What doesn’t work
Wednesday, February 11 2009
Via Krugman via NOW! Blog, from the WSJ:
The drug and medical-device industries are mobilizing to gut a provision in the stimulus bill that would spend $1.1 billion on research comparing medical treatments, portraying it as the first step to government rationing.
[...]The administration hopes to expand coverage while limiting use of treatments that don’t work well, but any efforts that might reduce coverage are politically sensitive.
One of the most insidious secrets in medicine is that new drugs are often less effective than old drugs at treating diseases, while having worse or unknown long-term side effects. So when your doctor writes for something “stronger”, he might just mean “more dangerous”.
As an example, I burned out on mesalamine – a fairly safe, well-established drug for treatment of IBD – and was prescribed something “stronger”: infliximab. I thought this meant infliximab would be better at treating my disease than mesalamine, which kept me in remission for a long time. But it didn’t: infliximab did a worse job of keeping me healthy, with much worse side effects. It nearly killed me. It was only until I read through this slideshow that I understood my mistake: infliximab is no better than mesalamine for Crohn’s (and much worse for UC). I’m not sure most gastroenterologists know that.
So it would be really helpful to sick people and their doctors if there were reliable data comparing new treatments to old treatments. Currently, the FDA doesn’t require such studies – only that new drugs be better than a placebo. The provision in the stimulus bill would address that problem, but it would mean a lot of newer, profitable drugs would be shown to be less effective than older, cheaper drugs. Of course, the pharmaceutical industry is fighting the proposal, so they can continue driving sick people into bankruptcy for their meds.
Krugman is right: “This is truly vile.”
I understand where you’re coming from, but infliximab and other biologic medicines work better when they are the first drug used. The system we have is really bad because it causes people to waste a bunch of time and money on ineffective treatments. For instance, I responded well to Flagyl, but once that was stopped, I didn’t respond to anything. Prednisone, followed by Colozal, followed by probiotics, followed by 6-MP, followed by Remicade all failed. If we had tried Remicade first, it may have worked better.
Maybe – I would be interested to know if there’s a peer-reviewed study that informs your understanding. And even if it does work better, that has to be weighed against the potential side effects and the fact that infliximab is about a thousand times more expensive than flagyl. As far as I know, there isn’t good data that compares major treatments to one another – but the pharmaceutical companies are fighting to make sure we don’t have that information.