Library (Scientific Research) Section
clearly needed within the Health Service, they require adequate supporting staff, and that both clinical pharmacology and pharmacy are essential ingredients.
253
Drug Information Centres: an Industry View
on the proper usage of company products and on their use in unusual circumstances, either proper or improper. Generally, this type of information is required speedily, frequently in an emergency, and it must, therefore, be accurate and succinct. Passive information is more detailed information, not normally required for routine use, where the breadth and depth of the search are of paramount importance. This type of information is more likely to be required by clinical investigators, or for academic research projects using company products. Many of these information commitments are of an ongoing nature, for example, our department has for some time been collaborating with a group working in the field of hypertension associated with pregnancy.
A drug information centre in industry can range from one person with very limited facilities to a large department using highly sophisticated techniques. In a few cases they are sufficiently large to be divided into a group dealing with purely internal documentation requirements, and another group dealing with medical information, as an extension of the medical services function. In most companies such units are part of the research or medical departments but in some, and particularly when they are large, they are responsible to technical servicing management. Our department is not divided in this way, and we provide a documentation back up which supports the fundamental research and development programmes as well as the marketing, clinical research and medical services functions; for all these groups we provide an access point to the published literature. As far as the fundamental research programme is concerned this is generally the extent of our involvement, but with a continuing commitment; some of the other functions, however, require an interpretative service, such as the evaluation of equivocal literature. We also provide a medical information service for enquiries from outside the company: from members of the medical, pharmaceutical and allied professions, as well as from academic institutes. Such enquiries come from the most senior to the most junior members of the professions, and are extremely wide ranging in nature. To be of value the information given must be accurate, factual, professionally sound and quickly provided. Where necessary the information officer must be prepared to take an interpretative role; to do this and to maintain a high standard, one must have access to comprehensive data resources on one's own and comparative products, as well as an efficient retrieval system which may be manual or computerized. Broadly speaking, this information can be divided into two categories: 'active' and 'passive'. Active information is basic information
Value of Drug Information Centres in Industry Drug information centres in industry have access to all the detailed knowledge accumulated from the time a drug was first developed: they have the key to information in the published literature, the knowledge of unpublished documentation, records of usage in unusual circumstances and, very important, access to the relevant experts. It is this breadth and depth of information that makes the industrial information centre unique for its own products; often what is an unusual, once-in-alifetime event to a particular practitioner has happened to others, and relevant data, filed away in the information centre, can be retrieved easily should the need arise. One of the major assets of information services in the industry, certainly as far as large companies are concerned, is the wide coverage of the scientific literature; there are hundreds of possibly relevant journals published in many languages and, for example, my own company counts on having about 95 % coverage of them, the information gleaned then being made available to all subsidiaries. It is not generally realized that in many large companies the information service is available twenty-four hours a day, seven days a week. Any user can contact the company out of hours; our telephone recording machine is cleared every hour, and the medical information staff are contacted if required. Any professional person can use the resources of the department directly, to amplify his knowledge, to reassure himself or to confirm information given to him by a third party. Moreover, company drug information units are often aware of work in progress or still unpublished both within and outside the company, though discretion may be needed in deciding whether and how to use it if it is relevant to the problem on hand. People working in drug information in industry have a detailed knowledge of a limited number of drugs and they are, therefore, very much aware of what facts need to be established before any query
REFERENCE Davies D M, Ashton C H, Rao J G, Rawlins M D, Routledge P R, Savage R L, Thompson J W & Zar M A (1976) British Medical Journal i, 89
Miss Pamela Buckland (CIBA Laboratories, Horsham, Sussex)
254
Proc. roy. Soc. Med. Volume 70 April 1977
concerning one of these drugs can be answered. Practising doctors or other intermediaries, on the other hand, often fail to realize what is relevant, and incomplete facts can lead to fruitless work or to incorrect judgments being made. The literature on successful drugs is vast and even research workers capable of doing their own search lack the time and resources. Company information departments can direct workers to the correct area with considerable saving of time. We do not see it as part of our role to undertake complex literature searches for everyone; however, we can give initial directional assistance or give some idea whether, for example, a certain proposed piece of work has been done previously and if so what the outcome was. Hospital Drug Information Centres No one, it seems to me, has really defined the role of drug information centres in hospital, and just as it is unclear to me, it is probably unclear to members of the medical profession, as well as to retail pharmacists and other ancillary medical staff. Some information centres make valid enquiries and are prepared to assume a responsible adviser/intermediary role. Others put forward imprecise queries and are surprised when one tries to clarify them; and, not infrequently, we receive a request for 'all information on your products X, Y and Z'; if we did send everything we have on, for example, Butazolidin and Serpasil, it would require a pantechnicon to deliver it. Some hospital units are prepared to act as a service to medical, pharmaceutical and ancillary services in a larger area, and this one welcomes, so long as they are quite sure that the service