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Medicine

New Drugs Trail Many Old Ones In Effectiveness Against Disease 230

Posted by Soulskill
from the peak-pharma dept.
Lasrick tips this report from Reuters: "Despite the more than $50 billion that U.S. pharmaceutical companies have spent every year since the mid-2000s to discover new medications, drugmakers have barely improved on old standbys developed decades ago. Research published on Monday showed that the effectiveness of new drugs, as measured by comparing the response of patients on those treatments to those taking a placebo, has plummeted since the 1970s. 'While experts agree that tougher trials and similar factors explain some of the decline in drugs' reported effectiveness, something real is going on here,' said Olfson. 'Physicians keep saying that many of the new things just aren't working as well,' and therefore prescribe antidepressant drugs called tricyclics (developed in the 1950s) instead of SSRIs (from the 1980s), or diuretics (invented in the 1920s) for high blood pressure instead of newer anti-hypertensives.'"
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New Drugs Trail Many Old Ones In Effectiveness Against Disease

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  • ... it looks funny,
    In a rich man world.

    I am not surprised of this not-so-new news. The same is happening with advertisement where the mantra is "shout shout 100 times to get that one single client to spend the money".
    We have a saying that basically goes: Do not shout "The Wolf" when there is no wolf. When the wolf comes for real, noone will belive you.

  • True True (Score:5, Informative)

    by Anonymous Coward on Wednesday June 05, 2013 @06:46AM (#43912793)
    Big Pharma Big Bucks is a decent documentary covering this: http://www.youtube.com/watch?v=zqCdZ19y39s [youtube.com]

    Additional Reading: Ben Goldacre's Bad Pharma, Jacky Law's Big Pharma, Marcia Angell's The Truth About the Drug Companies and Irving Kirsch's The Emperor's New Drugs Exposed.

    Companies are out for profit. That in itself isn't bad, but due to stockmarket pressure that becomes all they care about and start chasing the easy money spinners. The easiest money is repackaging old drugs. New drugs are too risky.

    BTW The Chaser's Checkout did a hilarious piece on Complementary Medicine: http://www.youtube.com/watch?v=QMYXKSy2fb8 [youtube.com]
    • Re:True True (Score:4, Insightful)

      by SharpFang (651121) on Wednesday June 05, 2013 @08:03AM (#43913181) Homepage Journal

      Moreover: Promote new, weaker drug. Still keep selling the old, efficient drug.
      People buy the new drug. They find it's inefficient. They switch to old drug.
      Two packages sold instead of one.

      • Re:True True (Score:5, Insightful)

        by hedwards (940851) on Wednesday June 05, 2013 @09:19AM (#43913765)

        I'm not a fan of big Pharma, but this is horseshit.

        Tricyclics are substantially more dangerous than the newer generation of medications, sure you can OD on any of the psych medications, but the newer medications tend to be more narrowly focused than the old ones. Have you ever looked at the listing of things to avoid when it comes to MAO inhibitors?

        A lot of the problem with the newer medications is that since they target smaller parts of the brain, it's less likely that any one medication will work properly, but it also means that it's less likely that it will interact with some other medication. For instance you can't take Prozac or Paxil if you're taking stimulant medication for ADHD because they use the same channels in the liver, IIRC.

        Ultimately, this is not likely to be a problem in the near future as brain imaging scans to see what exactly is going on in the brain become more prevalent and there's more formal testing of what the medicine is actually doing. At present there's very little attention paid to how much of the medication actually gets to the site where it's needed. Something as simple as an undiagnosed food allergy can result in little or none of the medication making it to the brain. Which also effects how much seratonin, dopamine and the rest are there for the medications to work with.

        • Re:True True (Score:5, Interesting)

          by h4rr4r (612664) on Wednesday June 05, 2013 @10:01AM (#43914145)

          Often it seems safety is traded for effectiveness. The best cough suppresent ever is herion, that was its original purposes. Since that was dangerous we moved to codeine, which was not as good but safer. Then we moved to Dextromethorphan, which is safer but works no where near as well and many folks cannot tolerate. Hallucinating while not getting good cough suppression sucks.

