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New Drugs Trail Many Old Ones In Effectiveness Against Disease

Soulskill posted about a year and a half ago | from the peak-pharma dept.

Medicine 230

Lasrick tips this report from Reuters: "Despite the more than $50 billion that U.S. pharmaceutical companies have spent every year since the mid-2000s to discover new medications, drugmakers have barely improved on old standbys developed decades ago. Research published on Monday showed that the effectiveness of new drugs, as measured by comparing the response of patients on those treatments to those taking a placebo, has plummeted since the 1970s. 'While experts agree that tougher trials and similar factors explain some of the decline in drugs' reported effectiveness, something real is going on here,' said Olfson. 'Physicians keep saying that many of the new things just aren't working as well,' and therefore prescribe antidepressant drugs called tricyclics (developed in the 1950s) instead of SSRIs (from the 1980s), or diuretics (invented in the 1920s) for high blood pressure instead of newer anti-hypertensives.'"

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Money money money... (1)

FunkyLich (2533348) | about a year and a half ago | (#43912773)

... it looks funny,
In a rich man world.

I am not surprised of this not-so-new news. The same is happening with advertisement where the mantra is "shout shout 100 times to get that one single client to spend the money".
We have a saying that basically goes: Do not shout "The Wolf" when there is no wolf. When the wolf comes for real, noone will belive you.

Trail? (-1)

Anonymous Coward | about a year and a half ago | (#43912775)

Seriously, you can't spell Trial right in a drugs research article?

Re:Trail? (5, Funny)

K. S. Kyosuke (729550) | about a year and a half ago | (#43912787)

I see you've been trialing your high school peers in English recently. :-)

Re: Trail? (1)

Anonymous Coward | about a year and a half ago | (#43912791)

It's a verb. It means they're behind them. Trial wouldn't even make sense at that place in the sentence.

Re:Trail? (0)

Anonymous Coward | about a year and a half ago | (#43913025)

Dude, do you even grammar?

Re:Trail? (0)

Anonymous Coward | about a year and a half ago | (#43913099)

"New Drugs Trial Many Old Ones In Effectiveness Against Disease"

How does that make sense?

Re:Trail? (1)

hedwards (940851) | about a year and a half ago | (#43913715)

Perhaps the new drugs sit in judgement of the old ones?

Re:Trail? (1)

kilfarsnar (561956) | about a year and a half ago | (#43913945)

Seriously, you can't spell Trial right in a drugs research article?

You look a little silly today.

True True (5, Informative)

Anonymous Coward | about a year and a half ago | (#43912793)

Big Pharma Big Bucks is a decent documentary covering this: http://www.youtube.com/watch?v=zqCdZ19y39s [youtube.com]

Additional Reading: Ben Goldacre's Bad Pharma, Jacky Law's Big Pharma, Marcia Angell's The Truth About the Drug Companies and Irving Kirsch's The Emperor's New Drugs Exposed.

Companies are out for profit. That in itself isn't bad, but due to stockmarket pressure that becomes all they care about and start chasing the easy money spinners. The easiest money is repackaging old drugs. New drugs are too risky.

BTW The Chaser's Checkout did a hilarious piece on Complementary Medicine: http://www.youtube.com/watch?v=QMYXKSy2fb8 [youtube.com]

Re:True True (3, Insightful)

SharpFang (651121) | about a year and a half ago | (#43913181)

Moreover: Promote new, weaker drug. Still keep selling the old, efficient drug.
People buy the new drug. They find it's inefficient. They switch to old drug.
Two packages sold instead of one.

Re:True True (4, Insightful)

hedwards (940851) | about a year and a half ago | (#43913765)

I'm not a fan of big Pharma, but this is horseshit.

Tricyclics are substantially more dangerous than the newer generation of medications, sure you can OD on any of the psych medications, but the newer medications tend to be more narrowly focused than the old ones. Have you ever looked at the listing of things to avoid when it comes to MAO inhibitors?

A lot of the problem with the newer medications is that since they target smaller parts of the brain, it's less likely that any one medication will work properly, but it also means that it's less likely that it will interact with some other medication. For instance you can't take Prozac or Paxil if you're taking stimulant medication for ADHD because they use the same channels in the liver, IIRC.

Ultimately, this is not likely to be a problem in the near future as brain imaging scans to see what exactly is going on in the brain become more prevalent and there's more formal testing of what the medicine is actually doing. At present there's very little attention paid to how much of the medication actually gets to the site where it's needed. Something as simple as an undiagnosed food allergy can result in little or none of the medication making it to the brain. Which also effects how much seratonin, dopamine and the rest are there for the medications to work with.

Re:True True (4, Interesting)

h4rr4r (612664) | about a year and a half ago | (#43914145)

Often it seems safety is traded for effectiveness. The best cough suppresent ever is herion, that was its original purposes. Since that was dangerous we moved to codeine, which was not as good but safer. Then we moved to Dextromethorphan, which is safer but works no where near as well and many folks cannot tolerate. Hallucinating while not getting good cough suppression sucks.

So now my options are to be accused of being a drug seeker by my doctor, take more powerful opiates I have left over from other procedures or going to canada and smuggling back Tylenol 3.

Sometimes the old stuff really was better.

Re:True True (-1)

Anonymous Coward | about a year and a half ago | (#43914201)

Have you considered quitting smoking?

Re:True True (2)

h4rr4r (612664) | about a year and a half ago | (#43914243)

I do not smoke. Why would you assume I do?
Do only smokers get upper respiratory infections?

Old business ideas (5, Insightful)

erroneus (253617) | about a year and a half ago | (#43912825)

1. Can't make any money unless you hold patents (monopoly) and can charge any price you want even [especially] at the expense of loss of life for those who cannot afford it. (They are just dying to get a new drug!)
2. People won't buy your crap unless it has the word "new" on the label. (Microsoft has driven that notion out of us over the past few years though)

Real breakthroughs and discoveries are rare. It seems a month doesn't go by without my hearing some new kind of benefit of using aspirin or acetaminophen.

