Jul 172011

Who would believe that the best trained and best paid doctors in the world prescribe unnecessary anti-psychotic drugs?  Is there evidence that such a practice is common in the US?

There is no question about the increased use of anti-psychotics in children in the US compared to the rest of the world.  Is it because the rest of the world has under-diagnosed childhood mental disorders? Doctors in Western Europe use pretty much same the diagnostic criteria  that we do in the US, so a gross under-diagnosis is unlikely. But is there an over-diagnosis of childhood mental disorders in the US?

Another explanation is that the drug companies making those anti-psychotic drugs are pushing their use in both adults and children. This is the most likely explanation.

Aljazeera has a long article about this problem. There is a very informative video embedded in their web page:  http://english.aljazeera.net/indepth/opinion/2011/07/20117313948379987.html

I have yet to find a good description of the story behind the $1.8 billion fine imposed on the Eli Lilly Company for its behavior regarding Zyprexa. But the drug company came out ahead anyway since it makes more than that every year on Zyprexa! If anyone has a good description of this fiasco, please post it in the comments here. Thanks.




 Posted by at 10:18 am
Jul 172011

The off-label use of drugs is legal but of doubtful benefit to the patient. Usually off-label use depends upon clinical studies published in prestigious medical journals. A closer look shows that almost all of the studies were done by the drug companies selling the drugs.

The results of the studies are manipulated to show some benefit -- it doesn't matter if the benefit is of little clinical significance. Then local doctors are recruited to promote this off-label use. These “thought-leaders” are well paid and they recite the same clinical study to promote off-label use. The “thought-leaders” act as if they know more than anyone else since they know the latest journal article about that particular drug. Other doctors who have not read the article quickly fall into line. The benefits of the drug are now beyond question.



 Posted by at 7:51 am
Jul 012011

It is estimated that the cost of Provenge, a new treatment for advanced stage prostate cancer, will be $93,000 per patient. Company sponsored studies have shown that it increases life expectancy by about four months (from nineteen months to twenty-three months). Taxpayers will have to foot the bill since most of these patients will be Medicare and Medicare is not allowed to take into account the cost-effectiveness of drugs.

In good economic times no one would question spending that kind of money but these are not good times.  There are forty million citizens who cannot afford decent medical care. The average waiting time in an Los Angeles County Emergency Room is several hours. It is highly questionable that our society can afford to provide medical care without taking into account cost-effectiveness.

As is becoming the norm, there are no independent studies on this treatment. All the studies done so far have been conducted by the company that holds the patent. Most of the study authors are company employees and stockholders. No one knows exactly how this treatment works. The studies have produced conflicting results. One study, D9902A showed no benefit for survival or disease progression. Another study, D9901 showed benefit for survival but no benefit on progression of disease.  So the results of the two studies were combined and published together. This combination showed benefit for survival but no benefit on disease progression. Only time will tell if this new treatment is a real breakthrough or just a money-maker. Until that time, the taxpayers are going to spend hundreds of millions and perhaps billions of dollars, every year.


 Posted by at 9:02 pm