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Worry over independent drug guide

The medical profession will be left more vulnerable to pharma's marketing activities if the DoH sticks to plans to axe the DTB

It has been described as the counter-weight to the pharma industry's heavy marketing by senior UK prescribers who have openly lamented the potential downfall of the 40-year-old Drug and Therapeutics Bulletin (DTB) publication. Traditionally circulated free of charge to practising physicians, the publication will see its funding withdrawn from the Department of Health (DoH), as part of a major cost-cutting exercise.

The DTB aims to provide independent, reliable and accessible guidance and information for doctors on the benefits, risks and usage of marketed medicines. The medical profession, which has launched a seemingly fervent campaign to deter the government from following through on its non-renewal decision for the DTB's contract, has voiced that it viewed the DTB's content as helpful and, in some quarters, even an appropriate balance to the significant marketing power of today's pharma companies.

In a statement of protest signed by more than 2,000 senior healthcare practitioners, the government is ardently encouraged to continue funding the DTB `in the best interests of patients and the NHS'. Among the signatures are those of the president of the General Medical Council, Sir Graeme Catto, chief executive officers at Asthma UK and Diabetes UK, and a professor of health economics at York University, Alan Maynard.

Furthermore, chairman of the British Medical Association's prescribing forum, Peter Fellowes, has reportedly written a letter to ministers advising them that, without the DTB, family doctors will be left 'vulnerable to the commercial pressures from cash-strapped PCTs'. He added that such circumstances would be to the detriment of patients.

Decision made
However, the DoH is resolute on its decision, based on its policy to ìlook very critically at central spendingî which, it said, ìshould be kept to an absolute minimumî. A spokesperson for the DoH told Pharmaceutical Marketing that ìthe decision not to renew the Department's contract for the central purchase and distribution of the DTB was informed by our policy to devolve as much responsibility as possibleÖ in order to maximise resources available for the NHS to manage at local levelî.

The DoH also pointed out that DTB is also a ìcommercial publicationî, and as such should not necessarily suffer a fatal demise by the withdrawal of government funding. Furthermore, in the eyes of the government, doctors have a wealth of similarly principled information sources, examples of which were listed as ìBritish National Formularies, advice and training from the National Prescribing Centre, guidance from NICE, the National Electronic Library for Health, various online databases and reference resources, such as Medline and various academic and professional journalsî.

Yet, the DTB was quick to shine light on its popularity and usefulness: ìWe've had thousands of letters from doctors saying they really value the DTB and that it is the only independent source of information on evidence-based clinical practice, which is key for GPs at the moment given that it is one of the changes in the NHS organisation in a move towards more evidence-based practice.î

A spokesperson told PM: ìOne of the arguments is that `doctors can get information from the internet, or go to things like the national formulary, but doctors don't always have the time to do that and the unique strength of DTB is its independence; it's not paid for or sponsored in any way by the pharmaceutical industry, and it also falls outside of the regulatory authorities and government.î

Short-sighted
The DTB's publishers also feel that, while the NHS might appear to be savings by withdrawing its funding, it is in actuality something of a false economy. ìIn the last issue, we did a comparison of particular cancer treatments and we showed that if prescribers followed the recommendations in that article they would actually be saving money! So we really do think it is quite short sighted of the Department of Health.î

A pilot subscription scheme, whereby a 12-month subscription to the DTB will be made available to prescribers at a discounted cost of £50, is underway.

30th September 2008

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