Intended for healthcare professionals

Rapid response to:


No more free lunches

BMJ 2003; 326 doi: (Published 29 May 2003) Cite this as: BMJ 2003;326:1155

Rapid Response:

Independent evidence-based information to promote rational pharmacotherapy.

Thank you for your theme issue (1) on potential unhealthy alliances
between prescribers and the pharmaceutical industry.

Providing independent drug information using scientific principles
may counteract detrimental results of such alliances. This is one of the
purposes behind the establishment of Institute for Rational
Pharmacotherapy (IRF) in 1999 as a department under the Danish Medicines

Our definition of rational pharmacotherapy signifies the treatment
that has:

- The largest effect

- The least serious adverse effects

- The fewest number of adverse effects

- The lowest possible expenses

IRF publishes a monthly medical journal (in Danish) and arranges
postgraduate training for G.P.s in relevant pharmacotherapeutic areas
(i.e. antibiotics, type II diabetes, psychopharmacology, cardiovascular
pharmacology, and rational treatment of obstructive lung diseases,
gynaecological endocrinology and analgesics). In addition, IRF arranges
public meetings on rational pharmacotherapy. In 2002, the title of this
meeting was "Perspectives and Achievements with Rational
Pharmacotherapy"; a conference organised under the Danish presidency of
the European Union.

On the Internet (2) IRF publishes reviews that critically evaluate
newly authorised medicinal products relevant to a large population. These
reviews are given in both Danish and English. IRF also prepares
pharmacotherapeutic guidelines for selected areas in co-operation with
scientific societies. Examples are guidelines for the treatment of
obstructive lung disease, for the use of TNF-alpha inhibitors in rheumatic
diseases and for the prevention of malaria. Moreover, IRF provides survey
statistics on the consumption of selected medicinal products in Denmark,
sponsors independent research and participates actively in the discussion
on rational pharmacotherapy in highly ranked international, peer-reviewed
media (3,4).

Based on suggestion by IRF, governmental medical representatives are
appointed locally in each county. These employees, who are typically
pharmacists or part-time G.P.s, monitors the use of drugs in Denmark and
advises G.P.s on their specific pattern in order to optimise
prescription patterns. It is also possible for the G.P.s to study their
personal prescription-pattern in relation to the use in the county as a
whole and in Denmark (5).

Thus, IRF aims to improve rational prescribing. Institutes such as
IRF and NICE may not only reduce the possible deleterious influence of
industry-driven marketing activities upon prescription, but can also be an
asset to the drug companies with the best products. We welcome a debate on
the possibility to initiate comparable initiatives in other countries.


1. Time to untangle doctors from drug companies. BMJ 2003; 326: 1155-1222


3. Thirstrup S, Kampmann JP. Adjustment of Europe��s drug regulation
to public-health needs. Lancet 2001; 358: 1734.

4. Bjarnason NH, Kampmann JP. Selection bias introduced by the
informed consent process. Lancet 2003; 361: 1990.


Competing interests: �
None declared

Competing interests: No competing interests

27 June 2003
Nina H. Bjarnason
Senior Medical Officer
and Jens P. Kampmann
Institute for Rational Pharmacotherapy, Danish Medicines Agency, DK-2300 S