We'd like to think that we're a modern civilization, with systems in place, and the right priorities when it comes to life saving research & development.
Think of it this way: do you cringe at the thought that 70 years ago, there were almost no antibiotics available? That if you had a serious infection that you'd probably die? That such an infection would now be trivial to cure?
That's how people will view our healthcare of today 70 years from now.
Or, we will have sure fire cures for baldness, and sexual dysfunction?
I keep thinking about this new antidepressant called Rexulti.
The patent ran out on Abilify. It went to generic status. Drug company panicked.
They changed the Abilify molecule a tiny bit, and a did <400 patient study. The patients were evaluated over a two month period, using a 10 question happy test. From mean change from baseline, -5.2 people got better by Placebo. -8.4 got better from drug.
In big bold letters, it screamed to doctors, "62 Percent Greater". In small print they said vs. placebo.
Does it work? I don't know, and I doubt they know. Do they have a new, dubious drug they can con doctors/patients into buying--yes!
And yes--if we knew the actually efficacy of a lot of drugs, we would be astonished.
I sincerely hope we have better medications in the future.
Are you arguing that sexual dysfunction is not a worthy condition to treat? I would argue it has severe psychological ramifications and a negative impact on people's lives. As much as dying from cancer? No. But not something you can ignore.
We've made tremendous strides over the past two decades in treating severe diseases. Look at drugs like Imbruvica, Harvoni, Kadcyla. Women with stage 4 breast cancer can now expect to live 3 to 5 years with their disease vs. dying within a year. Tremendous progress. Just because "lesser" drugs are being developed doesn't change that.
And you'll have to explain Rexulti and Abilify to me. Abilify isn't an antidepressant, it's an antipsychotic. My other comment is that treating psychological conditions is incredibly hard. The placebo effect is a huge issue with clinical trials whether or not for-profit companies run them.
And as for "me-too" drugs that you mentioned, they have value to. Jenkins from the FDA actually stated we need more of them, not less.[1] Yes, a new drug might only be a small tweak of an existing drug, but all humans aren't the same. A patient may not be able to take an older version, but the me-too works for them. That has added value.
And as for "conning" doctors or patients in buying drugs they don't need, I don't have a lot of sympathy. Doctors are the final decision makers on what drugs are prescribed. If they don't do their homework and just prescribe something because they like the sales rep, that's on them.
“Choice is a good thing,” Jenkins commented, as later drugs in a class often enhance safety or efficacy for certain individuals. The move away from “me-too” drugs, he said, is “not necessarily good for public health.”
> Yes, a new drug might only be a small tweak of an existing drug, but all humans aren't the same. A patient may not be able to take an older version, but the me-too works for them. That has added value.
Indeed this is true, individual patients will respond differently, and inexplicably, to medications in the same class (e.g., Prozac vs. Zoloft). Having these choices is very useful.
However there are considerations beyond pharmacology that reduce the value of these choices. Problems arise because of non-clinical factors, particularly what rules of insurers allow. Formularies have become quite restrictive in many environments making it difficult to make use of the range of alternatives that are theoretically available.
In the last 10 years several new antidepressants have been developed, approved and marketed. That doesn't mean that patients can easily get these drugs even if patients have failed to benefit with older options. Insurers erect barriers like stiff co-payments, or complicated prior authorization procedures as effective impediments.
Consequently what good are new medications if they can't reach the people who need them? There's a strong disincentive to try to use these drugs and I think it's likely manufacturers would have less reason to develop them if they can't sell them.
So doctors would like to be able to prescribe what would work better, but that's frequently not practical. I'd add that doctors are not so easily "conned" into prescribing an agent just because companies and reps are promoting it. Quite to the contrary, making up one's own mind based on the merits and ignoring the sales pitch is the reality.
In reality, we're barely out of the caves.