Why so much Avandia in the first place?

Stefan Kertesz

TEXT OF COMMENTARY

KAI RYSSDAL: A full-page ad in the Wall Street Journal on your average Tuesday runs more than $250,000. Multiply that by three or four national papers, and another handful of regional editions, and it's a big pile of money. But doubtless considered well-spent by the drugmaker GlaxoSmithKline.

The company took out the ads today to reassure patients about the safety of its diabetes drug, Avandia. A couple of weeks ago, the New England Journal of Medicine reported Avandia's been linked to heart attacks and deaths. As a result, two things have happened. Glaxo's stock price has taken a hit. Also, commentator Doctor Stefan Kertesz has seen a change in his rounds at the hospital.


DOCTOR STEFAN KERTESZ: During visits to patient's rooms, we hear the TV blaring: "If you think you've been harmed by Avandia, call our attorneys." The other day, one of us was called away from the bedside of a man with chest pains to handle a call from a patient worried about Avandia.

But all that pales in comparison to the possibility that some patients may have been hurt or killed by medicines offered with every intention of helping them.

But let me ask this: why were we prescribing so much Avandia in the first place?

In recent years, we've been putting patients on two or even three different medications just to meet the elusively low blood sugar standards that diabetic experts promote. Avandia was typically the second or third drug in that cocktail.

The real problem is a rise in absolutist quality standards for the treatment of each chronic medical condition. That includes the notion that we should drive diabetic blood sugar, cholesterol, even blood pressure as low as it can go.

Those standards, soon to be given sharp teeth by Medicare in a program called Pay for Performance, reflect advice from experts whose perceptions are skewed.

The research guiding our experts is based on single diseases. So the experts rarely take into account just how complicated and dangerous it can be to treat a patient with four diseases and 12 different medications that can mix in unforeseen ways.

And the experts who devise quality standards often benefit financially from the drug companies who naturally want us to prescribe more drugs in service of ever-more demanding targets for blood sugar, cholesterol or anything else.

Medicine is supposed to help people, not harm them.

So first, we need to demand that health care standards organizations, like the National Committee for Quality Assurance, publicly and fully disclose the financial interests of their experts. And next, our government must slow down before rushing head-long into a torrid affair with quality standards that may yet betray us all.

RYSSDAL: Doctor Stefan Kertesz is an assistant professor at the University of Alabama Birmingham School of Medicine.

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