          So now my options are to be accused of being a drug seeker by my doctor, take more powerful opiates I have left over from other procedures or going to canada and smuggling back Tylenol 3.

          Sometimes the old stuff really was better.

          • Your mileage may vary. Some people do get hallucinations from dextromethorphan. Other people get hallucinations from codeine or other opiates. (In both cases, that's people who are trying to get cough suppression; people who are trying to get hallucinations are a different market segment :-) And Bayer's original goal in developing heroin was to try to find a less addictive opiate (didn't succeed, but it's sometimes more useful medically than morphine.) My experience with dental-quantity doses has been

    • by Luckyo (1726890)

      I have a better angle: Same thing is happening there that happened in mechanical engineering and similar long researched fields. We've picked all the low-hanging fruit, and are now comparing the speed of reaching for that low hanging fruit to effort needed to pick ones high up.

      There is little reason to attribute malice to what can be sufficiently explained with concepts well known and met in other fields by similar research.

  • Old business ideas (Score:5, Insightful)

    by erroneus (253617) on Wednesday June 05, 2013 @06:53AM (#43912825) Homepage

    1. Can't make any money unless you hold patents (monopoly) and can charge any price you want even [especially] at the expense of loss of life for those who cannot afford it. (They are just dying to get a new drug!)
    2. People won't buy your crap unless it has the word "new" on the label. (Microsoft has driven that notion out of us over the past few years though)

    Real breakthroughs and discoveries are rare. It seems a month doesn't go by without my hearing some new kind of benefit of using aspirin or acetaminophen.

    What really needs to happen:

    1. People need to be more careful about their use of drugs -- a body less accustomed to drugs in it shows a better response to drugs when they are needed.
    2. People need to be more careful about how they live their lives and to take responsibility for their bodies. I could go on forever about that.
    3. More work needs to be done to discover the causes of the maladies plaguing our modern world. We already understand that lots of the cause IS our modern world, but no one wants to talk about it because we might have to give something up.

    There's less or no money in any of these ideas. Consequently, it won't happen.

    • by blackraven14250 (902843) on Wednesday June 05, 2013 @07:06AM (#43912895)
      Beyond the patent issues, there's also quite a few newer drugs that have reduced levels of side effects relative to the older ones. Tricyclic antidepressants vs. SSRIs is a particularly good example of this - SSRIs are less effective on many cases of depression, but they're one of the go-tos in cases of depression because their side effects are generally less severe than tricyclics. If you ignore the side effects entirely, sure, tricyclics are better - but keeping side effects to a minimum is always the preferred course of action.
      • by Sockatume (732728)

        The comparison between diuretics and new antihypertensives is a useful one too: diuretics, as the name suggests, deal with blood pressure by making you urinate out excess fluid. That's rather inconvenient.

        • by erroneus (253617)

          Yes... going to the bathroom is an inconvenience and often an interruption of my day. I have suggested the idea of adult diapers to people with similar concerns but no one seems to think it's a good idea.

          But seriously, all of these individual anecdotes don't negate the big picture issue which has been observed and commented on at least since the 1980s.

        • by hedwards (940851)

          One of the problems here is that the doctors don't always bother to conduct the testing necessary when doing the prescribing. I wound up with nasty hyponatremia the first time my doctor put me on blood pressure medication because my sodium levels weren't the problem, and she just assumed that lowering the levels would help. All it did was cause severe memory impairment and concentration issues within days. I discontinued the medication pretty much immediately and felt better.

          A better course of action would

          • by Qzukk (229616)

            The problem is that now that tort reform has taken hold and failed to curb excessive costs, insurers and governments have gotten wise to the fact that this testing is a huge profit center for docs and hospitals. "Gotta test everything because I make $50 per test!" replaced "Gotta test everything or I'll be sued!" So now they're pushing the doctors to do less testing.

