Do you really think the NIH is going to be more productive in creating better medications? Really?

The fact is, private drug company research driving innovation has failed. Its time for the government to step up and dump a lot of money at the NIH to fund it, otherwise we won’t have any antibiotics soon.

Trying all meds for all conditions might get you the shocking result that antibiotics is a treatment for stomach ulcers. You know chemo makes people nauseous and thin. How about tiny doses for morbid obesity?Who knows until tried in the field? Some desperate doc facing a desperate patient will try that. If it works? Around the world in a month.

Sometimes a clinician will find a remedy as surprising as that. He doesn’t even need to publish. It will tried by others, within weeks around the world. If it works for others, it becomes standard of care informally. Four years later, an academic will get a grant to test it. Three years after that, it gets published. Towo years after that, articles will get gathered to update the guidelines. So evidence based medicine is also the medicine of nine years ago. Meanwhile, the clinician is doing almost nothing he was doing nine years ago.

Your approach to the individual patient is good. I go farther than you do. I propose putting many safe and effective medications over the counter. Make all guidelines in plain English. Allow patients to use them. For example, patients with hypertension can take lisinopril on their own.

Guidelines as advice, as reviews of the subject for docs and patients learning? Great. As mandatory orders to the doctor, enforced by regs or medmal verdicts? No way.

Sorry for asking if you were a drug rep. It was a real question in my mind based on your comments, not a personal attack.

Am I right in understanding your argument is that since clinical trials won’t predict an individual’s response to a drug they are garbage? So a doctor should ditch what has worked effectively and safely for the larger percentage of test subjects and start fresh with each patient?

If I have to start fresh with each patient I could just start with the medicines in the PDR that start with “A” and work my way through alphabetically. I could try a chemotherapy drug for hypertension because previous trials on others cannot prove it wouldn’t be the perfect med for this individual’s blood pressure.

Is it not reasonable to start with the less expensive meds with proven efficacy and safety in others in a similar situation, before going to the $150/month med with the cool TV adds and the less proven record?

I don’t do this as a favor to insurance, and I am always willing to use more expensive meds if my patients fail the cheaper ones. Unlike the Pharm Companies and Insurance Companies, however, I take responsibility for bankrupting this country seriously. I do my patients a favor both financially and medically to start them on a more-proven $4 med before a less-proven med that will cause their premiums to rise.

I happen to be a patient and the relative of several patients.

As to evidence based medicine, it has its problems. One is a basic error. Most studies use parametric statistics (based on the bell shaped curve). These reliably predict the response fractions in the larger population, assuming the required criteria are obeyed. The most crucial is random selection of subjects. That is always disobeyed. The worst patients are always excluded to avoid being sued by the lawyers and left wing extremist advocacy groups.

The problem? Clinical care s a series of on-off, individual case experiments. That activity is described by the binomial distribution (like flips of a coin). You cannot apply a parametric finding to binomially distributed activity, the individually decided treatment of one patient.

So evidence based medicine is itself garbage science. It is promoted by HMO’s to force doctors into cheap care. The insurance goons know that from 11th grade statistics courses. They are just lying.

Any doctor sued for malpractice where guidelines are mentioned, should file a cross claim against the authors of the guidelines, all their employers and sponsors. These are enemies of clinical care and peddlers of garbage science. To deter.

I’ve just never heard anyone but a drug rep call generic medicines “enemies of clinical care.” Most generics are safe and affordable treatments for patients. Most evidence based off-label indications are in generic meds, because if there is any good evidence for another indication for a big money drug the drug company pays to apply for the indication.

Such disingenous cheerleading for pricy drugs over well-proven generics is exactly the reason I don’t talk to drug reps anymore. I appreciate the companies making “inovative treatments,” but lay off the baseless attacks on evidence-based older treatments. If your new product is so innovative you won’t need to rely on drama and sophistry to sell it.

“This economic model skews the budgets of
pharmaceutical companies, with only about 10% of
drug revenues actually going toward R&D, and less
than a fifth of that – just 2% of the total — going
toward truly innovative products. The rest of the
R&D funds are spent on existing products or “me
too” drugs that are not significantly better than
existing ones (Angell 2004, Love 2003). In fact,
only about 25% of new drug approvals are rated by
the Food and Drug Administration to have any
therapeutic benefit over existing treatments (NIHCM
2002).”