How DTB is written
Drug and Therapeutics Bulletin (DTB) articles provide healthcare professionals with practical and impartial advice on treatment. The way DTB produces articles has been gradually refined since it started in 1962, but the essential principles have remained unchanged.
DTB content is produced by the BMJ Evidence Centre and involves collaboration across an in-house team of medical and scientific editors that includes doctors, pharmacists and graduates with science background, external editors and external commentators.
Most articles start as a draft commissioned by the editorial team and written by an ‘outside’ expert. But the finished article is the result of detailed scrutiny, collaboration and revision involving a wide range of commentators and several editing stages. The resulting article, no longer attributable to any one source, is published unsigned and represents the view of DTB. It is not simply a distillation of the opinions of the commentators.
- to provide informed and unbiased assessments of drugs and other treatments (focusing on efficacy, safety, convenience and cost in particular in relation to other available treatments);
- to comment on how those drugs or other treatments should be used;
- to assess their place in overall management, and;
- to review evidence and give practical advice on the overall management of disease.
DTB’s related aims are to comment on how treatments are marketed and promoted, on the quality of the information available to prescribers and patients, and on the indication(s) for which the treatment has been licensed.
To help us achieve these aims, DTB has always been wholly independent of Government, regulatory authorities and the pharmaceutical industry and does not accept advertising or any other form of commercial sponsorship.
All contributors to DTB articles are asked to declare whether they have any interests or relationships which they think might influence their comments, and these are taken into account during the editorial process.
DTB is a founder member of The International Society of Drug Bulletins (ISDB).
DTB has an in-house editorial team based in the BMJ Evidence Centre that works with an Editorial Board, which comprises experienced specialists and generalists. Once a year, the Editorial Board meets with the in-house editorial team to consider articles for the forthcoming year.
Ideas for articles arise from:
- reports in medical and pharmaceutical journals
- regulatory authority announcements
- drug company promotion
- lay media items
- problems encountered in clinical practice
- readers’ letters
- issues arising from previous DTB articles
- ideas from the in-house team
After discussion, the list of possible topics is narrowed down to those that are considered most timely or useful. The Editorial Board member identifies possible authors from his or her knowledge of experts in the field. A detailed brief is then agreed for commissioning.
Once a draft has been written, the Editorial Board member has a key role as ‘lead editor’ for the article, advising at each stage of its development until publication.
An article can take several months to produce from the time of commissioning. But there is also scope for ‘fast track’ articles to take account of particular developments, such as the launch of an important new drug, publication of new data or key changes in practice.
Once the first draft of a commissioned article is received, the first task is to check that it adheres fully to the commissioning brief. This is done by the Editor and Deputy Editor working closely with the ‘lead editor’, and may result in further amendments being made by the author of the first draft.
The article is then steered through all subsequent consultation and redrafting stages until publication. The process involves:
- appropriate database searches
- critical appraisal of the data cited in the draft
- reorganisation of the draft according to house style
- addition of text and references if more background information or more detailed presentation of the data is required
The draft is then circulated to a range of commentators. This includes:
- independent experts, and any identified from published work or other sources
- general practitioners
- nurses and/or other healthcare professionals
- representatives from the medical departments of each company whose drugs have been mentioned
- DTB Editorial Board
- Evidence Centre team
- the Medicines and Healthcare products Regulatory Agency (MHRA)
- relevant consumer and patient groups
Those sent drafts are asked for “comments and criticisms, whether fact or judgement” and are required to send references to support their comments wherever possible. We do not release the names of authors or commentators at any stage of the publication process. .
This process, involving up to 40 commentators for any one article, reveals areas of both agreement and disagreement. It identifies relevant data not covered in the draft, highlights issues of particular interest to generalists, pinpoints areas of controversy and often exposes the lack of evidence behind accepted dogma
It is the article editor’s task, working with the Editor, Deputy Editor, lead editor and first-draft author, to consider all the comments and to integrate relevant points and data into a revised draft. This is then circulated again to key commentators, before final amendment.
