GHP April 2016

ghp April 2016 | 55 “The time has come for a full and open public enquiry into the way evidence of the efficacy of drugs is obtained and revealed. There is real danger that some current drug treatments are much less effective than had previously been thought.” Professor John Ashton, President of the Faculty of Public Health, added: ‘Public health relies on a comprehensive, accurate and cost effective evidence base to ensure we make decisions based on the best available research that improve and protect people’s health, as well as prioritise care in the best way for patients. A public enquiry could be a useful tool in ensuring that research is published in a transparent and independent way.” Dr J S Bamrah, Chairman of the British Association of Physicians of Indian origin, commented: “There has been an alarming increase in prescriptions in the modern world which cannot be simply explained in terms of increasing disease. The context of this in regards to the dangers of over-prescribing cannot be overstated. As Dr Aseem Malhotra rightly points out, there are a number of areas where there are incentives and conflicts that doctors and researchers have either been complicit or complacent, or plainly they have failed to declare their conflicts of interest. In some cases, this will have led others to believe in their authoritative assertions. “In my own field of psychiatry there are been much abuse and overuse of a number of drugs, and this pattern is destined to repeat unless someone like Dr Malhotra stands up to the establishment. His expose deserves a high level independent enquiry by the government as otherwise patients will continue to rely on medications they need not have been prescribed by trusted doctors.” Rita Redberg, Professor of Cardiology at the Univer- sity of California, San Francisco and editor of JAMA Internal Medicine, said: “As a practicing cardiologist for 30 years as well as a journal editor for seven years, I know how important it is to have reliable high quality data in peer-reviewed medical journals. It is crucial for clinicians to be able to trust what they read. We need this trust and transparency to be able to accurately advise our patients on risks and benefits of medical treatments. “In addition, all conflicts should be disclosed, such as relationships with industry and any other potential biases. Clinical trial registration before trial initiation on publicly available sites such as clinicaltrials.gov and publishing of all results is essential, even if results are negative or show harms of a treatment. We need to know that we have full access to all relevant informa- tion. Our current system needs more work and efforts towards achieving these goals.” Dr Aseem Malhotra is an NHS Consultant Cardiologist. He writes in a personal capacity but was recently appointed to the board of trustees to the UK Health Think Tank, The King’s Fund and is a member of the Academy of Medical Royal Colleges Choosing wisely Steering Group. Research & Development