What really needs to happen:

1. People need to be more careful about their use of drugs -- a body less accustomed to drugs in it shows a better response to drugs when they are needed.
2. People need to be more careful about how they live their lives and to take responsibility for their bodies. I could go on forever about that.
3. More work needs to be done to discover the causes of the maladies plaguing our modern world. We already understand that lots of the cause IS our modern world, but no one wants to talk about it because we might have to give something up.

There's less or no money in any of these ideas. Consequently, it won't happen.

Re:Old business ideas (5, Interesting)

blackraven14250 (902843) | about a year and a half ago | (#43912895)

Beyond the patent issues, there's also quite a few newer drugs that have reduced levels of side effects relative to the older ones. Tricyclic antidepressants vs. SSRIs is a particularly good example of this - SSRIs are less effective on many cases of depression, but they're one of the go-tos in cases of depression because their side effects are generally less severe than tricyclics. If you ignore the side effects entirely, sure, tricyclics are better - but keeping side effects to a minimum is always the preferred course of action.

Re:Old business ideas (0)

Anonymous Coward | about a year and a half ago | (#43913135)

Beyond the patent issues, there's also quite a few newer drugs that have reduced levels of side effects relative to the older ones. Tricyclic antidepressants vs. SSRIs is a particularly good example of this - SSRIs are less effective on many cases of depression, but they're one of the go-tos in cases of depression because their side effects are generally less severe than tricyclics. If you ignore the side effects entirely, sure, tricyclics are better - but keeping side effects to a minimum is always the preferred course of action.

Agreed. Specifically, tricyclics are very dangerous indeed in overdose.The last thing you want for a person suffering from depression is for them to have potentially lethal poison within easy reach.

CAPTCHA: despairs

Re:Old business ideas (1)

Sockatume (732728) | about a year and a half ago | (#43913415)

The comparison between diuretics and new antihypertensives is a useful one too: diuretics, as the name suggests, deal with blood pressure by making you urinate out excess fluid. That's rather inconvenient.

Re:Old business ideas (1)

erroneus (253617) | about a year and a half ago | (#43913469)

Yes... going to the bathroom is an inconvenience and often an interruption of my day. I have suggested the idea of adult diapers to people with similar concerns but no one seems to think it's a good idea.

But seriously, all of these individual anecdotes don't negate the big picture issue which has been observed and commented on at least since the 1980s.

Re:Old business ideas (2)

hedwards (940851) | about a year and a half ago | (#43913847)

One of the problems here is that the doctors don't always bother to conduct the testing necessary when doing the prescribing. I wound up with nasty hyponatremia the first time my doctor put me on blood pressure medication because my sodium levels weren't the problem, and she just assumed that lowering the levels would help. All it did was cause severe memory impairment and concentration issues within days. I discontinued the medication pretty much immediately and felt better.

A better course of action would have been to run the tests and verified that it wasn't potassium deficiency or one of the other causes of high blood pressure. As a practice, doctors really need to avail themselves of tests more often in prescribing. It's the 21st century and there are tests, in many cases, to help inform the prescription of medication which would go a fair distance to eliminating the problems that TFA talks about.

Re:Old business ideas (1)

Qzukk (229616) | about a year and a half ago | (#43914003)

The problem is that now that tort reform has taken hold and failed to curb excessive costs, insurers and governments have gotten wise to the fact that this testing is a huge profit center for docs and hospitals. "Gotta test everything because I make $50 per test!" replaced "Gotta test everything or I'll be sued!" So now they're pushing the doctors to do less testing.

The obvious solution would be to establish prerequisites for a given course of treatment but DEATH PANELLLLLSSSSS!

Re:Old business ideas (1)

h4rr4r (612664) | about a year and a half ago | (#43914279)

Anyone who thought tort reform would curb excessive costs was an idiot. They likely should not be considered competent and should probably be assigned a guardian.

Re:Old business ideas (1)

ColdWetDog (752185) | about a year and a half ago | (#43914087)

And which test would that be? You could test for sodium before you start taking the drug, but that doesn't really answer the question as to how your kidneys deal with the drug.

There are very few tests you can do a priori to determine if a drug will be safe and effective. We're getting a few and those tend to be, of course, expensive.

Unfortunately, it's pretty much "try this, watch for these side effects" at present. There is great hope that genomics / proteonomics / whateverthetrendynewfieldisomics will solve this problem. But like holographic storage, it's always five years away.

Re:Old business ideas (2)

BoRegardless (721219) | about a year and a half ago | (#43913955)

Guillotines cure depression 100% of the time, but side effects persist forever.

Re:Old business ideas (1)

Immerman (2627577) | about a year and a half ago | (#43914333)

Not really. Within a few decades the side effects are mostly indistinguishable from the natural course of events.

Re:Old business ideas (2)

CastrTroy (595695) | about a year and a half ago | (#43913525)

2. People need to be more careful about how they live their lives and to take responsibility for their bodies.

This is the major problem with most people I know. They do not even attempt to live a healthy lifestyle. They are in a complete complete fantasy world where eating a bowl of instant oatmeal with 15 grams of sugar in it is healthy, simply because it's oatmeal, or that it's ok to eat TV dinners for lunch every day because they are low calorie, nevermind the fact that they have half your day's recommended intake of sodium in a single meal. They don't exercise at all.

Now I'm not the healthiest person in the world, but I do exercise a fair bit, and try to eat healthy on most days. But I also don't delude myself, and I admit when I'm eating something unhealthy, or being lazy about getting my exercise..

Re:Old business ideas (0)

hedwards (940851) | about a year and a half ago | (#43913817)

One thing you're missing is that neither aspirin nor acetaminophen would be able to pass drug trials these days because they're just not safe enough to be approved. Aspirin has the unfortunate shape that causes it to interfere with the stomach's ability to maintain the lining, IIRC, and acetaminophen does incredibly bad things to the liver if you're taking absorbing more of it than is safe to.