In the last 2-3 weeks before the article finally goes to press for publication, the draft is again scrutinised meticulously. Even at this late stage, the text will need updating if new data are published. The article is checked to ensure that the main text and conclusion accurately reflect the evidence, and that answers to difficult questions are not fudged.
With very few exceptions, DTB only uses source material that is published (or, very occasionally, ‘in press’). We closely ally ourselves with our readers and so only use data in the public domain. In this way, the basis for the conclusions is available to our readers for independent assessment.
Most reliance is placed on information obtained from randomised double-blind controlled trials, systematic reviews or meta-analyses that have been published in full in peer-reviewed journals.
We try to avoid using data published only as abstracts or held ‘on file’ by drug companies. We may use such information exceptionally if no other data exist and the information appears to add insight in, for instance, in a rapidly developing field.
Data from the proceedings of company-sponsored meetings are sometimes included when discussing a new drug but we are not prepared to base conclusions on such data alone.
Articles will usually refer to advice given by the National Institute for Health and Clinical Excellence (NICE), or the Scottish Medicines Consortium, or the Scottish Intercollegiate Guidelines Network (SIGN), or the All Wales Medicines Strategy Group and important consensus statements made by professional bodies.
‘Consensus statements’ and ‘clinical guidelines’ now abound, however, and not all bodies producing them are independent of industry, so any recommendations are scrutinised critically and may be questioned.
We also rely on reviews by national bodies (such as those in the British National Formulary [BNF]) and legal documents (such as summaries of product characteristics and European Public Assessment Reports). Again, we may question accepted positions or draw attention to apparent inconsistencies.
Our commentators’ opinions are an important component of the editing process. As well as raising points about the interpretation and presentation of trial data, they can provide personal insights from those using or receiving treatments and, where problems are defined, can offer solutions.
Where no reliable ‘scientific’ data exist on a particular point, the article must make this clear but, in this situation, opinion and insights may sometimes suggest a way forward for practical clinical decisions.
Assessing the value of an opinion requires impartial judgment by the editorial team as to whether the idea is sound, has objective support and how widely it is held.
Consensus or weighted assessment?
While the resulting article may reflect consensus, this is not necessarily a primary objective: when consensus among our commentators is at odds with the published data, the scientific evidence, especially that from well-controlled clinical trials, prevails.
Quite commonly, our commentators are divided about the interpretation of data, while some issues are so complex and specialised that an attempt to paint a broad consensus would be misleading.
Occasionally, others may be persuaded about a point but we demand more rigorous evidence and may resist poorly founded consensus among our commentators. Finally, where current consensus has failed to resolve a problem, a new approach may be required.
While we often have to discuss opposing, supportable arguments, the message of the article, as reflected in the conclusion, aims to be clear, unambiguous and implementable.
Ultimately, the responsibility for producing a clear message based on a weighted assessment of all the evidence and opinion gathered lies with the Editor, conferring closely with the in-house associate editor and lead editor who have assembled, evaluated and distilled the data for the final version.
Many of the articles we publish stimulate post-publication correspondence. Usually the issues raised will have been considered during the consultative stages of producing the article. It is unusual, for example, to encounter scientific data that have been overlooked during the editorial process but correspondents may take a different view of the way the data should be interpreted.
Some letters raise fresh issues that call for clarification or elaboration, or suggest an idea for a follow-up article. A correction is published if an error or oversight has occurred. Occasionally, the importance of the criticism calls for a fuller response.
DTB is published by BMJ Publishing Group Ltd and is wholly independent of Government, the pharmaceutical industry, the regulatory authorities, medical advertising or any form of commercial sponsorship.
Articles in DTB are produced after wide consultation. The editing process puts most store on data from scientifically valid clinical trials; the opinions of commentators are also taken into account.
The conclusions reflect interpretation by a team of editors and aim to provide the best available advice on treatment; they represent a weighted assessment of the evidence but not necessarily a consensus. DTB assesses published research and uses this material to reach its conclusions. This allows the reader to verify the data if they so wish.