            The obvious solution would be to establish prerequisites for a given course of treatment but DEATH PANELLLLLSSSSS!

            • by h4rr4r (612664)

              Anyone who thought tort reform would curb excessive costs was an idiot. They likely should not be considered competent and should probably be assigned a guardian.

          • And which test would that be? You could test for sodium before you start taking the drug, but that doesn't really answer the question as to how your kidneys deal with the drug.

            There are very few tests you can do a priori to determine if a drug will be safe and effective. We're getting a few and those tend to be, of course, expensive.

            Unfortunately, it's pretty much "try this, watch for these side effects" at present. There is great hope that genomics / proteonomics / whateverthetrendynewfieldisomics will

            • by hedwards (940851)

              The point is that a drug that's meant to drop the sodium levels ought not to be given without establishing that the sodium levels are high in the first place. And they definitely do have testing for that. Same goes for medications that are meant to increase potassium levels.

              And no, of course they can't completely figure it out, but that doesn't get them off the hook for checking things like IGg and the levels of the hormones, neurotransmitters, elements or whatever they're wanting to change.

              SSRIs are a comm

              • I'm assuming you're talking about HCTZ - a common diuretic. Costs .10 a pill.

                IgG levels cost about $200, not sure what hormones you would test, but in general you're talking about close to a thousand dollars worth of blood work with no clinical guarantee of utility.

                Take two pills and call me in the morning .....

                And your SSRI example doesn't make sense. You cannot measure synaptic serotonin without putting probes in your brain. You just try the damned pill. If it works, fine. If it doesn't, try the next

      • Guillotines cure depression 100% of the time, but side effects persist forever.

        • by Immerman (2627577)

          Not really. Within a few decades the side effects are mostly indistinguishable from the natural course of events.

        • by femtobyte (710429)

          Assuming "cure depression" means "live a normal life, with standard healthy human emotional responses to events," the guillotine doesn't seem especially effective. In a sense, dead people express the symptoms of most extreme depression: an absolute nihilism, utterly unmotivated to do anything at all, don't even care about being dead, zero sense of self-worth, will just lie on the ground and rot.

    • by CastrTroy (595695)

      2. People need to be more careful about how they live their lives and to take responsibility for their bodies.

      This is the major problem with most people I know. They do not even attempt to live a healthy lifestyle. They are in a complete complete fantasy world where eating a bowl of instant oatmeal with 15 grams of sugar in it is healthy, simply because it's oatmeal, or that it's ok to eat TV dinners for lunch every day because they are low calorie, nevermind the fact that they have half your day's recom

    • by drinkypoo (153816)

      People won't buy your crap unless it has the word "new" on the label.

      In truth, you have this exactly backwards. People want to buy the old drug, because the patents have expired and generics are available. The bar for bringing a modified version of an old drug to the market is far lower in the USA than bringing a new drug. You don't have to even prove that it is as effective as the drug it is replacing. Then you get the insurance companies and medicare to drop the old drug, which they do (I've personally experienced it on medi-cal, anyway) and you run some ads to scare peopl

      • by erroneus (253617)

        That was part of my point. I was indicating problems with the old way of thinking. People, more likely as a result of the "New Coke" incident than Microsoft's despised Windows releases like WinME, Vista and Win8, just don't care to see "New" on the label.

        I would rather think the drug makers/pushers are out of touch rather than maliciously preying on patients.

        • by drinkypoo (153816)

          I would rather think the drug makers/pushers are out of touch rather than maliciously preying on patients.

          I would rather believe that rainbows come from unicorns, but belief won't make that so, either.

  • by gallondr00nk (868673) on Wednesday June 05, 2013 @07:04AM (#43912887)

    This doesn't really address the whole issue, but remember that the war on drugs has stopped scientists from being able to conduct research for decades. LSD and Ecstasy both had incredibly promising properties in treating some illnesses, especially in the area of mental health. This was until research was banned by governments around the world. I wonder what sort of illnesses, diseases and conditions we'd have cured today if they hadn't banned it.

