Medicine in the dark
Clinical trials focus on new drugs, which doesn't help doctors compare the effectiveness of one treatment with another.
By Michael Hochman and Danny McCormick

March 10, 2010


Some doctors treat patients with early-stage prostate cancer with radiation. Others favor surgery, while some advocate only close monitoring. Which approach is most successful? No one knows.

When it comes to diabetes management, doctors don't have answers to key questions: At what point should insulin be started? Is it safe to lower the blood sugar to normal levels? What is the best way to monitor blood sugar control?

Similarly, endocrinologists don't know what is the best way to treat patients with hyperactive thyroids...

It may seem perplexing that there is so much uncertainty about these relatively simple questions. All of the above treatments have been around for decades. Shouldn't we have definitive answers by now?

In this week's issue of the Journal of the American Medical Assn., we report the results of a study that may help explain why we don't. In the study, we analyzed 328 medication studies recently published in six top medical journals and found that just 32% were aimed at determining which available treatment is best. The rest were either aimed at bringing a new therapy to market or simply compared a medication with a placebo. Whether the therapy was better or worse than other treatments was simply not addressed.

Research involving new therapies is of course crucial for medical progress, but there is also a need for research that compares the effectiveness of the rapidly growing array of existing therapies and approaches.

So why, then, did only a third of medication studies focus on helping doctors use existing therapies more effectively? The answer lies in the fact that pharmaceutical companies fund nearly half of all medication research, including the lion's share of large clinical trials. For obvious reasons, commercially funded research is primarily geared toward the development of new and marketable medications and technologies. Once these products have won approval for clinical use, companies no longer have incentives to study exactly how and when they should be used.


Congress recently appropriated more than $1 billion in the American Recovery and Reinvestment Act to promote comparative effectiveness research. This is a good first step, but the money will need to be spent carefully...

Reform is also necessary to ensure that commercially funded research is designed in a way that is more helpful to doctors...

As medical science advances, clinical decision-making will only become more complex. Only by expanding public funding for comparative effectiveness research can we hope to put existing medical treatments and healthcare services to their best use. Doing so would ensure that national research priorities are determined by patient needs rather than by corporate agendas.


http://www.latimes.com/news/opinion/...,3812725.story

Every time I read and learn more about the "medical establishment", my trust and faith I once had in the system are disappearing. As sad it sounds, this article is a statement of the times we live in, financial gains at the top of anything else and new equates to better.

I see big pharma being no different than any other industry. When I was read this article, I see the common theme between two diverse industries, medicial field (real lives) and as trivial as the electronic games for children (fantasy). In the last two years since my introduction to Nintendo games, I have seen three new versions, DS, DS-L, DS-I and DS-something, all essentially do the same, extra things make it more expensive but not necessarily make the toy very different from the older versions. My only rationale for such improvement is to to make money......

Pharamaceutical companies are doing the exact same thing, except they are playing with people's lives. Minor changes in drug design and the same drug comes back to the market with an increase in price. As long as insurance pays for it, we dont notice or feel the financial burden (akin to parent buying a toy for a kid!). Modifications in the existing treatments are intellectually interesting to researchers and doctors and bring in a lot of money for the pharma.
Only difference I see is my kid is happy to see slight changes in her games, but I am not, feel like the biggest loser in this game. Thanks

Girija