Healthy Skepticism Library item: 7050

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Day M.
GPs should use 'premier' information sources when prescribing
BMJ 2006 Dec 16; 333:(7581):1239
http://www.bmj.com/cgi/content/full/333/7581/1239

Abstract:

GPs should not use internet search engines, such as Google or Medline, when seeking advice on what to prescribe, say senior NHS officials.

Instead they should stick to “premier” information sources, such as the National Institute for Health and Clinical Excellence (NICE), the Cochrane Collaboration, or national service frameworks.

Experts from the National Prescribing Centre told this week’s annual NICE conference that this would eliminate waste and improve patient care.

“Most start at Medline, when we should be starting with the most useful sources that have been sifted for usefulness,” said the centre’s medical director, Neal Maskrey.

He added that many GPs were ill equipped to make rational prescribing decisions based on complicated medical research papers or obscure reports.

“Given that less than 40% of GPs know what ‘absolute risk’ or ‘relative risk’ is, it’s not surprising they get it wrong sometimes,” he said, adding that NICE reports and national service framework reports had had difficult statistical analyses stripped away.

His colleague Jonathan Underhill, the centre’s assistant director of education and development, said the sheer quantity of medical research published every week meant that GPs could not be expected to keep abreast of all relevant developments by themselves.

He gave a conservative estimate that there were probably 1200 clinically relevant articles published each week.

He also encouraged GPs to consult official prescribing guides. “We need to be honest, and we need to look things up. And I think the patients will accept that now,” he said.

Other experts told the conference that increasingly sophisticated drug company marketing made it even more important that doctors seek clear, impartial advice.

Karol Sikora, a professor at Imperial College, London, warned that positive media reports created by subtle public relations activity were effectively direct to patient marketing by pharmaceutical firms.

The national cancer director, Mike Richards, however, said that there was evidence that specialist services were adhering to NICE guidance. He said this explained why the variation in treatment of cancer had reduced throughout England and Wales in the past two years. In an update of earlier reports he showed that there had been a further reduction in geographic variation in the use of drugs recommended by NICE for cancer.

Andrea Sutcliffe, the deputy chief executive of NICE, said that Professor Richard’s report showed “that NICE is achieving what we set out to do-to improve care for everyone and get effective new treatments that are good value for money out to patients faster.”

Some clinicians and patients’ groups at the meeting questioned NICE’s ability to incorporate emerging medical research quickly enough into its guidelines.

But one leading health economist, Alan Maynard, of York University, took a different view. He expressed concern that undue pressure from the pharmaceutical industry meant that the assessment of new drugs was being prioritised at the expense of reviews of existing medical and surgical treatments. “This is also an important part of NICE’s remit,” he said.