A new study
of drugs for schizophrenia is getting media attention both for
what it says and for what the media claim it says. The Washington
Post especially used the occasion to say it underscores the extent
to which physicians, patients and policymakers can be blindsided by
self-interested research by drugmakers.
According to the September 20 Washington Post, Federal
Study Finds No Benefit Over Older Cheaper Drugs. The New York Times
took a similar approach, claiming A landmark government-financed
study that compared drugs used to treat schizophrenia has confirmed
what many psychiatrists long suspected: newer drugs that are highly
promoted and widely prescribed offer few if any benefits over
older medicines that sell for a fraction of the cost.
However, the Associated Press cited Columbia University
researcher Dr. Jeffrey Liebermans positive assessment of the drugs.
Lieberman, who led the study, said Make no mistake, these
treatments are effective and far better than no treatment at all.
The study, released this week and appearing in the
Thursday edition of the New England Journal of Medicine, tested five
different medications for the illness and found that the majority of
patients stopped taking each one. However, the medical profession,
and even the editorial in the same journal, were more cautious in
their comments than either the Post or Times. The editorial pointed
out that Patients who carry the diagnosis of schizophrenia vary
markedly in these various aspects of their illness. That makes
assessing the impact of particular drugs difficult.
The Post story, written by Shankar Vendantam, explained
the study compared one older drug with four newer, more expensive
antipsychotics. According to the story, the researchers were
surprised to find that an older generic drug called perphenazine,
which is 10 times cheaper than the newer drugs, was about as
effective and about as safe.
But thats not what the study said. The study said 36
percent of the test subjects continued taking olanzapine, one of the
newer drugs, and only 25 percent continued taking the generic drug.
Thats close to a 50-percent difference from one drug to the other.
The journals editorial also referenced what it called the
apparently moderate increase in the efficacy of olanzapine and
clozapine.
Rather than make that point, Vendantam used his story
to complain about drug companies funding 90 percent of trials in
the scientific literature. Vendantam cited Lieberman calling for
the federal government to pay for all such studies. Lieberman said
they also ought to be funded by federal agencies that pay for drug
treatment for huge numbers of patients, such as the Centers for
Medicare and Medicaid Services (CMS), stated the story.
The Post claimed Pharmaceutical companies called
attention to aspects of the trial that showed their products to
advantage, as if the author were surprised by that point. Vendantam
also added that the industry has recently come under fire for
hiding unfavorable trial data. However, his own story left out
unfavorable data that disagreed with its initial claims. The Los
Angeles Times looked a little deeper into the cost issue: Even
though the new drugs are more costly, other expenses such as
hospitalizations during relapses must be factored into the
cost-benefit equation, the authors said. The paper went on to say
that Patients receiving olanzapine experienced fewer such
hospitalizations during the trial.
Some other points worth noting about the study include:
- The drugs work:
According to the Times, Dr. Robert Baker, who directs the
neuroscience group at Eli Lilly, said, I think what we can
conclude from this study is that there is no one-size-fits-all
treatment for schizophrenia. Dr. Lieberman echoed this
attitude: The drugs work but they are not satisfactory to
many patients, and three-quarters of the people in our study
voted with their feet and discontinued the drugs.
Old vs. new: Buried
deep in the Post article was a comment by Darrel Regier,
director of the division of research for the American
Psychiatric Association: It would be a tremendous mistake to
assume from this study that the cheaper, older drugs are,
quote, 'just as good.
