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.