Prescribing Advice for GPs

Do New Drugs Prolong Lives?

November 10, 2006 on 3:07 pm | In Prescribing Extra - Other |  Print | 2 Comments

A recent post discussed the publication of a manifesto by the Association of the British Pharmaceutical Industry (ABPI) that was critical of the lower use of new drugs in the UK compared to other selected countries.

In this article I commented that there was “no information linking lower use of new drugs to increased morbidity and mortality“. It seems that this comment got someone thinking; John Mack at Pharma Marketing obtained life expectancy data and plotted it against market share data form new drugs as quoted by the ABPI and there was a negative correlation. The higher the market share of new drugs the lower the life expectancy!

This correlation is not statistically significant (p=0.18 by my calculations) and is calculated on a small sample size (10 countries). There may also be many confounders to the data, for example greater baseline morbidity and mortality, differences in lifestyle factors such as smoking, diet and alcohol consumption.

However, this very simplistic first look does raise an interesting hypothesis; do new drugs prolong lives?

Action: Clinicians should exercise caution when prescribing new drugs and may wish to consider using established treatments where these are proven to prolong life expectancy or reduce morbidity.

Clinical Knowledge Summaries

November 9, 2006 on 3:17 pm | In Prescribing Extra - Other |  Print | No Comments

Connecting for Health (CfH) has announced that it has awarded a new contract for the supply of Clinical Knowledge Summaries (CKS) to a consortium.

The previous contract with BMJ Publishing to provide Clinical Evidence expired at the end of September 2006. Clinical Evidence will remain accessible, free of charge, until 31st December 2006 once a registration process in complete. From 2007 a paid subscription will be required to gain access.

The new contract involves the Department of Health holding the intellectual property rights to content generated during the contract. This will mean that upon contract expiry the NHS will still be able to access content generated during the period of the contract, unlike the current situation with Clinical Evidence.

Action: Clinical Evidence is a useful and concise resource. Registration is worthwhile to allow continued access until the end of 2006.

Ask About Medicines Week 2006

November 8, 2006 on 2:56 pm | In Prescribing Extra - Other |  Print | No Comments

This week (6th to 10th November) is Ask About Medicines Week for 2006. The aim of the campaign is to “increase people’s involvement in decisions about their use of medicines“.

This years campaign aims to promote four key messages:

• As we get older we take more medicines
• Asking questions about medicines helps us to use them safely and effectively
• Some people, particularly those in the oldest age groups, need to be encouraged to ask questions about their medicines
• Confusion about medicines can lead to inappropriate use of medicines, which is potentially dangerous to patients and costly to the NHS

In delivering these key messages some support materials have been made available online. Leaflets are available covering antibiotics, breast and lung cancer and there are limited supplies of medicines charts.

Action: Clinicians may find some of these leaflets a useful resource for patients.

PLoS Medicine calls for end to drug promotion

November 7, 2006 on 5:00 pm | In Prescribing Extra - Other |  Print | No Comments

PLoS Medicine has published an article calling for changes to the way healthcare professionals learn about medicines.

The article makes four recommendations:

• All health professionals should be educated explicitly about decision making and evaluation of evidence and promotion
• Health professionals should be helped to understand that there is no proven method for enabling them to gain more benefit than harm from promotion
• Health professionals should be helped to understand their responsibility to avoid pharmaceutical and device promotion
• Health professionals should be educated explicitly about the most reliable sources of information

The article states that misleading promotion can be a threat to health and states that there is evidence that “pharmaceutical promotion correlates with medically inappropriate and wasteful use of pharmaceuticals“. It is proposed that individual clinicians should avoid one-to-one meetings with sales representatives and be aware of the benefit-to-harm ratio of promotion.

Action: All healthcare professionals should carefully consider the educational benefits provided during exposure to pharmaceutical promotion before agreeing to meet with sales representatives.

ABPI report critical of new drug uptake in UK

November 6, 2006 on 4:50 pm | In Prescribing Extra - Other |  Print | No Comments

To coincide with Ask about Medicines week, the Association of the British Pharmaceutical Industry has issued a press release and published a manifesto that criticises the lower uptake of new drugs in the UK relative to other selected countries.

New drugs, those that have been available for less than five years, account for 17% market share in the UK while this is 27% in the USA, 24% in Australia and Spain and 22% in France and Germany.

It is unclear if these data are based on items prescribed or drug costs. Additionally, there is no information in this manifesto directly linking the lower use of new drugs to increased morbidity and mortality internationally. The manifesto also contains a map revealing age-standardised death rates from Coronary Heart Disease in men under 65. Again there is no link between this map and usage of new drugs.

The manifesto also contains information from surveys of journalists, politicians and the general public about the reputation of the industry. In all three of these three groups the reputation of the pharmaceutical industry is favourable and improving. The view of healthcare professionals is a conspicuous omission.

Interestingly, following the highly publicised launch of a revised Code of Practice, the number of complaints submitted to the Prescription Medicine Code of Practice Authority is up. So far this year 110 complaints have been received while number of complaints received in 2005 totalled 101. According to the press release, “the number of complaints received from healthcare professionals continues to be much higher than those from other sources“.

The ABPI end their manifesto stating, “our aim is to help shape a future where patients have access to the right medicines at the right time and, in so doing, we help to save lives and
make the NHS budget go further“.

Action: While the intentions of this manifesto are commendable in terms of improving patient care, clinicians should still exercise caution in their prescribing of new drugs.