Critical Review of Data Helps Trim Polypharmacy Regimens

April 8, 2006

Closer examination of claims about benefits and risks of blockbuster drugs may reveal a lack of evidence to support such widespread use, Thomas E. Finucane, MD, professor of medicine, Johns Hopkins University, Baltimore, told attendees at the American College of Physicians Annual Session here.

Closer examination of claims about benefits and risks of blockbuster drugs may reveal a lack of evidence to support such widespread use, Thomas E. Finucane, MD, professor of medicine, Johns Hopkins University, Baltimore, told attendees at the American College of Physicians Annual Session here.

"We have to keep in mind that we are dealing with an industry that has a goal of making money for its stockholders while our focus is on taking the best care of our patients. Build a wall around yourselves as you are bombarded with promotional information, and remain skeptical and vigilant," said Finucane.

Finucane provided a number of examples where he sees problems with overprescribing occurring as a mismatch between marketing claims and existing evidence. Part of the issue is that even the peer-reviewed literature is contaminated, he said. Not only are positive trials far more likely to be submitted for publication than negative trials, but the published literature is filled with industry-sponsored studies and the discussions in the papers are often filled with rhetoric unrelated to the scientific findings.

Furthermore, Finucane said, while highly regarded opinion leaders in a field may appear as the author of those papers, the manuscript itself may have been written internally and the author sought secondarily.

Finucane presented more critical reviews of the evidence for the efficacy and safety of proton pump inhibitors, selective serotonin reuptake inhibitors, gabapentin, newer hypnotic agents, newer drugs for overactive bladders, acetylcholinesterase inhibitors, and COX-2 inhibitors that might lead physicians to rethink their prescribing patterns for those medications.

He also recommended a number of websites that are good sources for unbiased information:
www.fda.gov/medwatch

www.medicalletter.org

www.nofreelunch.org

www.citizen.org/hrg

www.nice.org.uk