Starting or Strengthening a Drug Bulletin - A Practical Manual
(2005; 165 pages) View the PDF document
Table of Contents
View the documentPreface
View the documentHow the manual was produced
View the documentAbout ISDB
View the documentExecutive summary
Open this folder and view contents1. Introduction
Close this folder2. Rational use of medicines
View the document2.1 The relationship between evidence and rational use
View the document2.2 Other influences on the choice of medicines
View the document2.3 Sources of information for prescribers
View the document2.4 The special role of drug bulletins
View the document2.5 Specific ways in which bulletins can help
View the document2.6 Bulletins as part of wider initiatives for promoting rational use of medicines
View the document2.7 Summary
Open this folder and view contents3. What are drug bulletins?
Open this folder and view contents4. Defining aims, target and type of bulletin
Open this folder and view contents5. Planning resources
Open this folder and view contents6. Planning bulletin production: schedules and timing
Open this folder and view contents7. The editorial process
Open this folder and view contents8. Reviewing a new drug: is it a therapeutic advance?
Open this folder and view contentsAnnexe to Chapter 8: Evaluating harm
Open this folder and view contents9. Design and production
Open this folder and view contents10. Dissemination
Open this folder and view contents11. Organizational and legal issues
Open this folder and view contents12. Evaluating quality and usefulness
Open this folder and view contents13. Partnership and collaboration
Open this folder and view contents14. Keeping records and creating a memory
Open this folder and view contentsAppendix: Electronic sources of information
 

2.3 Sources of information for prescribers

Prescribers have many sources of information to help them prescribe rationally. Although useful, they all have limitations (Box 2.1).

Box 2.1 Different types of sources of information for prescribers

Source

Limitations

Textbooks

Take years to produce and are therefore liable to be out of date.

Medical journals

Difficult to get an overall view of the treatment options and a variable degree of influence on the content from biased sources.

Local or national formularies

Formularies vary in quality between different countries. They show the range of drugs that can be used for a practical purpose. Some explain how to make good choices from this range, but rarely have space for much background or comparative information.

Guidelines

Conclusions depend on the terms of reference of the organization producing the guidelines (see text below).

Official prescribing information prepared by drug companies and approved by regulatory authorities (e.g. data sheet, summary of product characteristics)

These are legal documents which vary a lot between countries and are much influenced by the power or the weaknesses of the national regulatory authority in regulating commercial promotion adequately. The information is often hard to use, partly because companies and regulatory agencies regard the documents as a protection against liability claims.

Promotional information

Primarily advocates the use and sale of a drug.

The conclusions in most of the traditional resource materials will have some bias that may well distort the message. Early trials of new medicines are designed and reported almost exclusively by drug companies and the conclusions published are likely to favour the company’s product. Furthermore journals tend to prefer to publish papers with 'positive' results, a tendency that again favours the pharmaceutical industry. The advice given by secondary reviewing bodies, such as the UK's National Institute for Clinical Excellence (NICE), or the Cochrane Collaboration, depends on the terms of reference of the reviewing group. For example, NICE deals with efficacy and cost and essentially ignores safety; reviews by the Cochrane Collaboration tend to deal with efficacy and so far pay much less attention to safety or cost. The documents produced by national regulatory agencies and by the European Medicines Agency (EMEA) consider efficacy and safety but not a product’s cost, relative efficacy (“added therapeutic value”) or ease of use.

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