Talk:Attention deficit hyperactivity disorder/Archive 9

Bias
Previous editors have commented that the therapeutics initiative is an anti pharm group. Does anyone have any references to back this up? Or is it just a baseless insult from someone who doesn't agree with the conclusions of their research?

Their work is well respected by Canadian Physicians. It is used by the BC government for making policy decisions. And they are a member of the international society for drug bulletins. An organization founded with the support of the WHO http://66.71.191.169/isdbweb/pag/index.php --Doc James (talk) 05:39, 21 November 2008 (UTC)


 * On the website under "Background" it says The International Society of Drug Bulletins (ISDB) is a world wide network of bulletins and journals on drugs and therapeutics that are financially and intellectually independent of pharmaceutical industry. It was founded in 1986, with the support of the WHO Regional Office for Europe. The rationale for the Society is that drug bulletins independent of funding from industry experience problems not faced by editors and publishers of other journals.


 * It sounds great, except that editors and publishers of "other journals" are NOT faced with these problems because they are NOT funded by industry!


 * References? Scientists publish research, not lists of activist organizations. Do you have references that say that they are "well respected by Canadian Physicians"? Even if you did, it would not be particularly relevant.


 * I have full access to the libraries of several research extensive universities and NONE of them carry the bulletins published by this organization. And my schools carry everything of any use.


 * If this group was above-board, they would be affiliated with, at minimum, the CMA. They are not. They are accredited by nobody and they're throwing around some acronyms for groups that they created in order to appear credible.


 * In fact, they are not as independent as they say. They are SELECTIVELY independent. In the fine print of their description of the organization, they state that they will, upon request, carry out research for PharmaCare - A LEADER IN THE PHARM INDUSTRY!


 * The burden of defending a source - showing evidence that it is credible - is on whomever is citing the source, not those challenging the citation. However, it is clear to me that the evidence all points in one direction. The publications of activist groups are not proper sources and rhetoric that paints a picture of objectivity does not change what they are. Scientist's peers are other scientists; legitimate science is published in peer-reviewed academic journals, usually affiliated with well-known organizations like the APA, AMA, or other academic and professional associations.  ICBSeverywhere (talk) 08:49, 21 November 2008 (UTC)

PharmaCare is part of the ministry of health of British Columbia. I am not sure were "leader in the Pharm Industry" comes from. www.health.gov.bc.ca/pharme/

They are affiliated with the University of British Columbia. They are recognized by the Canadian College of Family Physicians (CCFP). The group is made up of both pharmacists and physicians.

As you state above everything that you had concerns with you latter say is correct.

This is from the Health Council of Canada

Organization : Therapeutics Initiative of British Columbia

Length of Operation : 1994 – present

Category: University-based initiative (independent organization, at arm’s-length from government, pharmaceutical industry and other vested interest groups)

Type(s) of Interventions/Activities:

Educational programs Assessment of evidence of drug benefits and harms Drug use evaluations/reviews Evaluations of impact of policies and programs

Scope: Provincial ( British Columbia)

Focus: Ambulatory/primary care and hospital/acute care

Clientele/Audience:Physicians and pharmacists in British Columbia

Description:

Mandate: The mandate is to provide an unbiased source of therapeutics information to physicians and pharmacists. The organization aspires “to effect an immediate and long term change in physician prescribing habits that will result in improved health care in the province of British Columbia” (www.ti.ubc.ca/index.html).

Organizational structure: The Scientific Information and Education Committee (SIEC), the main working body of the Therapeutics Initiative (TI), is responsible for the accuracy and quality of the drug assessment process and assists in the translation of the evidence into clinically relevant messages. There are four working groups:

Drug Assessment Working Group Therapeutics Letter Working Group Education Working Group Evaluation Working Group.

Individuals conducting the assessments are physicians, pharmacists, pharmacologists and epidemiologists, who are trained and expert in Cochrane methodology of systematic review of evidence. The reports and conclusions generated are approved by the SIEC before being sent to Pharmacare or other governmental body making the request.

Governance: Drafts of Reports and Therapeutic Letters are presented to the SIEC before final conclusions are made. The conclusions are voted on and, if passed by a simple majority, are accepted as the position of the TI regarding the scientific evidence.

Stakeholder input: The SIEC is made up of family physicians, specialists, academic researchers, clinical pharmacologists, pharmacists and epidemiologists. In addition, there is a list of committed medical specialists who provide expertise as needed. Specialists who are expert in the particular therapeutic area and members of the Scientific Information and Education Committee review Therapeutics Letters (a bi-monthly newsletter). Feedback on Therapeutics Letters is encouraged and is posted on the website, along with any subsequent responses.

