Why medical research isn't as useful to you as it could be

LA Times health blog: Only 32% of medication studies compare the drug in question to already available treatments, rather than just placebo. And only 11% compared the drugs to non-pharma based treatments, like surgery or lifestyle changes. For evidence-based medicine (let alone cheaper healthcare) to work, stuff like this has gotta get fixed. (Via Steve Silberman)

• [mudpup]

  My stupid idea.
  No cure, no patent.
  Drugs that only treat the symptoms are big money makers, you cure the problem no need for the drug. There are only small incentives for the big pharmaceuticals to work on cures, cut some of the profit in prolonging treatments…

• [Anonymous]

  The 32% figure is talking about the comparison of one available drug to another, not – as this write-up makes it sound – one new drug to one available drug.

• [Anonymous]

  Evidence based medicine is just another pharmaceutical conditioned twist to render old open-patent holding drugs studies innefective, allowing for newer drugs to be compared to placebo.

  When medicine and research are ruled by profit and copyright, its not really medicine or research we talking about.

  Its a big joke.

  Cocaine letal dosis50% (the dose needed to kill half the takers) is 1g. Thats pure pure cocaine, 1g.

  Acetaminophen= 4g.

• [Anonymous]

  The LA times is right–most clinical trials are not directed at comparing two existing medications to one another. Why? 1) Pharma, who funds many if not most of these studies, has little interest in funding a study that may show that while their med is effective, it is less effective than another medication.
  2) The NIH has little interest in funding a lot of head to head trials of similar medications. This is not their mission, honestly. They exist to help drive basic understanding of disease mechanisms.
  As has already been noted, the process of drug approval is long and expensive. Our system is set up to drive innovation, which means that we are a lot less good when it comes to making the best of what we have. This is a value call–would you prefer new medications for untreatable diseases or cheaper medications for existing ones?

• [nox]

  But there’s no money in fixing it.

  There are promising alternatives to hormonal birth control that are incredibly underfunded because they don’t require a costly set of pills monthly. Hell, even heating testes in water was shown to be effective decades ago, but it makes no money.

  Healthcare research isn’t about healthcare, it’s about profit. It has to be. That’s what you get with capitalism. Per year, medical research has cost about the same as the Iraq war, around 90B.

  Investors need return. Who must inevitably bear these costs?

  I’m confused. I’m a big believer in the free market but what I just wrote makes me a communist. If the people end up paying for the costs of medical research anyways, why support a system that produces sub-optimal results?

  • [TooGoodToCheck]

    I don’t really think your opinions stated here make you a communist. Some things are done better by government than by the free market – that’s not communism.

    In the US, roads maintenance, law enforcement, and putting out fires are all jobs that are done primarily by the government. Private industry may have a roll in these things (especially maintaining the roads), but at the end of the day, the government takes responsibility for looking after these things, and mostly does them reasonably well. The fact that I think these functions are performed by the government better than I think private industry would do on its own does not make me a communist.

    There are some situations that are not well suited to unmediated private industry, and it is certainly my opinion that medical research is one thing that needs more government involvement.

  • [querent]

    “Hell, even heating testes in water was shown to be effective”

    I wanna dip my balls in it!

• [Anonymous]

  Anybody look who is behind the movement to compare drugs? Most of the money traces back to for-profit health insurance companies.

• [arbitraryaardvark]

  What you are calling research is, I think, mostly studies done in order to jump through the hoops to get FDA approval as safe and effective. Comparison with placebo is the specified protocol. I work as a human guinea pig for pharma companies, testing new drugs. (Anybody know a lawyer who works on these issue? My rights as an experimental subject were violated by Covance, one of the big drug test companies.)

• [yrogerg]

  I smell a few lies with statistics going on here, to be honest. Yes, only 11% compared drugs with non-drug interventions, but how many of the drugs in question are for conditions with credible surgical or lifestyle options? Blood pressure, sure, cholesterol, sure, but if you have a new malaria or HIV drug, for example, how could you possibly do this? Compare the efficacy of a new antibiotic to not getting an infection in the first place? What about drugs for conditions- as is the case for some psych disorders like bipolar, or for many cancers, where the established standard of care is a combination of drug and non-drug inteventions? How relevant is an apples-to-oranges comparison in those cases?

