E-DRUG: WHO/ISH Hypertension guidelines

["Prescrire / International " <internat@prescrire.org>]

E-DRUG: WHO/ISH Hypertension guidelines
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Dear Colleagues,

I am forwarding you a copy of our last correspondence sent to Dr Gro Harlem
Brundtland concerning the 1999 World Health Organization - International
Society of Hypertension Guidelines for the Management of Hypertension.

Should you wish to receive the whole correspondence and detailed critique
of the WHO/ISH guidelines, please send your mail address to:

La revue Prescrire
B. P. 459
75527 Paris Cedex 11
France
fax: + 33 1 48 06 52 37
e-mail : international@prescrire.org

Kind regards

Gilles Bardelay
Editor-in-Chief
La revue Prescrire 


__________

Dr Gro Harlem Brundtland
Director General
World Health Organization
Avenue Appia 20
1211 Geneva 27
Switzerland


Paris, 26 August 1999

Re: 1999 World Health Organization / International Society of Hypertension
Guidelines for the Management of Hypertension 

Dear Dr Brundtland,

We acknowledge the receipt of Dr. Jie Chen's response d.d. 2 June 99 to our
letter of April 16 in which we expressed our concerns about the 1999 WHO
ISH Guidelines for the Management of Hypertension.

WHO considers the debate that has been generated by the Guidelines a
positive development. We are therefore disappointed by WHO's response to
the criticism. The fact that the guidelines were prepared by eminent
international experts using the latest information from epidemiological
studies and randomized controlled trials does not provide guarantees for
the quality and the reliability of treatment guidelines nor does it clarify
the methodology that was used to create these guidelines.

Your letter raises a few questions to which we would appreciate a response:

1.	You mention that the current WHO/ISH recommendations will be
subject to review. This leaves unclear what the status of the present
guidelines is.
Does this mean that WHO has not endorsed them in the present form? When
will the review be concluded?

2.	 Your refer to the WHO's guidelines on relationships with
commercial enterprises and the document outlining the principles and
methodologies for the elaboration of therapeutic guidelines presently being
developed by the Noncommunicable Disease Cluster. Could we receive a copy
of these documents as soon as they are finalised?

3.	You mention the newly set up Committee on Private Sector
Collaboration.
What will be the terms of reference for the Committee on Private Sector
Collaboration? Who are the members of this committee? Which criteria and
guidelines will the committee use while judging whether a certain
collaboration may present a conflict of interest? 

In early 1998 La revue Prescrire was invited by the Drug Action Programme
(the present EDM) to become a WHO Collaborating Centre. La revue Prescrire
has a long history of collaboration with WHO. A few examples include:
participation in roundtables regarding drug information, contribution to
consultations on the implementation of WHO ethical criteria for medicinal
drug promotion, and participation in training workshops in the different
regions. La revue Prescrire also offers internships for starting editors
from developing countries and Eastern and Central Europe and participates
in the joint ISDB WHO manual for drug bulletins presently being finalised. 
At the time we were honoured by the request to become a WHO Collaborating
Centre and our initial response was positive. After careful consideration
we have decided not to follow through with the process to become a WHO
Collaborating Centre. Our intention is not to close the door to joint work
or collaboration. We will continue our contribution to WHO's work in the
area of rational drug use and drug information. But until we see guarantees
for safeguarding WHO's independence in the near future, we do not wish to
formalise our collaboration and in doing so endorse policies we cannot
support. 
Independence in the development of therapeutic information, rigorous review
procedures and clear editorial policies are prerequisites for the
reliability of the information. In every country around the world the
proper use of medicine depends on four main actors: consumers, health
professionals, government and the pharmaceutical and health care industry.
They each have their own missions, roles and responsibilities. As a result
of the industry's mission - which is to satisfy the shareholders through
maximising profits- and the stiff competition in the pharmaceutical market,
companies will promote their products heavily by emphasising positive
aspects and mentioning negative aspects as little as possible. Therefore
comparative information - essential to make well-informed therapeutic
choices - is not provided by pharmaceutical companies. 

This task has to be taken up by others including health professionals,
national governments and international organisations such as the WHO. These
actors must assure that public interest prevails over commercial interest.
They can only do this by performing their functions independently from
commercial influence. We acknowledge that cooperation between commercial
and non-commercial actors in the health field can be very useful. But each
actor should work with a clear understanding of its own mission and
independently from the others. This clarity seems to be missing in the
present direction WHO is taking.
We hope that the future will give us reason to reconsider our decision. I
look forward to receiving your response. 

Sincerely yours,
Dr Gilles Bardelay
Editor-in-chief

Cc: Dr. Jie Chen, Dr Michael Scholtz, Dr. Jonathan Quick.

 
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