Not wasting money on drugs is of course to be recommended but surely they are not going far enough. A look at recent reports on the effectiveness of a number of other drugs widely used on the NHS suggests that a lot more could be done in this direction. Here’s a list for starters Anti depressant SSRIs and related drugs NHS spend – £150 million in 2008 Decade long research by a professor at Sheffield University and published in top journals such as the BMJ concluded that these drugs, when all the published and unpublished trials are combined, are no better than a placebo.
An investigation, published in top medical journal in November, came to a similar conclusion. It found that these drugs were only effective when given to the relatively small number of people with severe depression. For the millions of others taking them they were no better than placebos. Aspirin (to cut heart disease risk) NHS spend – £20 million Low dose aspirin has been highly recommended for years to protect the heart. A report out just before Christmas concluded that the benefit of these drugs did not outweigh the risk of serious internal bleeding. However studies dating back ten years showed that the number of people who needed to take aspirin to have a heart benefit was between 150 and 400.
A study published this week in the Journal of the American Medical Society shows no benefit at all for aspirin versus placebo, given to almost 30,000 people deemed at high cardiovascular risk for 8 years. Was that really a good deal? Antipsychotic drugs (heavy tranquillisers) for dementia Total spend £200 million Report out in December found that these drugs had been given inappropriately to nearly 200,000 elderly patients with dementia for years. They were responsible for killing 1800 a year and causing heart problems in 1600 more every year. There had been many official warnings dating back at least 6 years saying they were both likely to raise risk of stroke and heart disease in these patients. Not only were they dangerous but major trials had found they didn’t even help with behaviour. Yet they continued to be prescribed in large numbers. About 20% of the total spend on the drug went to dementia patients, say £40 million. Avandia diabetes drug £30 million Known to cause weight gain and raise the risk of heart disease.
A report by a committee of the American Senate published last week concluded that “If every diabetic now taking Avandia were instead given a similar pill named Actos, about 500 heart attacks and 300 cases of heart failure would be averted every month because Avandia can hurt the heart.” The report also found that faced with evidence of the risk of heart disease, the manufacturers had tried to downplay the risk, intimidate doctors who spoke out against the drug and dismiss evidence that taking the other drug might reduce the risk. Perhaps a House of Commons committee could investigate there. Ezetimibe – cholesterol lowering £66 million The same top journal that recommended that aspirin should no longer be used to lower heart attack risk also recently produced a report that was much less widely publicised about this drug given along with statins to patient with a raised risk of heart disease.
The journal found that although it lowered cholesterol there was no evidence at all that it made anyone live any longer or – amazingly – that you would have any fewer heart attacks if you took it. It concluded “The long-term benefit, if any and safety profile of ezetimibe (alone or in combination) are not known.” So not very good evidence there then So there is nearly £300 million being spent on drugs with serious questions marks hanging over them. Is bringing the big guns to bear on homeopathy, which certainly never harmed anyone, really the best way to cut our drugs bill? Jerome Burne