Intended for healthcare professionals


Monographs in the Drug and Therapeutics Bulletin

BMJ 1995; 310 doi: (Published 11 March 1995) Cite this as: BMJ 1995;310:663

Seem to be biased

  1. M D Vickers*
  1. Professor of anaesthetics University of Wales College of Medicine, Cardiff CF4 4XN

    EDITOR,—The Drug and Therapeutics Bulletin, published by the Consumers' Association, gives the impression that its (unsigned) monographs are unbiased and accurate. Thus when I am well informed about the topic it comes as a shock to find every appearance of bias. A recent issue includes a monograph on tramadol, which has been available in the United Kingdom since last June but in use elsewhere since 1977 and registered in 45 other countries.1 Yet the monograph says that “experience is limited.”

    What I mainly object to, however, are the weasel words in the monograph—for example, the insertion of “clinical” in the phrase “we can find no clinical evidence for the claim that it has a ‘dual’ action.” There is convincing evidence in volunteers that both naloxone and yohimbine can each only partially reverse the analgesia produced by tramadol.*RF2, 3* Is the Consumers’ Association suggesting that experimental pain and pathological pain are mediated by different pathways?

    “Tramadol possibly causes less respiratory depression…than other opioid analgesics for equivalent pain relief” is another example. This is the first time my published results (which the bulletin references) have been impugned. A similar conclusion follows from a study on mean postoperative arterial oxygen saturation (K N Bakhshin et al, Poster presentation, 7th world congress on pain, 22-27 August 1993, Paris) as well as from the two other studies.

    When a drug becomes a market leader, as tramadol is in Germany, there must be a strong presumption that both patients and practitioners find that it has worthwhile advantages and acceptable safety. The clue to the generally denigrating attitude that this publication takes to virtually every new drug is clear from the final sentence: “It is more expensive than standard opioids.” These are more weasel words. Nothing will ever be cheaper than morphine; the real question is whether the drug has sufficient advantages to justify the cost.

    Reducing prescribing costs may be a legitimate aim of the Consumers' Association. It certainly is of the Department of Health, which pays for copies of the bulletin for all clinicians. Even if this is just coincidence, doctors should regard the Drug and Therapeutics Bulletin as surrogate government propaganda and take it not with a pinch but with an emetic dose of sodium chloride—BP (the cheapest on the market).


    • * Professor Vickers has received research grants from Searle, acted as clinical expert for the initial submission of tramadol for registration, and has spoken about this drug at meetings sponsored by Searle.


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