Big Pharma
Every man, every man for himself. Big Science. So said Laurie Anderson a generation ago. And Big Pharma is showing today just how knackered the American health care system is. The profitability of a drug has very little to do with its efficacy. Marketing to consumers leads to gross overuse of marginally useful drugs. And doctors, who one might think might be able to afford to be objective, are too often swayed by financial incentives, whether small (free lunches, pens, and the like) or large (consulting contracts). How do you know if your doctor is on the take? You don't. You just have to hope not.
Business Week, whose editors are once again deciding that what is bad for people might actually be bad for investors, made the sad finding that modern medical miracles are too often overstated.
Martin Winn's cholesterol level was inching up. Cycling up hills, he felt chest pain that might have been angina. So he and his doctor decided he should be on a cholesterol-lowering medication called a statin. He was in good company. Such drugs are the best-selling medicines in history, used by more than 13 million Americans and an additional 12 million patients around the world, producing $27.8 billion in sales in 2006. Half of that went to Pfizer for its leading statin, Lipitor. Statins certainly performed as they should for Winn, dropping his cholesterol level by 20%. "I assumed I'd get a longer life," says the retired machinist in Vancouver, B.C., now 71. But here the story takes a twist. Winn's doctor, James M. Wright, is no ordinary family physician. A professor at the University of British Columbia, he is also director of the government-funded Therapeutics Initiative, whose purpose is to pore over the data on particular drugs and figure out how well they work. Just as Winn started on his treatment, Wright's team was analyzing evidence from years of trials with statins and not liking what it found.
Yes, Wright saw, the drugs can be life-saving in patients who already have suffered heart attacks, somewhat reducing the chances of a recurrence that could lead to an early death. But Wright had a surprise when he looked at the data for the majority of patients, like Winn, who don't have heart disease. He found no benefit in people over the age of 65, no matter how much their cholesterol declines, and no benefit in women of any age. He did see a small reduction in the number of heart attacks for middle-aged men taking statins in clinical trials. But even for these men, there was no overall reduction in total deaths or illnesses requiring hospitalization—despite big reductions in "bad" cholesterol. "Most people are taking something with no chance of benefit and a risk of harm," says Wright. Based on the evidence, and the fact that Winn didn't actually have angina, Wright changed his mind about treating him with statins—and Winn, too, was persuaded. "Because there's no apparent benefit," he says, "I don't take them anymore."
In some cases, treatments for nasty diseases work splendidly. The antibiotics given to treat stomach ulcers kill the bacteria in almost all patients, and heal those ulcers in many of them: one in five by the end of treatment, and one in two by the end of a year. In medical terms, the number needed to treat NNT is about 1.1 for the antibiotic cocktail in terms of killing the ulcerating bacteria and about 5 for healing the ulcers.
For statin drugs, the NNT is about 20 to prevent heart attacks in high-risk patients. The NNT is between 75 and 200 to do the same for lower-risk patients. And for Zetia, the NNT is at least 1000 and may be infinite.
Think about that. All Zetia does is lower cholesterol, but it does not protect against heart disease. As long as Merck/Schering-Plough can keep reminding consumers about the cholesterol reduction, useless though it may be, it can keep selling its well-nigh useless but nonetheless profitable drugs to a populace that is mostly ignorant about current medical research.
Labels: Big Pharma, Lipitor, stupid corporate tricks, Zetia