Priority-setting mechanism: Priorities for the Therapeutics Letter are based on available expertise and drugs that are widely prescribed in primary care.

Infrastructure:

Human resources: The Drug Assessment Working Group (DAWG) consists of 3 family physicians, 2 clinical pharmacologists, 1 bio-statistician, 1 epidemiologist, 1 clinical trial expert and graduate students. The TI employs 7 FTEs and approximately 10 individuals on a part-time basis.

Financial resources: In 1994, a five-year annual $540,000 grant was provided from BC’s Ministry of Health. The most recent grant starting in 2004 is an eight-year, $1 million per annum grant from the Ministry of Health (UBC Reports Vol. 50, No.11, Dec. 2, 2004). Fees are charged to the Annual Drug Therapy Course participants. The TI also receives funding from CADTH for work for the Common Drug Review and other projects and from the Canadian Blood Services.

Data: The Therapeutics Initiative has access to up to date information from Pharmanet, Medical Services Plan and MSP coverage databases. Hospital separations data are available with about a six-month lag.

Products:

DAWG reports: The Drug Assessment Working Group (DAWG) produces detailed reports. Their purpose is to clarify the state of scientific evidence regarding the effectiveness and safety of drug therapy and to relate that evidence to the care of individual patients. Assessments follow a prescribed methodology with defined criteria/strategies detailed on the TI website. The preferred form of publication is a full trial report in a peer-reviewed journal. All reports containing evidence or interpretation of evidence are sent out for external review. Approximately 30 reports are completed annually (UBC Reports Vol. 50, No. 11, Dec. 2, 2004). Many reports are summarized and published in the Therapeutics Letters, which are available at no cost on the TI website. Reports are commonly shared with other drug plan managers.

Published articles: See list of published articles below.

Therapeutics Letter: A bi-monthly newsletter is produced by the Therapeutics Letter Working Group of the Therapeutics Initiatives, targeting problematic therapeutic issues for physicians and pharmacists in British Columbia. Prior to dissemination, the Therapeutics Letter is reviewed by experts in the field and the SIEC. Circulation is approximately 10,000 (UBC Reports Vol. 50, No. 11, Dec. 2, 2004). Since 1994 there have been 62 Therapeutic Letters produced, covering various topics, such as Clinical Pearls from Prescribe (Therapeutic Letter #60); Drugs for overactive bladder symptoms (Therapeutic Letter #57); Benign Prostatic Hypertrophy: An update on drug therapy (Therapeutics Letter #58); Increasing Drug Costs: Are we getting good value? (Therapeutics Letter #59).

Annual drug therapy course: A two-day drug therapy course for professionals in family practice, internal medicine and pharmacy is interactive and focused on common and new drug therapy issues from an evidence-based perspective. The 18th Annual Drug Therapy Decision Making Course is scheduled for March 2007 with an early registration fee of $450. Participants receive CME credits. The course is delivered by guests and local educators. Examples of the topics covered include: 5 papers that should change what you do; litigation; guidelines; colic treatment; drug suits; bipolar disorder; ADHD; BP measurements; herpes zoster immunization; fungal toe infections; and renal stones. There were 330 participants at the 2006 drug therapy course.

Community-based courses: Drug Therapy (TI Roadshow) provides small group drug therapy educational sessions for family physicians, internists, other interested specialists, pharmacists and nurses involved with patient drug therapy. The focus is optimizing patient benefit using interactive techniques to demonstrate evidence-based and cost-effectiveness data, using interactive, patient-oriented and problem-solving presentations. Participants receive credits from the College of Family Practice Continuing Medical Education and the College of Pharmacists Continuing Pharmacy Education. The November 2006 session, held in Prince George, was “Just say know to drugs.” The cost to participants was $25. During 2006, there were 33 community-based courses with about 1,500 participants; the majority were held in British Columbia.

Evaluation:

The impact on prescribing of selected TI educational programs is assessed using BC’s Pharmanet database and applying epidemiologic methods. Evaluation results are published in peer-reviewed journals where appropriate. (See below for published evaluations.) Evaluation methods include the following:

The impact of newsletters is evaluated by a randomized control trial.

Courses are evaluated using a controlled time series design.

