Independent Drug Bulletins to Promote the Prescription of Appropriate Drugs: A Necessary but Difficult Task

By Burnand, Bernard | Bulletin of the World Health Organization, June 2013 | Go to article overview

Independent Drug Bulletins to Promote the Prescription of Appropriate Drugs: A Necessary but Difficult Task


Burnand, Bernard, Bulletin of the World Health Organization


Drug treatments constitute a substantial portion of all health-care interventions. Despite their notable benefits, however, drug treatments are beyond the reach of sizable population groups and in some parts of the world there is little access to safe and effective medications even though new drugs are constantly being developed.

The effectiveness and safety of newly developed drugs are often viewed too optimistically. (1,2) According to a Cochrane systematic review published recently, new drugs are seldom found to be substantially better than existing treatments. (3) However, because of lack of full and transparent access to the protocols of many clinical trials, compounded by publication bias and selective reporting of their findings, the true effectiveness of many drugs remains unknown. It is a fact that the results of trials are more likely to be published if the findings are favourable than if they are not. (4) In addition, some measured outcomes are never reported, (5) which generally results in an overestimation of effectiveness and an underestimation of harmful effects. Thus, researchers and the public only come to know about those findings that are published and disclosed, and physicians prescribe treatments on the basis of this biased information. For all of these reasons, it is critically important that prescribing physicians have a source of information about drug effectiveness that is independent and as objective as possible.

Truly independent drug bulletins--those produced without financial or editorial intervention from the pharmaceutical industry, regulatory agencies and governments--are such a source. (6) They make a contribution to society by objectively comparing the effectiveness of different drugs. Independent drug bulletins began to appear in the 1960s, after the thalidomide scandal. At the time the pharmaceutical industry was producing new drugs that were modifying health-care practices. In the 1970s, a group of physicians and pharmacists in France began to meet to discuss and prepare independent information about drugs for other physicians and pharmacists. The group, which came to be known as "Prescrire", gained official recognition in 1980, when the French Minister of Health commissioned it to provide independent information to the drug authorities. The group was initially supported through government funding, but this was eventually suspended and its drug bulletin, Prescrire, has been fully independent since 1993. (7) Prescire is an example of a truly independent drug bulletin. It publishes no advertisements and is financed solely through subscriptions and training courses for health-care professionals. Its readership, mainly physicians and pharmacists living in FranCe, grew gradually until 2000, plateaued for several years, and jumped to about 35 000 in 2012 after the European Medicines Agency recommended the withdrawal of benfluorex. …

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