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Shotgun Hematinic Therapy

Fred Rosner, MD
Arch Intern Med. 1978;138(7):1129. doi:10.1001/archinte.1978.03630320067022.
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Among the numerous throw-aways that the mailman delivers to my door are advertisements from pharmaceutical companies concerning drugs and related products.

I recently received a set of complimentary starter prescriptions for a certain drug for the treatment of "iron deficiency anemia and megaloblastic anemia." The drug is composed of ferrous fumarate, ascorbic acid, cyanocobalamin, and folic acid. This "shotgun" approach for the treatment of anemia aroused me to share my concerns and frustrations with my colleagues.

Shotgun therapy is the "indiscriminate use of several therapeutic agents simultaneously, each of which is effective individually in specific types of anemia, without first determining their applicability to the case at hand."1 Why should a patient with pernicious anemia be given iron, folic acid, or ascorbic acid? If the patient has a concomitant deficiency of one or more of these factors, specific replacement is indicated, not shotgun therapy.

If a patient with a


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