But yes, ultimately, a lot of the problems wouldn't be problems if we would take more concern of lifestyle. Some people would still need heart surgery, but not nearly as many as if people wouldn't be smoking, over eating and sitting on the couch for long hours.

Re:Old business ideas (2)

drinkypoo (153816) | about a year and a half ago | (#43913923)

People won't buy your crap unless it has the word "new" on the label.

In truth, you have this exactly backwards. People want to buy the old drug, because the patents have expired and generics are available. The bar for bringing a modified version of an old drug to the market is far lower in the USA than bringing a new drug. You don't have to even prove that it is as effective as the drug it is replacing. Then you get the insurance companies and medicare to drop the old drug, which they do (I've personally experienced it on medi-cal, anyway) and you run some ads to scare people off the old drug. You know, "If you've been harmed by such and such drug, contact us for your shitty settlement". And since they buy the laws (Big Pharma always being one of the biggest campaign contributors for a broad range of politicians; Hilary Clinton got a record payout from them after giving up on single payer health care) they get to decide who is and isn't forced to run such ads, which also helps to keep competition out of the market.

The sole reason that new drugs often trail old drugs in effectiveness is that they only profit from patented drugs, and only new drugs are patented.

It is clear that the profit motive in medicine is a murderer.

Re:Old business ideas (1)

erroneus (253617) | about a year and a half ago | (#43914139)

That was part of my point. I was indicating problems with the old way of thinking. People, more likely as a result of the "New Coke" incident than Microsoft's despised Windows releases like WinME, Vista and Win8, just don't care to see "New" on the label.

I would rather think the drug makers/pushers are out of touch rather than maliciously preying on patients.

Clear failure (0)

Anonymous Coward | about a year and a half ago | (#43912849)

If the doctors are still prescribing old effective medicines instead of the New! Improved! Profitable! ones, the medical industry has clearly failed to inform the doctors properly. More money must be channeled into marketing, instead of this research stuff, which is way too expensive anyway.

Money indeed (0)

Anonymous Coward | about a year and a half ago | (#43912865)

If patents did what they were supposed to do (like they did years ago) this probably wouldn't be such a big problem now ......Instead of promoting inovation...now they just stifel it...greater cooperation between companies( and scientists) would probably make a bigger difference...

$50 billion sounds like a lot (0)

Anonymous Coward | about a year and a half ago | (#43912869)

Until you look at how much goes into regulatory compliance. Not to say the regulations are necessarily bad, but they are expensive and they are influencing drug companies to be highly risk averse. Instead of exploring big changes, they go after incremental improvements.

Re:$50 billion sounds like a lot (0)

benjfowler (239527) | about a year and a half ago | (#43913029)

What, you libertarians refuse to relieve that Big Pharma are just spoilt and greedy, and care far more about profit than actually being in the medical business to (*gasp*), heal people??

Re:$50 billion sounds like a lot (0)

Anonymous Coward | about a year and a half ago | (#43913143)

Because libertarians are "economic savages, green in tooth and claw." Their state of nature is nothing other than having enough law, enough civilization to push law of the jungle into the economic plane rather than the physical. Let's make up a set of rules so "I can WIN!"

That's being just a bit facetious, but not entirely. However I do feel that libertarians tend to be very myopic, and disregard a large range of externalities that will bite badly in the long run. (Hint - market response time may not play well with geologic, environmental, or even epidemiological time scales.)

Re:$50 billion sounds like a lot (2)

KiloByte (825081) | about a year and a half ago | (#43913193)

Wait, so government-granted monopolies such as patents are now libertarian fault?

The govt testing drugs and refusing those with harmful side effects, that's regulation I'm willing to accept. Denying people the right to do something just because someone else does the very same thing is flat-out oppression.

Re:$50 billion sounds like a lot (1)

Nadaka (224565) | about a year and a half ago | (#43914155)

Almost every libertarian I know is rabidly pro patent because it is a law that protects "property", the only thing they care about. Completely ignoring that intellectual property is an artificial construct and a restriction of natural rights. They insist that they have a natural right to control their work because it is theirs, completely ignorant of how foolish and contradictory it makes them.

obvious (0)

Anonymous Coward | about a year and a half ago | (#43912881)

Law of http://en.wikipedia.org/wiki/Diminishing_returns , low-hanging-fruit etc.

The inability to research? (5, Insightful)

gallondr00nk (868673) | about a year and a half ago | (#43912887)

This doesn't really address the whole issue, but remember that the war on drugs has stopped scientists from being able to conduct research for decades. LSD and Ecstasy both had incredibly promising properties in treating some illnesses, especially in the area of mental health. This was until research was banned by governments around the world. I wonder what sort of illnesses, diseases and conditions we'd have cured today if they hadn't banned it.

It pays to remember that through drug prohibition governments are not just waging a war against the individual's rights, but waging a war against scientific research.

Re:The inability to research? (1)

K. S. Kyosuke (729550) | about a year and a half ago | (#43912985)

Heroin is probably still one of the best analgesics around. So is Thalidomide, and people have recently started using it again. Just don't be a pregnant mother and you'll be fine. If you're suffering from HIV or etythrema nodosum and can't sleep for weeks, you're not going to give a f*&k that it's teratogennic in some stages of pregnancy, you'll just want to use the bloody thing.

Re:The inability to research? (4, Interesting)

dpilot (134227) | about a year and a half ago | (#43913451)

I remember reading somewhere that...

Thalidomide has 2 "rotations", left-handed and right-handed forms. One handedness was "effective" and the other caused the birth defects. The big Thalidomide crisis was because of bad quality control, there was significant contamination by the wrong-handed version, and we really didn't understand this stuff at the time. Therefore the "good Thalidomide" was banned along with the bad. The bad Thalidomide should be simply be considered a harmful manufacturing by-product that needs to be removed from the final product.

