Get the best from medicines
How the information gets here, and how it stays here
I am the main author of the C&M website and, sadly for me, also a bit of a workaholic anorak. I'm also author of the Psychotropic Drug Directory (which comes out every 18 months or so, and has sold nearly half a million copies worldwide since 1993). In order to make my book as comprehensive as possible, I have to have a good, solid and reliable method of getting new information and not missing anything.
How I do this is as follows:
Searching on "Medline". I search for over 250 terms (medicine names, conditions, symptoms, side effects etc) on a continual basis. Bearing in mind that over 1,000,000 new papers and reviews are published every year, this keeps me busy. Luckily not all these million papers is about mental health!
Daily update email from UKMI (UK Medicines information, via NHS), usually with links to about 1020 new articles or changes to medicines
Weekly NHS library update bulletin
Reading some of these articles and papers, using the original paper
Attending conferences and lectures
Doing research on specific topics, including using well–know and respected books
National and International Guidance (e.g. NICE, SMAC)
Talking to colleagues, service users and carers, and others as part of my fulltime job
All of this research for my book also unearths lots of stuff for this website. It also allows the same research to be used in two different ways.
With so much information available, it is important to sort out the important bits from the less important bits. So, for example, with a new research study I would see how good it looks e.g.
How many patients were there? (the more the better). Who were they? Where were they? Were they human? (animal studies can be interesting but animals aren't the same as you or I!)
How long was the study? Was it long enough to get a good idea of the treatment?
Did it have a placebo group? i.e. is the treatment being compared with a dummy treatment (if not, the results are not as good). Very few studies that don't have a placebo group are acceptable. Sometimes, "waiting list controls" are used i.e. some people get a treatment; others are told they're on a waiting list. In fact, the NICE guidelines for depression actually note that studies like this increase the response from the treatment because the people on the waiting list feel abandoned. To feel depressed AND abandoned tends to lead to your depression getting worse. This makes the treatment being researched seem more effective because even if the treatment did absolutely nothing, the control group would have got worse, making it look good.
Was it randomised? i.e. were people put in the treatment groups randomly or were people put in them by someone who might accidentally put people in one group if they thought the person might do well
Was it double–blind? i.e. did the patients and the people assessing not know which treatment they were having? If not, bias can easily come in
Who were the authors? If authors work for a drug company, the results are more likely to say their drug is good! Obvious, but true.
How was it analysed? Some studies use "completer analysis". This means that that they only include people who finished the study. So, everyone who left the trial because of e.g. adverse effects, it didn't work, they felt worse, aren't included. Just those who finished (who are more likely to have done better as they stuck with it). ITT (Intention To Treat) is better as it includes everyone who started the trial.
This doesn't mean that a study may not be really good without all this. But it's much more likely to be good if it has.
With all this, you can be assured that no stone has been left unturned looking for the right information. With such a mammoth task, there may be a bit of a delay sometimes (I'm always trying to catch up!) but I usually get there eventually.
...and how the information stays here
The original funding came from NIMHE, the National institute for Mental Health, England in 2006. This was to fund research into the "Choice" agenda in mental health. To cut a long story short, the result was this website. The research was led by Mick Collins from Nottingham and based on part of an existing website. The site was launched in October 2008 at the House of Commons.
The College of Mental Health Pharmacists (or UK Psychiatric Pharmacy Group as it was then) hosted the site for a while but it became clear that it had become too big to fund and manage on an "amateur" basis. So, a company was set up to manage and develop the website. How it is now run is by selling annual subscriptions to organisations (e.g. Trusts, community pharmacies, charities). This means that the original concept of everything being "free at the point of use" but with no sponsorship is maintained but there is enough money coming in to keep it running.
As it says elsewhere on the site, I am the main author, and I have no shares in any drug companies, and although I do lectures and consultancy work for the pharmaceutical industry, I remain fiercely independent.
Stephen Bazire