they offer is within their resources. I see the role of the hospital unit as similar to that in industry with active and passive functions; its particular value being the wealth of information and expertise available by virtue of its location. It is in an ideal position to have at hand all the standard texts and data sheets, and to be able to provide speedy information on general drug usage. Many of those using the unit will do so because they have information which they suspect is outdated and great care should, therefore, be exercised to ensure that information is kept up to date. Information is a constantly changing scene: what is accurate and good advice today can be superseded next week, so all documents must be dated at the time of compiling and checked that they are still good current information at the time of use. There should also be a ready reference to the names and telephone numbers of information colleagues in the various pharmaceutical companies. A hospital information unit is in an ideal situation to give general advice on the range and characteristics of drugs available in particular
therapeutic categories. However, it is important that judgments should be based on professional rather than on political or purely economic considerations; in the last event, it is the clinician who must select a drug for a particular patient. It would also seem natural to go to the hospital unit for information concerning the use of drugs in unusual circumstances, and though one would not necessarily expect the information to be immediately available in the department, the information pharmacist would in such cases contact an information officer in the company involved and act as an important intermediary; part of his or her function being to ensure that the fullest possible information has been obtained from the enquirer and that the query is followed through. Moreover, manufacturers need feedback to compile drug profiles, and so are grateful if someone takes the trouble to tell them the outcome of an unusual usage of one of their products; drug information staff are ideally placed to assume such a role. Recently there were queries from more than one unit concerning the penetration of drugs into breast milk; relatively little is known about this as, for ethical reasons, many drugs are not given to nursing mothers, but if they have to be, my company always offer to assay samples sent to us when the patient has been having drugs manufactured by us. More data are not collected because so few samples are sent and a coordinator would, therefore, be carrying out a real service for the particular patient and other potential patients. Further, one could envisage units in the various regions accumulating information on particular topics. For example, another query we received recently concerned the sugar content of tablets, and in such cases units with a special interest could form a liaison with industry so that the information is up to date and they may become known for this particular service. Information units working in isolation lead to needless duplication and to problems being tackled at a very superficial level, because of limited facilities. Regarding what I term passive information, the hospital unit is in an ideal situation to collect information on members of a group of drugs. Again I see this being carried out in collaboration with industrial units, as individual hospitals or even regions are unlikely to have the facilities to do it comprehensively; a budget of about £100 000 per annum would be considered quite modest for such a department in the industry, and that gives some idea of the resources necessary to carry out this task in a professional manner. There is also scope for hospital units to collect information on drug usage, either in conventional or unusual circumstances, and on side-effects and drug interactions. Here again industry would welcome feedback, which could well be of help to some other hospital.
255
Interface between Hospital
and Industrial Drug Information Centres The interface between hospital and industrial units has no fine demarcation. Industry will continue to receive requests from doctors and pharmacists which are quite easily answerable within the hospital. On the other hand, hospital departments will get intricate queries which they cannot be expected to answer. It is up to the hospital units to make contact with the information officers in industry who can best help them, and if hospital units are to develop this intermediary role, the calibre of the staff must be high because it is easy for misinterpretation and mistakes to arise. It is essential that everyone concerned is suitable both in terms of professional training and experience to form an effective link; all too often, through lack of experience, basic information does not reach the manufacturer because the link person failed to see its relevance, or alternatively did not ask the enquirer the additional questions necessary. Such an important appointment should therefore be filled by someone who has had several years' experience as a pharmacist and has accumulated sufficient clinical and biochemical knowledge to appreciate the rationale behind drug therapy. In industry such departments are usually in the charge of people with considerable experience and breadth of knowledge.
It is clear that there is no future in hospitals endeavouring to establish comprehensive information on every drug. This is not only impossible but is a ludicrous waste of money when the resources of industry are already available. It has been said that information from industry is biased; however, there is a code of ethics among staff in industrial units to give honest advice. In any case, to have a company's product used when there is likely to be an unfavourable clinical response will ultimately damage a drug's reputation.
Central Data Bank We should also briefly consider the rumoured central drug information bank. In concept this is nothing more than a comprehensive store of drug data. All such sources are only as good as the people operating them both in terms of input and retrieval, and as it would be impossible to find persons to run such a service with sufficient depth of knowledge in all areas, their powers of retrieval and interpretation would be limited. By definition such a service could only expect to have breadth of knowledge, but this is already available in hospital information centres, which surely are the most appropriate places for it to be developed and stored. Depth of knowledge is available in industry, in commercial literature retrieval services, at the National Lending Library, professional libraries and in some regional hospital libraries.
clearly needed within the Health Service, they require adequate supporting staff, and that both clinical pharmacology and pharmacy are essential ingredients.
