Better Evidence Needed for Popular Treatments

Physicians frequently look down on home remedies and other alternative therapies because there is rarely scientific evidence to support them. In an age of “evidence-based medicine,” there is no room for folklore.
When our readers tell us that Vicks VapoRub helps heal nail fungus, Listerine cures dandruff or that putting keys down the back of the neck can stop a nosebleed, many medical experts sneer.
The only trouble with this condescending attitude is that the evidence supporting many conventional treatments is often surprisingly inadequate.
A recent report in the Journal of the American Medical Association (Nov. 22/29, 2006) revealed that spinal surgery on herniated disks was not clearly better than standard therapy for sciatica.
Patients with arthritis were told that a new generation of anti-inflammatory drugs, the COX-2 inhibitors, would be much safer than older medications such as ibuprofen or naproxen. Tens of millions of patients were prescribed drugs like Vioxx, Bextra and Celebrex because they were supposed to be better. Now we know the evidence of safety was illusory and many people suffered heart attacks or strokes as side effects.
The most recent shocker involves drug-coated stents. These devices are tiny mesh tubes that prop open clogged coronary arteries. Bare metal stents had been used for years, but the arteries frequently clogged up again. Coating the metal with a medication designed to retard cell growth seemed like a breakthrough. Initial studies suggested that the pricey “drug-eluting stents” would be safer over the long term.
A new study from the Cleveland Clinic (American Journal of Medicine, Dec., 2006) now suggests that these new and improved stents are actually four or five times more likely to result in a blood clot that can lead to a heart attack. Millions of people now worry that they may be at increased risk of fatal heart attacks because of an intervention that was supposed to save them from this very fate.
Physicians want to do the right thing. Making good decisions does require scientific evidence. But too often the evidence is not as strong as manufacturers claim.
For years, makers of hormone replacement therapy (HRT) told doctors that estrogen and progestin would prevent a variety of serious health problems. Women were encouraged to take hormones to protect their hearts, their bones and their brains. We now know, however, that HRT can increase the risk of heart attacks, strokes and breast cancer.
The new generation of antipsychotic medications was supposed to be substantially better than older drugs for schizophrenia. But a new study shows that the pricey new pills offer no clear advantage over older medicines (American Journal of Psychiatry, Dec. 2006). Is it any wonder that patients are becoming skeptical about so-called drug breakthroughs?
Doctors and patients alike should have better information on which to base treatment decisions. People often turn to Consumer Reports for head-to-head evaluations of toasters, TVs or automobiles. The same type of objective analysis should be available for medication interventions.