We still know too little about our wealth of drugs
Put another way, 80 per cent of those on anti-depressants gain no benefit
There is more than enough food to choose from on the laden shelves of our high-street supermarkets, but the option of eight different lettuces pales in comparison with pharmaceuticals – where we are literally spoilt for choice. Thus, at the latest count, there are 80 different types of blood pressure-lowering pill, 50 anti-inflammatories, 40 antidepressants, 30 cholesterollowering medicines and so on.
Selling drugs is (very) profitable, so even a small slice of a crowded market will generate handsome revenues. Still, over the years, drug companies have come up with a range of devious ploys to boost the market share of their own brand by demonstrating it to be more effective and safer than it really is, or certainly better than their competitors. Those ploys include only recruiting patients for clinical trials who show a favourable response; excluding older people, who are more likely to experience side-effects; comparing their brand with another given at too low a dose (so theirs inevitably appear superior), or, conversely, at too high a dose (so theirs appear less toxic); or ensuring the trials are either too small, or run for too short a period to detect adverse effects.
The upshot of all this mischief is that it is virtually impossible for doctors to properly evaluate the merits of the drugs they prescribe, or to know if some might genuinely be better than others and thus to be preferred when initiating treatment.
Hence the interest in a major project, recently reported in this paper, examining the outcome in 520 clinical trials of different types of anti-depressant involving more than 100,000 patients. The vast majority, it emerged, had a “moderate-to-high risk of bias”. Still, two drugs in particular, Citalopram and Agometaline, proved to be both more effective and better tolerated.
This is useful to know – but more useful still is that the project also exposed the flimsy rationale of the more than sixfold increase in the prescribing of anti-depressants – from nine million prescriptions a year in the Nineties to 65million a year today. Thus, for 10 people with moderate to severe depression taking anti-depressants, five will report feeling “better” after a couple of months. But for four out of those five, that is not due to the drugs, as they would have improved without medication in any case. Or, put another way, 80per cent of those taking anti-depressants gain no benefit from doing so.
Then there is so much we don’t know about these drugs as they have never been properly investigated – such as their long-term adverse effects, or the likelihood of developing withdrawal symptoms on discontinuing them – or, indeed, their relative benefit and harm compared to non-drug treatment.
The reasonable conclusion would be that, although they may be helpful for some, the number taking them needs to be drastically reduced. The same, no doubt, also applies to that cornucopia of blood pressure and cholesterol-lowering pills and anti-inflammatories.
Curious case of the cold nose
This week’s medical query comes courtesy of Mrs AM from Kent, now in her 80s and well enough, except that on retiring to bed, her nose becomes so uncomfortably cold as to prevent her from falling asleep. She has tried covering it with a silk scarf with no improvement. She feels she needs to wear something similar to a knitted egg cosy to keep it warm. Might anyone similarly afflicted, she wonders, have a more practical solution?