Glaxo Chief: Our Drugs Do Not Work On Most Patients

Independent (UK) ^ | 12-8-2003 | Steve Connor

[blam]

Glaxo chief: Our drugs do not work on most patients

By Steve Connor, Science Editor
08 December 2003

A senior executive with Britain's biggest drugs company has admitted that most prescription medicines do not work on most people who take them.

Allen Roses, worldwide vice-president of genetics at GlaxoSmithKline (GSK), said fewer than half of the patients prescribed some of the most expensive drugs actually derived any benefit from them.

It is an open secret within the drugs industry that most of its products are ineffective in most patients but this is the first time that such a senior drugs boss has gone public. His comments come days after it emerged that the NHS drugs bill has soared by nearly 50 per cent in three years, rising by £2.3bn a year to an annual cost to the taxpayer of £7.2bn. GSK announced last week that it had 20 or more new drugs under development that could each earn the company up to $1bn (£600m) a year.

Dr Roses, an academic geneticist from Duke University in North Carolina, spoke at a recent scientific meeting in London where he cited figures on how well different classes of drugs work in real patients.

Drugs for Alzheimer's disease work in fewer than one in three patients, whereas those for cancer are only effective in a quarter of patients. Drugs for migraines, for osteoporosis, and arthritis work in about half the patients, Dr Roses said. Most drugs work in fewer than one in two patients mainly because the recipients carry genes that interfere in some way with the medicine, he said.

"The vast majority of drugs - more than 90 per cent - only work in 30 or 50 per cent of the people," Dr Roses said. "I wouldn't say that most drugs don't work. I would say that most drugs work in 30 to 50 per cent of people. Drugs out there on the market work, but they don't work in everybody."

Some industry analysts said Dr Roses's comments were reminiscent of the 1991 gaffe by Gerald Ratner, the jewellery boss, who famously said that his high street shops are successful because they sold "total crap". But others believe Dr Roses deserves credit for being honest about a little-publicised fact known to the drugs industry for many years.

"Roses is a smart guy and what he is saying will surprise the public but not his colleagues," said one industry scientist. "He is a pioneer of a new culture within the drugs business based on using genes to test for who can benefit from a particular drug."

Dr Roses has a formidable reputation in the field of "pharmacogenomics" - the application of human genetics to drug development - and his comments can be seen as an attempt to make the industry realise that its future rests on being able to target drugs to a smaller number of patients with specific genes.

The idea is to identify "responders" - people who benefit from the drug - with a simple and cheap genetic test that can be used to eliminate those non-responders who might benefit from another drug.

This goes against a marketing culture within the industry that has relied on selling as many drugs as possible to the widest number of patients - a culture that has made GSK one of the most profitable pharmaceuticals companies, but which has also meant that most of its drugs are at best useless, and even possibly dangerous, for many patients.

Dr Roses said doctors treating patients routinely applied the trial-and-error approach which says that if one drug does not work there is always another one. "I think everybody has it in their experience that multiple drugs have been used for their headache or multiple drugs have been used for their backache or whatever.

"It's in their experience, but they don't quite understand why. The reason why is because they have different susceptibilities to the effect of that drug and that's genetic," he said.

"Neither those who pay for medical care nor patients want drugs to be prescribed that do not benefit the recipient. Pharmacogenetics has the promise of removing much of the uncertainty."

Response rates

Therapeutic area: drug efficacy rate in per cent

Alzheimer's: 30
Analgesics (Cox-2): 80
Asthma: 60
Cardiac Arrythmias: 60
Depression (SSRI): 62
Diabetes: 57
Hepatits C (HCV): 47
Incontinence: 40
Migraine (acute): 52
Migraine (prophylaxis)50
Oncology: 25
Rheumatoid arthritis 50
Schizophrenia: 60

[RJCogburn]

Interesting I guess. But of course meds don't work on everyone and if they do not they are discontinued, or should be.

We ought not to loose sight of the fact that, for those for whom a drug works, the drugs of today are just wonderful.

[Conservativegreatgrandma]

I am not surprised by this and what's more, this doesn't even address undesirable side effects. Natural methods are far more effective and safer.

[Cicero]

Well, and who wouldn't take a drug that could fix cancer, even if the odds were only one in four?

I'm not sure how much good the genetic research mentioned would do, cost wise. Let's suppose that you could do tests eliminating half of those cancer patients as having the wrong kind of genes for the drug, so it was now effective with one patient in two. You would then distribute half as much of that drug, but you would have to charge only a little less than twice as much for it, since most of the cost of a drug is attributable to research and company overhead, and relatively little to actual manufacture. So you probably wouldn't cut health care costs by much.

