Healthy Skepticism Library item: 1407

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Comparing Prescription Drugs
Ny times editorial 2003 Aug 27

Full text:

The befuddled consumer can be forgiven for not knowing whether one prescription drug is better than another for any given illness. Most of the time medical experts do not know either. That is because the drugs used in this country are seldom tested against one another in head-to-head combat. Instead, each is tested separately against a placebo and then, if shown to be safe and effective, is approved for marketing. Whether a new drug is better or worse than other drugs used for the same condition is seldom determined.

That leaves patients and doctors to rely mostly on intuition, trial and error, or the salesmanship of the drug makers. Pharmaceutical companies typically promote their newest and most expensive drugs heavily, even if there is scant evidence that they are any better than older and cheaper rivals.

Perhaps the most startling revelation of this problem came last December, when researchers reported the results of a head-to-head comparison of an inexpensive older drug to treat high blood pressure and two newer, far costlier rivals.

The older drug, a diuretic, actually proved to be more effective than the newer drugs in lowering blood pressure and preventing serious complications, yet it cost only pennies a day. An Australian study yielded somewhat different results, suggesting the importance of multiple comparisons.

In many cases, a manufacturer introduces a new patented product that is little different from an existing drug that is losing patent protection and whose price will thus be plummeting. The manufacturer typically implies that the new drug is better, a tactic that causes many doctors to prescribe it.

The whole process has frustrated Thomas Scully, administrator of the federal Centers for Medicare and Medicaid Services, who told doctors early this year that they should be embarrassed if they prescribed Nexium, a new heartburn drug, because it offered no medical benefits over a cheaper older drug.

Ideally, all new drugs should be tested against their existing competitors before they are approved for marketing. That would let both patients and doctors know what advantages they offer, if any.

Congress is making moves toward reform with legislation that would provide modest sums for federal health agencies to sponsor research on the comparative effectiveness of top-selling prescription drugs. The drug industry opposes the bills. But at a time when prescription drug costs are escalating and consumers are deluged with commercials touting one drug or another, it is vital to provide objective, reliable information on what works best.