Medicine’s Magic Bullets

(From the MBGCSS Newsletter – August 2008)

Lenzer J. Medicine’s Magic Bullets? Discover July 2008:46-52.

COMMENTS: The revealing subtitle to this story in this popular, mass market science magazine: “How do today’s medical “breakthroughs” become tomorrow’s discredited science?” Cited is the 1998 JAMA article that found that more than 100,000 deaths in the U.S. were attributed to adverse drug reactions. A researcher studied commonly cited clinical studies in the three top medical journals between 1990 and 2000 found that 14 of 49 claims of original research studies were false or exaggerated. A 2003 analysis that was published in JAMA showed that industry-sponsored research had positive result 87% of the time versus 65% for non-industry funded research. A 2006 study in the American Journal of Psychiatry found that 90% of manufacturer-sponsored studies of antipsychotic drugs claimed that the drug was as good as or superior to similar drugs. A former editor-in-chief of the New England Journal of Medicine said that 90% of original research submitted is rejected. They are so hard-pressed to find the 10% that might be publishable that weak studies end up in print.

The media has played a large part in the problem of exaggerated or false claims. Headlines proclaim a new medical miracle, too many times based upon poor and biased studies. The number of drug ads has ramped up. Consumers have overly rosy expectations of drugs. Too many times, when I’ve carefully listened to the rapidly spoken list of “side effects” at the end of drug ads, some are the same conditions that the drug is supposed to treat!

The article discusses statins. A Harvard Medical School researcher and author, John Abramson, reviewed the literature on statins and found that they did reduce heart attacks and strokes, but in only a small group of patients. No studies demonstrated that statins were beneficial for primary prevention in women of any age or in men over age 65. Three-quarters of those on statins take them for primary prevention. Many statin studies do not measure outcomes, such as, heart attacks, serious adverse events, or all-cause mortality. They measure surrogate markers, in the case of statins, typically cholesterol levels. In the clinical trials, those who drop out (possibly due to adverse reactions) are dropped from the studies as non-compliant. This skews the results. Few or no harmful effects are observed in the trials. As we know, cholesterol has a vital role in cell physiology, particularly in neural tissues.