The hurdle of transforming trial results into real changes In medicine

Posted By


The big ALLHAT study of drug treatments for high blood pressure showed, as Harvard’s Jerry Avorn writes, “that for patients with hypertension but no major comorbidities, thiazide-type diuretics were as good as or better than other agents that at the time were considerably more costly, many hoped this “old-fashioned” approach would gain new respect and credibility. Yet, publication of this landmark study resulted in a surprisingly small change in patterns of care.”

Today Avorn has an invited commentary in the Archives of Internal Medicine in reaction to a study that describes in this way:

“Face-to-face educational presentations by investigator-educators, a practice known as academic detailing, was associated with a small but significant increase in the use of thiazide diuretics for hypertension.”

In his commentary, Avorn writes:

“Many well-documented advances in therapy are not adopted widely or quickly, whereas other, unimpressive new treatments are taken up in epidemic proportions, their use often fueled by marketing campaigns that are far more powerful than the medicines being advertised. As a result, patients are frequently exposed to new therapies that may be less effective or less safe than the older regimens they replace. For example, ezetimibe (Zetia and Vytorin; Merck/Shering-Plough Pharmaceuticals, North Wales, Pennsylvania) may not prevent atherosclerosis as well as the statin-only regimens it displaces for many patients; rosiglitazone maleate (Avandia; GlaxoSmithKline, Philadelphia, Pennsylvania) increases the risk of cardiovascular disease in patients with diabetes mellitus; and rofecoxib (Vioxx; Merck & Co Inc, Whitehouse Station, New Jersey) nearly doubled the occurrence of myocardial infarction or stroke in patients who took it, while offering no greater analgesic efficacy than older nonsteroidal anti-inflammatory drugs, such as naproxen sodium. The lavish promotion that drives such overuse is reserved for the most expensive drugs, because only a high-priced product can provide its manufacturer with the economic benefit to justify a big marketing campaign. Patients are left to bear the burden of the mediocre efficacy or increased risk of these products, while all of us get to pay for their high cost.”

He says the study published today wasn’t about “real academic detailing” but rather “far less effective group presentations, many of which probably degenerated (in a behavior-change sense) to conventional talk-at-you lectures. It is therefore not surprising that its impact on changing practice was so modest.”

You might also like


Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.

Comments are closed.