The answer

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Category : General, Medical Rants, Pharma

The question – how do we use data to make decisions about which drug to use. Doctors, Too, Ask: Is This Drug Right?

A growing number of health care organizations have in recent years taken rigorous steps to close one of medicine’s biggest information gaps. They are scrutinizing findings about all drugs, new and old, available to treat a particular health condition to determine which work best at the lowest cost.

Such evidence-based reviews, as they are known, are an effort to separate scientific wheat from chaff by examining not just the quantity, but also the quality of clinical trials and studies on a given drug. They also seek to determine how a drug’s risks and benefits stack up against competing treatments. These reviews have been applied to every major category of medication, from blood pressure treatment to antidepressants.

Practitioners like Dr. Brenner do not typically consult such reviews when deciding which drugs to prescribe, but instead rely on their own experience. But that may change as government agencies and academic centers disseminate drug review research more broadly.

The drive to base medical practice on such reviews is not new, but it is taking on more urgency as health care costs rise and many newer drugs prove to be only marginally better, if that, than older ones.

Dr. Eric L. Matteson, a rheumatologist with the Mayo Clinic, said such reviews also help to counterbalance the forces that influence doctors in writing prescriptions, like drug company pitches, medical specialists championing certain medicines and patients eager to get the latest drug advertised on television.

“The pressures to prescribe are enormous,” Dr. Matteson said. “You constantly have people at your door.”

One of the leading institutions doing drug class reviews is the Evidence-based Practice Center at Oregon Health and Science University in Portland. In recent years, some states have started to use reviews produced by the center to draw up lists for preferred drugs that their Medicaid programs will cover.

Today, about 12 states, including Washington, Oregon and Missouri, use the center’s reports to differing degrees.

Earlier this month, the federal government announced that it was planning to spend $15 million in coming years to pay for evidence-based reviews that will compare the effectiveness of various procedures and drugs used to treat 10 of the most common health conditions, including stroke, arthritis, pneumonia, diabetes and ulcers. The studies will be made available to doctors and the public as well as to government and private health plans.

That makes a lot of sense. This is an excellent use of our research resources. But Big Pharma disagrees –

Another recent study has suggested that an older pain reliever, naproxen, which is sold as Aleve, might also increase heart attacks, though several experts said the Aleve data was less troubling because the numbers appeared too small to be statistically significant. Drug companies say they support the idea of evidence-based medicine. But they also contend that the Oregon center’s approach is more about cutting costs than about science.

“What Oregon is doing is hiding a cost-cutting agenda that they are marketing widely under the rubric of evidence-based medicine,” said Dr. Mark Horn, the medical director for the government relations group at Pfizer. Dr. Mark Helfand, the director of the Oregon center, dismissed that suggestion.

I know Dr. Helfand – and he is beyond reproach.

I repeatedly call for better data concerning pharmaceuticals. We have researchers studying the data and publishing important studies. I hope that we will increase support for this vital research.

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Comments (1)

And even if there is a cost-cutting agenda, so what?

As long as efficacy and safety aren’t being sacrificed for low cost, is that a problem. Drug prices are already a lot less subject to market forces than most products. Does Dr. Horn think they should be completely immune? Bah.

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