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Tuesday, June 13, 2006

Doctors fight to save DTB drug guidance from government axe

A highly respected and influential journal which gives doctors independent advice on the drugs they prescribe is set to close because the government is withdrawing its funding after 40 years. The Drug and Therapeutics Bulletin is sent to every doctor in the country and offers what many describe as highly readable guidance on the value of sometimes heavily marketed pills. But the Department of Health has refused to renew its contract.

Senior doctors have signed a statement of protest, and more than 2,000 have written to ministers, including Patricia Hewitt, the health secretary.

DTB is "highly valued and trusted" to give independent and reliable information about drugs, the statement says. Its conclusions "are also widely regarded as a unique counterweight to the influence of the pharmaceutical industry".

The statement urges the government to continue with its bulk subscription for doctors "in the best interests of patients and the NHS". It is signed by, among others, Sir Graeme Catto, the president of the General Medical Council, Alan Maynard, professor of health economics at the University of York, and the chief executives of two large patient charities, Asthma UK and Diabetes UK.

Peter Fellowes, the chairman of the British Medical Association's prescribing forum, says in a letter to the government that the demise of the DTB "will leave GPs more vulnerable to the commercial pressures of the pharmaceutical industry and counter pressures from cash-strapped PCTs [primary care trusts] and that will undoubtedly be to the detriment of our patients".

The DTB, owned by Which?, sees drug prescribing as a consumer issue and has not always been comfortable reading for the government. The availability of some expensive new medicines, particularly for cancer, has become a hot political issue.

The government set up NICE, the National Institute for Clinical Excellence, to weigh up the evidence and rule on whether drugs work and are value for money in the NHS. Nice has become a battlefield where pharmaceutical companies, patient groups, doctors and scientists fight for their own interests. Some doctors say they find the DTB's advice more helpful.

It costs £1.4m a year to send DTB to 120,000 doctors and to make it available online to all health professionals. The Labour peer, Lord Toby Harris, says this is a small saving for the Department of Health "whereas the pharmaceutical industry spends £1.65bn on marketing in the UK, including 8,000 reps to see GPs, and we all know about the provision of freebies and hospitality".

A Department of Health spokeswoman said the cost was not justified, "in the light of other resources".

Ike Iheanacho, the DTB's editor, said the department's reasons for ending the contract were about saving money yet the DTB regularly recommended doctors to use more cost-effective medicines.

http://www.guardian.co.uk/medicine/story/0,,1796246,00.html

The closure of the trusted Drug and Therapeutics Bulletin is another sorry example of the Labour government's short term NHS cost cuts. In comparison to the annual £1.4 m cost of the DTB, the NHS's drugs bill is around £11 billion a year.

Even a cursory cost benefit analysis indicates that a 0.1% saving on the drugs bill will pay for the preservation of the DBT eight times over.

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