    It pays to remember that through drug prohibition governments are not just waging a war against the individual's rights, but waging a war against scientific research.

    • Heroin is probably still one of the best analgesics around. So is Thalidomide, and people have recently started using it again. Just don't be a pregnant mother and you'll be fine. If you're suffering from HIV or etythrema nodosum and can't sleep for weeks, you're not going to give a f*&k that it's teratogennic in some stages of pregnancy, you'll just want to use the bloody thing.
      • by dpilot (134227) on Wednesday June 05, 2013 @08:43AM (#43913451) Homepage Journal

        I remember reading somewhere that...

        Thalidomide has 2 "rotations", left-handed and right-handed forms. One handedness was "effective" and the other caused the birth defects. The big Thalidomide crisis was because of bad quality control, there was significant contamination by the wrong-handed version, and we really didn't understand this stuff at the time. Therefore the "good Thalidomide" was banned along with the bad. The bad Thalidomide should be simply be considered a harmful manufacturing by-product that needs to be removed from the final product.

        • by VAXcat (674775) on Wednesday June 05, 2013 @09:26AM (#43913829)
          Not exactly true. Thalidomide does indeed have two mirror image isomers,. and there is some research to indicate that indeed only one of these isomers causes damage. BUT - thalidomide undergoes racemization in the human blood stream - that is, even if you start only with "good" thalidomide in your drug, it will be metabolized into a mix of good and bad in the bloodstream - so, even if you only ingest the "good twin", you wind up with the damage causing "bad twin" in your body anyway.
        • by Rich0 (548339)

          If that is the case then all somebody needs to do is a number of large clinical trials to prove that the single isomer is both safe and effective and submit a marketing application. There is a decent chance it would be accepted.

          Of course, it will cost probably $100M or so to do all those trials, regardless of outcome, and the drug isn't patented so you won't make more than a few cents per pill selling it. The only way it will happen is if the government funds it.

          Oh, and because of the safety concerns you'

  • by Telecommando (513768) on Wednesday June 05, 2013 @07:05AM (#43912889)

    Perhaps the older drugs were manufactured for maximum effectiveness and the newer ones for maximum profit.

    • by RabidReindeer (2625839) on Wednesday June 05, 2013 @08:10AM (#43913223)

      Perhaps the older drugs were manufactured for maximum effectiveness and the newer ones for maximum profit.

      Close, perhaps. Cynical, certainly.

      A lot of the older drugs were discovered more or less accidentally. Mostly because their effects were anything but subtle.

      Unfortunately, so were the side-effects.

      There are perfectly good humanitarian reasons for chasing new drugs.

      First of all, drugs have varying effects depending on the patient. So the "go to" drug might not effectively - if at all - on some people. Or even harm them.

      Secondly, the side-effects of the drugs may be prohibitive for some people.

      So there's definitely a demand for drugs that are more finely-targeted than the original sledgehammer medications. Problem is, the more precise the solution, the more likely that the number of people it works effectively for is going to be very small. And, on top of that, the objectionable features become more objectionable, relatively speaking.

      That's aside, of course from the all-too-common situation where the business decision is made to push a drug even when it's more of a medical liability than an asset just because it's more of a (potential) financial asset than a liability.

      • by dpilot (134227)

        > That's aside, of course from the all-too-common situation where the business decision is made to push a
        > drug even when it's more of a medical liability than an asset just because it's more of a (potential)
        > financial asset than a liability.

        Then 5 or 10 years back there was also the case where a very effective peanut allergy drug was nearly finished with trials and approaching approval. The developing company was bought out by a bigger rival. The new owners squashed the new drug, because they w

        • by edremy (36408)

          > That's aside, of course from the all-too-common situation where the business decision is made to push a > drug even when it's more of a medical liability than an asset just because it's more of a (potential) > financial asset than a liability.

