From info-desert to info-demic: the role of independent drug bulletins
In the late 1950s and early 1960s independent drug bulletins first began to be published. At that time, laws on the licensing of medicines had yet to be introduced, there was little effective control of marketing and promotion of medicines, and summaries of product characteristics for prescribers and information leaflets on medicines for patients did not exist.1,2 Crucially, there was little recognition of the importance of scientific evidence to clinical practice and few publications provided clinicians with independent evaluations on the use of medicines.
The birth of independent drug bulletins
The first independent drug bulletin, The Medical Letter on Drugs and Therapeutics, was introduced in the USA in 1959.2 In 1962, the UK Drug and Therapeutics Bulletin was launched “to provide clinicians with clear, reliable, usable, impartial and independent information to help ensure patients [got] the best deal”.1 Both publications stressed the importance of improving the health of patients and were born out of organisations that had been developed to support consumers (Consumers’ Union in the USA and Consumers’ Association in the UK). Over the years many more independent drug bulletins have been established across the world.3
International collaboration
It has been noted that “access to unbiased information (or the lack of it) can be the difference between a good and a short-sighted national medicine policy”.3 In the 1980s, the World Health Organization (WHO) Regional Office for Europe, together with several drug bulletins, helped to launch the International Society of Drug Bulletins (ISDB). This was a worldwide network of independent bulletins that promoted rational prescribing.4,5 ISDB’s aims include assisting in the development, support and promotion of independent drug bulletins, as well as helping them to achieve the highest professional standards.3 To this end, WHO and ISDB published a practical manual to help drug bulletins produce high-quality information in an impartial, objective and accessible way.5
As editors of drug bulletins, we recognise that independence is a fundamental basis for providing evidence-informed, practical information to help practitioners make rational decisions about medicines.5 The main requirements for ISDB membership are editorial and financial independence. Also, bulletins must not carry any advertising relating to therapeutic or diagnostic activities. In 2016, ISDB introduced a further requirement that members of the editorial team of an ISDB-member bulletin and authors of articles that could influence therapeutic choices must be free from any conflict of interest with the pharmaceutical industry or related healthcare products industry.4 Not all medical journals routinely publish conflict of interest statements for their articles, and not all medical journals have policies for disclosure of conflicts of interest from their staff and editorial boards.6 Along with our ISDB colleagues, we believe that it is important that readers know that our content is independent of commercial and other biases.
A need for independent information
We believe it is critically important that those involved in prescribing new medicines have access to information about medicines that is independent and as objective as possible.7 Prescribers need help to make sense of the evidence on the harms and benefits of new medicines so that they can provide balanced advice to patients as part of a shared decision-making process. In the early days of drug bulletins there was too little evidence-based information on medicines. Since then, the increase in the volume of published information has become overwhelming.8 In addition, commercial companies may be involved in exploiting scientific literature to influence healthcare professionals;9 key messages are used to promote new medicines or healthcare products in research articles, review articles, editorials and commentaries. It has been shown that manufacturing company sponsorship of studies of medicines and medical devices leads to more favourable efficacy results and conclusions than sponsorship by other sources.10 Furthermore, many authors involved in developing clinical guidelines have conflicts of interest and many patient support groups are supported or sponsored by pharmaceutical companies.11-13
Our drug bulletins publish independent evaluations of medicines and other therapeutic interventions, highlight safety issues associated with the use of medicines and discuss controversial topics related to the pharmaceutical industry, medicines regulators and national health policies. Although the initial focus was on producing information for healthcare professionals, we, like many other bulletins, have since broadened our approach to include summaries and other material for patients and consumers.
The future of independent drug bulletins
With the introduction of ever more complex pharmaceutical products and the increasing number of medications taken by older people, the need for high-quality information on the safe and effective use of medicines that has been produced independent of pharmaceutical industry, government and regulatory bodies has never been greater. The role of drug bulletins in providing targeted practical advice and rigorous independent evaluations of medicines and other therapeutic interventions remains as important as ever. Nevertheless, the challenge facing us as editors of drug bulletins is to embrace different channels of communication (eg, social media networks, podcasts and video messages) to ensure that our independent evaluations of medicines and therapeutic interventions continue to be seen and heard.
1. Drug and Therapeutics Bulletin at 40. Drug Ther Bull. Drug and Therapeutics Bulletin 2002;40:25-26.
2. Abramowicz M. The Medical Letter [internet]. 2007 [cited 2021 Sep 01]. Available from: https://secure.medicalletter.org/downloads/Abram0907.pdf.
3. Olsson S, Pal S. Drug bulletins: independent information for global use. Lancet. 2006;368:903-4.
4. International Society of Drug Bulletins. ISDB [internet]. 2021 [cited 2021 Sep 01]. Available from: https://www.isdbweb.org/.
5. International Society of Drug Bulletins and World Health Organization. Starting or strengthening a drug bulletin–a practical manual [internet]. 2005 [cited 2021 Sep 01]. Available from: https://www.isdbweb.org/publication/starting-or-strengthening-a-drug-bulletin-a-practical-manual.
6. Phizackerley D. Registering our interest. Drug Ther Bull. 2020;58:18.
7. Burnand B. Independent drug bulletins to promote the prescription of appropriate drugs: a necessary but difficult task. Bull World Health Organ. 2013;91:391-91A.
8. Bastian H, Glasziou P, Chalmers I. Seventy-five trials and eleven systematic reviews a day: how will we ever keep up? PLoS Med. 2010;7:e1000326.
9. Publication planning: an effective corporate strategy to influence health professionals. Prescrire Int. 2013;22:304-7.
10. Lundh A, Lexchin J, Mintzes B, Schroll JB, Bero LA. Industry sponsorship and research outcome. Cochrane Database Syst Rev. 2017;2:10.1002/14651858.MR000033.pub3.
11. Tabatabavakili S, Khan R, Scaffidi MA, Gimpaya N, Lightfoot D, Grover S. Financial conflicts of interest in clinical practice guidelines: a systematic review. Mayo Clin Proc Innov Qual Outcomes. 2021;5:466-75.
12. Bero LA, Parker L. Risky business? Pharmaceutical industry sponsorship of health consumer groups. Aust Prescr. 2021;44:74-6.
13. Fabbri A, Parker L, Colombo C, Mosconi P, Barbara G, Frattaruolo MP, et al. Industry funding of patient and health consumer organisations: systematic review with meta-analysis. BMJ. 2020;368:l6925.
Authors
David Phizackerley
Deputy Editor
Drug and Therapeutics Bulletin
BMJ, BMA House, London
James Cave
Editor and GP
The Downland Practice
Chieveley, Berkshire
Disclaimer
The views expressed in this World EBHC Day Blog, as well as any errors or omissions, are the sole responsibility of the author and do not represent the views of the World EBHC Day Steering Committee, Official Partners or Sponsors; nor does it imply endorsement by the aforementioned parties.
