Re: Pathways to independence: towards producing and using trustworthy evidence
Independent information does exist, but deserves more attention and visibility
Moynihan and colleagues are investigating pathways for the production and the use of trustworthy evidence free from financial conflicts of interest in medical research, education and practice. It appears worthwhile to point out that independent sources of information do exist, and many are members of the International Society of Drug Bulletins (1-2).
La revue Prescrire is one of these independent drug bulletins. Since 1981, it has been living proof that the provision of independent, trustworthy information and continuing education free from commercial ties is feasible (3). Prescrire has made the choice of independence from drug and device companies, as well as from government, a cornerstone of its editorial and business model. Prescrire is a non-profit organisation that is wholly financed by subscriptions and receives no revenue from advertising or grants. The principle of independence is anchored in Article 1 of the organisation’s bylaws: "To work, in all independence, in favour of quality healthcare, first and foremost in the interest of patients (...)." Prescrire’s texts are produced by members of the in-house editorial team, all of whom are free from conflicts of interest (4).
Editorial choices are guided solely by the content’s usefulness to healthcare professionals in daily contact with patients. Prescrire publishes independent, comparative, systematic reviews of new products (including their packaging), e.g. new active substances, new indications and new pharmaceutical forms. It closely monitors adverse drug effects, medication errors, market withdrawals and product shortages. It also provides information on therapeutic strategies and on the regulatory environment for health products, particularly at the EU level. It addresses corporate capture and conflicts of interest at all levels of the health sector, including in peer-reviewed journals.
For its reviews of new medicines and indications, Prescrire has put in place a unique system that rates the therapeutic advantage of a new drug or a new clinical use (5). This system identifies products representing true advances or those which are no better than existing treatments. It provides clear warnings about the products which should never have been authorised, due to uncertainty over their harms or benefits, or because they are clearly dangerous. The rating system considers not only the inherent value of each product in terms of its harm-benefit balance, but also its advantages and disadvantages relative to the best therapeutic options available in Europe. The system is built upon 7 ratings ranging from “Bravo” (major therapeutic advance) to “Not acceptable”. In 2019, 11 of the 108 (10%) new drugs analysed in Prescrire constituted a notable therapeutic advance, 61 (56%) were rated “Nothing new”, 14 (13%) were deemed “Not acceptable” and 9 (8%) got a “Judgement reserved” (6). In addition, the packaging of 173 drugs was examined, and in 34 cases was judged dangerous (7).
Independent information on drugs and therapeutic strategies free from commercial ties does exist. Greater attention and visibility for these sources of information would produce a positive impact on patient safety, independent medical education and patient-centred care.
6. Prescrire Rédaction « L’année 2019 du médicament, en bref » Rev Prescrire 2020 ;40(436) :146-147
7. Prescrire Rédaction « Le Palmarès 2019 du conditionnement » Rev Prescrire 2020 ;40(436) :86-87 & https://www.prescrire.org/fr/3/31/58307/0/NewsDetails.aspx
Competing interests: No competing interests