Why Don’t Drug Labels Make the Actual Harms and Benefits Clear?

By Jacob Molyneux, blog editor/senior editor

How can we know if a drug really works? Gary Schwitzer, publisher of HealthNewsReview.org (an incisive Website that grades the quality of health news reporting) addresses this question on his blog this week by drawing attention to a recent perspective piece published in the New England Journal of Medicine (NEJM). It’s called “Lost in Transmission — FDA Drug Information That Never Reaches Clinicians” and it states the problem clearly:

The 2009 federal stimulus package included $1.1 billion to support comparative-effectiveness research about medical treatments. No money has been allocated — and relatively little would be needed — to disseminate existing but practically inaccessible information about the benefits and harms of prescription drugs. Much critical information that the Food and Drug Administration (FDA) has at the time of approval may fail to make its way into the drug label and relevant journal articles.

The most direct way that the FDA communicates the prescribing information that clinicians need is through the drug label. Labels, the package inserts that come with medications, are reprinted in the Physicians’ Desk Reference and excerpted in electronic references. To ensure that labels do not exaggerate benefits or play down harms, Congress might have required that the FDA or another disinterested party write them. But it did not. Drug labels are written by drug companies, then negotiated and approved by the FDA.

One example given in the NEJM article is the sleeping pill Lunesta:

Clinicians who are interested in (Lunesta’s) efficacy cannot find efficacy information in […]

Comparative Effectiveness Research–Is Health Care Reform Possible Without It?

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Improve health, reduce costs: that’s the mantra health care reform advocates keep repeating. And it’s easy to see why: this year, total health care spending in the United States is expected to reach $2.5 trillion, accounting for almost 18% of the gross domestic product. By 2018 the total could be $4.4 trillion-and because economic growth is expected to be slower over this period, that total may account for one-fifth of the gross domestic product in 2018. And even with all of this spending, the United States lags behind other industrialized nations on many measures of health and well being.

While there are many paths to achieving the twin goals of better outcomes and lower costs, a consensus has been growing among health policy experts and economists that part of the solution is to improve the way medical research is conducted and then put it into practice in both providers’ and consumers’ decision making. Comparative effectiveness research (CER)-a model by which cost-benefit analyses of different treatments for a given condition are compared-provides the means for understanding which interventions yield the best health outcomes for the least amount of money.

Read the rest of the article in the October issue of AJN here. With something so complex, life altering, and expensive as health care, how could we not expect to do a little comparative shopping about cost and quality?

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Medical Research–You Get What You Pay For

But someone is paying for the production of the content on the Internet—if it’s not a reputable organization or journal, who is it? Is it unbiased? Is it evidence-based, and who vetted the evidence and the authors? Let the readers—and their patients—be wary of what they read online and ask themselves just who paid for it, and why.

Health Care Reform Must Target Hospitals, Physicians Who Push Expensive Treatments Over Prevention

But the cost of the hospitalization alone for an uncomplicated bariatric surgery is now about $28,000. That goes up to over $38,000 if complications arise—and almost $70,000 if the patient has to be readmitted. Now, what if a patient decides he'd like to go to a nutritionist every week for several years to gradually lose the weight and change his eating habits permanently? Let's say that the cost of seeing a nutritionist is $100 per visit—that's just over $15,000, but who's paying to put up signs advertising a hospital's nutritional service for weight loss ?

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