Re:The inability to research? (4, Interesting)

VAXcat (674775) | about a year and a half ago | (#43913829)

Not exactly true. Thalidomide does indeed have two mirror image isomers,. and there is some research to indicate that indeed only one of these isomers causes damage. BUT - thalidomide undergoes racemization in the human blood stream - that is, even if you start only with "good" thalidomide in your drug, it will be metabolized into a mix of good and bad in the bloodstream - so, even if you only ingest the "good twin", you wind up with the damage causing "bad twin" in your body anyway.

Re:The inability to research? (0)

Anonymous Coward | about a year and a half ago | (#43914261)

citation please? seriously, i was under the impression it was widely used for some time w/o issue--then some generics or secondary plants came online with bad quality and things got real.

Re:The inability to research? (0)

Anonymous Coward | about a year and a half ago | (#43914075)

Heroin was designed to be not as addictive as morphine which it was to replace. Dilaudid was invented to replace this. Dilaudid is so addictive people can only have two doses of it but if you have had back surgery you will welcome those doses.

Re:The inability to research? (-1)

Anonymous Coward | about a year and a half ago | (#43913261)

Sigh... A "friend" of mine experimented with both LSD and Ecstasy and all he got in return was long term depression/panic attacks/cognitive deficits

I guess randomly killing brain cells isn't a very effective way of "expanding your mind"

Can I upvote you, Score 5: Naivete

Re:The inability to research? (1)

dpilot (134227) | about a year and a half ago | (#43913463)

Random doses of any drug can have harmful side-effects - even Tylenol.

That doesn't mean LSD and Ecstasy should be put on the market, the point was that even research has been forbidden. Perhaps with modification and/or careful dosage control they could become effective medications. With current laws we'll never know.

Re:The inability to research? (1)

hedwards (940851) | about a year and a half ago | (#43913901)

As far as I know, neither LSD nor Ecstasy have ever passed any sort of medical trials on safety. Considering that the US is not the only country that has banned them, it takes a bit of explanation as to why they were banned across so much of the world, if they're genuinely safe.

There's other treatments for things that are banned because of safety concerns as well. But, you don't hear as much bitching about it as you do about drugs being banned.

Re:The inability to research? (0)

Anonymous Coward | about a year and a half ago | (#43914013)

There can't be any formal testing of an illegal thing, because it is illegal.

It's illegal because everyone knows that it's bad.

It must be bad, because it is illegal.

QED

Re:The inability to research? (1)

Qzukk (229616) | about a year and a half ago | (#43914037)

it takes a bit of explanation as to why they were banned across so much of the world, if they're genuinely safe.

Nobody knows if they're safe or not, they made people feel funny therefore they needed to be banned because mommy government knows best.

Re:The inability to research? (1)

h4rr4r (612664) | about a year and a half ago | (#43914213)

They were banned simply because they had recreational use. It really is that simple.

Ecstasy has actually been tested for safety before, it is used experimentally in some psychiatric treatment.

What exactly are treatments that are not drugs? How is a LSD anymore or less of a drug than Tylenol?

Re:The inability to research? (1)

Nadaka (224565) | about a year and a half ago | (#43914183)

Recreational doses are much higher than therapeutic doses, just like almost every other drug.

Re:The inability to research? (2)

h4rr4r (612664) | about a year and a half ago | (#43914193)

Neither of those drugs work by killing brain cells. Nor should either of them cause those. You are likely correlating events that are not causally linked.

Re:The inability to research? (0)

Anonymous Coward | about a year and a half ago | (#43914281)

You got voted "0" while the parent post got voted "+5" because the parent post told certain people what they wanted to hear. Which is not necessarily the truth.

No evidence, but... (5, Insightful)

Telecommando (513768) | about a year and a half ago | (#43912889)

Perhaps the older drugs were manufactured for maximum effectiveness and the newer ones for maximum profit.

Re:No evidence, but... (0)

Anonymous Coward | about a year and a half ago | (#43913183)

There's plenty of evidence. All studies (conducted by the drug manufacturer) which show negative effects by a drug are hidden and destroyed. Only studies that indicate a positive influence are published. And once you have enough of these studies, the drug is approved by what ever governmental body and you can start selling it.

This is business as usual. Caveat emptor! No drug manufacturer has to take the Hippocratic Oath [wikipedia.org] ...

Re:No evidence, but... (5, Insightful)

RabidReindeer (2625839) | about a year and a half ago | (#43913223)

Perhaps the older drugs were manufactured for maximum effectiveness and the newer ones for maximum profit.

Close, perhaps. Cynical, certainly.

A lot of the older drugs were discovered more or less accidentally. Mostly because their effects were anything but subtle.

Unfortunately, so were the side-effects.

There are perfectly good humanitarian reasons for chasing new drugs.

First of all, drugs have varying effects depending on the patient. So the "go to" drug might not effectively - if at all - on some people. Or even harm them.

Secondly, the side-effects of the drugs may be prohibitive for some people.

So there's definitely a demand for drugs that are more finely-targeted than the original sledgehammer medications. Problem is, the more precise the solution, the more likely that the number of people it works effectively for is going to be very small. And, on top of that, the objectionable features become more objectionable, relatively speaking.

That's aside, of course from the all-too-common situation where the business decision is made to push a drug even when it's more of a medical liability than an asset just because it's more of a (potential) financial asset than a liability.

Re:No evidence, but... (1)

dpilot (134227) | about a year and a half ago | (#43913515)

> That's aside, of course from the all-too-common situation where the business decision is made to push a
> drug even when it's more of a medical liability than an asset just because it's more of a (potential)
> financial asset than a liability.

Then 5 or 10 years back there was also the case where a very effective peanut allergy drug was nearly finished with trials and approaching approval. The developing company was bought out by a bigger rival. The new owners squashed the new drug, because they wanted to re-purpose a drug they already had for peanut allergies. It wasn't as effective as the new drug they'd just acquired, and had worse side-effects, but it was more profitable.

