Study: Doctors May Not Know Which Drug Is Best

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Doctors prescribe specific drugs based on how well they think individual drugs actually work. A study in the Journal of the American Medical Association says that in many cases, doctors don't have enough information to know which drug is best.


And one of the issues that's come up in the health care debate over and over isn't just the cost of our health care. It's what we're getting for that money. When it comes to drugs, doctors mostly prescribe them based on how well doctors think individual drugs actually work.

Now, a study in the Journal of the American Medical Association says that in many cases, doctors don't have enough information to know which drug actually is the best. NPR's Joanne Silberner has more.

JOANNE SILBERNER: One night when physician Michael Hochman was in training, a patient came into the cardiac care unit. The senior doctor prescribed a drug. One of the other junior doctors wanted to know: Why that drug?

Dr. MICHAEL HOCHMAN: And he really didn't have a good answer. And so I then asked, well, why do you prefer this medicine? And he said it's just what I've always used, and it's what I'm used to using.

SILBERNER: That didn't sound like a good answer to Hochman. As his training continued though, he heard it more and more. With new drugs, sometimes the reason was, well, it looked good compared to placebo. When Hochman was done with his training, he and his colleague checked six of the leading medical journals. They picked out 328 recent studies on drugs.

Dr. HOCHMAN: Well, I learned what we expected we were going to learn going in, and that's that only a minority - 32 percent - of all studies involving medications are aimed at helping doctors use existing therapies more effectively.

SILBERNER: The rest were more useful for marketing purposes. Descriptions of new drugs, comparisons to a placebo - no help to doctors trying to figure out whether to prescribe new drug X or old drug Y or even, say, a non-drug option like exercise or physical therapy. And that's a problem, says Hochman. He's still prescribing drugs in the dark.

In his research, Hochman only found two studies that looked at the price of drugs. He also found that most of the research that pits drugs in head-to-head competitions is funded by the government, not drug companies.

That's understandable, says Jerry Avorn. He is a professor of medicine at Harvard and a frequent critic of drug companies.

Professor JERRY AVORN (Medicine, Harvard University): Companies, understandably, are going to want to fund trials of their drugs or their devices that are going to highlight their product in the best possible way.

SILBERNER: But he says doctors and patients need more information.

Prof. AVORN: Given the state that our health care system's in, we really don't need more studies that just show a drug is better than nothing. We need to know how does a particular drug compare with a choice that a doctor might make as an alternative, and also what's the best buy for the patient or for the taxpayer.

SILBERNER: That information may be coming, eventually. President Obama, in his stimulus package last year, set aside $1.1 billion to fund more head-to-head studies. In a commentary in the Journal of the American Medical Association, Alec O'Connor of the University of the Rochester called for the FDA to consider comparative effect in the studies when it considers new drugs.

But that's going too far for Peter Pitts. He heads the Center for Medicine in the Public Interest, a group that gets funding from the drug industry. He says a drug that comes out a loser in a comparative effectiveness study may still work for some people, and doctors need that choice.

Mr. PETER PITTS (Center for Medicine in the Public Interest): Asking the FDA to make comparative effectiveness a third leg in addition to safety and efficacy does not get the job done.

SILBERNER: But others say the comparative information needs to be out there for consideration so doctors like Michael Hochman can have comparative information on prescription drugs the same way consumers can get that kind of information when they're thinking about buying new cars or computers.

Joanne Silberner, NPR News.

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