The drugs don't work

POSTED BY: canttakesky
UPDATED: Sunday, October 26, 2025 11:22
VIEWED: 2880
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CANTTAKESKY

Saturday, September 22, 2012 1:41 PM

Finally, a physician discovers what the rest of us already know. Medicine is not a science. Medical journals are simply ads for Big Pharma. And it's called publication bias--which they apparently don't teach in medical school.

Quote:

http://www.guardian.co.uk/business/2012/sep/21/drugs-industry-scandal-
ben-goldacre?fb=optOut

The drugs don't work: a modern medical scandal

The doctors prescribing the drugs don't know they don't do what they're meant to. Nor do their patients. The manufacturers know full well, but they're not telling.

Reboxetine is a drug I have prescribed. Other drugs had done nothing for my patient, so we wanted to try something new. I'd read the trial data before I wrote the prescription, and found only well-designed, fair tests, with overwhelmingly positive results. Reboxetine was better than a placebo, and as good as any other antidepressant in head-to-head comparisons. It's approved for use by the Medicines and Healthcare products Regulatory Agency (the MHRA), which governs all drugs in the UK. Millions of doses are prescribed every year, around the world. Reboxetine was clearly a safe and effective treatment. The patient and I discussed the evidence briefly, and agreed it was the right treatment to try next. I signed a prescription.

But we had both been misled. In October 2010, a group of researchers was finally able to bring together all the data that had ever been collected on reboxetine, both from trials that were published and from those that had never appeared in academic papers. When all this trial data was put together, it produced a shocking picture. Seven trials had been conducted comparing reboxetine against a placebo. Only one, conducted in 254 patients, had a neat, positive result, and that one was published in an academic journal, for doctors and researchers to read. But six more trials were conducted, in almost 10 times as many patients. All of them showed that reboxetine was no better than a dummy sugar pill. None of these trials was published. I had no idea they existed.

It got worse. The trials comparing reboxetine against other drugs showed exactly the same picture: three small studies, 507 patients in total, showed that reboxetine was just as good as any other drug. They were all published. But 1,657 patients' worth of data was left unpublished, and this unpublished data showed that patients on reboxetine did worse than those on other drugs. If all this wasn't bad enough, there was also the side-effects data. The drug looked fine in the trials that appeared in the academic literature; but when we saw the unpublished studies, it turned out that patients were more likely to have side-effects, more likely to drop out of taking the drug and more likely to withdraw from the trial because of side-effects, if they were taking reboxetine rather than one of its competitors.

... Read more at the link.

KWICKO

Saturday, September 22, 2012 2:03 PM

I kind of thought this was widely known already.

Drug companies pay for lots and lots of "studies"... and then publish only the results that make their new wonder drug look like it works.

"I supported Bush in 2000 and 2004 and intellegence [sic] had very little to do with that decision." - Hero

Mitt Romney, introducing his running mate: "Join me in welcoming the next President of the United States, Paul Ryan!"

Rappy's response? "You're lying, gullible ( believing in some BS you heard on msnbc ) or hard of hearing."

SIGNYM

Saturday, September 22, 2012 2:34 PM

Quote:
I kind of thought this was widely known already.

Yeah, I thought so too. I recall a news item about 8 years ago on exactly the same theme: the manufacturer of Synthroid (the brand-name version of the thyroid hormone replacement levothyroxin) paid a university medical doctor/ researcher to run tests to determine if generic and brand-name were equally effective. Nine studies later, only one was published - the one which showed that Synthroid was more effective. The twist on the tale was that the researcher was so upset that the other studies had been withheld that SHE published them... and was sued because the pharma said that they paid for the studies and therefore the results were theirs not hers. (I never did hear the end of that court case. But having worked for a private consulting lab many years ago, I can tell you that's how things work.) The President of Glaxo Smith Klein came out four years ago and said himself that any particular drug will only work with about 30% of the people who take it.

Many drugs DO work. Anesthetics reliably put people to sleep for surgery. Antibiotics reliably kill non-resistant pathogens. Steroids reliably reduce swelling. Even artorvastatin reliably reduces cardiac events, on a population basis.

But not all drugs work for all people, and some drugs work in so few cases they're almost not worth prescribing... except for the few cases where they DO work. And drugs are quite often over-prescribed.

But to say that ALL drugs do nothing is, of course, an exaggeration and simply not true.

BYTEMITE

Saturday, September 22, 2012 3:39 PM

This is why I think whenever anyone prescribes a drug, they should know the complete pathway of the drug. Where it goes, what it acts on, why, the chemistry, why there might be side effects, and where it goes after it's done.

With many drugs, it's often a reasonable guess that, oh, the drug has this group, which is like the group on this other compound, so it's likely to do this. And that's not necessarily bad, though sometimes those less known drugs don't act as expected in vivo.

But other times, something is synthesized that the drug company has not even a guess what's the active group and what it might do, so they perform studies, like these, to see if they can get some data that supports it's effectiveness on some condition or another. These trials will be varied across the spectrum of human illness, mental health to heart problems to liver and so on, until they find something that they can publish works for one particular thing, but then their results for that one particular thing can be a false positive.

NIKI2

Saturday, September 22, 2012 3:45 PM

Nasty subject, especially as I take more than a few pills every day, and one of them IS Synthroid! My thyroid always tests fine, and it didn't before, so I guess I'll just go on taking it, but I certainly know what you and Byte are saying and fully agree. And yeah, I've heard enough of study suppression over time that it's not surprising to me. Actually not much Big Pharma can DO would surprise me, they get away with an awful lot.

