Department of Health ends contract with drugs bulletin
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7550.1109-a (Published 11 May 2006) Cite this as: BMJ 2006;332:1109
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This decision could well have negative effects worldwide. The
delivery of safe, effective care depends on access to unbiased, reliable
drug information. In the UK, every NHS doctor receive regular issues of
the British National Formulary. But in developing countries, few health
professionals have access to such information. Instead, they have to rely
largely on drug promotional literature.
Thanks to the work of organizations such as the International Society
of Drug Bulletins, there is a chance that this situation can improve,
which means that more lives will be saved and more complications averted.
The ISDB provides technical support to a network of independent drug
bulletins worldwide, including India, Bangladesh, Pakistan, Nepal, Burkina
Faso, Eritrea, Nicaragua, and several central Asian countries. Despite the
critical nature of their remit, many of them are doubtless partially or
completely dependent on support from their own governments.
Founded in 1963, the UK Drug and Therapeutics Bulletin is widely seen
as a leading example, if not the leading example, worldwide of an
independent drug bulletin. What message is the UK Government sending to
governments of other, poorer countries by deciding to scrap its funding of
the DTB? What will be the implications for independent drug and
therapeutic bulletins in those countries? And what will be the
implications for the quality of prescribing in those countries? How many
deaths and adverse events will be caused as a result of continued lack of
access to unbiased, reliable prescribing information?
If the Department of Health had allowed public discussion of the
implications before making its decision, we might have been able to
discuss issues like the above - and many others. Decisions as important as
this should not be taken by a group of executives behind closed doors.
Competing interests:
None declared
Competing interests: No competing interests
In the February 2005 issue of DTB I learned that the cost of
oxycodone is 4 times the cost of regular long-acting morphine, without any
special advantage in terms of efficacy or tolerability. I adjusted my
practice accordingly. DTB's opinion has been confirmed in a recent meta-
analysis from the Marsden Hospital in London and Bristol University (Arch
Intern Medicine 2006 vol. 166 : 837).
I could quote many other examples like this, which leads me to ask :
If saving money is the issue, why kill one of the few practical and
respected sources of rational prescribing? The logic supporting this
choice appears to me as puzzling as extending pub hours to reduce
antisocial drinking.
Competing interests:
None declared
Competing interests: No competing interests
It is sad to see DTB funding withdrawn on one hand but it is not the
end of the world on the other.
Good non-biased information is available from other sites. We have
National Prescribing Centre (NPC) providing wonderful evidence based cost
effective information and non-biased critical appraisal of trials. We have
MeReC bulletins etc. It would have been nice to have DTB but for whatever
reasons the funding is withdrawn, dont just think it is end of the line.
We need to remember that it is better to direct away resources if
duplication is occurring. Hard choices.
Mohammed Ahmed
Bilton Medical Practice,
Bradford
Competing interests:
None declared
Competing interests: No competing interests
This action by the Department of Health is a disgrace. On the same
page that the BMJ reported this it was noted that there are believed to be
over a quarter of a million admissions to UK hospital related to adverse
drug reactions. There is no doubt from research here and in the US that a
significant proportion of these, perhaps the majority, are avoidable.
Presumably then prescribers' knowledge of drugs has room for improvement
and adding resources would seem more logical than removing one of the most
important. Naturally cost constraints are given as the reason for this
action but the cynic might wonder. Does NICE want an independent source of
information which may disagree with its conclusions? And does the
pharmaceutical industry welcome a publication which often says that
"novel" drugs are not so novel after all? If they are content with that
perhaps they could fund the continued distribution of the DTB, at least
for a time.
Competing interests:
None declared
Competing interests: No competing interests
The editors of the Drug and Therapeutics Bulletin have stated that
the journal could not continue on a subscription only basis, because
doctors and their trusts in UK do not have adequate money to subscribe
(1). While the doctors in UK find it difficult to subscribe for medical
journals with their relatively handsome salaries, it is unreasonable to
expect the doctors of the poor developing countries to subscribe for the
BMJ and other journals of the BMJ publishing Group with their paltry
salaries.
The BMJ Publishing Group generously initiated the offer of free
access to the electronic version of its 23 specialist journals to anybody
in the 50 poorest countries in the world in 2001 and extended the free
access to over 100 of the poorest countries in the world in 2002 (2).The
noble aim of these initiatives was for those in the developing world to
become equal participants in the global discourse on health and to
minimize the information gap between the developed and developing
countries. It has benefited everybody in the development of science by
increasing contributions from the developing world.
However reduced revenue from subscriptions was one of the key reasons
compelled BMJ publishing group to put some content behind access controls
in January 2005 (3). Though the authors assured that the users from the
World Bank's list of 120 low and lower middle income countries will
continue to have free access (4) we from Sri Lanka find it difficult to
access.
