E-DRUG: News from Australia
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Dear Colleagues,
A Quality Use of Medicines (QUM) map was recently launched in Australia.
The Map provides a graphical (mapped) interface to a Web accessible database
of Australian QUM projects. If you have a Web browser, it is accessible at:
http://www.qummap.health.gov.au/.
The aim was to:
* encourage networking of health professionals and consumer groups with
similar interests;
* reduce inefficiencies and duplication of effort;
* show where activities are concentrated and where there are deficiencies;
* assist policy planning and resource allocation.
The "official" press release can be found at:
http://www.health.gov.au/mediarel/yr1999/gt/gt99018.htm
A related Australian Prescriber Editorial (Volume 22 Number 2 1999) can be
found at:
http://www.australianprescriber.com/
Finally, there is an ongoing most interesting Web debate concerning the role
of pharmaceutical promotion in GP prescribing software archived at:
http://www-sph.health.latrobe.edu.au/telehealth/telepres.htm#Promotion
(if this long URL wraps please enter it all in your browser).
We have already had a helpful Canadian contribution from Joel Lexchin. I
invite more international contributions to this important debate.
A summary of this debate is appended for those that lack access to the Web.
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This has been a fascinating debate. It has also provided an excellent
example of the democratic power of Internet Listserv discussion forums (as
distinct to the traditional approach of asking favoured organisations
through hierarchical structures).
Let me summarise the arguments as I see them:
On the one hand we have colleagues who feel insulted and outraged at any
suggestion that their prescribing could possibly be influenced by
pharmaceutical promotion. They know it is not! They also appreciate the
benefits promotion provides, such as subsidised software, more available
medical education, etc.
On the other hand, we have the evidence based medicine brigade (EMB'ers) who
unkindly produced scientific literature that showed promotion certainly
influences some doctors, some of the time! They also point out the inherent
imbalance of information that promotion produces. They want pharmaceutical
promotion consigned to the electronic trash bin.
In the middle are the pragmatists. They accept the world as it is (rather
than what it might be). They acknowledge the arguments on both sides. They
advocate a balanced approach: perhaps advertisements AND independent drug
information; perhaps some standards as to when, where and how promotion
appears on the screen.
In addition, there seems general acknowledgment that this issue involves
more players than just GP's and the pharmaceutical industry (APMA).
Governments have an interest because they subsidise drug costs. Other health
professionals, especially pharmacists and nurses, play an important role,
both in dispensing and reinforcing medication instruction and information.
Finally, it is consumers (&/or patients) who's health we are trying to
improve; increasingly they will be viewing their electronic medical record
and discussing with their doctor the possible therapeutic options displayed
by decision support software. They also must be involved through Internet
discussion and peak groups such as the Consumers' Health Forum.
How should this debate be progressed? I propose a three-pronged approach:
First, I reiterate once again the value of the APMA posting their draft
electronic promotional code on the Internet. Why not on the APMA's excellent
Web site, which has already posted Consumer Medicines Information
(http://www.apma.com.au/headers/publications.html), linked to Web based
discussion forum inviting comment? Surely in this day and age, an electronic
Code of Pharmaceutical Promotional Conduct should be posted electronically
for electronic debate!
At the same time, let a wider range of "medication team" organisations, such
as APEC, PHARM, NPS, ASCEPT, RACP, RACGP, PSA, CHF, ACA, etc. be asked for
formal comment. The broader the canvassing of views, the less likely will be
the criy, "deals are being done".
Finally, when comments are collated and synthesised, let the Department of
Health and Aged Care call a broadly based meeting of stakeholders to agree
upon and ratify the final Code.
Cheers,
Dr. Ken Harvey, Senior Lecturer, School of Public Health,
La Trobe University, Bundoora, 3083, Australia,
Telephone +61 3 9479 1750, Facsimile +61 3 9479 1783, Internet:
http://www-sph.health.latrobe.edu.au/kharvey/
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