E-DRUG: Save DTB gradual vs unplanned change
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Dear E-drug colleagues,
Gilles Bardelay, co-founder of la revue Prescrire, has contributed this
posting for E-drug:
The recent announcement of the financial difficulties encountered by Drug
and Therapeutics Bulletin (DTB) has triggered a debate on E-drug on the best
way to fund independent bulletins ("Save the Drug Therapeutics Bulletin").
We would like to set the record straight as far as Prescrire is concerned.
1-Choosing one¹s dependency
All ISDB member bulletins aim to distribute high-quality information on
medicine in general and on drugs in particular. Independence from drug
companies is crucial in the long term, nothing can be achieved without that
condition. Each member bulletin has to make a pragmatic choice as to the
persons or organizations on which it is to depend for its financial
resources.
From the very outset, Prescrire¹s founders sought to ensure that its
flagship publication, la revue Prescrire, would depend solely on its
³clientele², namely professional caregivers. A call for subscriptions was
launched in the very first issue, published in January 1981. Yet it took
fully 12 years to achieve total financial independence, and to be in a
position to renounce the yearly government subsidy received from 1980 to
1992.
Since 1993, Prescrire has been solely and totally dependent on its paying
subscribers. This means we are no longer beholden to the authorities, and
that our status is no longer ambiguous. But it must be recognized that the
grant helped us to launch Prescrire in favourable conditions.
2- Sustainability
Prescrire is not a model but simply an experience unique to the French
context and to the long-term objectives fixed by its founders.
Regardless of how a drug bulletin is funded, what matters is the results it
achieves, namely the quality of the information it distributes, its
sustainability, and its impact on society.
Quality depends most of all on the editorial team, its determination, its
methods, and its know-how. Of course, financial resources are important, but
money alone cannot replace human commitment.
Sustainability is also crucial it takes time to make things change. The
impact of reliable, independent information is only perceptible after
several decades. This is why regular turnover of the editorial team is
necessary, along with stable long-term funding. And while governments may
change, the bulletin must continue. In that context government funding is
risky.
3-Direct and indirect impact
The impact of drug bulletins is naturally a major concern. It is one thing
to produce excellent articles, but another thing to get them distributed
and read! Even more important, the message is expected to find its target,
lead to a change in practices and, in the end run, improve people¹s health,
both individually and collectively.
One must be very careful (and modest) when attempting to measure the impact
of a drug bulletin, particularly because the effects are also indirect: on
competing media, drug companies, the lay media, patient associations,
decision makers, etc.
Thus, Prescrire takes multiple factors into account when measuring its
impact, in terms of purely surrogate endpoints:
-The number of paying subscribers to our French edition: 28,500;
-The overall subscription renewal rate: 85%;
-The number of general practitioners among our subscribers (this is our main
historical target): 13,600 (27% of a total of 50,000 GPs in France); in
fact, independent surveys suggest that la revue Prescrire is read regularly
by 35% of French GPs, taking group practices into account;
-The number of press releases: 10 to 15 per month (to a panel of 400 lay
journalists);
-The number of articles in the lay media mentioning these press releases: 20
to 30 per month;
-The impact on drug company sales tactics (Prescrire rep monitoring network,
etc.): a major impact. One in three French GPs no longer accepts visits from
sales reps; and the government has been obliged to regulate this activity
(Charter);
-The impact on the French medicines agency: a major impact, in terms of
transparency; drug safety decisions, etc.
The impact cannot be measured solely in terms of circulation figures,
especially for free bulletins.
Drug companies have a direct impact on consumers, patients and
decision-makers, and this has become a massive public health issue. What
impact can bulletins have against this background?
We must take courage, and continue to do our best, in the short, medium and
long term.
DTB must continue, but the sudden interruption in government funding is
unacceptable: several years are probably needed for a gradual change in the
nature of its income.
Gilles Bardelay
Co-founder of la revue Prescrire
Director General