Now it is found that closing access to research articles would have a
negative effect on authors' perceptions of the journal and their
likeliness to submit (3). Hence we believe that the BMJ publishing group
will reconsider its earlier decision to put some content behind access
controls and allow free access at least for the users in the low income
countries.
Members of the British Medical Association also should come forward
to kindly support the doctors of poor income countries without pressing
the BMA publishing group to put around £2m a year into the BMA's reserves.
The BMJ editor has stated it as one of the reasons for why BMJ can not be
free in a reply to a letter (5).
1. Brettingham M. Department of Health ends contract with drugs
bulletin, BMJ 2006;332:1109 (13 May), doi:10.1136/bmj.332.7550.1109-a
2. Smith R, Williamson A. BMJ journals free to the developing world,
BMJ, Feb 2002; 324: 380 ; doi:10.1136/bmj.324.7334.380
3. Schroter S. Importance of free access to research articles on
decision to submit to the BMJ: a survey of authors. BMJ 2006;332:394-396
4. Delamothe T, Smith R. Paying for bmj.com, BMJ, Jul 2003; 327: 241
- 242 ; doi:10.1136/bmj.327.7409.241
5. Dobbin AE. All journals from the BMJ Publishing Group should be
free online, BMJ 2000;320:188 ( 15 January )
Competing interests:
I am the Secretary of the National CPD Centre in Sri Lanka and Assistant Secretary of the Sri Lanka Medical Association
Competing interests: No competing interests
The failure to renew the DTB subscription is undoubtedly a very short
-sighted and tragic mistake. Does the DoH want general practitioners and
specialists alike to rely on potentially biased sources of information?
At a price of £1.4m per year, this publication has done more good than any
comparable NHS expenditure.
I do hope the DoH reverses this damaging decision.
Competing interests:
None declared
Competing interests: No competing interests
The Drug and Therapeutics Bulletin is too important to disappear. If
there was a need for a drug bulletin in the 1960s, that need must be
greater now considering the greater choice of drugs available.
Health professionals are busy people and so appreciate receiving
independent assessments of new drugs. The evaluations of the Drug and
Therapeutics Bulletin are read by everyone from medical students to
clinical professors; even policy makers! The related publication
'Treatment Notes' is now providing helpful information for patients. The
Drug and Therapeutics Bulletin has also inspired other drug bulletins
around the world.
Australian Prescriber underwent a similar hiatus in the 1980s. Within
a few months it was realised that if you do not have an independent source
of information there is nothing to balance the advertising that bombards
prescribers. Australian Prescriber was quickly resurrected and is now
recognised as an important component of Australia's National Medicines
Policy.
While the central contract for the Drug and Therapeutics Bulletin may
have ended, I am sure that fundholders and those responsible for
encouraging good prescribing at the local level will continue to support
the publication. They need to act now before the editorial team is
disbanded.
This is not the end of the DTB.
Competing interests:
Editor of a drug bulletin
Competing interests: No competing interests
Let the DTB be
The decision by the DOH to discontinue the funding of an invaluable
information resource like the DTB is not just a disgrace but exposes the
fallacy of their so called drive to encourage cost-effectiveness across
the NHS by axing frontline staff (e.g. nurses and doctors) and the tools
(e.g.the DTB) required to implement same.
Would it be more cost-effective for the NHS and its health
practitioners to rely on pharmaceutical industry handout/recommendations
on their products or an independent, reliable, regular and proven source
of information which the DTB represents?
We have personally kept every copy of the DTB not only because of the
quality of its contents, reviews, clinical relevance and recommendations
but as a quality resource for an evidence-based practice in our role as
hospital specialist and general practitioner.
Only recently, the DOH extended prescriptive rights to non-medical
staff and the DTB stated that (May 2006), it is crucial that non-medical
prescribing occurs within the context of rigorous clinical governance
framework, close monitoring of safety and ongoing training and
professional development. It is ironical that the DOH has seen it wise to
remove a major source of professional development-the DTB-instead of
extending the benefit of this bulletin to our new prescribing colleagues.
The DOH rolls out 'choose and book' and 'patient choice' initiatives
without consulting with patients or their representatives. Again they have
decided to do away with a professional developng resource for health
practitioners without bothering to at least hear out their views.
We hope this is not a ploy to privatise the DTB through the back
door. Which major drug company would not want to lay their hands or
control what comes out from the DTB? We urge all health practitioners to
join forces to help reverse this decision. Today it is the DTB, it could
be the BNF (British National Formulary) tomorrow.
Competing interests:
None declared
Competing interests: No competing interests