Australian Prescriber - the first 30 years

As Australia slipped towards a constitutional crisis in late 1975, a new medical journal slipped into letter boxes across the country. Australian Prescriber had arrived.

Health professionals had previously received the Prescribers' Journal published by the UK Department of Health, but by 1975 it was time for an Australian publication. With Dr Robert Hodge, the Senior Adviser in Clinical Pharmacology to the Australian Department of Health, as its editor, the journal set out for its 'lofty, but attainable aims'. The Executive Editorial Board was going to fill the need for a 'concise, authoritative, unimpeachably unbiased journal giving guidance to treatment'.

This set the pattern for the 30 years to come. Each issue features a variety of articles about drugs and therapeutics with occasional papers on other influences on prescribing. From its inception, the journal was distributed free to doctors, dentists, pharmacists and perhaps most importantly students of these professions.

The first issue announced that only metric units would be used in the journal. It also stressed the importance of clearly written prescriptions. This simple advice was to land the new journal in immediate trouble.

To illustrate the illegibility of some prescriptions the first issue included a copy of a scrawled prescription from the 1950s. Unfortunately someone who could read the prescription was the doctor who wrote it. With rumblings of litigation the Executive Editorial Board had to apologise for publishing something illegible!

Just as there was no electronic prescribing in the 1970s, there was no computer-assisted design. The new cover of 1977 required hundreds of tablets and capsules to be laid out by hand to spell out the journal's initials. This colourful concept was to reappear in different forms until 1994.

Creating the 1977 cover

In 1979 Australian Prescriber asserted its independence by refusing to provide 'interested parties' with copies of articles before publication.²The journal's ability to make independent unbiased comments, particularly about new drugs, is one of the reasons for its success.

Dr Rod Hall, who became the editor in 1980, demonstrated this independence by publishing an article criticising the Federal Government's decision in 1982 to discontinue Australian Prescriber as a cost-cutting measure.³ By then health professionals had recognised the educational value of the journal and lobbied to reverse the government's decision.³ There was even comment in the Lancet about the folly of closing the journal.⁴

There was a possibility that Australian Prescriber would be taken over by a private publisher. The Medical Journal of Australia was a possible contender, but this privatisation did not take place. The second issue of 1982 seemed destined to be the last.

The journal was gone, but not forgotten. No publication of comparable quality emerged to fill the gap left by Australian Prescriber, yet there was still a need to provide health professionals with objective and independent information about new treatments. In 1983, the government concluded that the cost of publishing the journal was minimal compared to the costs of prescribing and therefore Australian Prescriber was resurrected after an absence of 18 months.

Under the direction of Dr Hall, the journal settled into a regular pattern of four issues a year. The Australian Adverse Drug Reactions Bulletin which had been incorporated into the original journal, but survived the cuts of 1982, continued as a separate publication.

The importance of independent information about drugs was becoming increasingly recognised internationally. In 1986 Australian Prescriber became one of the founding journals of the International Society of Drug Bulletins (ISDB).

In 1988 Australian Prescriber began a long-running series called 'Pharmacokinetics made easy'. This series, written by Professor Don Birkett, a member of the Executive Editorial Board, eventually became an international textbook which is now in its second edition.⁵ During this time the journal also published a booklet collecting together the articles in the series 'Abnormal laboratory results'. This is now available as a separate publication and a new edition is expected later this year.⁶

Editing the journal remained the responsibility of the senior medical advisers in the Therapeutic Goods Administration (TGA), but with the growth in drug evaluation it was becoming clear the dual roles were unsustainable. After returning to the editor's chair, which was capably filled by Dr John McEwen between 1988 and 1989, Dr Hall began the process which eventually led to the recruitment of a dedicated editor.

The first issue officially under my editorship was published in 1990. It contained the results of a readership survey which highlighted a problem which was to plague the Executive Editorial Board and production staff for years. The mailing list was found to be disturbingly inaccurate and the Board could never comprehend why the Department of Community Services and Health, as it was then known, was unaware of how many doctors there were and where they practised.

Questioning the Department was made easier once the Executive Editorial Board appointed an independent chairman. Until 1990 the editor had chaired the Board. Having a chairman who was not paid by the publisher enhanced the journal. Professors Peter Fletcher and Rob Moulds have both been strong independent chairmen willing to support and defend Australian Prescriber when necessary.

