|The Therapeutics Initiative's objectives are unbiased review and dissemination of therapeutic evidence. Our recommendations are intended to apply to most patients; exceptional patients require exceptional approaches. We are committed to evaluate the effectiveness of our educational activities using the Pharmacare/PharmaNet databases without identifying individual physicians, pharmacies or patients. The Therapeutics Initiative is funded by the BC Ministry of Health through a 5-year grant to the University of BC. The Therapeutics Initiative provides evidence based advice about drug therapy, and is not responsible for formulating or adjudicating provincial drug policies.|
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Busy clinicians need distilled, concise, reliable, and readily available information about all types of therapy, especially drugs. 1) Distilled and concise, because most practitioners have little time to read original evidence or to perform their own detailed analysis of large volumes of information. 2) Reliable, because many sources of information reflect biases that may differ from patients’ best interests. 3) Readily available, because space and time constraints preclude a large office library or prolonged searching. The Therapeutics Initiative attempts to partially fill these needs. This is the 35th in a series called the Therapeutics Letter, all available on our website (click here). What other sources might a conscientious practitioner find useful to stay up to date without spending too much time or money?
Many BC practitioners have web access. This has become a major tool for health information in general and drugs in particular, but screening for reliability challenges most clinicians. Highly respected groups in several countries distill drug information into concise bulletins, many of which have web sites.
The Australian Prescriber has full downloading without a subscription. Medical Letter (US) has sample articles, a table of contents and a CME exam at their site. Similarly, the Drug and Therapeutics Bulletin (UK) gives on-line browsers access to some reviews. La Revue Prescrire’s website (France) appears only in French. It includes an index to more recent content.
Searches will often reveal commercial websites like the Medical Sciences Bulletin or PharminfoNet. DruginfoNet looks like the Physician’s Drug Reference (U.S. version of the CPS) and is based on pharmaceutical company package inserts. The US Food and Drug Administration (FDA) publishes the package inserts for approved drugs. This allows you to get information on new drugs that may not yet be available in the CPS. The Iowa Drug Info Service accesses the files used by the FDA in the U.S. drug approval (or rejection) process. This site may be of interest to those wanting detailed information on new drugs.
Many sites provide guidelines. Most useful for Canadian practitioners is the Canadian Medical Association (CMA) Infobase (Clinical Practice Guidelines site). See table for web addresses.Overall, the Internet has potential, but still probably provides no better information than subscription sources for most problems encountered by the practitioner.
The best-known subscription source is the Medical Letter. Founded in 1959, with Drs. Goodman and Gilman of pharmacology textbook fame among the first editors, it focuses on new drugs and new information about old drugs. Sometimes it reviews a class of drugs or occasionally the treatment of a specific condition. New drugs are placed in context and the Letter offers a clear conclusion. US cost comparisons are not always relevant to Canada. It costs $49 US (~$75) for 26 four page issues annually.
The Drug and Therapeutics Bulletin is another excellent subscription resource. It is unbiased and aimed at both doctors and pharmacists. It cites British costs and also ends each article with a clear conclusion. The 8-page monthly costs £49 (~$110) a year.
Prescrire International disseminates quality drug reviews translated from its flagship French periodical La Revue Prescrire that since inception in 1981 has grown to 20,000 subscriptions internationally. Among drug bulletins this probably has the most elaborate scrutiny, including many family medicine reviewers, and the strongest statements about the value of a medication. Its 26 pages make it look like a journal. An abstract appears at the beginning of each article. Samples of these reviews can be found each month in the Canadian Family Physician. For 310F (~$65) subscribers receive 6 issues annually.
The Australian Prescriber provides another excellent independent review of medications in magazine format. Writing is crisp and layouts attractive with key points boxed. A synopsis opens each article and brief references are provided, followed by the novelty of a consumer comment. Self-tests are included. The editor has a policy of reviewing new drugs early, even before complete information is available. Australian drug approvals usually precede Canada’s and sometimes the drug brand names are different. The subscription price is $125 Aust (~$110).The best source of unbiased systematic reviews of drug therapy evidence is the Cochrane Library, available on CD ROM with 4 updates annually or on the Internet with paid subscription. If you have access to OVID via the CMA or through UBC Library (etc.) you can also access the Cochrane Collection directly, amongst the OVID databases. The scientific rigor of this source is not matched by any other. Topics covered are still limited but rapidly expanding. You are unlikely to have time to read a complete review, but often the answer to your question can be found quickly in the abstract and "metaview" (the meta-analysis of the included trials). In Canada it is available from the CMA for $350 ($300 for CMA members) for 4 yearly updates on CD, or from Update Software for an annual Internet subscription.
