medicines or drug combinations and to protect the public from excessive exposure to these products.
Policy Analyses
Policy Analyses
Complex and dynamic policies govern prescription drug regulation. Policymakers face the challenge of maximizing innovation while protecting public health, and developing payment policies that promote evidence-based usage. Center investigators evaluate regulatory policies to provide policymakers with information to continually optimize pharmaceutical regulation.
Prescription Abuse
Prescription Abuse
Prescription drugs provide therapeutic value to millions of Americans. At the same time, rates of prescription drug abuse and overdose deaths are skyrocketing. The annual number of fatal drug overdoses in the United States now surpasses those of motor vehicle deaths. The Center supports innovative research and public advocacy to help stem this epidemic.

Janet Holbrook

Associate Professor
Department of Epidemiology

jkrfyDr. Holbrook is an Associate Professor of Epidemiology at the Johns Hopkins Univeristy Bloomberg School of Public Health. She has over twenty years of experience in the design and conduct of multicenter studies, particularly randomized clinical trials. Currently, Dr. Holbrook serves as the Director of the Coordinating Center for the Multicenter Uveitis Steroid Treatment Trial (MUST) and for the Trial of CPAP for Asthma (CPAP). MUST is a multicenter randomized comparative effectiveness trial comparing an intraocular fluocinolone acetonide intravitreous implant versus systemic treatment for non-infectious uveitis. The trial enrolled 255 patients at 23 centers, 21 in the United States and one each in the United Kingdom and Australia, and reached the designed primary outcome (visual acuity at 2 years) in December 2010. Since uveitis is a chronic disease, questions concerning the long-term outcomes are of interest. The NEI has funded the MUST Research Group to continue follow-up on all participants for 7 years. The CPAP trial is a multicenter phase 2 trial, involving 18 clinic centers in the Asthma Clinical Research Centers (ACRC) network. The objective of the trial is to evaluate the efficacy and tolerability of CPAP for treatment of asthma in 192 subjects.

The ACRC network was funded by the American Lung Association (ALA) in 1999 with the mission to conduct research that has a direct impact on clinical care. The Network has leveraged the ALA funding of the core infrastructure to obtain grant funding from NIH and the pharmaceutical industry. Dr. Holbrook has served as the deputy director of the ALA-ACRC Data Coordinating Center since it was founded. The ACRC Network has completed the 7 randomized clinical trials, is finishing follow-up in 2 trials and has 2 trials open for recruitment. The completed trials have enrolled between 300 and 2,000 participants and all have been published in high impact journals. The network is considered a model for the conduct of multicenter randomized trials that address clinically meaningful questions. Dr. Holbrook teaches a course on the design, conduct and interpretation of clinical trials at the Bloomberg School of Public Health and for the FDA Commissioner’s Fellowship Program. 

To learn more about Dr. Holbrook, click here

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