Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

King's Fund critical of Health Minister

The King's Fund has criticised the Secretary of State for Health after her intervention in the use of the breast cancer drug Trastuzumab (Herceptin).

The Policy Position released by the King's Fund has raised two concerns about the Ministers intervention. These are:

  • that fast tracking might equate to more risk

Risk to patients may be increased by making drugs widely available on the NHS when little is known about the safety profile of the drug.

  • that local decisions are being undermined

The intervention of the Secretary of State for Health in the decisions around the use of Trastuzumab has indicated that the governemtn is willing to pre-empt the processes followed by NICE and PCTs.

The full document contains a more detailed analysis of why problems have been caused in many organisations across the NHS. Given the wide press coverage this debate is getting it is possible that clinicians will be asked about this drug by their patients. This article provides a good background to the issues that are being raised by the debate.

Action: Clinicians may wish to read this document or have a copy to hand should questions about this debate arise.

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Code of Practice criticised by Lancet

The Lancet has criticised1 the new Code of Practice produced by the Association of the British Pharmaceutical Industry (ABPI) by noting that the code only applies to prescription only medicines and not so-called over-the-counter medicines.

As already reported, the BMJ has criticised the new Code stating that it lacks teeth. It is becoming clear that the ABPI has a lot more work to do in convincing clinicians that it can regulate the pharmaceutical industry.

Action: As previously suggested, Clinicians should be aware of the Code of Practice and also be prepared to make complaints to the Prescription Medicines Code of Practice Authority or the Medicines and Healthcare products Regulatory Agency.

References:

  1. Lancet 2005; 366:1828

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NICE Guideline on OCD

The National Institute of Health and Clinical Excellence has published a Guideline detailing the core interventions for Obsessive Compulsive Disorder (OCD) and Body Dysmorphic Disorder (BDD).

The Guideline covers treatment in adults and children and takes a stepped-care approach to treatment. Treatments including individual or group based cognitive based therapy, exposure and response prevention, selective serotonin reuptake inhibitor antidepressants are recommended based upon the severity of the condition and the patient's preference.

The document also contains estimates that OCD affects 1-2% of the population and BDD affects 0.5-0.7%, it is therefore important that all clinicians are able to recognise the signs and symptoms of these disorders and respond appropriately.

Action: All clinicians should be aware of the content of this Guideline appropriate to their level of patient interaction. At a minimum level, clinicians should be able to recognise the signs and symptoms of these disorders and make suitable referrals.

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BMJ criticises new ABPI Code of Practice

The Association of the British Pharmaceutical Industry's new Code of Practice for the Pharmaceutical Industry has been criticised in the British Medical Journal for "lacking teeth". The article is available online.

As already report, the new Code does not come into force until January 2006 but it has already been attacked for being "fundamentally weak" by the editor of the Drugs and Therapeutics Bulletin. Professor Andrew Herxheimer of the Cochrane Centre also stated that, "not much has changed".

Action: Despite the weaknesses of the new code Clinicians should be aware of the Code of Practice and also be prepared to make complaints to the Prescription Medicines Code of Practice Authority or the Medicines and Healthcare products Regulatory Agency.

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MeReC Extra covers ASCOT, UTI and BNFC

The National Prescribing Centre has published a MeReC Extra that covers the ASCOT Study, the Cochrane Review of UTI treatment in women and BNF for Children.

The editorial on the ASCOT Study reaches the conclusion that the current NICE Hypertension Guideline should be followed until it is updated. The same advice has already been given in a previous article on this site.

A Cochrane systematic review of 32 clinical trials involving 9,605 patients has shown that 3 days treatment with trimethoprim is effective in attaining symptomatic cure from urinary tract infections (UTIs) in non-pregnant women aged between 18 and 65. Longer courses are required for bacteriological cures but are associated with more adverse effects. 3-day courses are already recommended by the Standing Medical Advisory Committee (SMAC) and the Health Protection Agency (HPA). The Cochrane Review supports the continued use of 3-day courses with longer courses reserved for patients where bacterial eradication is necessary, for example in recurrent infections or where the patient is planning pregnancy.

The final article reminds readers of the recently published BNF for Children, available online at http://bnfc.org or http://www.bnfc.nhs.uk.

Action: Clinicians who are involved in treating hypertension, UTIs or children are encouraged to read the appropriate sections of this publication.

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