• [Anonymous]

  Pharmaceuticals love to test new drugs against placebo since that’s where they’ll show their greatest effectiveness. Doctors, OTOH, can’t really use that information well since they care more about differences between medicines (e.g. Drug A is 20% more effective than Drug B rather than Drug A is 65% more effective than placebo and Drug B is 60% more effective than placebo). Ethically, it’s also better to compare between drugs because otherwise you’re giving a placebo for something that ought to be treated.

  As for pharmaceutical profits, don’t forget that they are beholden to doctors to write prescriptions for their pills. Doctors aren’t stupid, and most aren’t bought. Nowadays, drug reps are even banned from most (all?) academic medical centers, and the days of going to a pharma-funded ski resort are coming to an end. Both the AMA and drug companies themselves saw that was getting out of hand.

  Also, while it may be more profitable to focus on lifelong treatment, it’s very risky. If a study comes out saying that a non-medical treatment is equally effective, or another company develops a cure, the drug company loses somewhere around $10 billion. I don’t think they’re going to take that risk when it’s faster to go with what’s easiest to develop, which might be a cure, or might just be a marginal improvement over another drug (more common). Plus, as time goes on, the chance of the “lifelong” drug being obsoleted approaches certainty, so it’s a foolish thing to strive for.

• [Anonymous]

  For comment #2: the 4 grams of acetaminophen is the recommended max daily dose, not the LD50. In adults, single doses above 10 grams or 140 mg/kg have a reasonable likelihood of causing toxicity. In adults, single doses of more than 25 grams have a high risk of lethality.

  Get your facts straight and talk to a pharmacist.

• [Anonymous]

  Is comparing drugs really necessary? If drug A is 30% more effective than placebo & drug B is 50% more effective than placebo, do you really thinks that drug A will be more effective than drug B in yet another study?

  • [apoxia]

    The answer is yes. Studies often find widely disparate findings. Placebos vary widely between studies.

• [Matt J]

  That paragraph makes no sense. Everything is compared to placebo. And that means you can compare on treatment to another by saying how much more effective than placebo it is. And yes, people do do studies into surgery and lifestyle changes vs. placebo.

  • [Anonymous]

    Ah, I’ve been beaten to the punch.

    When I initially skimmed the first sentence of this post, I got it completely backwards, and thought, “Oh those damn pharma companies, trying to fool us by not comparing drugs with placebo.”

    There’s little reason to bother. If the trials have been well-conducted in the first place, you know how effective the other medication is, and you only need to measure your own.

    Sure, adding another element to your test might add another data point to the total picture, but most of the time I think it’s just expected to be a big, “Take that!” if it works out.
    (If it doesn’t the study is swept under the rug and nobody ever reads it. Nothing to see here, move along.)

    There are a lot of problems with medical research. But the LA Times post manages to miss them all.

• [Patrick Austin]

  This is clearly a big problem, but it’s a hard one to fix without a huge overhaul of the regulatory system.

  Drugs get approved if they work and if they don’t harm people too much. Testing them against competing drugs doesn’t help with that process.

  I’d assume that comparing the efficacy of a drug to the efficacy of other treatments requires a hell of a lot more study participants, time and money. In general it’s probably also pretty hard to compare efficacy between studies, since you’ll be dealing with different populations/severity of conditions/study design/etc. It’s a lot easier to just test a drug against a placebo.

  Comparing drugs to other treatments is even harder, since a lot of treatments don’t go through any clinical evaluation whatsoever. Surgery, behavioral interventions and physical therapy all exist in worlds almost entirely devoid of the gold standard double-blind controlled studies.

  The system is crappy. I’d be curious to know how we stack up to Europe/Asia in the comparative effectiveness study department.