Urban legend or true story - I don't know. The inability to know stuff like this is a problem in itself.

Re:No evidence, but... (2)

edremy (36408) | about a year and a half ago | (#43913623)

> That's aside, of course from the all-too-common situation where the business decision is made to push a > drug even when it's more of a medical liability than an asset just because it's more of a (potential) > financial asset than a liability.

Then 5 or 10 years back there was also the case where a very effective peanut allergy drug was nearly finished with trials and approaching approval. The developing company was bought out by a bigger rival. The new owners squashed the new drug, because they wanted to re-purpose a drug they already had for peanut allergies. It wasn't as effective as the new drug they'd just acquired, and had worse side-effects, but it was more profitable.

Urban legend or true story - I don't know. The inability to know stuff like this is a problem in itself.

Almost certainly an urban legend. This behavior doesn't make sense in the context of the drug market. The first-tier drug companies like Merck and Glaxo fund everything from a few high priced, patented drugs. They have a limited amount of time to make money off of these before they come off patent and the generic makers cut the prices by 10x. This is why you see a constant stream of "me too" modifications of existing drugs- they need to something under patent to make money. Buying a drug and then burying it in favor of something existing would be stupid- you have a chance to reset the patent clock and get ~15 years of high profits as opposed to trying to compete against the generics

Re:No evidence, but... (1)

hedwards (940851) | about a year and a half ago | (#43913931)

It's almost certainly an urban legend. The closer you get to approval the less likely you are to see this sort of behavior. There's no guarantee that you'd get approval for the medication to treat something else, and if you've really got to stage 3 trials, there's a ton of money that's been invested already, enough that the medication will be released if it passes the final trials and gains approval.

In this case, there's no profit motive to do that as repurposing an older drug would probably cost them more than just releasing the new one. Plus, the old medication would be closer to having its patent expire anyways.

So what? (5, Insightful)

swamp_ig (466489) | about a year and a half ago | (#43912905)

So what?

Sure the old drugs are great, but there's plenty of new ones that are great too.

Take statins for example - relatively new class of medication that have dramatically changed the treatment of high cholesterol - which leads to the number one killer of heart disease. Another example - artemisinin - great treatment for malaria, relatively recent invention.

Not to mention the survivorship bias http://youarenotsosmart.com/2013/05/23/survivorship-bias/ [youarenotsosmart.com] - there's heaps of old drugs that just aren't used anymore because frankly they were no good and had a ton of side effects. You don't hear about those ones much simply because they aren't used. This gives the perception that 'the old drugs are better' when in truth they were just as bad or worse, and only the good ones have stood the test of time.

But even if it were true - should we then give up drug discovery? Give up the chance to find the next great drug just because the low hanging fruit are already taken? What exactly is the solution to this?

Re:So what? (1)

K. S. Kyosuke (729550) | about a year and a half ago | (#43913021)

Sure the old drugs are great, but there's plenty of new ones that are great too.

I think the issue has two sides, actually: There's research into, e.g., how to replace antibiotics that bacterial strains have become resistant to, and that often fails. Then, there's research into whole new classes of drugs and treatments that are promising, and often game-changing, but those are the areas where we're collecting the first pieces of the low-hanging fruit. Once you find the best ways of doing something, it's obviously difficult to find different best ways of doing the same thing with different chemicals. It's like having a screwdriver and then trying to invent a hammer that's different from a screwdriver but does the same thing.

Re:So what? (1)

rjr162 (69736) | about a year and a half ago | (#43913309)

not quite, because how do you *know* it's the best way? You don't. it's just the best way of the ways you know, but there are many unknown ways of which some could be better.

For your example: "It's like having a screwdriver and then trying to invent a hammer that's different from a screwdriver but does the same thing."

It'd be more like "It's like having a screwdriver and then trying to invent something that's different from a screw driver but does the same thing, such as an electric drill or screw driver, and then beyond that a cordless drill or screw driver"

Re:So what? (4, Informative)

jo_ham (604554) | about a year and a half ago | (#43913057)

The big problem with statins (from a pharma standpoint) is that they hit on the perfect one right away and the patent is soon going to expire, opening the door to generics. This is great for the patients, but it stops the money train.

All of the work on alternate statins that can be patented (throwing new function groups on there, changing the core structure but keeping the interaction with the target receptors etc the same) has resulting in a less effective drug.

With atorvastatin, and others like simvastatin going generic before a new patented, more effective (or as effective) analogue could be developed, the pharma industry has gone into panic. They were some of the must lucrative drugs of all time.

Re:So what? (1)

Impy the Impiuos Imp (442658) | about a year and a half ago | (#43913523)

Then complain to your doctor, or the people at fancy institutions that make guidelines. They do the prescribing.

Re:So what? (0)

Anonymous Coward | about a year and a half ago | (#43913219)

I agree not all old cures are necessarily awesome. https://en.wikipedia.org/wiki/Trepanning

Re:So what? (1)

Impy the Impiuos Imp (442658) | about a year and a half ago | (#43913507)

A good observation. To rephrase the issue, old drugs that work well work well and are still used becaise nothing better exists. Meanwhile the 99 out of 100 that don't work as well as new stuff are left on the ash heap of history. See also buggy whips, carpet beaters, ice boxes, ...

You dont have to tell me. (0)

Anonymous Coward | about a year and a half ago | (#43912907)

One of my meds (not to mention millions of other people's) was discontinued without notification, because the patent expired. They replaced it with a new one that was chemically the same but in capsule form. Even the marketing for the new drug says it is exactly the same. Nobody has it in stock though. Don't tell me they are "recovering R&D costs" because that ship has sailed. The drug is over $400 a bottle, does nothing new, it doesn't work better, and the active chemical has been around for a long time now.