253
Drug Information Centres: an Industry View
on the proper usage of company products and on their use in unusual circumstances, either proper or improper. Generally, this type of information is required speedily, frequently in an emergency, and it must, therefore, be accurate and succinct. Passive information is more detailed information, not normally required for routine use, where the breadth and depth of the search are of paramount importance. This type of information is more likely to be required by clinical investigators, or for academic research projects using company products. Many of these information commitments are of an ongoing nature, for example, our department has for some time been collaborating with a group working in the field of hypertension associated with pregnancy.
A drug information centre in industry can range from one person with very limited facilities to a large department using highly sophisticated techniques. In a few cases they are sufficiently large to be divided into a group dealing with purely internal documentation requirements, and another group dealing with medical information, as an extension of the medical services function. In most companies such units are part of the research or medical departments but in some, and particularly when they are large, they are responsible to technical servicing management. Our department is not divided in this way, and we provide a documentation back up which supports the fundamental research and development programmes as well as the marketing, clinical research and medical services functions; for all these groups we provide an access point to the published literature. As far as the fundamental research programme is concerned this is generally the extent of our involvement, but with a continuing commitment; some of the other functions, however, require an interpretative service, such as the evaluation of equivocal literature. We also provide a medical information service for enquiries from outside the company: from members of the medical, pharmaceutical and allied professions, as well as from academic institutes. Such enquiries come from the most senior to the most junior members of the professions, and are extremely wide ranging in nature. To be of value the information given must be accurate, factual, professionally sound and quickly provided. Where necessary the information officer must be prepared to take an interpretative role; to do this and to maintain a high standard, one must have access to comprehensive data resources on one's own and comparative products, as well as an efficient retrieval system which may be manual or computerized. Broadly speaking, this information can be divided into two categories: 'active' and 'passive'. Active information is basic information
Value of Drug Information Centres in Industry Drug information centres in industry have access to all the detailed knowledge accumulated from the time a drug was first developed: they have the key to information in the published literature, the knowledge of unpublished documentation, records of usage in unusual circumstances and, very important, access to the relevant experts. It is this breadth and depth of information that makes the industrial information centre unique for its own products; often what is an unusual, once-in-alifetime event to a particular practitioner has happened to others, and relevant data, filed away in the information centre, can be retrieved easily should the need arise. One of the major assets of information services in the industry, certainly as far as large companies are concerned, is the wide coverage of the scientific literature; there are hundreds of possibly relevant journals published in many languages and, for example, my own company counts on having about 95 % coverage of them, the information gleaned then being made available to all subsidiaries. It is not generally realized that in many large companies the information service is available twenty-four hours a day, seven days a week. Any user can contact the company out of hours; our telephone recording machine is cleared every hour, and the medical information staff are contacted if required. Any professional person can use the resources of the department directly, to amplify his knowledge, to reassure himself or to confirm information given to him by a third party. Moreover, company drug information units are often aware of work in progress or still unpublished both within and outside the company, though discretion may be needed in deciding whether and how to use it if it is relevant to the problem on hand. People working in drug information in industry have a detailed knowledge of a limited number of drugs and they are, therefore, very much aware of what facts need to be established before any query
REFERENCE Davies D M, Ashton C H, Rao J G, Rawlins M D, Routledge P R, Savage R L, Thompson J W & Zar M A (1976) British Medical Journal i, 89
Miss Pamela Buckland (CIBA Laboratories, Horsham, Sussex)
254
Proc. roy. Soc. Med. Volume 70 April 1977
concerning one of these drugs can be answered. Practising doctors or other intermediaries, on the other hand, often fail to realize what is relevant, and incomplete facts can lead to fruitless work or to incorrect judgments being made. The literature on successful drugs is vast and even research workers capable of doing their own search lack the time and resources. Company information departments can direct workers to the correct area with considerable saving of time. We do not see it as part of our role to undertake complex literature searches for everyone; however, we can give initial directional assistance or give some idea whether, for example, a certain proposed piece of work has been done previously and if so what the outcome was. Hospital Drug Information Centres No one, it seems to me, has really defined the role of drug information centres in hospital, and just as it is unclear to me, it is probably unclear to members of the medical profession, as well as to retail pharmacists and other ancillary medical staff. Some information centres make valid enquiries and are prepared to assume a responsible adviser/intermediary role. Others put forward imprecise queries and are surprised when one tries to clarify them; and, not infrequently, we receive a request for 'all information on your products X, Y and Z'; if we did send everything we have on, for example, Butazolidin and Serpasil, it would require a pantechnicon to deliver it. Some hospital units are prepared to act as a service to medical, pharmaceutical and ancillary services in a larger area, and this one welcomes, so long as they are quite sure that the service they offer is within