The impact on health and health care utilization is also assessed. For example, the 2005/2006 Report 8 by the Office of the Auditor General of British Columbia (March 2006), Managing Pharmacare: Slow progress toward cost-effective drug use and a sustainable program, indicates that the TI program was included in the review of the Pharmacare program. The report concludes that “progress to expand these useful initiatives [including TI] to maximize their benefit has been slow” with the key factors being “lack of sufficient human resources, clear direction, appropriate performance measures and key accountabilities” (p. 2). Strategies for Knowledge Translation and Exchange:

Therapeutic Initiatives products, described above, are strategies with targeted audiences:

Courses. Available to physicians and pharmacists, accessible outside the urban areas of British Columbia.

Newsletters. TheTherapeutic Letter is a bi-monthly letter that uses brief, simple, practical messages. As a member of the International Society of Drug Bulletins, it has an international audience (http://66.71.191.169/isdbweb/pag/summary.php).

Collaborations. A Therapeutics Initiative International Network facilitates collaboration with other groups involved in evidence-based drug assessment, therapeutic criteria and guidelines development and physician and pharmacist educational research.

Common drug reviews. TI members complete these for the federal government (CADTH). Challenges/Barriers Encountered:

Dissatisfaction with Therapeutics Initiative by some physicians. An article in the BC Medical Journal (Vol. 43, No. 2, March 2001), authored by 12 physicians, expressed concern about Therapeutics Initiative. Concerns identified were: a lack of openness regarding selection of experts and other participants involved in the process and their compensation, institutional allegiances, budget and financial arrangements (i.e. not all information was disclosed, such as physicians’ clinical experience); and an unclear process of appeal. The TI provided a written response to this challenge and after some delay it was published in the BC Medical Journal (www.bcma.org/public/bc_medical_journal/bcmj/2006/may_2006/pv_bassett.asp).

Lack of cost data. Therapeutics Initiative has been perceived by some not to be independent from the provincial government’s interest in decreasing Pharmacare costs. However, TI reviews and reports to government did not include cost data and have been limited to evidence of drug benefits and harms derived from clinical trials (interview with Dr. Wright, UBC Reports Vol. 50, No. 11, Dec. 2, 2004). Facilitators Identified:

Active involvement with international organizations. Therapeutics Initiative members are actively involved in The Cochrane Collaboration, which provides “vision for greater access to reliable and unbiased data” (interview with Dr. Wright, UBC Reports Vol. 50, No. 11, Dec. 2, 2004).

Awards:

Health Services Research Advancement Award, $5000; Canadian Health Services Research Foundation, Presented to Dr. James M. Wright, representing the Therapeutics Initiative, September 17, 2005, Montréal.

Praise for TI: “The Therapeutics Initiative has made an exceptional impact on prescription drug practices in British Columbia by disseminating research-based evidence about commonly used therapies to the physicians and pharmacists in British Columbia, as well as to the public Pharmacare program and the British Columbia Ministry of Health. This outstanding effort has positively influenced prescription practices.” www.chsrf.ca/funding_opportunities/hsraa/2005_e.php

Address:

Therapeutics Initiative of British Columbia University of British Columbia 2176 Health Sciences Mall Vancouver, BC Canada V6T 1Z3 Telephone: 604-822-0700 Fax: 604-822-0701 Email:  info@ti.ubc.ca  This email address is being protected from spam bots, you need Javascript enabled to view it

Website: www.ti.ubc.ca

Selected References:

Therapeutics Letters published in peer-reviewed journals

Bassett K, Mintzes B, Musini VM, Perry TL Jr., Wong M, Wright JM. (2002). New Drugs VII: Mirtazapine, salmon-calcitonin nasal spray, gatifloxacin and moxifloxacin. Canadian Family Physician; 48:1780–1785.

Bassett K, Wright JM, Puil L, Perry TL Jr., Heran B, Cole C. (2002). Cyclooxygenase-2 inhibitor update: Journal articles fail to tell the full story. Canadian Family Physician; 48:1455–1460.

Cassels A, Wright JM, Mintzes B, Jauca C. (2001). Direct-to-consumer advertising. Finasteride for male pattern hair loss. Canadian Family Physician; 47:1751–1755.

Garland EJ, Wright JM. (2007). Antidepressant medications in children and adolescents. Médecine; 3:109-111.

Jauca C, Wright JM. Therapeutics Letter: Update on statin therapy. (2003). International Society of Drug Bulletins Newsletter; 17(3):7–9.

McCormack J, Rangno R, Wright JM. (2003). Thiazides first-line treatment for hypertension. Canadian Family Physician; 49:879.

