* Bruce Hugman is Managing Director, EQUUS Communications, London, UK.
THE difficulty of balancing benefit and risk in drug therapy, drug scares, patient non adherence to treatment, anxiety and uncertainty about the risks of drugs, and secrecy and suspicion in pharmaceutical matters, were among the pressing concerns which gave rise to an international conference on Effective Communications in Pharmacovigilance, held in Erice, Sicily, in September 1997.
Over 70 professionals from 30 countries, representing patients, doctors, nurses, pharmacists, pharmaceutical companies, lawyers, academics, regulators, journalists and communications experts put their collective brain power to the question of how drug safety information could be better communicated between all interested parties in the ultimate interest of patient welfare.
Quality of care starts with communication
It was acknowledged that even the best scientists and clinicians may lack the specialised skills of effective modern communications, and that insufficient time and priority had been given to discussion and training in this area. Much more attention needed to be paid not only to the content of communications, but also to their form, production quality and the media chosen for their dissemination.
The danger of secrecy
The climate or context in which communication takes place was also seen as a critical variable: in a climate of secrecy, suspicion and uncertainty would flourish, and leaks of information and media scares would be all the more likely. These, in their turn, would lead to an undermining of public confidence in medicine, in the judgement of doctors, and in the integrity of clinicians and pharmaceutical companies in general.
Participants from developed and developing countries alike agreed that a climate of openness and trust, particularly in relation to the activities of regulators and pharmaceutical companies, was an essential prerequisite to a better understanding of benefit-risk issues and to increasingly rational therapy. Accessibility of information was a core requirement. Practitioners needed to be encouraged to see feedback of information from practice, especially adverse drug reactions, as a major professional responsibility.
The value of partnership
The concept of partnership was seen as the ideal to be pursued in the whole area: partnership especially between clinician and patient (the notion of informed choice by patients was seen as a high priority); between professionals and the media (so often at apparent variance with each other); and between professionals in this field with professionals in other areas where significant influence can be exercised (with teachers and schools, for example, where children’s attitudes and knowledge are established).
Conflicts between public health priorities and the needs of individual patients were noted among the dilemmas to be faced. This was one of the many aspects, which could be resolved only by multidisciplinary partnership in which the varying objectives and wishes of all the players were negotiated as between equals. Patients and consumers, especially, need a stronger voice in determining not only the risks acceptable to them individually, but also to society as a whole. For this, more and much better communication was essential.
The conference produced a declaration of principles, the Erice Declaration, which is available on the Internet1 and from the Uppsala Monitoring Centre (see address below). A full report of the conference proceedings is currently in preparation.
The work of the conference will form the basis of a working group of the Council of International Organizations of Medical Science (CIOMS) which will publish its findings and recommendations in late 1998. The work will be continued in a series of CIOMS meetings, leading to guidelines for good practice in 1998.
For further information contact: The Uppsala Monitoring Centre, Collaborating Centre for International Drug Monitoring, Stora Torget 3, S-753 20 Uppsala, Sweden. Tel: + 46 18 656060, fax: + 46 18 656080, e-mail: email@example.com