          Then 5 or 10 years back there was also the case where a very effective peanut allergy drug was nearly finished with trials and approaching approval. The developing company was bought out by a bigger rival. The new owners squashed the new drug, because they wanted to re-purpose a drug they already had for peanut allergies. It wasn't as effective as the new drug they'd just acquired, and had worse side-effects, but it was more profitable.

          Urban legend or true story - I don't know. The inability to know stuff like this is a problem in itself.

          Almost certainly an urban legend. This behavior doesn't make sense in the context of the drug market. The first-tier drug companies like Merck and Glaxo fund everything from a few high priced, patented drugs. They have a limited amount of time to make money off of these before they come off patent and the generic makers cut the prices by 10x. This is why you see a constant stream of "me too" modifications of existing drugs- they need to something under patent to make money. Buying a drug and then buryi

          • by DarkOx (621550)

            Buying a drug and then burying it in favor of something existing would be stupid- you have a chance to reset the patent clock and get ~15 years of high profits as opposed to trying to compete against the generics

            If you have a patented drug that treats condition X and the patent still has some years of life in it. It absolutely makes sense to keep drug Y a secret; especially if drug Y treats condition X better(be it in effectiveness, fewer side effects, etc) and you know that everyone will want to switch from X to Y when you make Y available.

            This will give remaining life of your patent on X and the full life of the patent on Y years of being able to sell a drug for the condition at high margins, as you won't have c

        • by hedwards (940851)

          It's almost certainly an urban legend. The closer you get to approval the less likely you are to see this sort of behavior. There's no guarantee that you'd get approval for the medication to treat something else, and if you've really got to stage 3 trials, there's a ton of money that's been invested already, enough that the medication will be released if it passes the final trials and gains approval.

          In this case, there's no profit motive to do that as repurposing an older drug would probably cost them more

        • by Guppy (12314)

          Urban legend or true story - I don't know. The inability to know stuff like this is a problem in itself.

          Actual drug (anti-IgE Monoclonal antibody), WHARGARBL explanation. You're thinking of the Talizumab (TNX-901) [wikipedia.org] and Omalizumab (Xolair) [wikipedia.org] dispute:

          TNX-901 was developed by Houston-based Tanox, started by two biomedical scientists, Nancy T. Chang and Tse Wen Chang, in 1986. There was a legal dispute whether Tanox had the right to independently develop TNX-901 under the tripartite partnership formed by Tanox, Novartis, and Genentech in 1996. Trials of TNX-901 for treating extreme peanut sensitivity, which affect children especially, were unfortunately mired in legal battles.

          Although I've linked to the Wikipedia article on this subject, I don't consider the currently posted version of the article to be a good source of information on the subject; several sections of the article are written in a style unsuitable for an encyclopedia. For instance, use of rhetorical questions in the body of an article smacks of non-neutrality and non-factu

  • So what? (Score:5, Insightful)

    by swamp_ig (466489) on Wednesday June 05, 2013 @07:08AM (#43912905)

    So what?

    Sure the old drugs are great, but there's plenty of new ones that are great too.

    Take statins for example - relatively new class of medication that have dramatically changed the treatment of high cholesterol - which leads to the number one killer of heart disease. Another example - artemisinin - great treatment for malaria, relatively recent invention.

    Not to mention the survivorship bias http://youarenotsosmart.com/2013/05/23/survivorship-bias/ [youarenotsosmart.com] - there's heaps of old drugs that just aren't used anymore because frankly they were no good and had a ton of side effects. You don't hear about those ones much simply because they aren't used. This gives the perception that 'the old drugs are better' when in truth they were just as bad or worse, and only the good ones have stood the test of time.

    But even if it were true - should we then give up drug discovery? Give up the chance to find the next great drug just because the low hanging fruit are already taken? What exactly is the solution to this?

    • Sure the old drugs are great, but there's plenty of new ones that are great too.