More than just effectiveness (5, Informative)

adoarns (718596) | about a year and a half ago | (#43912911)

I am an epileptologist, and I would certainly love to see more effective anti-seizure drugs on the market. But although the newer anticonvulsants aren't necessarily better at stopping seizures than older ones (like the classic four: phenytoin, carbamazepine, phenobarbital, and valproic acid), they are better tolerated, have fewer severe adverse effects, have much more predictable serum concentrations, fewer drug-drug interactions, and require little to no routine bloodwork monitoring. For the 1% of the population suffering from epilepsy who have to take these drugs on a regular basis, this has been a significant change.

Re:More than just effectiveness (2)

drjoeward (1366975) | about a year and a half ago | (#43913391)

i was just going to say, most of the old medications were found to be very effective, but not very targeted in where they work in the body. Hence lots of side effects, Modern medicinal chemistry and molecular modeling allow for the design of better molecules that work only where they are supposed to. you don't even have to go that far to see one. Look at Benadryl and Claritin. both are antihistamines, but benadryl did not target the Histamine receptors responsible for the allergic response, it also affected others and made most people sleepy. Claritin on the other hand is much more targeted and has dramatically less side effects.

you can go on and on about side effects and how many older meds have such issues and with those issues a patient is going to weigh benefit vs side effect and likely not take the damn med. So is it is better to only target what is broken and to have a med the patient will comply with, even if it is somewhat less effective, because in the long run it is better!

Re:More than just effectiveness (1)

Impy the Impiuos Imp (442658) | about a year and a half ago | (#43913545)

> I am an epileptologist

You study things that are around butterflies?

Re:More than just effectiveness (0)

Anonymous Coward | about a year and a half ago | (#43914053)

No, that would be a lepidopterist.

Makes me think... I'm not being a grammar Nazi here, but definitely a related undertaking. Can I be a vocabulary Fascist?

Serves you right (-1)

Anonymous Coward | about a year and a half ago | (#43912965)

This is the price you Americans are paying for your moronic litigious culture.
You want to sue the manufacturer because a few morons on the march overdosed and had a heart attack?
Be ready to treat all your illnesses with aspirin because the "fat cat" "big pharma" simply does not dare to innovate.
You made your own bed, now nighty-night.

shareholders (1)

Anonymous Coward | about a year and a half ago | (#43912971)

I once talked to someone who had intimate knowledge of how pharmaceuticals worked and he told me that pharmaceutical companies basically didn't do any research any more because any investment in research was a long term risk and therefore looked bad on short term quarterly report.

After all, any research item can very well turn out to be a dead end, and if the research (eventually) turns out to be promising then it'll still be a long time before you'll see it turn a profit ... and as a CEO you might not even work there anymore by that time, so why bother.

Apparently it's expensive mostly because the moment you discover a new compound you need to patent it ASAP before you actually figure out if it's useful or not, otherwise a competitor might patent it first, and applying for international patents is expensive, and *a lot* of patents need to be applied for.

He also told me that about 90% of all the new drugs actually come from research out of universities, not the pharmaceuticals themselves, and that the vast majority of the money they spend is spend on PR, commercials etc. instead of anything actually useful to society.

Re:shareholders (2)

Black Parrot (19622) | about a year and a half ago | (#43913477)

He also told me that about 90% of all the new drugs actually come from research out of universities, not the pharmaceuticals themselves

I keep reading that from a broad variety of sources as well.

(Is it true?)

Re:shareholders (2)

edremy (36408) | about a year and a half ago | (#43913699)

He also told me that about 90% of all the new drugs actually come from research out of universities, not the pharmaceuticals themselves

I keep reading that from a broad variety of sources as well.

(Is it true?)

Depends on what you mean by "research". A lot of the initial leads do come from universities, but the process to turn a lead into something you can buy over the counter is difficult, very long and hugely expensive. You frequently see a drug company buy the rights to the idea and then do the human trials. The HPV vaccine Gardasil [wikipedia.org] is a good example- a group of people at several universities developed the concept. Merck then took over and ran the phase III human trials (the one that sees if it actually works in the field) as well as the R&D to manufacture it.

IMHO, this isn't a bad way to work- most drug companies can't really do the blue sky stuff and universities don't have the $$$ to bring something to market.

Re:shareholders (1)

Black Parrot (19622) | about a year and a half ago | (#43913969)

IMO it's a rotten way of doing it, because having the people who want to sell the drug do the trials introduces a motive to overreport effectiveness and underreport side effects.

And it's not just a hypothetical concern; we know of instances where companies have done both.

Re:shareholders (2)

femtobyte (710429) | about a year and a half ago | (#43914121)

So, the big drug companies aren't doing the actual innovative parts of research. They're just grinding through the large and expensive trials to standards set by national regulations. So, why have the drug companies at all? Dump them and have the final large-scale drug testing procedures done by government agencies as a public service. Approved drugs get released to the public domain, so they'll be manufactured (cheap and competitively) as generics. The trials are already rigidly defined methods and standards --- not an area where you need the mythical "free enterprise innovation," just routine bureaucratic administration and recording of results. No profit motive for hiding adverse symptoms; no gigantic advertising budgets (which are much larger than R&D budgets); no obscene profit margins --- you'd be able to produce/distribute drugs at vastly reduced cost, with far more transparency about effects. "We the people" are already paying for the fundamental research (through government grants) that initially develops most drugs --- so why should we get gouged by big pharma to complete the routine testing cycle, and introduce profit-motivated conflicts-of-interest against full transparency and disclosure?

Re:shareholders (1)

edremy (36408) | about a year and a half ago | (#43914313)

Well, it depends again on what you mean by "innovative". It doesn't all work this way- I worked at Merck for a shirt while back in the late 1980s and Crixivan [wikipedia.org] was pretty much entirely internal, including the massive (and extremely expensive) effort to do the xray crystal structure of HIV-1 protease in record time. Human trials, scaleup of production and the like aren't exactly trivial things to do either- they aren't cookbook.

Politically it wouldn't fly in the US anyway. While profit motive isn't always the a great option, would you rather have political appointees deciding if Gardasil testing should go forwards? Right now there are a number of people in Congress trying to rewrite the way that NSF/NIH award grants [sciencemag.org] - those sort of shenanigans would be long term far more damaging.

