Tooth and nail

doi:10.1136/bmj.39357.591076.47

BMJ 2007;335 (6 October), doi:10.1136/bmj.39357.591076.47

Editor's Choice

Editor's choice

Tooth and nail

Fiona Godlee, editor

fgodlee{at}bmj.com

If you're interested in what BMJ editors do when they are outand about, there's a new blog on bmj.com (http://blogs.bmj.com/bmj/category/comment/editors-at-large).It gives a flavour of some of the conferences we've been atand some of the people we've met: the eponymous Dr Kawasakifor one, UK public health grandee Rod Griffiths for another.I met Rod at a conference in Athens and we got talking aboutfluoride. No one in their right mind would get involved in thedebate about water fluoridation, he said. It's a minefield.But this week we do get involved, and against his better judgment,so does Rod.

In the Analysis section (doi: 10.1136/bmj.39318.562951.BE),KK Cheng, Iain Chalmers, and Trevor Sheldon summarise the problemsthat bedevil reasoned discussion on whether fluoride shouldbe added to water supplies. Highly polarised disputes are fuelledby misuse of what little evidence there is, and the Departmentof Health is not innocent of this, they say. It commissioneda systematic review, to which two of the authors contributedbut then, in Cheng and colleagues' view, misrepresented thefindings in fluoride's favour.

Objective though they strive to be, my reading is that Chengand colleagues come down against fluoridation because of uncertaintyabout its safety, questions of autonomy, and because there areother ways of preventing caries. Meanwhile, at my invitationRod Griffiths tells us how, as regional director for publichealth, he took on an already fluoridated water supply and consistentlydefended it because he saw no evidence of harm and some of benefit(doi: 10.1136/bmj.39356.470694.59). Cheng and colleagues wantmore and better research on fluoride's effects. Griffiths wantsresearch into why people get so worked up about it all.

Evidence on fluoride may be lacking, but there's a growing bodyof evidence and experience on the effects (largely adverse)of direct to consumer advertising. Some of this was outlinedin the BMJ two years ago (BMJ 2005;330:5-6, doi: 10.1136/bmj.330.7481.5);more comes in a stark warning this week from New Zealand. LesToop and Dee Mangin explain that, in the absence of legislationto prevent it, direct to consumer advertising has taken hold.Having opened Pandora's box, New Zealand's government now seemsunable to close it (doi: 10.1136/bmj.39346.525764.AD).

It's obvious why industry wants direct to consumer advertising:it's particularly effective at driving up prescription of expensivenew drugs. What is not obvious is why the European Commissionhas allowed this question back on the table after its plansto relax the rules were voted out in 2002. The commission hasnow set up a new body, the Pharmaceutical Forum (http://ec.europa.eu/enterprise/phabiocom/comp_pf_en.htm),which is dominated by industry groups. Its proposal is to requireobjective rather than independent information for patients—butwho will judge objectivity?

Drug information for patients may be woefully inadequate acrossEurope. But as Nicola Magrini and Maria Font said a few weeksago (BMJ 2007;335:526, doi: 10.1136/bmj.39310.506308.AD), thisshould be a spur for improving access to unbiased information.We must not allow industry to fill the information gap withadvertising by another name.

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to Technorati Technorati What's this?

Industry funded patient information and the slippery slope to New Zealand: Les Toop and Dee Mangin
BMJ 2007 335: 694-695. [Extract] [Full Text] [PDF]