by Steve Connor
A senior executive with Britain's biggest drugs company has admitted that
most prescription medicines do not work on most people who take them.
Allen Roses, worldwide vice-president of genetics at GlaxoSmithKline (GSK),
said fewer than half of the patients prescribed some of the most expensive drugs
actually derived any benefit from them.
It is an open secret within the drugs industry that most of its products are
ineffective in most patients but this is the first time that such a senior drugs
boss has gone public. His comments come days after it emerged that the NHS drugs
bill has soared by nearly 50 per cent in three years, rising by £2.3bn a year to
an annual cost to the taxpayer of £7.2bn. GSK announced last week that it had 20
or more new drugs under development that could each earn the company up to $1bn
(£600m) a year.
Dr Roses, an academic geneticist from Duke University in North Carolina, spoke
at a recent scientific meeting in London where he cited figures on how well
different classes of drugs work in real patients. Drugs for Alzheimer's disease
work in fewer than one in three patients, whereas those for cancer are only
effective in a quarter of patients. Drugs for migraines, for osteoporosis, and
arthritis work in about half the patients, Dr Roses said. Most drugs work in
fewer than one in two patients mainly because the recipients carry genes that
interfere in some way with the medicine, he said.
"The vast majority of drugs
- more than 90 per cent - only work in 30 or 50 per cent of the people," Dr
Roses said. "I wouldn't say that most drugs don't work. I would say that most
drugs work in 30 to 50 per cent of people. Drugs out there on the market work,
but they don't work in everybody."
Some industry analysts said Dr Roses's comments were reminiscent of the 1991
gaffe by Gerald Ratner, the jewelry boss, who famously said that his high street
shops are successful because they sold "total crap". But others believe Dr Roses
deserves credit for being honest about a little-publicized fact known to the
drugs industry for many years.
"Roses is a smart guy and what he is saying will surprise the public but not
his colleagues," said one industry scientist. "He is a pioneer of a new culture
within the drugs business based on using genes to test for who can benefit from
a particular drug."
Dr Roses has a formidable reputation in the field of "pharmacogenomics" - the
application of human genetics to drug development - and his comments can be seen
as an attempt to make the industry realize that its future rests on being able
to target drugs to a smaller number of patients with specific genes.
The idea is to identify "responders" - people who benefit from the drug -
with a simple and cheap genetic test that can be used to eliminate those
non-responders who might benefit from another drug.
This goes against a marketing culture within the industry that has relied on
selling as many drugs as possible to the widest number of patients - a culture
that has made GSK one of the most profitable pharmaceuticals companies, but
which has also meant that most of its drugs are at best useless, and even
possibly dangerous, for many patients.
Dr Roses said doctors treating patients routinely applied the trial-and-error
approach which says that if one drug does not work there is always another one.
"I think everybody has it in their experience that multiple drugs have been used
for their headache or multiple drugs have been used for their backache or
whatever.
"It's in their experience, but they don't quite understand why. The reason
why is because they have different susceptibilities to the effect of that drug
and that's genetic," he said.
"Neither those who pay for medical care nor patients want drugs to be
prescribed that do not benefit the recipient. Pharmacogenetics has the promise
of removing much of the uncertainty."
Response rates
Therapeutic area: drug efficacy rate in per cent
-
Alzheimer's: 30
-
Analgesics (Cox-2): 80
-
Asthma: 60
-
Cardiac Arrhythmias: 60
-
Depression (SSRI): 62
-
Diabetes: 57
-
Hepatitis C (HCV): 47
-
Incontinence: 40
-
Migraine (acute): 52
-
Migraine (prophylaxis): 50
-
Oncology: 25
-
Rheumatoid arthritis: 50
-
Schizophrenia: 60
Originally
published on Monday, December 8,
2003 by the
lndependent/UK
Webmaster's
notes:
"Response rate", an often
misused term. It has nothing to
do with actual cure rate, and it
does not necessarily indicate any
significant improvement or symptom
alleviation. It only means that some
kind of positive response was
observed, however small it may have
been. When it comes to cancer, the
term "response rate" is often abused
to sell patients on expensive
chemotherapy drugs or other
mainstream treatments which often
have extremely poor success rates.
The GSK
vice-president blamed the drugs
failure on genetics. Yes,
there must be something about
natural human genetics which does
not respond well to unnatural
chemical compounds which attempt to
force the body to function
abnormally to repress symptoms of
illness and in the process create
more medical conditions and the need
for more and more drugs. As
opposed to natural herbs, vitamins,
minerals and other nutrients which
help the body function normally and
help prevent and actually cure
illness by addressing the root
causes instead of just symptoms.
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