Via Sam Smith, Shankar Vedantam reporting in the Washington Post:
Pharmaceutical giant Eli Lilly and Co. recently funded five studies that compared its antipsychotic drug Zyprexa with Risperdal, a competing drug made by Janssen. All five showed Zyprexa was superior in treating schizophrenia.
But when Janssen sponsored its own studies comparing the two drugs, Risperdal came out ahead in three out of four.
In fact, when psychiatrist John Davis analyzed every publicly available trial funded by the pharmaceutical industry pitting five new antipsychotic drugs against one another, nine in 10 showed that the best drug was the one made by the company funding the study.
“On the basis of these contrasting findings in head-to-head trials, it appears that whichever company sponsors the trial produces the better antipsychotic drug,” Davis and others wrote in the American Journal of Psychiatry.
Such studies make up the bulk of the evidence that American doctors rely on to prescribe $10 billion worth of antipsychotic medications each year. Davis pointed out the potential biases in design and interpretation that produced such contradictory results. Other experts note that industry studies invariably seek to boost the image of expensive drugs that are still under patent. Moreover, they say, the trials are relatively brief and test drugs on patients with simpler problems than doctors typically encounter in daily practice.
By contrast, when the federal government recently compared a broader range of drugs in typical schizophrenia patients in a lengthy trial, two medications that stood out were cheaper drugs not under patent. The medication that worked best for patients with severe, intractable schizophrenia was clozapine, whose sales lag well behind every other drug in its class. And an earlier leg of the study found that the largely unused drug perphenazine had about the same risks and benefits as far more expensive competitors that are widely assumed to be safer.
…
Uwe Reinhardt, a political economist at Princeton, said drug companies, device manufacturers and even physicians are reluctant to delve into questions of cost-effectiveness because such inquiries may find that the latest, most expensive treatment is not worth the cost.“I have come to believe a lot of inefficiency is quite deliberate and supported by Congress,” he said. “One person’s inefficiency is another person’s income.”
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Uwe Reinhardt, a political economist at Princeton, said drug companies, device manufacturers and even physicians are reluctant to delve into questions of cost-effectiveness because such inquiries may find that the latest, most expensive treatment is not worth the cost.
“I have come to believe a lot of inefficiency is quite deliberate and supported by Congress,†he said. “One person’s inefficiency is another person’s income.â€
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Does this come as a surprise? As for the superiority of one therapy over another, first explore how the study was constructed based on indications and outcomes to provide a favorable response. Tricks of the trade. There are many prescribing physicians who are well aware of this practice, preferring to make their own decisions as to efficacy and cost-effectiveness. In the end, even in this realm, let the buyer beware.
Sadly, no surprise at all.
The low level of use of clozapine and perphenazine suggests that the proportion of prescribers making their own sound judgments on cost-effectiveness is low. Nor are most buyer-patients equipped to make their own sound choices. This is a market in which most customers are at a substantial disadvantage in evaluating the merits of various drugs and other therapies.
Will my mother (or yours) “first explore how the study was constructed based on indications and outcomes to provide a favorable response”?
Jon,
No, your mother won’t, and for most patients, you are absolutely correct. My point, however, was directed with the prescribing physician in mind. They should be critical of how studies are conducted, and many are. In the end, it is “let the buyer beware.”
If there is no patient advocate, the higher cost drugs are pushed through — many times because other anti-schizophrenic drugs have been tried and have failed. While a single drug can serve one particular indication, it still doesn’t address that every person has a unique body chemistry, and will respond better to one treatment vs another. This is one possible reason why new medications in this area are paired up with only the most recent treatment.
And here’s Lilly’s information regarding just this situation: “http://newsroom.lilly.com/ReleaseDetail.cfm?ReleaseID=182246”
Another possible answer is that it becomes a very expensive practice to conduct efficacy trials with every know treatment option, unless the study has federal funding and is being conducted at the university medical school level.
But you touched on an important point. Family involvement is essential for treatment of these patients. If you are from a wealthy family, you typically receive the best available treatment. If you are homeless and receiving your medical benefits from the local free clinic, you get whatever is available. In many cases, that is simply not the best society can do.
But back the original article, the conclusion is cynical, and in large part, I do agree with it. Big pharma has an obligation to make a profit for shareholders, but we should always question how that is balanced against their obligation to promote better treatments and more cures.