E-DRUG: Why the DoH is dumping the Drug Ther Bull
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[Link to the report Charles mentions below:
www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf. Pls repair link. Moderator]
Patients and consumers of medicines, as well as health professionals,
should be up in arms about the Department of Healths decision to stop
funding The Drug & Therapeutics Bulletin (DTB). For many years, the DoH
has paid to have the Bulletin distributed to all prescribing doctors in
the UK. Now - within weeks of extending almost unfettered drug
prescribing powers to nurses and pharmacists - the Department has
suddenly pulled the plug on the DTB by withdrawing this lifeline grant.
One can just about imagine a scenario in which the Departmental impulse
to prudence and cost cutting seemed to drive the decision to break the
DTB, but it still seems extraordinary that no-one had the imagination to
put the brakes on. That includes the Secretary of State, though she may
well have been deprived of vital information and appropriate advice
about the political sensitivity of the decision made in her name.
The DTB is not simply a drug bulletin a source of sensible
independent, evidence-based advice about how useful medicines seem to
be, and how (or why not) to prescribe them. The DTB is also an
institution whose contribution to the development of ethical, rational
and economic drug prescribing in the UK dates back to 1964 - the year of
the Declaration of Helsinki, which first gave people rights above those
of experimental animals. Now the consumer movement is under assault, in
danger of losing its strongest voice in this field.
The loss in prospect involves far more than some lack of independent
advice for drug prescribers. The Department of Health can fairly argue
that there are now other good sources of drug information e.g. the
British National Formulary, the National Prescribing Centre and the
National Electronic Library for Health but that largely misses the
point. What the Drug & Therapeutics Bulletin has consistently done and
is uniquely placed to do - is to represent the interests of medicines
users in the development of a national drug policy that serves the
health needs of users above all.
Directly and indirectly, the DTB has played a major part as a
representative and consultative organisation on just about every issue
to do with effective medicines control. Consider, for example, the
contribution of the DTB and friends (Collier, Herxheimer, Ihenacho et
al) to the recent House of Commons Health Committee report on The
Influence of the Pharmaceutical Industry. Many of the Committees main
recommendations reflect deep consumer concerns and give overwhelming
evidence of the need to maintain and build a strong consumer presence in
this field. For example:
"During this long inquiry we became aware of serious weaknesses in the
MHRA. Worryingly, in both its written and oral evidence the Agency
seemed oblivious to the critical views of outsiders and unable to accept
that it had any obvious shortcomings, except those that could be
remedied by more transparency. The Agencys attitude to its public
health responsibilities suggested some complacency and a lack of
requisite competency, reducing our confidence in its ability to
undertake the reforms needed to earn and deserve public trust. Nor did
we conclude that the MHRA provides the discipline and leadership that
this powerful industry needs. We recommend that there be an independent
review of the MHRA
" (paragraph 376)
And this brings us to the point: far from being a (stunningly
short-sighted) cost-cutting exercise, this decision to cut loose the DTB
seems a thoroughly punitive act. It is both a punishment and an attempt
by the Department to secure a quieter future for itself probably also
to curry favour with the commercial sector for whom the Bulletin has
also proved a thorn in the side.
This is a deeply worrying development, evidence of the risk that the
weakness and complacency that marks the performance of the MHRA is also
a hallmark of its sponsoring department, the DoH. How very prescient of
that parliamentary Committee to have identified the basic need to pursue
health priorities and trade imperatives as ring-fenced concerns. The
Committee final recommendation was this:
"We recommend that responsibility for representing the interests of the
pharmaceutical industry should move into the remit of the Department of
Trade and Industry to enable the Department of Health to concentrate
solely on medicines regulation and the promotion of health". (Paragraph
392)
Quite apart from all this, it also seems to me that the Secretary of
State is backing a real loser. The backlash has barely begun, and will
surely soon surface in Parliament. I expect to return to this issue
before too long.
Charles Medawar
Social Audit Ltd
PO Box 111
London NW1 8XG
+44 (0)20 7586 7771
charles@socialaudit.org.uk
Declaration of interest: CM was a member of the DTB editorial board in
the early 1990s. He was also engaged as one of four specialist advisers
to the House of Commons Health Committee, on its recent enquiry into
"The Influence of the Pharmaceutical Industry".