New Drugs Have Allure, Not Track Record

NY Times :

New Drugs Have Allure, Not Track Record

Recently, one of my residents told me about a patient with bipolar disorder whose psychiatrist had prescribed an exotic cocktail of drugs — a sedative, a new mood stabilizer and the latest antipsychotic medication. I was puzzled — not by her case, which the resident described as textbook manic depression, but by what was left out. This patient, it seems, was never offered lithium, the single most effective treatment for bipolar disorder.

When I met with my residents in their weekly seminar, I decided to make a big deal of this case. “What do you think about her treatment?” I asked them.
There was a long silence. “What’s wrong with it?” one resident replied. Finally, a resident offered that he knew the right answer was lithium, but that newer treatments were more popular.

Now I got it. Never mind that lithium has proved its safety and efficacy over decades of use; it’s passé — eclipsed by all the new and sexy blockbuster drugs.
Lithium salts have been used to counter bipolar disorder since the 1950s, when it was discovered that they greatly reduced the intensity and frequency of mood swings in about 70 percent of patients with the disorder. While lithium must be taken with care — it is therapeutic in a narrow range of blood levels, and overdoses can be toxic — it is also the only psychotropic drug that has ever been shown to have specific antisuicidal effects. That makes it especially valuable, given the high risk of suicide associated with mood disorders.

But lithium is cheap and unpatented, so drug companies have little interest in it. Instead, they have made a new generation of mood stabilizers, some more tolerable than lithium, but none more effective.
And lithium is hardly the only unsexy but effective drug to fall by the wayside. New medical treatments are a bit like the proverbial new kid on the block: they have an allure that is hard to resist.

I wonder how many people suffer negative consequences because the “sexy” new drug is inferior to the drab “old” treatment.
One might expect doctors to make medical decisions based on science but they are human too.

One of the many problems with operating health care as a for-profit industry.

i think its more a problem of the drug companies being allowed to advertise to the public instead of just to doctors.

I agree, this also ends up driving the price of the drugs up. All that advertising they do does cost money.

also a very good point

It does increase the cost of drugs, but its cost-effective for the drug makers if the advertising increases their market share. This could be by either increased consumer demand or by greater physician awareness of the drug. Drug companies wouldn’t advertise their products if the advertising didn’t work.

And no one asks what is the cost to the human body when a person is on so many different drugs(cocktail) for so many years, in terms of diseases such as liver cancer.

If the average consumer can not buy these drugs without the doctor’s prescription than why are they marketing to the average consumer? The need to be marketing to the doctors instead of marketing to one and all.

Because the drug makers have discovered that many doctors are willing to prescribe a drug if a patient asks for it by name, at least that is how it is in the US.

One reason to ask for generics, besides the fact that they are cheaper is that they have been on the market at least ten years.

To be released at all a new drug has to go thru clinical trials to prove it “safe and effective”. But the real trials start when it hits the market and scores or hundreds of thousands of people are taking it. The first generation of patients taking a drug are, in effect, beta testers.

At the same time that drug companies advertising the hell out of a new drug they are waiting for reports of unforeseen side effects, interactions with other drugs, allergies, &c, &c.

If I were King I would ban Medicare/Medicaid/insurance payments for drugs that have been on the market less than five years – the folks who are willing to pay their own $$$ can be guinea pigs.

Exactly! A big reason for prescribing the newer “sexy” drugs is because the doctors want to make more of a profit. I find that to be greedy and disgusting. They should stick with the older drugs that have been proven to be effective and safe so long as the older drugs are working for the patient.

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