One threat to the independence of the journal came in 1990 when the TGA toyed with the idea of funding the journal by selling advertising space in Australian Prescriber. Fortunately the proposal did not progress. Accepting drug company advertising could have compromised the journal's independence and resulted in its expulsion from the ISDB.

When the TGA started to receive funding from the pharmaceutical industry, it was decided to transfer responsibility for Australian Prescriber to the Pharmaceutical Benefits Branch of what was then called the Department of Health, Housing and Community Services. This move was appropriate as the new policy on the quality use of medicines (QUM) was being implemented.7 Australian Prescriber had already published the proceedings of a seminal conference about rational prescribing convened by the unlikely alliance of the Consumers' Health Forum of Australia and the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists.⁸This was the first of a series of supplements reporting the beginnings of activities which are now part of practice. The academic detailing workshop⁹ paved the way for the educational visiting activities of the National Prescribing Service and the Drug and Therapeutics Information Service, while the Australian National Formulary Workshop¹⁰ foreshadowed the development of the Australian Medicines Handbook.

With all this activity, the demand for the journal increased. One way of meeting this demand was to explore the nascent technology of electronic publication. Following the original idea in 1994 an application was made to the Australian Vice-Chancellors' Committee for funding to develop an Australian Prescriber website. A grant was awarded in 1995 and Dr Darren Williams, with the help of Dr Andrew Dawson of the Executive Editorial Board, established the website at the University of Melbourne in 1996. Although the website has subsequently been hosted in different locations its popularity continues to grow. By 2000 there were 100 000 hits a month on the site rising to over a million in 2004.

Australian Prescriber was one of the first medical journals in the world to make its full text freely available on the internet. As it could be accessed by anyone, there was a need to explain some of the articles to a lay audience. Many of the articles in the electronic journal are now accompanied by comments for consumers which briefly summarise important messages from the articles.

Editorial teams 1975: From left, Emilio Maculan (secretary), Dr Robert Hodge (editor), Linda Turner (designer) and Dennis Blewett (journalist)

2005: From left, Cherie Graham (administrative support officer), Dr John Dowden (editor), Susan Reid (production manager) and Maureen Ryan (editorial assistant)

The electronic version of Australian Prescriber is an important way of providing independent information to an international audience. In 2002 the website was accredited by the international Health On the Net Foundation for the quality of the information in Australian Prescriber.

The international role of the journal was further underlined when it was chosen to produce a publication for the World Health Organization. The proceedings of the International Conference on National Medicinal Drug Policies, held in Australia, were published as a supplement to Australian Prescriber in 1997.¹¹

Despite the success of the journal and other QUM initiatives, funding for pharmaceutical education was reduced in 1996. A review was announced to look at 'the future role (if any) for the Australian Prescriber'.

The review consisted of market research and also a nationwide consultation by Dr Andrew Herxheimer. When Dr Herxheimer reported in 1997 he found that Australian Prescriber's resources were 'tiny and precarious' and had been 'whittled away over the years'. As the staff had by now been reduced to two there was a danger that 'Australian Prescriber would collapse'. Dr Herxheimer found that there was a need for an independent Australian drug bulletin and that Australian Prescriber should be published more, not less, frequently. The report was accepted and by 1999 sufficient funds were available to allow Australian Prescriber to be published six times a year.

Despite this reprieve the Department of Health and Aged Care, as it was then called, decided in 2000 that it would no longer be the publisher of Australian Prescriber. There then followed almost a year of uncertainty which led the Executive Editorial Board to once again fear for the journal's existence.12 After some difficult negotiations, the journal became part of the National Prescribing Service (NPS) in 2002.

Once the initial anxieties were overcome, the journal settled well into the NPS. There are many opportunities for Australian Prescriber to assist the NPS to promote the quality use of medicines, while continuing its tradition of editorial independence. The continued funding of Australian Prescriber, as an integral part of the NPS, in the Federal budget of 2005 confirms the success of the partnership and augurs well for the future.

Australian Prescriber would not have survived for three decades without the hard work and goodwill of many people involved in its production. Ultimately, however, a journal will only survive if people read it. The fact that Australian Prescriber has the widest readership of any Australian medical publication suggests that the journal is giving health professionals the information they need. If this helps to improve the care of patients then Australian Prescriber will celebrate many more anniversaries.