A Tough Pill to Swallow

A new study of drugs for schizophrenia is getting media attention both for what it says and for what the media claim it says. The Washington Post especially used the occasion to say it underscores the extent to which physicians, patients and policymakers can be blindsided by self-interested research by drugmakers.

     According to the September 20 Washington Post, Federal Study Finds No Benefit Over Older Cheaper Drugs. The New York Times took a similar approach, claiming A landmark government-financed study that compared drugs used to treat schizophrenia has confirmed what many psychiatrists long suspected: newer drugs that are highly promoted and widely prescribed offer few if any benefits over older medicines that sell for a fraction of the cost.

     However, the Associated Press cited Columbia University researcher Dr. Jeffrey Liebermans positive assessment of the drugs. Lieberman, who led the study, said Make no mistake, these treatments are effective and far better than no treatment at all.

     The study, released this week and appearing in the Thursday edition of the New England Journal of Medicine, tested five different medications for the illness and found that the majority of patients stopped taking each one. However, the medical profession, and even the editorial in the same journal, were more cautious in their comments than either the Post or Times. The editorial pointed out that Patients who carry the diagnosis of schizophrenia vary markedly in these various aspects of their illness. That makes assessing the impact of particular drugs difficult.

     The Post story, written by Shankar Vendantam, explained the study compared one older drug with four newer, more expensive antipsychotics. According to the story, the researchers were surprised to find that an older generic drug called perphenazine, which is 10 times cheaper than the newer drugs, was about as effective and about as safe.

     But thats not what the study said. The study said 36 percent of the test subjects continued taking olanzapine, one of the newer drugs, and only 25 percent continued taking the generic drug. Thats close to a 50-percent difference from one drug to the other. The journals editorial also referenced what it called the apparently moderate increase in the efficacy of olanzapine and clozapine.

     Rather than make that point, Vendantam used his story to complain about drug companies funding 90 percent of trials in the scientific literature. Vendantam cited Lieberman calling for the federal government to pay for all such studies. Lieberman said they also ought to be funded by federal agencies that pay for drug treatment for huge numbers of patients, such as the Centers for Medicare and Medicaid Services (CMS), stated the story.

     The Post claimed Pharmaceutical companies called attention to aspects of the trial that showed their products to advantage, as if the author were surprised by that point. Vendantam also added that the industry has recently come under fire for hiding unfavorable trial data. However, his own story left out unfavorable data that disagreed with its initial claims. The Los Angeles Times looked a little deeper into the cost issue: Even though the new drugs are more costly, other expenses such as hospitalizations during relapses must be factored into the cost-benefit equation, the authors said. The paper went on to say that Patients receiving olanzapine experienced fewer such hospitalizations during the trial.

Some other points worth noting about the study include:


    The drugs work: According to the Times, Dr. Robert Baker, who directs the neuroscience group at Eli Lilly, said, I think what we can conclude from this study is that there is no one-size-fits-all treatment for schizophrenia. Dr. Lieberman echoed this attitude: The drugs work but they are not satisfactory to many patients, and three-quarters of the people in our study voted with their feet and discontinued the drugs. Old vs. new: Buried deep in the Post article was a comment by Darrel Regier, director of the division of research for the American Psychiatric Association: It would be a tremendous mistake to assume from this study that the cheaper, older drugs are, quote, 'just as good.