In April 1962, Consumers' Association published the first issue of a British edition of the American Medical Letter on Drugs and Therapeutics. A year later, formal ties with the parent journal were severed, the title was changed, and Drug and Therapeutics Bulletin (DTB) was launched. Initially, articles in DTB were brief (each around 500 words), references few (rarely more than five) and the circulation around 5,000. Gradually, articles and reference lists have lengthened, and our circulation has grown to 130,000 (a figure bolstered by bulk purchasing agreements with Departments of Health, or their equivalents, in the UK and Eire).
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Drug and Therapeutics Bulletin at 40
DTB's launch was greeted with suspicion. In the early 1960s, there were, after all, no drug licensing laws (first introduced in 1968), no formal controls of drug promotion or arrangements for pharmacovigilance, nothing equivalent to the British National Formulary (first published in its present format in 1981) or summaries of product characteristics (SPCs), and little recognition of the importance of scientific evidence to clinical practice. Coupled with this, the practice of doctors and drug companies went essentially unquestioned, with, for instance, no obligation to give patients details of their illness or treatment.
From the outset, DTB's aim has been to provide clinicians with clear, reliable, usable, impartial and independent information to help ensure patients get the best deal. Now, as then, we try to set out the text in a logical sequence and in sufficient detail to allow readers to follow the arguments and to form alternative views if they wish. Wherever possible, conclusions are based on evidence from published randomised controlled clinical trials. If these do not exist, we say so and base our advice on the best alternative evidence we can find (see How Drug and Therapeutics Bulletin produces articles. DTB 1997; 35: 73-4). When we have identified problems, we make the issues explicit, and suggest solutions.
The publication of DTB itself is only one aspect of our mission. In 1984, we ran our first conference and now hold three open meetings each year (see page 32 for details on the latest). In 1986, we co-founded the International Society of Drug Bulletins. In 1989, we began publishing booklets on Medicines cheaper over the counter, and in 1997 wrote and produced a series of books on Medicines and the NHS.1 In 1995, we launched the eDTB CD-ROM, and in 2000 Treatment Notes, our publication for patients.
Our proudest achievement is to have provided for 40 years critical, constructive and independent advice which readers continue to trust and value.2 We are of course pleased when our advice has influenced thinking and practice more widely. In 1964, for instance, we urged that androgens should not be used as simple tonics or haematinics (1964; 2: 75-6), a view now unquestioned. Likewise, we successfully campaigned for the removal, or restriction, of phenacetin (1965; 3: 29), prednisone (1979; 17: 87-8), phenylbutazone and oxyphenbutazone (1984; 22: 5-6). We argued against the excessive promotional claims made for the NSAID tiaprofenic acid (1983; 21: 49-50), prompting successful prosecution of the manufacturer by the Department of Health. Recently, we have exposed fundamental weaknesses in the arguments for using the drugs ▼zanamivir (2001; 39: 9-10) and ▼sibutramine (2001; 39: 89-91).
In addition to our effects on the use of individual products, we have also influenced broader management issues. We are particularly proud of our series on Drugs for the doctor's bag (1976; 14: 42-4, 1989; 27: 17-9, 1995; 33: 3-5, 2000; 38: 65-8), which has become standard advice; our campaign to persuade the publishers of the Data Sheet Compendium to include in the index generic, as well as brand, names (1977; 15: 65); our 1984 symposium,3 which was used as a basis for establishing the Cochrane Collaboration; our proposal in 1985 that all medicines should be accompanied by "clearly written and easily understandable package information leaflets" (1985; 23: 87-8), and in the same year, our drive to make government more responsible for ensuring that drug names were less confusing (1985; 23: 77-9); our review on Prescribing unlicensed drugs or using drugs for unlicensed indications (1992; 30: 97-9), which clarified the position and established practice; our advice on Using medicines in school (1994; 32: 81-3), which ultimately prompted the production of national guidelines;4 our seminar on Is domestic violence a medical issue? (June 1996), which was the key stimulus for the Department of Health's recognition of the problem and development of a detailed policy;5 our article on Managing childhood gastro-intestinal reflux (1997; 35: 77-80), coupled with our seminar on Paediatric prescribing outside the licence: is there a problem? (June 1998), which stimulated the current work by the Medicines Control Agency to limit the unlicensed or off-label use of drugs in children; and, more recently, our article revealing that not all SPCs carried the required black-triangle symbol (2001; 39: 25-7), a deficit soon rectified.
We are delighted to share with you our birthday celebration and look forward to many more.