Obstacles to health information for all

Cuéllar-Montoya, Zoilo; Maldonado, Jorge E; Moncayo, Álvaro

doi:10.1016/s0140-6736(04)17393-5

The Lancet

2004

DOI: 10.1016/s0140-6736(04)17393-5

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Obstacles to health information for all

Zoilo Cuéllar-Montoya¹,

Jorge E Maldonado²,

Álvaro Moncayo³

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2011

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Cited by 2 publications

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“…Too often commercial interests-rather than clinical or therapeutic needs-drive the conception, design, analysis, interpretation, and dissemination of clinical research [6,7]. In addition, recent cases of fraud, suppression of negative results, and selectivity in terms of publication, such as those on selective COX-2 inhibitors [8], selective serotonin re-uptake inhibitors, antidepressants [9], and rosiglitazone [10], have shown that peer-reviewed medical literature cannot always be regarded as a valid and reliable source of information [11,12].…”

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Separating the wheat from the chaff: essential information in therapeutics

Llop

Bosch

Figueras

et al. 2011

Eur J Clin Pharmacol

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Prescribing is a complex decision-making process influenced not only by patients' needs, but also by other factors, such as available resources, priorities of national healthcare policies, and market pressures [1]. The information on medicines and therapeutics that reaches prescribers is also one of these factors. The need for continuous updating of this information is vital for both healthcare professionals and healthcare systems, although keeping up with therapeutic advances in health care is challenging [2].In the last two decades, access to scientific publications and other sources of medical information has changed dramatically, from the need to gain access to information to the need to select it. More than ever, genuine data and news are diluted in an ocean of banalities. For example, it took 20 years, hundreds of studies, and millions of treated patients to realize that the so-called second-generation antipsychotics are actually no better than the older drugs in terms of efficacy and side-effect profiles [3].New information and communication technologies give users the opportunity to retrieve a wealth of information [4,5]. Nevertheless, the reliability, quality, and relevance of the information retrieved to clinical and public health vary, and the information overload carries an inevitable risk of "infoxication".Too often commercial interests-rather than clinical or therapeutic needs-drive the conception, design, analysis, interpretation, and dissemination of clinical research [6,7]. In addition, recent cases of fraud, suppression of negative results, and selectivity in terms of publication, such as those on selective COX-2 inhibitors [8], selective serotonin re-uptake inhibitors, antidepressants [9], and rosiglitazone [10], have shown that peer-reviewed medical literature cannot always be regarded as a valid and reliable source of information [11,12]. The design of pre-marketing trials, the conduct of post-marketing surveillance, and communication to prescribers are driven by the need to sell. Table 1 summarizes the main problems associated with the dissemination of information on medicines.The real meaning of words: is it possible to define "essential information" in therapeutics?More than 30 years ago, a World Health Organization (WHO) expert committee noted that despite the fact that thousands of medicines had been marketed in previous years, their public health impact was uncertain. WHO defined essential medicines as those that satisfy the healthcare needs of the majority of the population [13]. The WHO concept of essential medicines, launched in 1977, helped to establish that some medicines are more helpful than others and that essential medicines should therefore be available at all times in adequate amounts and in the appropriate dosage forms-and at a price that individuals and the community can afford [14].Similarly, in order to promote a healthy and cost-effective use of medicines, prescribers, other healthcare professionals,

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Separating the wheat from the chaff: essential information in therapeutics

Llop

Bosch

Figueras

et al. 2011

Eur J Clin Pharmacol

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The growth of a culture of evidence-based obstetrics in South Africa: a qualitative case study

Daniels

Lewin

2011

Reprod Health

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BackgroundWhile the past two decades have seen a shift towards evidence-based obstetrics and midwifery, the process through which a culture of evidence-based practice develops and is sustained within particular fields of clinical practice has not been well documented, particularly in LMICs (low- and middle-income countries). Forming part of a broader qualitative study of evidence-based policy making, this paper describes the development of a culture of evidence-based practice amongst maternal health policy makers and senior academic obstetricians in South AfricaMethodsA qualitative case-study approach was used. This included a literature review, a policy document review, a timeline of key events and the collection and analysis of 15 interviews with policy makers and academic clinicians involved in these policy processes and sampled using a purposive approach. The data was analysed thematically.ResultsThe concept of evidence-based medicine became embedded in South African academic obstetrics at a very early stage in relation to the development of the concept internationally. The diffusion of this concept into local academic obstetrics was facilitated by contact and exchange between local academic obstetricians, opinion leaders in international research and structures promoting evidence-based practice. Furthermore the growing acceptance of the concept was stimulated locally through the use of existing professional networks and meetings to share ideas and the contribution of local researchers to building the evidence base for obstetrics both locally and internationally. As a testimony to the extent of the diffusion of evidence-based medicine, South Africa has strongly evidence-based policies for maternal health.ConclusionThis case study shows that the combined efforts of local and international researchers can create a culture of evidence-based medicine within one country. It also shows that doing so required time and perseverance from international researchers combined with a readiness by local researchers to receive and actively promote the practice.

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Obstacles to health information for all

Cited by 2 publications

References 5 publications

Separating the wheat from the chaff: essential information in therapeutics

Separating the wheat from the chaff: essential information in therapeutics

The growth of a culture of evidence-based obstetrics in South Africa: a qualitative case study

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