      I think the issue has two sides, actually: There's research into, e.g., how to replace antibiotics that bacterial strains have become resistant to, and that often fails. Then, there's research into whole new classes of drugs and treatments that are promising, and often game-changing, but those are the areas where we're collecting the first pieces of the low-hanging fruit. Once you find the best ways of doing something, it's obviously difficult to find different best ways of doing the same thing with differe

      • by rjr162 (69736)

        not quite, because how do you *know* it's the best way? You don't. it's just the best way of the ways you know, but there are many unknown ways of which some could be better.

        For your example: "It's like having a screwdriver and then trying to invent a hammer that's different from a screwdriver but does the same thing."

        It'd be more like "It's like having a screwdriver and then trying to invent something that's different from a screw driver but does the same thing, such as an electric drill or screw driver, a

    • Re:So what? (Score:5, Informative)

      by jo_ham (604554) <(moc.liamg) (ta) (999mahoj)> on Wednesday June 05, 2013 @07:40AM (#43913057)

      The big problem with statins (from a pharma standpoint) is that they hit on the perfect one right away and the patent is soon going to expire, opening the door to generics. This is great for the patients, but it stops the money train.

      All of the work on alternate statins that can be patented (throwing new function groups on there, changing the core structure but keeping the interaction with the target receptors etc the same) has resulting in a less effective drug.

      With atorvastatin, and others like simvastatin going generic before a new patented, more effective (or as effective) analogue could be developed, the pharma industry has gone into panic. They were some of the must lucrative drugs of all time.

      • by Rich0 (548339)

        The big problem with statins (from a pharma standpoint) is that they hit on the perfect one right away and the patent is soon going to expire, opening the door to generics.

        I suspect that this will become more the norm. Back in the 90s there were a plethora of tools for designing drugs that didn't exist beforehand, so taking old drugs and running them through the new methods often led to new drugs in the same class which were just all-around better.

        However, not a whole lot has changed in that department - when we come up with a new drug today it works VERY well. Even if you compare a statin like atorvastatin which clearly is superior to simvastatin, the differences just aren

  • by adoarns (718596) on Wednesday June 05, 2013 @07:11AM (#43912911) Homepage Journal

    I am an epileptologist, and I would certainly love to see more effective anti-seizure drugs on the market. But although the newer anticonvulsants aren't necessarily better at stopping seizures than older ones (like the classic four: phenytoin, carbamazepine, phenobarbital, and valproic acid), they are better tolerated, have fewer severe adverse effects, have much more predictable serum concentrations, fewer drug-drug interactions, and require little to no routine bloodwork monitoring. For the 1% of the population suffering from epilepsy who have to take these drugs on a regular basis, this has been a significant change.

    • i was just going to say, most of the old medications were found to be very effective, but not very targeted in where they work in the body. Hence lots of side effects, Modern medicinal chemistry and molecular modeling allow for the design of better molecules that work only where they are supposed to. you don't even have to go that far to see one. Look at Benadryl and Claritin. both are antihistamines, but benadryl did not target the Histamine receptors responsible for the allergic response, it also aff

  • More difficult now (Score:5, Insightful)

    by Anonymous Coward on Wednesday June 05, 2013 @07:54AM (#43913137)

    Several reasons for this:

    1. Patent Law - Because all most all of the simple compounds have been patented, with the patent already expired, New drugs have to get more and more complicated in order to guarantee gaining a patent. More complicated means more expensive, but not necessarily more effective.

    2. Increased safety - The requirements to get a drug on the market keep getting tougher and tougher. Almost everyone in the industry agrees that if aspirin was developed today, it would be a coin flip as to whether it would gain approval. (And certainly wouldn't be available OTC.)

    3. Laziness - Many new drugs are just minor modifications of existing drugs made to get around patents. This is unlikely to provide any benefit to patients other than breaking the other company's monopoly. See Viagra vs Levitra: they are effectively identical.

