Why the DoH is dumping the DTB
Patients and consumers of medicines, as well as health professionals, should be up in arms about the Department of Health’s decision to stop funding The Drug & Therapeutics Bulletin (DTB). For many years, the DoH has paid to have the Bulletin distributed to all prescribing doctors in the UK. Now - within weeks of extending almost unfettered drug prescribing powers to nurses and pharmacists - the Department has suddenly pulled the plug on the DTB by withdrawing this lifeline grant.
One can just about imagine a scenario in which the Departmental impulse to prudence and cost cutting seemed to drive the decision to break the DTB, but it still seems extraordinary that no-one had the imagination to put the brakes on. That includes the Secretary of State, though she may well have been deprived of vital information and appropriate advice about the political sensitivity of the decision made in her name.
The DTB is not simply a ‘drug bulletin’ – a source of sensible independent, evidence-based advice about how useful medicines seem to be, and how (or why not) to prescribe them. The DTB is also an institution whose contribution to the development of ethical, rational and economic drug prescribing in the UK dates back to 1964 - the year of the Declaration of Helsinki, which first gave people rights above those of experimental animals. Now the consumer movement is under assault, in danger of losing its strongest voice in this field.
The loss in prospect involves far more than some lack of independent advice for drug prescribers. The Department of Health can fairly argue that there are now other good sources of drug information – e.g. the British National Formulary, the National Prescribing Centre and the National Electronic Library for Health – but that largely misses the point. What the Drug & Therapeutics Bulletin has consistently done – and is uniquely placed to do - is to represent the interests of medicines’ users in the development of a national drug policy that serves the health needs of users above all.
Directly and indirectly, the DTB has played a major part as a representative and consultative organisation on just about every issue to do with effective medicines’ control. Consider, for example, the contribution of the DTB and friends (Collier, Herxheimer, Ihenacho et al) to the recent House of Commons Health Committee report on The Influence of the Pharmaceutical Industry. Many of the Committee’s main recommendations reflect deep consumer concerns – and give overwhelming evidence of the need to maintain and build a strong consumer presence in this field. For example:
"During this long inquiry we became aware of serious weaknesses in the MHRA. Worryingly, in both its written and oral evidence the Agency seemed oblivious to the critical views of outsiders and unable to accept that it had any obvious shortcomings, except those that could be remedied by more transparency. The Agency’s attitude to its public health responsibilities suggested some complacency and a lack of requisite competency, reducing our confidence in its ability to undertake the reforms needed to earn and deserve public trust. Nor did we conclude that the MHRA provides the discipline and leadership that this powerful industry needs. We recommend that there be an independent review of the MHRA …" (paragraph 376)
And this brings us to the point: far from being a (stunningly short-sighted) cost-cutting exercise, this decision to cut loose the DTB seems a thoroughly punitive act. It is both a punishment and an attempt by the Department to secure a quieter future for itself – probably also to curry favour with the commercial sector for whom the Bulletin has also proved a thorn in the side.
This is a deeply worrying development, evidence of the risk that the weakness and complacency that marks the performance of the MHRA is also a hallmark of its sponsoring department, the DoH. How very prescient of that parliamentary Committee to have identified the basic need to pursue health priorities and trade imperatives as ring-fenced concerns. The Committee final recommendation was this:
"We recommend that responsibility for representing the interests of the pharmaceutical industry should move into the remit of the Department of Trade and Industry to enable the Department of Health to concentrate solely on medicines regulation and the promotion of health". (Paragraph 392)
Quite apart from all this, it also seems to me that the Secretary of State is backing a real loser. The backlash has barely begun, and will surely soon surface in Parliament. I expect to return to this issue before too long.
Charles Medawar
20 June 2006
Declaration of interest: CM was a member of the DTB editorial board in the early 1990s. He was also engaged as one of four specialist advisers to the House of Commons Health Committee, on its recent enquiry into "The Influence of the Pharmaceutical Industry".