Mintzes B, Bassett K, Wright JM. (2001). Prevention and treatment of influenza A and B. Canadian Family Physician; 47:2242–2247.

Puil L, Mail J, Wright JM. (2002). Asymptomatic bacteriuria in pregnancy. Rapid answers using the Cochrane Library. Canadian Family Physician; 48:58–64.

Wright JM, Musini V, van Breemen, M, Jauca CD. (2003). Update on combined HRT. Canadian Family Physician; 49:599.

Wright JM, Puil L, Lee C, Bassett K. (2002). Serious adverse event analysis: Lipid-lowering therapy revisited. Canadian Family Physician; 48:486–495.

Wright, JM. Management of anxiety disorders in primary care. (1997). Therapeutics Letter 18. Canadian Journal of Clinical Pharmacology; 4:64–66.

Wright, JM. Review and update 1996. (1997). Therapeutics Letter 16. Canadian Journal of Clinical Pharmacology; 4:12–13.

Drug Assessment Working Group publications

McCormack J, Perry TL Jr., Rangno R, van Breemen C, Wright JM. (2002). Assessing the quality of clinical practice guidelines. CMAJ; 166:168–169.

Mintzes B, Bassett K, Wright JM. (2002). Drug safety without borders: Concerns about bupropion. CMAJ; 167:447.

Morgan S, Bassett KL, Mintzes B. (2004). An outcomes-based approach to decisions about drug coverage policies in British Columbia. Psychiatric Services; 55:1230–1232.

Morgan S, Bassett KL, Mintzes B. (2004). Outcomes-based drug coverage in British Columbia. Health Affairs; 3:269–275.

Wright JM, Perry TL Jr., Bassett K, Chambers K. (2001). Reporting of 6 month versus 12 month data in the celecoxib trial. JAMA; 286:2398–2400.

Drug Evaluation Working Group publications

Dormuth CR, Maclure M, Bassett K, Jauca C, Whiteside C, Wright JM. (2004). Periodic letters on evidence-based drug therapy improves prescribing: A randomized trial. CMAJ; 171:1057–1061.

Herbert C, Wright JM, Maclure M, Dormuth C, Wakefield J, Premi J, et al. The Better Prescribing Project – a randomized controlled trial of a case-based educational feedback intervention to support evidence-based practice. CAME Newsletter. May 2000.

Herbert CP, Wright JM, Maclure M, Wakefield J, Dormuth C, Brett-MacLean P, et al. (2004). Better Prescribing Project: a randomized controlled trial of the impact of case-based educational modules and personal prescribing feedback on prescribing for hypertension in primary care. Family Practice; 21:575–581.

Maclure M, Dormuth C, Naumann T, McCormack J, Rangno R, Whiteside C, Wright JM. (1998). Influences of educational interventions and adverse news about calcium channel blockers on first-line prescribing of antihypertensive drugs to elderly people in British Columbia. The Lancet; 352:943–948.

Mandami M, Warren L, Kopp A, Paterson M, Laupacis A, Bassett KL, Anderson G. (2006). Interprovincial differences in population rates of upper gastrointestinal bleeding following introduction of COX2 inhibitors. CMAJ; 175:1535–1538.

Mintzes B, Morgan S, Yan L, MacMahon M, Bassett KL. (2005). Medicine by media: Did a critical television documentary result in more appropriate prescribing of cyproterone-estradiol (Diane-35)? CMAJ ; 173:1313–1315.

Mintzes M, Barer M, Lexchin J, Bassett KL. (2005). Introduction of direct-to-consumer advertising of prescription drugs in Canada: An opinion survey on regulatory policy. Social & Administrative Pharmacy ; 1:310–330.

Morgan S, Bassett KL, Wright JM, Yan L. (2005). First-line first? Trends in thiazide prescribing in BC seniors. PLoS Med; 2:80

Morgan SG, Bassett KL, Wright JM, Evans RG, Barer ML, Caetano PA, Black CD. (2005). Breakthrough drugs and growth in expenditures on prescription drugs in Canada. BMJ; 331: 815 – 816.

Paterson MJ, Bassett KL, Laupacis A, Anderson GM, for the BC–Ontario Pharmacosurveillance for Decision-Making Collaborative. (2006). Data sharing for more informed drug coverage policy: Initial results from a two-province collaborative. Health Affairs; 25:1436–1443.

