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Life begins at 60: DTB and the new challenges ahead
  1. James A Cave
  1. The Downland Practice, Berkshire, UK
  1. Correspondence to Dr James A Cave, The Downland Practice, Berkshire, UK; jcave{at}

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Today, it is hard to imagine the drug and therapeutics landscape of the UK 60 years ago. In 1962, statutory regulation of medicines would not be established for almost another 10 years, the British National Formulary was evolving from the former National War Formulary and still included a lot of traditional tonics and mixtures, and the concept of evidence-based medicine was decades away. However, in April 1962, the Drug and Therapeutics Bulletin (DTB) began to provide clinicians with vital, impartial and independent information on the harms and benefits of medicines at a time when there was very little else available.

Things have changed significantly over our 60 years. Evidence-based guidelines began to be developed in the late 1980s and the concept of evidence-based medicine was introduced in the 1990s. The development of the Cochrane Collaboration in 1993 exemplified the desire for a systematic approach to analysing clinical trial data to provide clinicians and policy-makers with reliable reviews of the effects of health interventions. In a ground-breaking development, the National Institute for Clinical Excellence (NICE) was set up in 1999 to create a national approach to decide what medicines and treatments the NHS should provide, and in 2003 it became a legal requirement for the NHS to fund interventions recommended by NICE’s technology appraisals.1 One of NICE’s first acts was to determine that the antiviral, zanamivir, was not cost-effective and should not be provided by the NHS. In response, the chairman of Glaxo Wellcome reportedly threatened to move the company abroad if the decision …

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