Hospital formularies restrict evidence based practice
BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7515.515-b (Published 01 September 2005) Cite this as: BMJ 2005;331:515
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
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
Competing interests: No competing interests
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
Competing interests: No competing interests