Clinical trial registry initiative.

336 Bulletin of the World Health Organization | April 2006, 84 (4) Letters a Executive Director, Medical Communications, Merck Research Laboratories, 126 E. Lincoln Ave., Rahway, NJ 07065, USA (email: laurence_hirsch@merck.com). b Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill. 529 Hillsborough St, H 7, Chapel Hill, NC 27514-3114, USA. (Email: muula@email.unc.edu) Clinical trial registry initiative Editor – The news item in the January 2006 issue of the Bulletin announcing a new WHO clinical trial initiative,1 inappropriately and inaccurately refers to Merck, a company that has always been committed to the highest stani dards of scientific integrity and patient safety. Merck promptly and approi priately disclosed the results of Vioxx clinical trials — positive and negative — including VIGOR and APPROVe. Merck’s behaviour over Vioxx is not that of a company “withholding negative research findings,” as your article inaci curately suggests. We also wish to clarify the timing of certain events. The editorial by the International Committee of Medical Journal Editors (ICMJE) calling for regi istration of clinical trials as a condition of publication, which you cite in your news item, appeared online at www. nejm.org on 8 September 2004, and on 16 September 2004 in the print version of the New England Journal of Medic cine, as well as in other ICMJE journals. This was several weeks prior to Merck’s voluntary withdrawal of Vioxx on 30 September 2004,2 i.e. not in response to the withdrawal as the Bulletin news item implies. Additional information can be found on our Vioxx information page at: http://www.merck.com/newsroom/ vioxx_withdrawal/. Merck has been an active particii pant in the WHO International Clinical Trials Registry Platform, taking part in meetings when invited, and commenti ing on proposals. Merck’s commitment to registering all Phase II, Phase III, and postimarketing controlled clinical trials that we conduct anywhere in the world goes well beyond both the curi rent US law that mandates registration of clinical trials designed to test the efficacy of products for lifeithreatening or otherwise serious illnesses and the industry commitment to register all “confirmatory” trials. Our policy on the registration and publication of clinical trials is posted at: http://www.merck. com/mrl/swf/Merck_Position_on_ Clinical_Trials_Registries.swf. We look forward to continued dialogue with WHO and other stakei holders to promote transparency and allow patients and their healthicare providers access to clinical trial infori mation, while preserving protection of intellectual property. O Competing interests: none declared. Laurence J Hirscha 1. WHO clinical trials initiative to protect the public. Bull World Health Organ 2006;84:10-1. 2. Clinical trial registration: a statement from the International Committee of Medical Journal Editors. N Engl J Med 2004;352:1250-1. Dual job holding by public- sector health professionals may be beneficial to patients Editor – The paper recently pubi lished in the Bulletin by Jan et al. on dual job holding (in the public and private sectors) by health professioni als in developing countries makes an important contribution to the debate on human resources for health.1 Dual job holding can provide continuity of care to those patients who can move between the two sectors. For example, patients attending a private facility would have the opportunity of obtaini ing services they cannot afford to pay for but which might be available in the public sector. Jan et al. appear to be suggesting that the flow of patients from the public to the private sector is a bad thing per se. In the case of Malawi, however, the flow of patients from the predominantly free public health sector to the private sector may even be desirable as it reduces pressures on the public sector. Also, pai tients who demand services that are not available within the public sector, but which are available in the private sector, can be offered them against payment by dually employed physicians. Dual job holding can also increase health professionals’ status, as patients can witness that those working in state facilities are equally competent to work in private facilities, whose infrastruci ture may support firstiworld medicine. Dual job holding also increases the productivity of health professionals as they can be employed after “normal working hours”. Such health professionals may be able to inject new ideas from the private into the public sector, where in some cases the quality of care may be beti ter than that in the public health system. Clearly, it would be unethical for health professionals to treat private patients during the time they are employed by the public sector and to use its resources for individual income generation. But if health professionals bear this in mind, and refrain from abusing public resources, there should be no problem. The migration of health profesi sionals from Africa to developed couni tries is bad enough2 and all attempts to retain them in developing countries should be investigated. But doing it in an ethical way that does not jeopardize patients’ well being is a difficult chali lenge. Finally, although the phenomenon of public health sector professionals who also hold jobs in the private sector has been described,3 there is a need to study their privateisector counterparts who also work in the public sector. O Competing interests: none declared Adamson S Muula b 1. Jan S, Bian Y, Jumpa M, Meng Q, Nyazema N, Prakongsai P, et al. Dual job holding by public sector health professionals in highly resource- constrained settings: problem or solution? Bull World Health Organ 2005;83:771 6. 2. Muula AS. Is there a solution to the “brain drain” of health professionals and knowledge from Africa? Croat Med J 2005;46:21 9. 3. Ferrinho P, Van Lerbeghe W, Fronteira I, Hipolito F, Biscaia A. Hum Resour Health 2004;2:14. Corrigendum In Vol. 84, issue number 3, 2006, page 181, the correct affiliations for the sixth author of this paper, Yohannes Kinfu, should be “Australian National University, Canberra, Australia, and ACDIS, Africa Centre, University of KwaZulu-Natal, Durban, South Africa”. The name of the eleventh author was incorrectly spelled; it should read “Kubaje Adazu”.