(I'll agree with you on the open access to trial data and advertising bits- we need to simply ban public ads for prescription drugs and dramatically restrict sales tactics to doctors. I hated seeing chemists get recruited by the sales folks at Merck- it seemed like they were going over to the dark side.)

Step by Step (0)

Anonymous Coward | about a year and a half ago | (#43912995)

They're just trying to keep one step ahead of the generics.

Re:Step by Step (1)

Black Parrot (19622) | about a year and a half ago | (#43913485)

They're just trying to keep one step ahead of the generics.

I.e., patent expirations. That's what makes generics.

Depends on what drugs we're talking about. (0)

Anonymous Coward | about a year and a half ago | (#43913031)

Many drugs are looking worse because of publication bias - like the new anti-depressants. [wikipedia.org]

Then as far as say antibiotics, we are seeing resistant strains of bacteria coming into being - partly because of the abuse of antibiotics.

And yes, I'm sure there's a bit of manipulation of drug trials and number massaging.

And then there is a combination of the above.

Re:Depends on what drugs we're talking about. (1)

Black Parrot (19622) | about a year and a half ago | (#43913489)

We actually have a far better arsenal of anti-depressants than we had 30-40 years ago.

More difficult now (5, Insightful)

Anonymous Coward | about a year and a half ago | (#43913137)

Several reasons for this:

1. Patent Law - Because all most all of the simple compounds have been patented, with the patent already expired, New drugs have to get more and more complicated in order to guarantee gaining a patent. More complicated means more expensive, but not necessarily more effective.

2. Increased safety - The requirements to get a drug on the market keep getting tougher and tougher. Almost everyone in the industry agrees that if aspirin was developed today, it would be a coin flip as to whether it would gain approval. (And certainly wouldn't be available OTC.)

3. Laziness - Many new drugs are just minor modifications of existing drugs made to get around patents. This is unlikely to provide any benefit to patients other than breaking the other company's monopoly. See Viagra vs Levitra: they are effectively identical.

4. Increased difficulty in animal testing - Years ago you could do anything to mice/rats, and the ethics committees only cared about larger animals. Now you have to argue in front of a panel that there is no way an animal could suffer as a result of your testing. I am talking about mice that are going to be killed at the end of the month anyway. And don't even think about using the word LD50: you will be looking for a new facility to do testing for you. This forces more testing back into the test tube, and in vitro environments are different enough from a real body that it is common to see something that works in a test tube to not work in a mouse, and vice versa.

5. Current failure of computer modeling: A lot of research money has moved from trial/error research by chemists to using software to model binding sites of proteins and trying to compute structures that may fit. While this may one day work, I know of no drug on the market or in clinical trails that was developed using computational chemistry as a primary tool. Note: Computational chemistry has brought some good things with it - see Lipinski's Rule of 5, but that was the result of a statistical analysis rather than modeling.

Yes, I am a medicinal chemist.

Patents, Marketing and law of diminishing returns. (1)

Coeurderoy (717228) | about a year and a half ago | (#43913177)

Patents kill the flexibility enabling companies to create new drugs without spending inate amount of money in order to avoid the pitholes left by the competition. And Marketing works better on "illnesses" bought be people in good health and with enough money, so Attention disorder medication (paid by young parents) E.. disorder payd by the midlife crisis, etc... it also works better on variations of existing medications that are going out of patent protection... Assume Pharma X makes 50% of it's income with Y it will get the most "powerful" manager to handle this business line, so even if Z is mutch more interesting, has future potential, the "Power Manager" will do everything he or she can to make sure the Z stays "small" and Y wich is their fiefdoom stays "big". Additionally once you cure a couple of illnesses you have to way for the germs to mutate away and then they typically become harder to manage, or you do not really need a new medication, and what is left is "harder"... So although the main reasons are "evil", part of it is just nature.... -

Funny story (1)

Murdoch5 (1563847) | about a year and a half ago | (#43913229)

My doctor won't even offer me new drugs, he will fall back to the tried and true warriors that have been known to work over the last 30 years. He knows for the most part the kind of side effects they give off and how they will work with my body. The new stuff is to unpredictable, and well I know that new medication gets tested ( be it poorly ), they just can't plan for the side effects, as I've developed side effects off new medication that weren't even known.

New anticoagulants (0)

Anonymous Coward | about a year and a half ago | (#43913247)

I am led to believe by the smart medical people I work with that the newer anticoagulants are a lot better than warfarin, in particular warfarin's side effects and long list of interactions.

The Real Comparison (1)

wsloand (176072) | about a year and a half ago | (#43913259)

While the new drugs are often less effective when compared to themselves, they are usually similarly or more effective when on top of the standard of care. For example, what tends to happen is that in the old studies with diuretics people had a systolic blood pressure going in of 200 mm Hg. Now, people are already on those diuretics and have a systolic blood pressure going in of 150 mm Hg. Given the same drug as a comparison, you often see that either the new drug is better in efficacy or similar in efficacy and better in safety.

Yes, it's safety and effectvieness (1)

dak664 (1992350) | about a year and a half ago | (#43913331)

That's all that has to be demonstrated for a new drug, at least in the US. Not that it is more effective than a previous drug, only that it is safe and more effective than a placebo. So a new version of an old drug might replace a phosphate group with a sulfate group, and it does not matter if the new drug is less effective than the old one, it can be patented and handed over to the marketing department for another 15 years of cash flow. There are a million variations possible, rinse and repeat as needed to maintain the monopoly and high price.

It's About Patents (1)

Bing Tsher E (943915) | about a year and a half ago | (#43913333)

The old drugs are 'protected' by patents that have expired. There are generic versions available. The 'cost of the research and development' has been paid out, and the older drugs are now actually affordable.

