In all honesty, I've always been cautious of any trial by drug companies. They send drug reps to doctors' meetings. They produce shiny literature that shows their drug in the most positive light. The drug reps are usually attractive (I recall one redhead in a tight green outfit incl tights; I was actively trying to stop myself from jumping on her when she bent over). But they know feck all. I've questioned drug reps (past the "oh, what's that drug/what does it do/how does it work?") and their knowledge breaks down.

I've always gone by guidelines but even when trials are meta-analysed, it is still only comparing published data. There's no way to get hold of unpublished data. The analyses can sometimes back up the drug company data, or it can minimise the benefit or even show some drugs in a negative light ie no better than placebo.

IMO it would be better if you had an independent centre that carried out the trials. Drug company produces new drug to treat xyz, independent centre selects target and placebo patients and carries out trial. Data is collected and analysed. Results are published for all to see. No hiding. Complete transparency throughout.

Creating an independent centre can be difficult but there is a move for GPs to do the trialling. We as GPs have lots info on our patients eg height/weight/co-morbidities. There are local groups of GPs who carry out particular trials. I don't know whether it's the best thing but given GP practice population can vary from 1000-10,000, you have lots of patients and hence data.

It is a nice idea, but there are so many potential problems. The whole life sciences industry especially those that run trials now would object. Then how do you deal with drugs from abroad? If you give the local industry a hard time they simply move offshore like Boots.

There also need to be changes at the hospital level. Far too many drugs are now becoming ineffective due to resistance improving. In a matter of a few years many antibiotics will be useless and death rates will soar. We need a cultural change in the use of antibiotics. These should only be administered in hospital and should be completed to minimise resistance increasing. There needs to be better use of natural measures such as friendly bacteria to eliminate the ones that are currently treated with antibiotics.

Medical reps need to be banned. As you say they are very attractive, and nearly all female. Doctors need to choose medications based on effectiveness not how hot the rep is. If Doctors can get their drugs supplied from a central depository that holds all available drugs then doctors would not become diverted by a sexy rep. Keep the sales teams away from doctors.

Keeping antibiotics in hospitals only is a fallacy. Majority of people don't need them but some patients can deteriorate rapidly to the point of needing hospitalisation and death. Unless you're prepared to pump money to have more beds available, more staff and running costs (at a time when the NHS is supposed to save £20b), it won't work. Starting antibiotics early can minimise the potential for an infection to spread and develop sepsis. Why should someone die/need ITU/hospitalisation just because they couldn't get antibiotics for a lower respiratory tract infection in the community.

What would be awesome is a kit that tests whether an infection is viral or not. Given tonsillitis is usually 50/50 bacterial/viral, it is normally treated with antibiotics. A throat swab can take days to come back by which time a person may well be too poorly. A rapid (eg 10mins or quicker) test would be enough.

Remember that in some countries, people can buy antibiotics like we buy paracetamol ie over the counter. Don't forget that farmers often pump livestock full of antibiotics. Remember that resistance occurs because bacteria can exchange bits of nucleic acids containing resistance genes the same way humans can swap saliva through kissing.

Also bear in mind that drug companies don't want to spend money on developing antibiotics because of low return.

Yes Antibiotics are given out too freely. It is not helped with overworked GP's being bombarded by patients to give antibiotics for every sniffle. As for the hospital option if resistance keeps growing then we could find that being the only option to reduce the spread of bugs like MRSA.

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MRSA is present in a lot of people but it usually just sits there doing nothing. Only when there is a route into the body esp blood stream is it problematic. MRSA is already resistant to penicillins so giving these antibiotics out won't affect anything but other antibiotics can do. This becomes a public health issue and as such we are given antibiotic guidelines to follow which change to reflect the local prevalence of infections. Ciprofloxacin is banned in every hospital I've worked in because of the risk of C.difficile infection. Cephalexins are also being restricted in use both in GP and in hospital.

The "strongest" antibiotics are given intravenously so it still doesn't hold to restrict their use as we don't routinely give IV antibiotics.