their resources. I see the role of the hospital unit as similar to that in industry with active and passive functions; its particular value being the wealth of information and expertise available by virtue of its location. It is in an ideal position to have at hand all the standard texts and data sheets, and to be able to provide speedy information on general drug usage. Many of those using the unit will do so because they have information which they suspect is outdated and great care should, therefore, be exercised to ensure that information is kept up to date. Information is a constantly changing scene: what is accurate and good advice today can be superseded next week, so all documents must be dated at the time of compiling and checked that they are still good current information at the time of use. There should also be a ready reference to the names and telephone numbers of information colleagues in the various pharmaceutical companies. A hospital information unit is in an ideal situation to give general advice on the range and characteristics of drugs available in particular
therapeutic categories. However, it is important that judgments should be based on professional rather than on political or purely economic considerations; in the last event, it is the clinician who must select a drug for a particular patient. It would also seem natural to go to the hospital unit for information concerning the use of drugs in unusual circumstances, and though one would not necessarily expect the information to be immediately available in the department, the information pharmacist would in such cases contact an information officer in the company involved and act as an important intermediary; part of his or her function being to ensure that the fullest possible information has been obtained from the enquirer and that the query is followed through. Moreover, manufacturers need feedback to compile drug profiles, and so are grateful if someone takes the trouble to tell them the outcome of an unusual usage of one of their products; drug information staff are ideally placed to assume such a role. Recently there were queries from more than one unit concerning the penetration of drugs into breast milk; relatively little is known about this as, for ethical reasons, many drugs are not given to nursing mothers, but if they have to be, my company always offer to assay samples sent to us when the patient has been having drugs manufactured by us. More data are not collected because so few samples are sent and a coordinator would, therefore, be carrying out a real service for the particular patient and other potential patients. Further, one could envisage units in the various regions accumulating information on particular topics. For example, another query we received recently concerned the sugar content of tablets, and in such cases units with a special interest could form a liaison with industry so that the information is up to date and they may become known for this particular service. Information units working in isolation lead to needless duplication and to problems being tackled at a very superficial level, because of limited facilities. Regarding what I term passive information, the hospital unit is in an ideal situation to collect information on members of a group of drugs. Again I see this being carried out in collaboration with industrial units, as individual hospitals or even regions are unlikely to have the facilities to do it comprehensively; a budget of about £100 000 per annum would be considered quite modest for such a department in the industry, and that gives some idea of the resources necessary to carry out this task in a professional manner. There is also scope for hospital units to collect information on drug usage, either in conventional or unusual circumstances, and on side-effects and drug interactions. Here again industry would welcome feedback, which could well be of help to some other hospital.
255
Interface between Hospital
and Industrial Drug Information Centres The interface between hospital and industrial units has no fine demarcation. Industry will continue to receive requests from doctors and pharmacists which are quite easily answerable within the hospital. On the other hand, hospital departments will get intricate queries which they cannot be expected to answer. It is up to the hospital units to make contact with the information officers in industry who can best help them, and if hospital units are to develop this intermediary role, the calibre of the staff must be high because it is easy for misinterpretation and mistakes to arise. It is essential that everyone concerned is suitable both in terms of professional training and experience to form an effective link; all too often, through lack of experience, basic information does not reach the manufacturer because the link person failed to see its relevance, or alternatively did not ask the enquirer the additional questions necessary. Such an important appointment should therefore be filled by someone who has had several years' experience as a pharmacist and has accumulated sufficient clinical and biochemical knowledge to appreciate the rationale behind drug therapy. In industry such departments are usually in the charge of people with considerable experience and breadth of knowledge.
It is clear that there is no future in hospitals endeavouring to establish comprehensive information on every drug. This is not only impossible but is a ludicrous waste of money when the resources of industry are already available. It has been said that information from industry is biased; however, there is a code of ethics among staff in industrial units to give honest advice. In any case, to have a company's product used when there is likely to be an unfavourable clinical response will ultimately damage a drug's reputation.
Central Data Bank We should also briefly consider the rumoured central drug information bank. In concept this is nothing more than a comprehensive store of drug data. All such sources are only as good as the people operating them both in terms of input and retrieval, and as it would be impossible to find persons to run such a service with sufficient depth of knowledge in all areas, their powers of retrieval and interpretation would be limited. By definition such a service could only expect to have breadth of knowledge, but this is already available in hospital information centres, which surely are the most appropriate places for it to be developed and stored. Depth of knowledge is available in industry, in commercial literature retrieval services, at the National Lending Library, professional libraries and in some regional hospital libraries.