It's no surprise that the drug companies want people to use the 'New! Shiny!' drugs and discard the old ones. They make a lot more money. Whether the drugs work or not, they want people OFF those nasty old drugs they don't make much money producing.

It's all about making money.

Dr Gregory House had a point (1)

dkleinsc (563838) | about a year and a half ago | (#43913355)

Ed Vogler is a brilliant businessman, a brilliant judge of people, and a man who has never lost a fight. You know how I know that the new ACE inhibitor is good? Because the old one was good. The new one is really the same, it's just more expensive. A lot more expensive. See, that's another example of Ed's brilliance. Whenever one of his drugs is about to lose its patent he has his boys and girls alter it just a tiny bit and patent it all over again. Making not just a pointless new pill, but millions and millions of dollars. Which is good for everybody, right? Except for the patients. Psht. Who cares? They're just so damn sick. God obviously never liked them anyway.

This sort of thing is to be expected in a for-profit system of health care products: If the primary reason for doing something is profits rather than results, you get perverse incentives. For example, it's far more profitable to create an ongoing treatment to a disease than it is to create a cure for that same disease, because a cure is a one-time purchase but an ongoing treatment can require payments for 40 or 50 years.

Re:Dr Gregory House had a point (1)

Attila Dimedici (1036002) | about a year and a half ago | (#43913605)

So, what incentives do you propose to replace profits? Please note, this has to be an incentive that does not exist within the current system. I often see people recommend that we remove the profit motive from the medical field, but I have never seen them recommend replacing it with another motive. Usually they suggest that people only go into any of the various aspects of the medical field for altruistic reasons. This sounds good, until you realize that under our current system, people are free to enter any of the aspects of the medical field for altruistic reasons, so what they are saying is that they want to reduce the number of people in the various aspects of the medical field by removing those who entered it (or stay in it) because of the profit motive.

Re:Dr Gregory House had a point (1)

dkleinsc (563838) | about a year and a half ago | (#43914005)

I know, from your previous posts, that your basic view of the world is that the only reason anyone does anything is for profit, but when you ask or read the writings of people in medical fields, the reasons they cite are:
1. A genuine desire to save and improve the lives of their patients.
2. Like how many /.ers have a knack for applying technical skills and become programmers or admins, some go into medicine because they have that same knack for applying biology.
3. Some are motivated by what they experienced while dealing with a medical problem.
4. Some were pushed to do it by their parents, who in some cases also were in medicine.
5. Some want the fame and prestige and respect that goes along with it.
6. And yes, some are after a good steady job in about the $75-$200K range. This is rarely the sole motivator, though, because medicine is harder to get into than more profitable professions like business and finance.

Making billions on some new drug or device or treatment usually isn't a big motivator, in large part because the people doing the medical work almost never actually see those billions. That suggests that in theory at least we could get the same sort of results by hiring doctors, nurses, researchers, etc to work in non-profit hospitals and labs, make and sell devices and treatments and drugs and the like at cost, and save something like 30% of our health care spending.

Re:Dr Gregory House had a point (1)

h4rr4r (612664) | about a year and a half ago | (#43914349)

This makes me wish I believed in hell so this Ed Vogler could burn in it for eternity.

It's the gov't silly (1)

rsilvergun (571051) | about a year and a half ago | (#43913425)

It's expensive to make drugs. Most of the basic research is done by the government, and then the drug companies swooped in, ran a few study groups and patent the thing. We've been in 'Austerity' mode for about 10 years now. Slashing gov't left and right so we could slash taxes. Didn't anyone realize there would be consequences?

The root of this problem could also be pointed at (1)

Rooked_One (591287) | about a year and a half ago | (#43913533)

... the patient, or patient's caregiver's.

I can say this from experience, growing up with parents that thought there was a magic pill for everything. I suppose them not having any religion, could have contributed to this, *just* as much as money.

I say this because, again, people want a magic pill. Doctor says "Oh there this new thing we'll put you on." Patient takes it and is unable to google anything, or pre-google, just took it with absolutely no knowledge of what negative side effects it could have. I was personally put on every anti-depressant of the early 90's, and they did a number on me. I guess being diagnosed by a shrink at the age of 12 (this was around 1989) with ADD simply by me looking up when the madman snapped his fingers after giving me a puzzle to complete. I'd look up and say "what?" He would say nothing, then repeat that process. Looking back, I should probably sue the guy as i'm sure the transition of that to methamphetamine later (Rx again) could have only harmed me in my pre-pube days.

Re:The root of this problem could also be pointed (1)

h4rr4r (612664) | about a year and a half ago | (#43914375)

Why bring religion into it?
I would guess those who already believe in magic are more likely to to believe in a magic pill than those who don't believe in any magic.

Re:The root of this problem could also be pointed (1)

Ioldanach (88584) | about a year and a half ago | (#43914387)

I guess being diagnosed by a shrink at the age of 12 (this was around 1989) with ADD simply by me looking up when the madman snapped his fingers after giving me a puzzle to complete.

He'd already decided to diagnose you. If you hadn't looked up, he would have called it an example of hyperfocusing, the other half of ADD. Sounds like a charlatan's trick.

But that's not all... (1)

PopeRatzo (965947) | about a year and a half ago | (#43913813)

It's not enough that drug companies are putting out inferior, less-effective drugs to replace better ones, but they're putting all their marketing billions into making sure that the doctors prescribe the less-effective drugs instead of the better ones.

Note to corporate heads: when the mobs come to disembowel you and hang your corpses in the town square, don't say you were never warned.

Confusion of Goals (1)

pubwvj (1045960) | about a year and a half ago | (#43913895)

Ah, yes, the results, for the patient, might not be any better but the profits on new patents is far higher.

New drugs really aren't about clinical efficacy (1)

Rambo Tribble (1273454) | about a year and a half ago | (#43914285)

They are about exclusivity. The patent holder only needs to convince doctors to prescribe the medication to have guaranteed profitability. I suspect more is spent on marketing to said physicians than is spent on clinical trials, by a pretty wide margin.
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