Anna Donald on drugs in the headlines

Hardly a day passes without press reports on products of one kind or another, be they heart drugs, vitamin tablets or laser surgery.

Of late: the diabetes drugs Avandia and Actos may cause heart failure. Our national heart disease director Professor Roger Boyle thinks all men older than 50 should take the anti-cholesterol drugs statins to reduce Britain's rates of heart disease and stroke. Mobile phone masts are safe after all.

What does it all mean for managers and clinicians?

No doubt it would be foolish to jump with every headline. Nonetheless, the relative value of the thousands of available products changes frequently enough, and with enough impact on health outcomes and budgets, to warrant regular review of those that we buy and use.

There are two reasons for the rapid turnover of 'best-buys.' The first is the arrival of new products, such as statins and Viagra, that put older ones in the shade.

The second reason is the continuous arrival of new research (more than 20,000 studies each week) revealing previously unknown effects in products that have been around for a while.

This is usually due to the research being carried out over a lengthy period to reveal effects that shorter studies could not; involving more participants than previous, small studies so identifying effects with more certainty; or having less-biased methods and conduct so revealing new effects.

The big HERS trial in the US revealing the cancer risk and surprising lack of cardiovascular benefit from hormone replacement therapy is an example of how new research can dramatically change products' rankings.

Given the avalanche of research and new products, it is not surprising that the 'best buy' list of products keeps changing.

And when products not only help and harm people in very different quantities, but can also vary. 500-fold or more in price, it makes sense to review products - old ones as well as new - regularly, at least once a year, with some kind of alert system for dramatic findings requiring more urgent action.

How to do it? That is a good question. Most hospitals have pharmacist-based systems for reviewing drugs and the National Institute for Health and Clinical Excellence issues guidance on a selection of new technologies.

But given the pounds and lives that could be saved, surprisingly. few NHS organisations have established systems for regularly reviewing the stockpile of drugs and devices, old and new, that they currently buy and use.

It should not be rocket science to do so. If we are that way inclined, an interesting preliminary exercise is to walk around any ward, department, surgery or theatre to see the drugs and devices and to ask ourselves, how well do they work? Which are best value? Which are gathering dust? What systems. exist to know these things? When last were they reviewed and decluttered? What is the likely financial and health cost to our institution and patients of any discrepancy between these. products and the best currently available?

While some wards are pristine, many are like my wardrobe - containing things which look terrible but cost a lot, or which were donated by a well-meaning aunt so cannot be thrown away, or which look fancy and are too complicated to use (or which still have shoulder pads - eek).

All too often, I meet people (typically at dinner parties, where I have learned that it is easier if no-one knows you are a doctor, let. alone an evidence-based one) receiving treatments which were superseded years ago and whose doctors have not pressed the update button.

Which of course gives me the. fun dilemma (not) of whether to launch into an evidence-based lecture or let them enjoy their carrots in peace while risking their heart/stomach/leg/brain. Is it worth the cost and hassle to update?

Usually it is. Among drugs and devices, there is virtually no relationship between quality and price. This means that today's most effective treatment may well be one of the cheapest.

Take aspirin, for example, for reducing the risk of second strokes. At less than 0.3 pence a day, it is more than 100 times cheaper as. well as being more effective than the next best treatments currently available.

Decluttering your medical products to include the best and exclude the worst will usually save you money. The problem, though, with the lack of a price-quality relationship, is that price cannot tell you what to do. The best treatment might be the cheapest, the most expensive, or somewhere in between.

This state of affairs is unusual, to say the least. It is hard to think of another industry in which price - as well as look and feel - does not give some indication of quality of the product: refrigerators, fruit, cars.

Frustratingly, with most medical products, price does not tell you much and can even be downright contradictory. And it is usually impossible to ascertain clinical quality by the look of a tablet or a machine that goes 'ping'.

That is why scientific evidence is so important, because it is usually the only way to tell what is best to buy, given available choices.Hopefully, this state of affairs will change.

Earlier this year, the Office of Fair Trading published its pharmaecutical price regulation scheme report, highlighting the problem and calling for pricing changes so that the market works more efficiently. Watch this space.

Dr Anna Donald is co-founder of healthcare information provider Bazian.