New medicines aren’t always better

New Medicines or Tried and Tested?
new medicines drugs research old DNA precision

chemotherapy bottles

The best doctor is an honest one and we can always rely on Dr LeFanu to tell it as it is. In this week’s Daily Telegraph, in an article In Medicine, Less Can Be More, he refers to reviews in the New England Journal of Medicine of “breakthroughs” published over the last decade, “Where a third or more of innovative remedies or practices eventually turn out to have a worse outcome.” New medicines aren’t always better. Dr LeFanu gives us some examples:

“Thus, one might suppose the more intensive the chemotherapy, the greater the chances of long-term survival – but for women with breast cancer this turns out not to be the case. Similarly, the addition of pre-implantation genetic screening to in-vitro fertilisation, as a means of ensuring only ”normal’’ embryos are replaced in the womb, significantly reduces the chances of a successful pregnancy.

“Again, the appeal of the technique of angioplasty in dilating narrow coronary arteries and the insertion of a stent is obvious enough – but for those with ”stable’’ symptoms this turns out to be no better than conventional treatment with drugs. Finally, while it might seem self-evident that those with type 2 diabetes would benefit from intensive treatment to ensure their blood sugar falls within the normal range, this has the unfortunate consequence of increasing the mortality rate. Taken together, this is yet further evidence for the seeming paradox that ‘less is more’ – where less medicine results in better health.”

Follow the logic; “Less is more” – less medicine to the point at which the prescription contains nothing at all (homeopathy!) would sometimes be even better. As Prof Sir John Weir (homeopathic physician to the British monarch) said, “Sometimes the best prescription is made when the patient doesn’t turn up.”!

New DNA Cancer Treatment Promise

That quote from Dr Le Fanu was in September 2013. Now in June 2016 in response to another great promise, ‘Most exciting cancer treatment since chemotherapy’ could save patients using DNA tests, he can write (link):

When it comes to promoting new cancer therapies, hype springs eternal. But prodigious cost – up to £20,000 for a course of treatment – is what sustains the profitability of the drug companies.

The current focus, as reported in this newspaper last week, is on “precision” medicine – first identifying and then targeting the abnormal genes in cancer cells – which, it is claimed, is a major advance on the conventional blunderbuss approach of blasting the tumour with potent chemotherapy.

“It is rather perplexing to learn that the clinical trials of these new drugs found that they extended the duration of survival from just three to six months”

“The potential is huge,” said Prof Roy Herbst, of Yale University – so it is rather perplexing to learn that the clinical trials of these new drugs found that they extended the duration of survival from just three to six months.

This is par for the course. A review published last year of the 70 new cancer drugs introduced in the past decade found “a median gain in overall survival of just 2.1 months”, in marked contrast to “old-fashioned” chemotherapy that is now routinely associated with cure rates of up to 90 per cent in sensitive cancers such as lymphomas and leukaemia.

There are exceptions, of course…

… Earlier this year, at a major conference on “new ideas in cancer”, the director of the internationally renowned Tata Memorial Hospital deplored “the exorbitant cost and unrealistic expectations” of these new cancer drugs. Paradoxically, the most intriguing of those new ideas is a renewed interest in the conventional chemotherapy that has been so successful in the past, but now, being off-patent, is no longer of interest to the drug companies. It is, as a result, quite astonishingly cheap, and can thus be given over many years at a low dose (minimising side effects) to induce and maintain remission from cancer – a method of administration known as metronomic chemotherapy.

Image credit: Wikimedia Commons

Posted in Medicine, Pharmaceutical Industry, Science, Scientific Research and tagged , , , , , , , , , , .