Thousands of schizophrenics might be alive if they had been on clozapine

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not give the cost of Clozapine nor a cost comparison between it and other anti-psychotic medications.  Frequent monitoring and dealing with common side effects increase costs and potential for hospitalization. But even giving the cost of the drug alone is not giving the entire cost picture.

Clozapine is usually prescribed from specialized clinics and requires frequent monitoring (weekly for 6 months, then biweekly for 6 months, then ongoing). So there is the cost of the drug and monitoring and dealing with side effects and any effects on health care utilization (e.g. hospitalization for decompensation) vs other regimens. The story does not mention costs for additional monitoring.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

One problem is that only relative risks are given without any information on baseline risk.  It would be much better if the story provided the annual or 10-year risk of dying untreated, with clozapine and with other antipsychotics.  This would give the reader a better idea of the potential benefit (lower mortality) vs. harms (rare agranulocytosis, common – constipation etc) and hassles (weekly monitoring initially) and costs (one of the most expensive drugs).

The story leads with a statement that "thousands of lives could have been saved" if more schizophrenics were prescribed clozapine instead of no medication or newer anti-psychotics.  This is an overstatement and not an entirely correct interpretation of the study.  There are cardiac risks associated with most anti-psychotic medications and schizophrenics generally have a higher rate of suicide than the general population, so we cannot say how many lives would have been saved with clozapine. 

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story notes the rare, serious harms of clozapine and there is a comparison of mortality data of this medication with other anti-psychotics from the Finnish study.  However, the story does not mention the other long-term, more common and also potentially serious side effects of clozapine and many other anti-psychotic medications.  Clozapine is poorly tolerated (hypotension, sedation, constipation and others) and more common side effects limit tolerability and use.

Does the story commit disease-mongering?

Not Satisfactory

The story didn’t give adequate explanation for the statement that thousands of lives worldwide could have been saved if patients had been treated differently.  This is an overstatement and not an entirely correct interpretation of the study.  There are cardiac risks associated with most anti-psychotic medications and schizophrenics generally have a higher rate of suicide than the general population, so we cannot say how many lives would have been saved with clozapine.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story focuses on clozapine as a viable drug treatment for schizophrenia when other anti-psychotic medication does not work.  Use of the drug as a "last resort" should be reconsidered based on new evidence that there is lower long-term mortality risk with this drug compared to other commonly prescribed anti-psychotic medications.  The story does not mention that patients taking clozapine are typically monitored frequently (weekly to monthly) for white blood cell counts (loss of white blood cells led to the death of patients taking the drug in the 1970s).  The story also does not mention that some forms of psychotherapy are useful as adjunct treatment with medications for schizophrenics.  There are also intensive community help programs that appear effective.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The story does not mention that access to Clozapine (Clozaril) is still restricted in the U.S. WWW.CLOZARILCARE.COM.  The story does note physicians’ reluctance to prescribe this medication based on rare but serious side effects which affect white blood cells and can lead to death. The story mentions the drug was "banned" from the market, but it was voluntarily removed from the market by the manufacturer after reports of rare but serious side effects. 

The story is also inaccurate when it says the drug is sold generically as Clozaril.  Clozapine is the generic name.