Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
DTB or not DTB?
- John S Dowden (12 May 2006)
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Value for money
- Trevor Watts (12 May 2006)
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BMJ Publishing Group should allow free access for the poor developing countries
- Murali Vallipuranathan (13 May 2006)
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Cost-cutting, or worse?
- Michael Schachter (14 May 2006)
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DTB
- Mohammed Ahmed (15 May 2006)
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Save the D&TB
- Roger E. Stephenson, Peter J. Selley (15 May 2006)
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Choices.
- Piero Baglioni (16 May 2006)
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MoH's decision will have negative impact on health care in developing countries
- Neil M Pakenham-Walsh (19 May 2006)
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Let the DTB be
- Nosa Akporehwe, Kerstin A. Akporehwe (30 May 2006)
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John S Dowden, Medical Editor, Australian Prescriber Australia
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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 |
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Trevor Watts, Senior Lecturer and Honorary Consultant in Periodontology Department of Periodontology, KCL Dental Institute, Guy's Hospital, SE1 9RT
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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 |
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Murali Vallipuranathan, Senior Registrar (Community Medicine) Ministry of Health Care, 385, Deans Road, Colombo-10, Sri Lanka
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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 |
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Michael Schachter, Senior Lecturer in Clinical Pharmacology St Mary's Hospital London W2 1NY
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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 |
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Mohammed Ahmed, Practitioner BD8 8JT
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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
Competing interests: None declared |
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Roger E. Stephenson, GP principal Bow, Devon EX17 6EY, Peter J. Selley
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As ordinary GPs we also share your respondents' concern about the withdrawal of D&TB. It has been so central to our day-to-day prescribing decisions that our partnership agreement specifies reference to it as one of the few remaining authoritative guides. We would urge all doctors who are going to suffer to complain, as the D&TB requests, to: Rt Hon Patricia Hewitt MP, Secretary of State for Health, Dept of Health, Richmond House, 79 Whitehall, LONDON SW1A 2NS or email: dhmail@doh.gsi.gov.uk and copy to: dtbengland@which.co.uk. There will now be no alternative to NICE's monopoly. Competing interests: None declared |
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Piero Baglioni, Consultant Physician Prince Charles Hospital CF47 9DT
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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 |
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Neil M Pakenham-Walsh, Coordinator, Global Healthcare Information Network 16 Woodfield Drive, Charlbury, Oxon OX7 3SE
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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 |
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Nosa Akporehwe, Locum Consultant ,Neurological Rehabilitation Specialist Regional Neurological Rehabilitation Centre, Hunters Moor Hospital, Newcastle NE2 4NR, Kerstin A. Akporehwe
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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 |
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