As to over-prescribing, HAH, that's the understatement of the week, ain't it?!

DREAMTROVE

Saturday, September 22, 2012 3:52 PM

Quote:
Byte:

This is why I think whenever anyone prescribes a drug, they should know the complete pathway of the drug. Where it goes, what it acts on, why, the chemistry, why there might be side effects, and where it goes after it's done.

This is so well said I can't think of anything to add.

ETA: Maybe that patent law causes the new drugs to be prescribed and old ones to be abandoned. You will always get some cases where a drug "worked" because some elements are random and somewhere around a third of patients will take some form of alternative treatment along side anything they get from the doctors, and doctors are prone to ascribe any positive changes to the drug they prescribed.

FREMDFIRMA

Saturday, September 22, 2012 6:18 PM

Actually, I have a proposal here that might satisfy all of us, odd that it sounds since we're usually all but cannon shelling each other in regards to this...

Now, it grinds me a bit to suggest actually expanding or increasing funding for a *gaghackspit* Government agency, but the truth is there's no way in bloody hell joe sixpack can test all this crap for themselves, it just ain't possible.

Substantially expand the FDA, increase it's funding significantly, while barring personnel exchange with Big Pharma via both conflict-of-interest and compliance/NDA type measures, and I mean that in BOTH directions - if you work for the FDA you can't jump ship to Big Pharma, as well as vice versa.
Additionally, I would support subsidizing the education of folks interested in a scientific career in exchange for a contractual agreement to work for the FDA, along with internship and apprenticeship programs.
(PAID ones, REAL ones, not bullshit abusive ones like Corpos use, or crummy useless makework either - there *IS* plenty of "grunt work" to be done in science which requires less skill and training, and this will ease them in and take the load off the high end people)

In exchange for this I would ask the removal of the FDA's enforcement power in regard to anything but truth in labelling, as well as a degree of seperation from other Government agencies in order to provide a bulwark against corruption of the process - allow them to sell their drugs, supplements, what have you, so long as the potential customer is PROPERLY INFORMED OF WHAT THE EFFECTS ARE, both in practice and potential.
If the customer chooses something that may or may not "officially" work, or something that may be harmful to them, let that be the customers decision and remove the moral judgement element - they were informed, they made a choice.

That's just an unrefined, first-thought suggestion, but I think it has legs.
Think we can work with this ?

-Frem

CANTTAKESKY

Saturday, September 22, 2012 7:02 PM

Quote:
Originally posted by DREAMTROVE:
Quote:
Byte:
This is why I think whenever anyone prescribes a drug, they should know the complete pathway of the drug. Where it goes, what it acts on, why, the chemistry, why there might be side effects, and where it goes after it's done.

This is so well said I can't think of anything to add.

Well I can add this. They should know, but more often than not, they don't. Mechanistics studies, indeed science itself, are slow. They know part of the pathway, some of the chemistry, some acute side effects but not the long term ones... Drugs are always a work in progress.

So do we not allow them until the complete pathway is known? Or do we allow them to market the drugs with what little they do know, as long as there is truth in labeling?

I'm with Frem re truth in labeling. I would like to see the FDA change its mandate to enforcing labeling ONLY. With ties cut completely with Big Pharma. My only disagreement there is I don't see why reducing FDA responsibilities should result in expanding its budget.

So I say let everyone market whatever drug they have, even if the knowledge on the mechanism is in its infancy. Just make sure people know how little we really know about each drug. Truth in labeling.

Something Big Pharma won't have.

BYTEMITE

Saturday, September 22, 2012 7:08 PM

>_> Actually I think the average joe six pack CAN understand this stuff. People in general have about the same amount of brain utilization they can manage without burning themselves out regardless of ethnicity or gender or social strata. Plus, this stuff really isn't that hard provided people haven't been conditioned to cross their eyes and turn their brains off whenever numbers come up in text.

FREMDFIRMA

Sunday, September 23, 2012 7:06 AM

Quote:
Originally posted by canttakesky:
So do we not allow them until the complete pathway is known? Or do we allow them to market the drugs with what little they do know, as long as there is truth in labeling?

I'm with Frem re truth in labeling. I would like to see the FDA change its mandate to enforcing labeling ONLY. With ties cut completely with Big Pharma. My only disagreement there is I don't see why reducing FDA responsibilities should result in expanding its budget.

Well, how bout this...

Quote:
EXPERIMENTAL:
This drug has not been sufficiently tested for safety and effectiveness, any use should be considered "off-label" and physicians should refrain from prescribing save at patient request.

And then add what they do know, yes ?
Works for me.

As for budget/personnel expansion, simple logistics - the FDA flat out does not have, at this time, the resources or personnel to do it's job effectively... I mean it, they really don't.
Automation and refining the process can only do so much, the greatest need is for boots on the ground - right now a lot slips by cause there just ain't ENOUGH inspectors/testors/what-have-you, and I am bloody well aware of it.
So sometimes ya gotta make the tradeoff, and I would rather do it up front, from both a financial and safety perspective, than playing catch up trying to get stuff off the shelves after it's killed some folk, yadda yadda.

Cheap at the price, AND one could also sell it on the employment aspect too, more jobs, more people working instead of starving, even if science types are often underpaid, alas.

-Frem

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