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LETTERS: Joseph Kwan Hospital formularies restrict evidence based practice BMJ 2005; 331: 515-b [Full text]

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Hospital Formularies

Anne Holmes   (6 September 2005)

Drug approvals

Jayaprakash Ayillath Gosalakkal   (7 September 2005)

Hospital Formularies 6 September 2005
Anne Holmes, general practitioner Tithebarn Medical Centre, Stockton-on-Tees, TS19 8RH Send response to journal: Re: Hospital Formularies	Whilst Kwan (1) is frustrated by hospital formularies, some of prefer to take a more global view of cost effectiveness and formularies support this. There is only a finite pot for health care and whilst the new drug x may show additional benefit, it may not be enough to justify cutting another service to pay for it. Some hospital doctors attempt to bypass the formulary by asking GPs to prescribe the non formulary item. In my experience it is rare to be given any evidence to support this request so I am left wondering whether this recommendation is a whim or as a result of a recent drug representative visit. On some of the occasions when I have been given the evidence (rare enough for me to go and review the papers) I have found that our interpretation of the evidence doesn't match. So, if evidence based medicine is to thrive, please let us use its name judiciously. (1) Kwan, J. Hospital formularies restrict evidence based practice. BMJ 2005;331:515(3 September) Competing interests: None declared
Drug approvals 7 September 2005
Jayaprakash Ayillath Gosalakkal, Consultant Paediatric neurology University Hospitals of Leicester Send response to journal: Re: Drug approvals	I agree with Dr Kwang that drug approvals are often based on budgets and other considerations.We are often asked to name the drug that the new drug would be replacing.In some situations like antiepleptic drugs the new drug would be an addition in refractory cases.First class evidence does point sometimes to serial monotherapy and a cafeteria approach.We find it difficult to convey such subtelities.I would plead for national committess to oversee such specialized areas including representatives from organizations like the BPNA.This would avoid often acrimonious turf wars to get drugs approved in which smaller specialities often loose out.I also find it odd that some drugs are stocked in all local pharmacies but not in the university hospitals.There is also great difficulties in getting even drugs with first class evidence approved for rare diseases. Competing interests: Consultant in an obscure speciality struggling to get drugs approved