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Rapid Responses: Rapid Responses published:
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Is health for all, HFA, the ultimate, dead? Rejuvenate, acknowledge and roll it back on the agenda.
- anthony lwegaba, Bridgetown, Barbados, WI (22 September 2003)
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Not so NICE on the Receiving End
- Carol A Teasdale (25 September 2003)
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A bad week for drug ads
- Jocalyn P Clark (30 September 2003)
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Time to be more up front
- Rhona MacDonald (30 September 2003)
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Re: A bad week for drug ads
- Adrian H Sie (30 October 2003)
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anthony lwegaba, lecturer in preventive medicine School of clinical medicine and research, UWI, QE Hosp, Bridgetown, Barbados, WI
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Dear Editor, I keenly read reports on large public health impact issues and further propose that: HFA through primary health care, PHC, is the supreme ambitious global health vision ever formulated. It is a universal social contact by governments and the people for health as a right. Humanity should keep it on health and social agenda. As a vision, unlike a goal or objective, it was very unfortunate that at first it was time-tagged 2000, not withstanding the need to show progress. Little since has been said about HFA, leading to unintended ignorance or for some to think it expired. The naked truth is HFA has no end, because; individuals, families, communities, countries and regions develop at different pace, not a justification for disparity. Also, aspects of HFA categorized as demands and needs, health determinants (biological, physical, socioeconomic, health system) are dynamic, recycled, ever changing such as new and re- emerging diseases, demographic and epidemiological transition. PHC charts the road to HFA through availability, accessibility, affordability, acceptability, scientific-soundness, basic care elements, community partnership and integrated social development of health services (1). In view of the above, to keep our vision at the forefront, it would be good all editors to high light and classify developments that have or are likely to have major impact internationally under among others, HFA/PHC, in all journals. Those concerned, and UN, should use the additional database linkage to monitor, report and advise nations on HFA status. There have been several HFA road signals variously reported in editorials in recent years: the Australian system of drug assessment for cost effectiveness and efficacy, and the off springs, the National Institute for Clinical Excellence, NICE, (England and Wales), the USA proposed bill HR 2356; concordance in prescribing; the World Trade Organization’s TRIPS 2003 announcement on access to drugs by poor countries; all round community response to HIV/AIDS especially in poor countries and HAART; HFA’s visits to USA capital included the Clinton unhatched health plan. (2,3,4,5). No interests declared. Anthony Lwegaba, Lecturer, SCMR-UWI, QEH, Barbados. Lwegaba@lycos.com 1. Alma-Ata 1978: Primary health care report of the international conference on primary care, WHO 1978. 2. Richard Smith. A bad week for drug companies? BMJ editorial 2003; 327. 3. Pollock A M, Price D. New deal from World Trade Organization, BMJ 2003; 327: 571-2 4. White C. Doctors fail to grasp concept of concordance. BMJ 2003; 327:642 5. Kennedy E M (Senator). (Editors Choice) Quality, Affordable Health Care for Americans. American Journal of Public Health 2003; 93:14. Competing interests: None declared |
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Carol A Teasdale, N/A HR1 1QN
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Dear Mr Smith You said, "but the National Institute for Clinical Excellence (NICE) in England and Wales looks for evidence that a treatment is appreciably better than what is already available before advocating its use in the NHS, which is most of the market in Britain." How can you believe this whilst we use synthetic thyroxin, and patients aren't informed that there is a choice of a natural version if all does not go well for them? Synthetic thyroxin was never proved to be a better product. In fact, in America, the FDA declared that it shouldn't have been introduced as a grandfathered drug in the first place. If you care to check back I don't think that you will find the evidence that it has ever been "appreciably better than what is already available" in Britain either. It may have been believed at one time that all things synthesised had a more consistent potency. However a belief is not a scientific proof and it certainly is not proof that it is better than what is already available. The potency issue is irrelevant anyway as set standards are applied to both kinds of the medication. In fact so shoddy has thyroxin research been that it hasn't even identified that patients need days of the week on the packaging. They also need different colours for the various strengths, more choice in strengths and larger tablets for the elderly. Maybe NICE should have made the manufactures explain the overwhelming rise in the cost of thyroxin, as it so obviously hasn't gone on research. Isn't demanding explanations for extortionate price rises in their remit too? Competing interests: None declared |
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Jocalyn P Clark, Editorial registrar BMJ WC1H 9JR
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When I opened this week’s BMJ (clinical research edition) it fell open at the centrefold. Drug ads have hit a new low. The ad, for the Boehringer Ingelheim manufactured Asasantin Retard, is of a middle aged woman seen through the field of view of a sniper rifle. Her brain is targeted, it seems, to reduce the risk of her having another stroke. Aiming the rifle at her head (a "head shot" to you non hired-guns) presumably assures the kill. The accompanying headline warns us to "Take Cover." Asasantin apparently works assassin-like to provide "powerful protection from secondary stroke." I find this image deeply misogynistic, violent, and a shocking departure from normal advertising practice, even of the pharmaceutical industry whose ads are often said to be sexist, racist, or both (1-4). And this ad cannot simply be dismissed as a relic of the history of art in which gender stereotypes are present (5,6). BMJ readers were unbothered by the use of an updated Delacroix painting of a bare breasted woman to sell breast cancer drugs (http://bmj.bmjjournals.com/cgi/content/full/321/7260/DC1), but I suspect they will be troubled by this contemporary image of violence toward women. A complaint to the regulators is warranted. References 1. Lusk B. Pretty and powerless: nurses in advertisements, 1930- 1950. Res Nurs Health 2000; 23:229-36. 2. Lovdahl U, Riska E. The construction of gender and mental health in Nordic psychotropic-drug advertising. Int J Health Serv 2000; 30:387-406 3. Lusk B. Patients’ images in nursing magazine advertisements. ANS Adv Nurs Sci 1999; 21:66-75 4. Lovdahl U, Riska A, Riska E. Gender display in Scandinavian and American advertising for antidepressants. Scand J Public Health 1999; 27:306-10. 5. Clark JP. Babes and boobs: Analysis of JAMA cover art. BMJ 1999; 319:1603-5. 6. O’Kelly C. Gender role stereotypes in fine art: a content analysis of art history books. Qual Soc 1983; 6:136-48. Competing interests: I am an editor at BMJ but not involved in the selection or screening of the pharmaceutical adverts that appear in the journal. |
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Rhona MacDonald, editor career focus BMJ
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I absolutely agree with Jocalyn Clark. I was shocked to see the advertisment and concerned that it was in the 27th Sept issue again. I find the ad threatening and in very poor taste, particularly after the Washington sniper and the general violent environment we live in. It would have bothered me just as much whoever was in the sniper's line of fire, not just because it is a middle aged woman. My issue is against violence in general and this ad certainly promotes that. I think that it warrants a complaint to the Advertising Standards Authority and the Code of Practice Committee. I also think since the BMJ has an open peer review system and is committed to being explicit and up front, we should start doing the same for the drug advertisments that we publish. After all, we are involved in the process to some extent. Competing interests: I am an editor at the BMJ but not involved in drug advertisments in any way |
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Adrian H Sie, Specialist Registrar in Paediatrics Wishaw General Hospital, ML2 0DP
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I agree with the other respondents that this advert is immediately and unambiguously offensive. I am also insulted that this advert was conceived of as appealing to me as a professional involved in health care. Competing interests: None declared |
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