Drug Report Cards Could Save Lives

If you were going to buy a new car, a laptop computer or a stereo system, you'd want to know how to get the best buy for your money. Instead of relying on advertising from the manufacturer, you might turn to an unbiased evaluation from an objective source such as Consumer Reports.

What makes their ratings so useful is the head-to-head comparison of each product according to various criteria. You can find out which cars are safest, most reliable, comfortable and fuel efficient. "Best buy" recommendations make it easy to select a good value.

Using such a resource, a teenager can make a more informed decision about buying a CD player than most doctors can make about prescribing a blood pressure pill or a heartburn medicine. Physicians rarely get comparative data about drugs.

The FDA requires only that a drug company prove that its product is better than an inactive sugar pill. As long as the medication works better than a placebo and is relatively safe, it usually gets approval.

That doesn't tell physicians or patients how well a particular drug stacks up against its competitors. Is Nexium really better than Prilosec or Prevacid for relieving heartburn? Does Zoloft alleviate depression better than Prozac? Which one has fewer side effects?

Without head-to-head comparisons, many doctors make their choices based more on drug company promotion than objective research.

It came as a great shock to many physicians when an old-fashioned, dirt-cheap diuretic outperformed newer and more expensive blood pressure medicines. The large, long-term trial (ALLHAT) was funded primarily by the federal government (JAMA, Dec 18, 2002). A 10-cent water pill called chlorthalidone did as well or better than far pricier drugs like Norvasc, Zestril or Cardura.

Now that Congress is considering a drug benefit for Medicare patients, it wants to get the biggest bang for its $400 billion investment. To do that, lawmakers are asking for research that will provide objective data on effectiveness.

Physicians need to know whether Vioxx is as good or better than Celebrex and whether both of these pain relievers are superior to generic ibuprofen (Motrin), naproxen (Aleve or Naprosyn) or plain old aspirin. A long-term trial taking pain relief and safety factors such as heart attacks and ulcers into account would be invaluable.

The market for cholesterol-lowering drugs runs to billions of dollars each year. Doctors and patients would both benefit if they knew whether more expensive medicines like Crestor, Lipitor and Zocor produce better long-term outcomes than older drugs like lovastatin or niacin.

Drug companies have not embraced such studies since they are not required by the FDA and can be quite costly. But Congress is pushing for a comparative drug report card and may even start footing the bill.

If it makes sense for consumers to be able to evaluate digital cameras, DVD players or house paint with a Consumer Reports-type rating system, then it makes even more sense for physicians and patients. When it comes to drugs, not only dollars are at stake, but also health and life itself.