Sam Uretsky

Safer Drugs Another Victim of Lobbyists

Health care costs are rising — for lots of reasons. The American population is getting older, so that more people need more care. New drugs and diagnostic methods increase costs. Lack of proper diet and sufficient exercise leads to more people with chronic conditions. There’s fraud and waste and defensive medicine that leads to unneeded tests and referrals to specialists. There are efforts to control costs, such as prior approval systems, which call for more paperwork and reviews so that it can be difficult to tell whether it would have been less expensive in the long run to just let the prescriber do whatever she wanted to do.

Aside from that, sometimes everybody is just wrong. It happens. Back in 1921, James Walsh wrote “All down the course of medical history we find in each generation as a rule at least one, but often a whole series of remedies or modes of treatment which were vaunted as cures for disease and sometimes recognized as such even by authorities in medicine, though afterwards on further investigation they proved to have no curative effect at all and indeed were determined by scientists to be rather harmful than beneficial to mankind.” This observation is still true, and isn’t limited to fringe medicine. We still have a good number of complimentary and alternative theories that have their adherents, but beyond that, we have treatments that seemed like good ideas at the time, and turn out to be duds, and we’re resisting any effort to get rid of the duds that, at best are wasting money, and in some cases making us sicker.

Right now, one of the most significant problems in public health in the United States is the increase in incidence of Type 2 Diabetes. This is the form of diabetes once called Maturity Onset, and is marked by resistance to insulin (Type 1, once called Juvenile Diabetes, is caused by failure to produce enough insulin.) Type 2 diabetes leads to a collection of serious health problems, which can involve vision loss, circulatory problems, kidney and heart disease. The one well-established treatment is “lifestyle changes” — lose weight, exercise more, stop smoking. The trouble is, some people can’t, and others won’t. Some people seem to have a gene that promotes fat deposition. Others just don’t have the time, or the resources to follow these guidelines. People with osteoarthritis, another challenge that comes with age, may no longer be capable of vigorous exercise.

So, physicians turned to drugs — and typically, the more the better. Unfortunately, a series of studies seem to show that aggressive treatment of some cardiac risk factors in diabetic patients has no benefit in reducing heart disease, and may cause drug related adverse effects, as well as increasing costs. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Study Group tried bringing systolic blood pressure (the high number) down to 120 as compared with other patients who were held to 140. The results showed no reduction in heart attacks and strokes, in fact the rate of cardiovascular deaths was slightly higher, and there were serious drug related problems as well. Another study from the same group indicated that there’s no benefit to using two cholesterol-lowering drugs as compared with just one. Keep in mind that it’s routine to rely on the most recently published study, and studies, and their interpretations often disagree, but opposing results do show that there are no clear answers, even with modern methods, and more drugs and newer drugs aren’t always better treatment. The drugs just cost more, and had new, and often unpredicted adverse effects.

Recent studies show that a widely used drug for diabetes, rosiglitazone, might cause heart damage, and that other drugs might be equally effective and safer. But rosiglitazone became widely used when it turned out that an earlier drug, troglitazone, caused severe liver damage, so that rosiglitazone seemed to be better and safer.

The answer is simply well-conducted research, but when a center for this research was proposed as part of the health-care reform proposal, the Pharmaceutical Research and Manufacturers of America (PhARMA) made quashing the proposal one of the targets of their lobbying effort. The trade association spent $6.3 million lobbying Congress in the last three months of 2009. It’s as if they’re afraid that knowing which treatment is safest and most effective might, just might, cut into their profits.

Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.

From The Progressive Populist, April 15, 2010