In practice we often don’t need the latest information, but rather quick and reliable information to treat conditions with which we are less familiar. A small but good library can be the most helpful source.
The Medical Letter again meets this need with Drugs of Choice published every two years (last in 1999) for $20 US (~$30). The Public Citizen’s group in the US, founded by Ralph Nader publishes Worst Pills, Best Pills as a book for $16 US (~$24) and as a monthly newsletter for an annual subscription of $20 US (~$30). The inflammatory tone may be a deterrent to some doctors, but it contains interesting data and comparisons and will encourage conservative prescribing. The CMA has also published a Drugs of Choice, (1998), an evidence based handbook of drugs. It provides a list of the drugs of first and second choice plus dose and cost information for most common conditions in family practice. CMA members can buy this book or diskette for $21.95 ($24.95 for non-members). Therapeutic Choices is a handbook published by the Canadian Pharmaceutical Association (CPA), 3rd edition this year. It presents the management of common conditions concisely, using point form, tables and flow charts ($68.50).Larger references are familiar to many. Goodman and Gilman, The Pharmacologic Basis of Therapeutics produced its 9th edition in 1996; 11 pharmacologists and 33 physicians contributed to this venerable standard. It offers the best information for mechanism of action of drugs, and the pharmacokinetic tables at the back are very useful for sorting out complicated drug-patient problems. At $162.75 it provides good value for the amount of information it contains.
Bulletins, particularly The Medical Letter, the Drug and Therapeutics Bulletin from the UK and Prescrire International, are distilled, concise and reliable sources of new drug information. The Australian Prescriber and the Therapeutics Letter are free online sources. Up-to-date concise and reliable handbooks include the CMA’s Drugs of Choice and CPA’s Therapeutic Choices.
|Australian Prescriber||61 (2) 6289-7038||61 (2) 6289-8641|
|CMA Infobase (guildelines)||www.cma.ca/cpgs/||1 (800) 663-7336||1 (613) 565-2382|
|Cochrane Library||1 (888) 855-2555||1 (613) 236-8864|
|Drug and Therapeutics Bulletin||www.which.net/health/dtb/main.html||44 (20) 7770-7571||44 (20) 7770-7665|
|Drugs of Choice||www.cma.ca/catalog/252.htm||1 (888) 855-2555||1 (613) 236-8864|
|Food and Drug Administration (USA)||www.fda.gov/cder/|
|Goodman and Gilman||www.mcgrawhill.ca/medical/hardman.htm||1 (800) 565-5758||1 (800) 463-5885|
|Iowa drug info service||www.uiowa.edu/~idis/idisnews.htm||1 (319) 335-4800||1 (319) 335-4077|
|Medical Letter||www.medletter.com/||1 (800) 211-2769||1 (914) 632-1733|
|Prescrire International||www.esculape.com/prescrire/||33 (1) 492-372-65||33 (1) 480-787-32|
|Therapeutics Letter||www.ti.ubc.ca/pages/letter.html||1 (604) 822-0700||1 (604) 822-0701|
|Therapeutic Choices||www.cdnpharm.ca/||1 (800) 917-9489||1 (613) 523-0445|
|Worst Pills, Best Pills||www.citizen.org/hrg/||1 (202) 588-1000||1 (202) 588-7798|
|We attempt to maintain the accuracy of the information contained in the Therapeutics Letter by extensive literature searches and verification by both the authors and the editorial board. In addition this Therapeutics Letter was submitted for review to 55 experts and primary care physicians in order to correct any identified shortcomings or inaccuracies and to ensure that the information is concise and relevant to clinicians.|
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©Therapeutics Initiative. Last updated: June 21, 2000.