Wakefield J, Herbert CP, Maclure M, Dormuth C, Wright JM, Legare J et al. (2003). Commitment to change statements can predict actual change in practice. Journal of Continuing Education in the Health Professions; 23:81–93.

http://www.healthcouncilcanada.ca/en/index.php?option=com_content&task=view&id=199&Itemid=10

--Doc James (talk) 09:17, 21 November 2008 (UTC)


 * Well, I stand corrected - sort of. In the U.S., Pharmacare is a perscription plan manager and a subsidiary of CVS - the largest med provider in the country. I apologize for that error, but it is not clear in the documentation. Perhaps it's obvious to Canadians, but I am not a Canadian.


 * Nothing else you have included here is relevant, and a link to the website would have sufficed. In fact, most of it has nothing to do with anything discussed here.


 * As you state above everything that you had concerns with you latter say is correct.


 * That statement makes no sense. I said nothing of the sort, nor have I contradicted myself.


 * Some of the references you listed are sources that I would consider acceptable and some are not, but you did not reference any of THOSE. The source in question is an article published in a NEWSLETTER.


 * Regardless, the quality of an article relies on a number of factors and the quality of the source (journal in which it is published) is a first-pass evaluation. "Therapeutic Letter" does not qualify as a good source for accurate scientific knowledge - period. If it did, I would then evaluate the article itself - the method, the premises, the conclusion. Having read the article in question, I can say that it would not survive that pass, either. It is selective, misleading, and obviously biased. In my opinion, it borders on propaganda.


 * What I don't understand is why there is so much discussion over a single source. If the statement you were trying to make (whatever it is) is accurate, surely there is another, more legitimate, source that supports it!
 * ICBSeverywhere (talk) 05:23, 26 November 2008 (UTC)

Another ref has been added to support the passage.--Doc James (talk) 05:27, 26 November 2008 (UTC)this is all crap and not true!!!!!!!! take it off!!!!!

Award received by the TI
This is from the Canadian Health Services Research Foundation. Justifying my comment that they are a well respected organization in Canada.

http://www.chsrf.ca/funding_opportunities/hsraa/2005_e.php

--Doc James (talk) 09:21, 21 November 2008 (UTC)

Their courses qualify as CME activity for the College of Family Practice Continuing Medical Education and the College of Pharmacists Continuing Pharmacy Education.

--Doc James (talk) 09:24, 21 November 2008 (UTC)

Review method used
The TI uses a standardized systematic review methodology. This includes a replicable search of computerized bibliographic databases (Med line, EMBASE, Cochrane Database of Systematic Reviews, Web of Science) as well as the drug reviews that are posted on the US FDA’s web site and the manufacturer’s submission to PharmaCare. The goal is to en sure that these reviews are based on all available randomized trials. A multidisciplinary working group, including pharmacologists, physicians, pharmacists, epidemiologists, and a biostatistician, assists with each review.http://www.bcmj.org/therapeutics-initiative-role-and-function --Doc James (talk) 09:57, 21 November 2008 (UTC)

Strange that they would go to all that trouble yet not publish in ANY journal. Because of this, it fails the criteria of an ideal source. As mentioned before the "review" also does not state who the authors are on the review, although you have stated who the authors are. Now you said that the people working on this project are your friends. Did you play any role in this organization or the publication of this letter?--scuro (talk) 12:22, 1 December 2008 (UTC)


 * It is a government funded organization and there for published by the organization. There have been letters that have been published in journals however this one was not.  I know some of the authors however have played no role in the organization or the TIs publications.--Doc James (talk) 17:28, 1 December 2008 (UTC)


 * It doesn't meet the criteria of an ideal source. That is where the discussion should stop.--scuro (talk) 18:05, 1 December 2008 (UTC)

It does meet the criteria of a good source and possibly an ideal one. As this seems to be such an issue I will poss the question of if this source can be used on med pages. http://en.wikipedia.org/wiki/Wikipedia_talk:WikiProject_Medicine#Ref_sources Doc James (talk) 19:49, 1 December 2008 (UTC)


 * Have added a number of references that agree with the TIs conclusions. One is a book by Dr. Barkelys the another is a published meta analysis.  Hopefully this will put these questions to rest.  The TI may not be an ideal source but what it says is supported by multiple other publications and is not actually controversial.  Doc James (talk) 16:13, 2 December 2008 (UTC)

Global cerebral metabolism in ADHD
I have looked into the PET scan study by Zametkin from 1990. He has done further work in 1994 and 1997 which doesn't seem to support his study from 1990. Not one else has it seems done further work on this area. Not sure if this is notable, but I have balanced his first conclusions by adding his subsequent conclusions.Doc James (talk) 07:33, 23 November 2008 (UTC)