The type of article produced by a bulletin will vary greatly according to circumstances, the medical and social context in which the bulletin is operating, therapeutic areas addressed, and national or local drug policy. The aim of an article may be to:
• produce a critical review of what has already been published about a therapeutic question;
• inform readers about recent events, such as an alert on a new drug side effect or a regulatory decision;
• publish results of original research, such as a local drug utilisation survey or comparisons of drug prices;
• express an opinion or campaign on a specific health problem, usually in an editorial, or a letter to the editor and its response;
• be locally relevant, by quoting local practices, brand names, regulations etc.
Because the type of article varies, the methods used to search for documentation will also vary. However, the four basic criteria outlined at the beginning of this chapter remain central: the article should be reliable, transparent, adapted to local needs and easy to use.
The selection of topics depends on the bulletin’s main target audience, on the availability of other information sources, on the availability of potential competent editors and on public health priorities.
Articles that identify essential medicines or other essential therapies may be especially important if there is no good quality national formulary or guide to appropriate drug therapy, or if the basic essential drugs concept has been forgotten, as in some industrialised countries. As an example, la revue Prescrire of France referred to the methods used in developing countries to prevent diarrhoea because they have been almost forgotten in France. (Prévenir la diarrhée chez les jeunes enfants. Tenir compte de l'expérience des pays pauvres. Rev Prescr 1997;18:527-9). (Preventing diarrhoea in young children. Draw on the experience of poor countries).
In the face of excessive drug promotion, a key task may be to identify non-essential drugs. Bulletins often provide comparative information on new drugs and therapies to help readers to distinguish between real therapeutic innovations and new drugs that provide no real treatment advantage (see Chapter 8 for more detail on this). Some ISDB bulletins consider all (or nearly all) new therapeutic entities and publish a critical analysis (e.g. Dialogo sui Farmaci, Italy; Information sui Farmaci, Italy; Pharmaca, Croatia; Pharma Kritik, Switzerland; Geneesmiddelenbulletin, Netherlands; la revue Prescrire, France). Others select drugs that they consider innovative or controversial (e.g. Drug and Therapeutics Bulletin, UK; Boletín Terapéutico Andaluz, Spain; Pharmainformation, Austria).
As mentioned above, many countries have no pharmacovigilance system in place or have a system that does not produce enough information. In this case a major role of the bulletin is to warn readers of adverse drug reactions. See Box 7.1 for examples of actions by drug bulletins.
Box 7.1 Examples of actions by bulletins on pharmacovigilance
• In 1998, the drug bulletin of Burkina Faso, La Lettre du Cedim, developed the concept of pharmacovigilance in its country and called for reporting of adverse reactions.3
• The German bulletin arznei-telegramm is an example of a drug bulletin that has encouraged reporting of side effects by its own readers, developed an important database, and which publishes alerts or raises questions when needed.
• Some bulletins publish a regular section on drug side effects (e.g. Dialogo sui Farmaci, Italy; Pharmaca, Croatia; la revue Prescrire, France); a few have created a sister bulletin focused only on pharmacovigilance, like Alerta created by the Boletín Terapéutico Andaluz of Spain.
Sometimes specific topics may be especially relevant locally because reliable information is not available. For example, the former Datis Bulletin of Zimbabwe published original articles on intoxications with local plants, mushrooms or pesticides; La Lettre du Cedim, Burkina Faso, has published articles on snake bites; the Indian bulletin BODHI has published critical reviews on Indian traditional medicines; and the French bulletin la revue Prescrire has published critical articles and a book on homeopathic drugs.
Some bulletins also include a specific section on drug regulation to highlight relevant or irrelevant regulatory decisions and matters of regulatory policy. For example, Drug and Therapeutics Bulletin’s articles on how drugs get to the market (Drug and Therapeutics Bulletin 1990;28:101-4) or on the European licensing system (European Medicines Agency and the new licensing arrangements. Drug and Therapeutics Bulletin 1994;32:89-90), or the work of la revue Prescrire (http://www.prescrire.org) together with the Medicines in Europe Forum on the new European legislative framework for medicines (2004) are good examples of articles explaining regulations. Ideas for article topics can be prompted by warnings from regulatory agencies (such as “Dear Doctor” letters), or the published recommendations of institutions such as the UK National Institute for Clinical Excellence and WHO.
The choice of topics also depends on the evolution of international knowledge about medical treatments and therapeutic strategies. It is useful to screen international information sources, such as the latest editions of textbooks, the web sites of evaluation agencies in health care, the Cochrane Library, and messages on electronic forums (such as E-drug), to find areas where new, relevant consensuses or guidelines have emerged as a result of new research evidence. The appendix at the end of the manual provides a list of useful web sites and information sources.
You can also use local epidemiological data to set priorities for topics for articles. What are the most common or the most serious diseases? Collaboration with editors of epidemiological reports, centres for tropical diseases and international organizations can be helpful.
No matter what country you are in, you are likely to find it necessary to publish articles denouncing misleading promotional campaigns or warning health professionals and patients about therapeutic or pharmacoeconomic problems (e.g. the articles on prices and therapeutic value of drugs in Worst Pills, Best Pills Newsletter (USA) (.Cutting your drug bill while reducing your risk of avoidable adverse drug reactions: six examples. Worst Pills, Best Pills Newsletter February 2005) or Butletti Groc (Spain),.Gasto en medicamentos e innovación terapéutica. (Cost in medicine and therapeutic innovation). Butlleti Groc 2004;17 (4-5): 3-18 (in Catalan; French version available at la revue Prescrire), or the special issue of la revue Prescrire (France) on drug prices. Prescrire Rédaction, Prix des médicaments: la folle envolée. (Medicine prices: shooting out of control. Rev Prescrire 2004; 24 (256 - Supplément):881-45). Bulletin articles may also be a means to disclose important information on drug safety, efficacy or policy that has not been published. For examples, see the articles of BODHI (India) on Essentiale, The Network’s Drug Bulletin (Pakistan) on chlormezanone or fluoxetine, and of Pharmaca (Croatia) on drug donations.
As resources are generally scarce and the supply of authors is limited, you may want to avoid some topics even if they seem interesting, for example, because:
• good quality information sources on these topics are already available locally, in which case it is better to refer to these;
• the diseases concerned are both rare and minor;
• little evidence is available; except if risky irrational therapies are being used, or the aim of an article is to highlight the lack of evidence and call for review of licensing decisions.
Do not hesitate to write articles again and again about key issues. This serves both as a reminder and to inform new readers.