Glaxo chief: Our drugs do not work on most patients

Indepedent News _UK ^ | 08 December 2003 | Steve Connor

[trajanus_red]

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 arthritis50 Schizophrenia: 60

[CJ Wolf]

They used to call those products snake oil.

[Lucy Lake]

Wonder about the drug efficacy rate for antibiotics? It isn't mentioned.

[staytrue]

I like flovent from glaxo very much. When these drugs do work, they do very well.

[waRNmother.armyboots]

"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."

It is the responsibility of patients to tell their physicians if a medication is not working. It is then the responsibility of the physician to no longer prescribe it or try a different medication. Contrary to popular believe medicine is indeed an art and not a strictly a science. Human beings are very unique. Anyone who has worked in health care can tell you that. Our bodies are very complex and as the psalmist say "wonderfully made".

[bigfootbob]

This confirms the suspicions I've had since for several years now. It explains the odd questions my rhuematologist have asked after prescribing new medications.

[Question_Assumptions]

If it works for you, it's an effective drug. If it doesn't, it's nake oil. There is often no way to tell until you administer the drug but what this really means is that doctors and patients need to pay attention to whether they do any good or not and stop using them if they are useless rather than wasting money on them.

[laurav]

This isn't huge news. I can't think of any drug that would work for everyone -- take an antibiotic and you might have a drug-resistant strain. Maybe your migraine is different from your neighbors. Levitra quickly got half the new scrips for impotence because Viagra didn't work for a big chunk of the men who tried it. A product isn't snake oil as long as it works for a higher percentage of patients than the placebo. Whenever you try a drug for a condition, you have to evaluate, and if it doesn't work, try another. The great thing about our system of multiple drug companies and big rewards for success in this country is that people do try to come up with drug products that plug a hole in the market, that work for those that other drugs have proved ineffective for. If people are shocked that drugs don't have quite the efficacy of Jesus healing the blind, that's pretty naive.

[elbucko]

I have found the elixir developed by the late Dr. Arthur Guinness to be very effective.

[aynrandfreak]

Well thanks for ruining the placebo effect for the 30% that it was working on.

[Texan5]

Finally, a doctor honest enough to say what quite a few of us have observed for a long time-there are just too many lawsuits against drug companies for the smoke surrounding this not to be indicative of a state of combustion. Snake oil, indeed.....

[Ancesthntr]

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.

Gee, aren't we all happy to be spending $400 billion over the next ten years for crap that doesn't work most of the time?

[RS]

Wonder about the drug efficacy rate for OxyContin, Lorcet, Norco, Hydrocodone and Kadian ?

[pabianice]

Hell. Anyone who's tried any of the "new generation" allergy products knows they're useless. There hasn't been one that's worked since chlortrimeton was introduced 60 years ago.

[CJ Wolf]

Well many of the "snake oils" worked for people as well.

[Endeavor]

Not quite snake oil. Only as we understand the genetic variances that humans and animals have to various therapeutics will we be able to improve on efficacy rates. I doubt very seriously if drugs will be tailored to each specific humans' variances, but categories of variances can be catered to, thus enhancing efficacy.

Before genetic testing, it was a crap shoot to identify those in the population who would benefit. Now that there is the possibility for developing testing modalities to determine whether you, individually, will benefit from drug "A" we can to some degree limit trial and error.

This article is a slanted slam on drug companies. And no, I don't work for one.

[uncbob]

Well the drug I take for HBP works great

The drug I take for my asthma work great

The drug I take for a rare Blood disease ET works great

[trajanus_red]

What do you mean, "works great"? My dog of 10 years was working great, until they found a tumor in his brain. Why do I mention that? To show that your feeling and opinion of "working great" doesn't necessarily work so great.

[<1/1,000,000th%]

Until drugs are custom designed for your specific genetic makeup, this will be problem. Don't hold your breath.

[uncbob]

What do you mean, "works great"? My dog of 10 years was working great, until they found a tumor in his brain. Why do I mention that? To show that your feeling and opinion of "working great" doesn't necessarily work so great.

Well if I hadn't had those drugs your dog would have outlived me
So ALIVE is great compared to DEAD