    4. Increased difficulty in animal testing - Years ago you could do anything to mice/rats, and the ethics committees only cared about larger animals. Now you have to argue in front of a panel that there is no way an animal could suffer as a result of your testing. I am talking about mice that are going to be killed at the end of the month anyway. And don't even think about using the word LD50: you will be looking for a new facility to do testing for you. This forces more testing back into the test tube, and in vitro environments are different enough from a real body that it is common to see something that works in a test tube to not work in a mouse, and vice versa.

    5. Current failure of computer modeling: A lot of research money has moved from trial/error research by chemists to using software to model binding sites of proteins and trying to compute structures that may fit. While this may one day work, I know of no drug on the market or in clinical trails that was developed using computational chemistry as a primary tool. Note: Computational chemistry has brought some good things with it - see Lipinski's Rule of 5, but that was the result of a statistical analysis rather than modeling.

    Yes, I am a medicinal chemist.

  • Patents kill the flexibility enabling companies to create new drugs without spending inate amount of money in order to avoid the pitholes left by the competition. And Marketing works better on "illnesses" bought be people in good health and with enough money, so Attention disorder medication (paid by young parents) E.. disorder payd by the midlife crisis, etc... it also works better on variations of existing medications that are going out of patent protection... Assume Pharma X makes 50% of it's income with
  • My doctor won't even offer me new drugs, he will fall back to the tried and true warriors that have been known to work over the last 30 years. He knows for the most part the kind of side effects they give off and how they will work with my body. The new stuff is to unpredictable, and well I know that new medication gets tested ( be it poorly ), they just can't plan for the side effects, as I've developed side effects off new medication that weren't even known.
  • While the new drugs are often less effective when compared to themselves, they are usually similarly or more effective when on top of the standard of care. For example, what tends to happen is that in the old studies with diuretics people had a systolic blood pressure going in of 200 mm Hg. Now, people are already on those diuretics and have a systolic blood pressure going in of 150 mm Hg. Given the same drug as a comparison, you often see that either the new drug is better in efficacy or similar in effi

  • That's all that has to be demonstrated for a new drug, at least in the US. Not that it is more effective than a previous drug, only that it is safe and more effective than a placebo. So a new version of an old drug might replace a phosphate group with a sulfate group, and it does not matter if the new drug is less effective than the old one, it can be patented and handed over to the marketing department for another 15 years of cash flow. There are a million variations possible, rinse and repeat as needed to

  • Ed Vogler is a brilliant businessman, a brilliant judge of people, and a man who has never lost a fight. You know how I know that the new ACE inhibitor is good? Because the old one was good. The new one is really the same, it's just more expensive. A lot more expensive. See, that's another example of Ed's brilliance. Whenever one of his drugs is about to lose its patent he has his boys and girls alter it just a tiny bit and patent it all over again. Making not just a pointless new pill, but millions and millions of dollars. Which is good for everybody, right? Except for the patients. Psht. Who cares? They're just so damn sick. God obviously never liked them anyway.

    This sort of thing is to be expected in a for-profit system of health care products: If the primary reason for doing something is profits rather than results, you get perverse incentives. For example, it's far more profitable to create an ongoing treatment to a disease than it is to create a cure for that same disease, because a cure is a one-time purchase but an ongoing treatment can require payments for 40 or 50 years.

    • So, what incentives do you propose to replace profits? Please note, this has to be an incentive that does not exist within the current system. I often see people recommend that we remove the profit motive from the medical field, but I have never seen them recommend replacing it with another motive. Usually they suggest that people only go into any of the various aspects of the medical field for altruistic reasons. This sounds good, until you realize that under our current system, people are free to enter an
      • by dkleinsc (563838)

        I know, from your previous posts, that your basic view of the world is that the only reason anyone does anything is for profit, but when you ask or read the writings of people in medical fields, the reasons they cite are:
        1. A genuine desire to save and improve the lives of their patients.
        2. Like how many /.ers have a knack for applying technical skills and become programmers or admins, some go into medicine because they have that same knack for applying biology.
        3. Some are motivated by what they experienced