Granted, if it were a powerful drug with harmful side effects, it would be good to use it only where it could do some good.

[sharkhawk]

Most chemotherapy drugs do not work for all patients. But if they cure 50% of the people who would otherwise die, why would you discontinue them?

[Pedrobud]

Conservativegreatgrandma - Where is the data to show that. It would be great if that is true, but the studies have to be done double blind, placebo controlled so there is no doubt. I will stay with real meds if I need them. If you are paying attention, you saw many so called natural products made things worse and were dangerous in some patients. Natural products do not require any testing and many claims are totally made up or one person who tried it saw some benefit and therefore it works. Not true !!

[sharkhawk]

Natural methods are far more effective and safer.

You can use nuts and berries to try to treat your cancer, as for me, I will trust science and Doctors to do their best.

[RJCogburn]

I would discontinue them in those patients in whom there was no beneficial response. Is that what you mean?

[Conservativegreatgrandma]

I can tell you horror stories. Natural medicine saved my sister's life after medical doctors and drugs nearly killed her. She's no exception.

[RJCogburn]

Natural methods are far more effective and safer.

Depends on what is being treated. I would not argue with you about the common cold.

[sharkhawk]

Apologies. I thought you meant discontinue the drugs altogether, read it too fast. Too many luddites long for the good old days, as evidenced by the poster who said natural remedies work better. I have seen this from both sides, my Mom has been part of a trial for an experimental MS drug for the past 15 years, it has slowed the progress of the disease, and allowed her to live a normal life. My Dad had bilarial duct cancer, the Doctor tried 3 different chemotherapy drugs, unfortunately none worked, but I don't blame the drugs or the Drs. They can't always know what will work on which individual.

[sharkhawk]

So our ancestors lived longer, healthier lives than we do now?

[MizSterious]

"But of course meds don't work on everyone and if they do not they are discontinued, or should be."

If you knew anyone who has hepatitis c, you'd understand the scandal that is the standard treatment for that drug. It's essentially like chemo for cancer. The cure is nearly worse than the disease itself. And it is only (according to these stats) 47% effective. It's also outrageously expensive, enough to bankrupt poor souls whose insurance won't cover it. If this is the best they can do....!!

[NittanyLion]

If you knew anyone who has hepatitis c, you'd understand the scandal that is the standard treatment for that drug. It's essentially like chemo for cancer. The cure is nearly worse than the disease itself. And it is only (according to these stats) 47% effective. It's also outrageously expensive, enough to bankrupt poor souls whose insurance won't cover it. If this is the best they can do....!!

Evidently, as of now that IS the best they can do. Medicine is an evolving science, and often the road to the perfect drug is a long, incremental one. Isn't an expensive cure, effective in 47%, with bad side effects, better than nothing?

I have little doubt that if there was a better med available to treat Hep C, it would be on the market...

[sistergoldenhair]

since most of the cost of a drug is attributable to research and company overhead, and relatively little to actual manufacture. So you probably wouldn't cut health care costs by much.

Don't forget the costs associated with government regulation.

[RJCogburn]

I can tell you horror stories. Natural medicine saved my sister's life after medical doctors and drugs nearly killed her. She's no exception.

Anecdotal stories such as yours are interesting but really prove nothing. Answers are found objectively.

[dalereed]

"So our ancestors lived longer, healthier lives than we do now?"

I hope not but I can count on my fingers the number of my relatives on both sides that have died before 90 and 5 that I can think of that lived to be over 100 in the last 200 years.

I'm 66 and haven't been sick since I had the german measles when I was 8 years old.

[cajungirl]

I wonder if the efficacy rates quoted for drugs for diabetes were for the oral ones. As far as I know Insulin helps 100% of the time. And for those who wish to eschew their chemo cause it only works less than half the time, well that is their business but for me, I will take those odds given the alternative.

[Indie]

The thing that gets me is it always has to be one or the other.
Either the drug execs and government types say RX Drugs are the only ones that work and natural alternatives, including the ones that might hurt the profit of the big guys, are irrelevant and ineffective.
I think anyone who has read the research knows that Rx Drugs work well for most, and natural alternatives can work well for many as well. I use both.
This is a little bit of a surprise to me that he said this. I wonder what his hidden agenda could be??

[Conservativegreatgrandma]

Years ago, I had rheumatoid arthritis. At that time, aspirin was the best my doctor could recommend. Sixteen aspirin a day does horrible things to you.

Someone recommended Adele Davis book. I got well. Haven't had RA in years.

My sister nearly had her liver destroyed by drugs being used to treat her RA. Out of desperation, found a doctor to use natural methods. She's now healthy. Even the most skeptical in our family has to agree that there is a world of difference. This is only one example. I can go on and on.