Newer Drugs Doesn’t Mean Better Drugs 10/5/2006 4:06:23 PM
. There has been a surge in prescriptions of the newer antipsychotic drugs in recent years, including those prescribed for children. Alarmingly so. However, there is strong evidence that Schizophrenia patients do better on older psychiatric drugs compared with newer and far costlier medications, according to a study published recently that overturns conventional wisdom about antipsychotic drugs, which cost the United States $10 billion a year. Schizophrenia is a serious mental disorder that is believed to affect about one in 100 adults. It is characterized by psychotic symptoms such as hallucinations and delusions and negative symptoms such as social withdrawal.
The study, funded by the British government, is the first to compare treatment results from a broad range of older antipsychotic drugs against results from newer ones. The study was requested by Britain's National Health Service to determine whether the newer drugs, which can cost 10 times as much as the older drugs, are worth the difference in price. The researchers conducting the trial were certain they would find exactly the opposite. The actual findings were so contrary and different from what they expected that they had to make sure the research data had not been recorded backward.
A U.S. government study last year found that one of the older drugs did as well as newer ones, but at the time, many American psychiatrists warned against concluding that all the older drugs were as good, and there was an uproar from the psychiatric community. Yesterday, in an editorial accompanying the British study, the lead researcher in the U.S. trial asked how an entire medical field could have been misled into thinking that the expensive drugs, such as Zyprexa, Risperdal and Seroquel, were much better. "The claims of superiority for the [newer drugs] were greatly exaggerated," wrote Columbia University psychiatrist Jeffrey Lieberman. "This may have been encouraged by an overly expectant community of clinicians and patients eager to believe in the power of new medications. At the same time, the aggressive marketing of these drugs may have contributed to this enhanced perception of their effectiveness in the absence of empirical information."
Peter Jones, a psychiatrist at the University of Cambridge in England who led the study, searched yesterday for the right word to describe what had happened to his colleagues.
" 'Duped' is not right," he said. "We were beguiled." Over the past decade, older antipsychotics such as Haldol have been widely criticized for triggering uncontrolled body movements, even as the new "atypical" antipsychotics were hailed for causing fewer side effects. Recently, however, concern has grown that antipsychotics in general, and some of the newer drugs in particular, may be causing metabolic side effects.
While the researchers had expected a difference of five points on a quality-of-life scale showing the newer drugs were better, the study found that patients' quality of life was slightly better when they took the older drugs. Jones said a conservative interpretation of the data suggested that there is no difference, "so the notion you would pay 10 times as much would be difficult to justify. Why were we so convinced?" he asked, referring to the widespread opinion among psychiatrists that the new drugs were worth the great difference in cost. "I think pharmaceutical companies did a great job in selling their products. That is certainly one issue. It became almost a moral issue on whether you would prescribe these dirty old drugs," he added. "It became the 'my son' phenomenon. What would you prescribe for your son?" In retrospect, Jones and others said, there were hints going back many years. In 2003, Robert Rosenheck, a psychiatrist at the Department of Veterans Affairs, found there was no difference between Haldol and Zyprexa after patients taking Haldol were treated to prevent the movement side effects.
One drug maker, worried about loss of profits, immediately questioned the findings. Carole Puls, a spokeswoman for Eli Lilly and Co., which makes Zyprexa, said it was problematic to compare large groups of medications because there are differences between the drugs in each class. Individual patients need different medication options, she said. Janssen Pharmaceutica, which makes Risperdal, and AstraZeneca, which makes Seroquel, did not respond to requests for comment.
Caution is the word here on any medication taken, and it is good to be reminded that marketing of drugs is dollar driven first, and humanitarian driven...second or third.
