E-drug: Re: HOT: can we turn WHO around? (cont'd)
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In March Ciprian Jauca invited E-druggers to sign an electronic letter
concerning the new guidelines for the management of hypertension.
More than 800 physicians worldwide signed.
Here is the reply from the Director-General, Dr Brundtland:
(can be found on http://www.uib.no/isf/letter/reply.htm)
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Director-General Dr Brundtland's reply to the letter about the 1999 WHO/ISH
Guidelines for the Management of Hypertension
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WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE
Dear Dr Sandvik,
4 May 1999
1999 World Health Organization-International Society of Hypertension Guidelines
for the Management of Hypertension
Thank you for your letter dated 16 March 1999 concerning the 1999 Guidelines
for
the Management of Hypertension. I have also seen other correspondence on this
subject on the Internet. The concerns expressed in your letter about the
"goals of treatment" and the debate these guidelines have generated are
appreciated.
The recommendations contained in the 1999 Guidelines were prepared by a
WHO/ISH Working Group in 1997 and 1998. They were developed by eminent
international experts using the latest information from epidemiological
studies and randomised controlled trials. The guidelines emphasize that a
decision to lower elevated blood pressure in a particular individual is not
based on the level of blood pressure alone, but on assessment of the total
cardiovascular risk.
Needless to say, cost-effectiveness, availability, accessibility, and
affordability of drugs, which were not addressed in the guidelines, need to
be taken into consideration when countries develop their own policies. In
this respect, the new guidelines may be used to provide the basis for such
policies and should be modified to suit local circumstances influencing the
management of hypertension in a given country.
I should also like to indicate at this stage that the newly-established
Noncommunicable Disease Cluster is currently developing new principles and
methodologies for the elaboration of future guidelines. These principles will
address, in addition to a strong emphasis on the evidence base of
recommendations, consideration of cost-effectiveness and other factors
related to the public health impact of the guidelines. Therefore, the
current WHO/ISH
recommendations will be subject to broad review which WHO will conduct in close
consultation and coordination with the International Society of Hypertension
in line with the new methodologies for guideline development.
As to the concerns you express about the role of the private industry and its
potential influence, there should be no conflict of interest in our
partnership with private industry. This subject will be closely monitored by
the Committee on Private Sector collaboration which I established in recent
months.
Yours sincerely,
Gro Harlem Brundtland, MD, MPH
Director-General
Hogne.Sandvik@isf.uib.no
(Hogne is the moderator of a Norwegian network for GPs, Eyr, and initiated
this action. The letter is posted on his website, see above)
Kirsten Myhr, MScPharm, MPH
myhr@online.no
E-drug moderator
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