        • OK, so you want to get rid of the profit motive for doing medicine. When I ask you what you want to replace it with, you list off seven things which currently motivate people to go into the medical field, one of which you want to do away with. How exactly is removing one of the motivating factors for pursuing medical innovation going to increase the incentive for people to pursue medical innovation?
          What you fail to understand is that I do NOT consider profit as the ONLY motivation for people to do things.
          • by dkleinsc (563838)

            I'm not advocating getting rid of the profit motive of people actually doing medicine, I'm targeting the people who hire other people to do the actual medical work. Switching to non-profit doesn't mean that medical professionals don't get paid, it means that Wall Street doesn't get a huge chunk of everybody's health care dollars for doing not much useful.

            But don't believe me, believe the markets: There are quite a few really successful non-profit medical groups in the US, e.g. the Mayo Clinic.

    • by h4rr4r (612664)

      This makes me wish I believed in hell so this Ed Vogler could burn in it for eternity.

  • It's expensive to make drugs. Most of the basic research is done by the government, and then the drug companies swooped in, ran a few study groups and patent the thing. We've been in 'Austerity' mode for about 10 years now. Slashing gov't left and right so we could slash taxes. Didn't anyone realize there would be consequences?
  • ... the patient, or patient's caregiver's.

    I can say this from experience, growing up with parents that thought there was a magic pill for everything. I suppose them not having any religion, could have contributed to this, *just* as much as money.

    I say this because, again, people want a magic pill. Doctor says "Oh there this new thing we'll put you on." Patient takes it and is unable to google anything, or pre-google, just took it with absolutely no knowledge of what negative side effects it could ha
    • by h4rr4r (612664)

      Why bring religion into it?
      I would guess those who already believe in magic are more likely to to believe in a magic pill than those who don't believe in any magic.

    • by Ioldanach (88584)

      I guess being diagnosed by a shrink at the age of 12 (this was around 1989) with ADD simply by me looking up when the madman snapped his fingers after giving me a puzzle to complete.

      He'd already decided to diagnose you. If you hadn't looked up, he would have called it an example of hyperfocusing, the other half of ADD. Sounds like a charlatan's trick.

  • It's not enough that drug companies are putting out inferior, less-effective drugs to replace better ones, but they're putting all their marketing billions into making sure that the doctors prescribe the less-effective drugs instead of the better ones.

    Note to corporate heads: when the mobs come to disembowel you and hang your corpses in the town square, don't say you were never warned.

  • Ah, yes, the results, for the patient, might not be any better but the profits on new patents is far higher.

  • They are about exclusivity. The patent holder only needs to convince doctors to prescribe the medication to have guaranteed profitability. I suspect more is spent on marketing to said physicians than is spent on clinical trials, by a pretty wide margin.
  • Warfarin, originally used as rat poison, is still the number one anti-coagulant. However it requires regular monitoring (blood tests) to ensure therapeutic levels are being taken or there is a risk of embolism or internal bleeding.

    When Plavix came out ten or so years ago the major draw for a lot of patients was that it required no regular monitoring which is a pain in the ass for users of warfain. Unfortunately because Plavix works by a completely different method of action it can't be used as a universal

  • Comments on efficiency of use of funds by corporate overlords aside, is anyone really surprised that R&D in general (not just pharma) is showing diminishing returns? All the low-hanging fruit in science and technology has already been picked. Given that what is knowable and doable has limits, R&D eventually will become asymptotic to those limits. Investment will have to keep increasing to reap ever smaller gains. Disruptive discoveries/inventions and paradigm shifts make the progression not a smooth
  • They just lost a case in India a month or so ago, where the Indian court decided that there was so little difference in outcomes and side effects that they refused to allow a patent on a new drug that was to replace one whose patent was expiring.

    And the ones in the last couple years pulled off the market in the US as having more side effects, and not especially better than the old ones in danger of being sold as a generic (the list is left as an excercise for the reader)?

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