In 2002, one of the biggest clinical trials ever organized by the USl government found that generic high-blood pressure pills, which had been in use since the 1950s and cost only pennies a day, worked better than newer drugs that were up to 20 times as expensive. The implication was that billions of dollars could be saved in treating tens of millions of people with hypertension.
Six years later, though, the use of the pills, called diuretics, is far smaller than some trial organizers had hoped. The percentage of hypertension patients receiving a diuretic rose to around 40 percent in the year after the Allhat results were announced, up from 30 to 35 percent beforehand, The New York Times writes. But usage has plateaued. And over all, use of newer hypertension drugs has grown faster than use of diuretics since 2002, according to Medco Health, a pharmacy benefits manager.
The Allhat experience is worth remembering, the Times points out, as some policy experts and government officials call for more such studies to directly compare drugs or other treatments, as a way to stem runaway medical costs and improve care. The aftereffects of the study show how hard it is to change medical practice, even after a government-sanctioned trial costing $130 million produced what appeared to be solid evidence.
A confluence of factors, the Times writes, blunted the trial’s impact. One was the simple difficulty of persuading docs to change their habits. Another was scientific disagreement, as many academic medical experts criticized the trial’s design and the government’s interpretation of the results. And pharma responded by heavily marketing expensive hypertension drugs - in some cases, paying speakers to publicly interpret the Allhat results in ways that made their products look better.
Usage “should have more than doubled,” Curt Furberg, a public health sciences professor at Wake Forest University who was the first chairman of the steering committee for the study, which was known by the acronym Allhat, tells the Times. “The impact was disappointing..the pharmaceutical industry ganged up and attacked, discredited the findings.” He eventually resigned in frustration as chairman of the study’s steering committee; one member received more than $200,000 from Pfizer, largely in speaking fees, the year after the Allhat results were released.
According to the Times, there was another factor: medicine moves on. Even before Allhat was finished, and since then, new drugs arrived. Others, meanwhile, became available as generics, reducing the cost advantage of the diuretics. And many docs shifted to using two or more drugs together, helped by drugmakers offering combination pills containing two meds.
So Allhat’s main query - which drug to use first became “an outdated question that doesn’t have huge relevance to the majority of people’s clinical practices,” John Flack, the chairman of medicine at Wayne State University, who was not involved in the study and has consulted for some drugmakers, tells the paper.
Sean Tunis, a former chief medical officer for Medicare, remains an advocate for comparative-effectiveness studies. But, as Allhat showed, “they are hard to do, expensive to do and provoke a lot of political pushback,” he tells the paper. He now runs the nonprofit Center for Medical Technology Policy, which tries to arrange such trials.
Here is the complete story…
Discuss Add this link to... Bury
Six years later, though, the use of the pills, called diuretics, is far smaller than some trial organizers had hoped. The percentage of hypertension patients receiving a diuretic rose to around 40 percent in the year after the Allhat results were announced, up from 30 to 35 percent beforehand, The New York Times writes. But usage has plateaued. And over all, use of newer hypertension drugs has grown faster than use of diuretics since 2002, according to Medco Health, a pharmacy benefits manager.
The Allhat experience is worth remembering, the Times points out, as some policy experts and government officials call for more such studies to directly compare drugs or other treatments, as a way to stem runaway medical costs and improve care. The aftereffects of the study show how hard it is to change medical practice, even after a government-sanctioned trial costing $130 million produced what appeared to be solid evidence.
A confluence of factors, the Times writes, blunted the trial’s impact. One was the simple difficulty of persuading docs to change their habits. Another was scientific disagreement, as many academic medical experts criticized the trial’s design and the government’s interpretation of the results. And pharma responded by heavily marketing expensive hypertension drugs - in some cases, paying speakers to publicly interpret the Allhat results in ways that made their products look better.
Usage “should have more than doubled,” Curt Furberg, a public health sciences professor at Wake Forest University who was the first chairman of the steering committee for the study, which was known by the acronym Allhat, tells the Times. “The impact was disappointing..the pharmaceutical industry ganged up and attacked, discredited the findings.” He eventually resigned in frustration as chairman of the study’s steering committee; one member received more than $200,000 from Pfizer, largely in speaking fees, the year after the Allhat results were released.
According to the Times, there was another factor: medicine moves on. Even before Allhat was finished, and since then, new drugs arrived. Others, meanwhile, became available as generics, reducing the cost advantage of the diuretics. And many docs shifted to using two or more drugs together, helped by drugmakers offering combination pills containing two meds.
So Allhat’s main query - which drug to use first became “an outdated question that doesn’t have huge relevance to the majority of people’s clinical practices,” John Flack, the chairman of medicine at Wayne State University, who was not involved in the study and has consulted for some drugmakers, tells the paper.
Sean Tunis, a former chief medical officer for Medicare, remains an advocate for comparative-effectiveness studies. But, as Allhat showed, “they are hard to do, expensive to do and provoke a lot of political pushback,” he tells the paper. He now runs the nonprofit Center for Medical Technology Policy, which tries to arrange such trials.
Here is the complete story…
Discuss Add this link to... Bury
Comments