Where Do I Get Prescribing Information?

You may have heard about the uproar concerning "Comparative Effectiveness" proposals which would require head-to-head comparisons of various treatments or drugs in studies which have the power (i.e., which usually means a large number of subjects tested) to determine which treatments or drugs provide the "best" results.

We haven't seen many head-to-head drug tests because they are economically risky for participating manufacturers. Several years ago in a head-to-head test a well-known cholesterol-lowering "statin" didn't fare well against another manufacturer's product, teaching the industry a lesson about losing market share, losing sales, requiring your company to spend a lot more money on promotion to convince doctors to prescribe your drug, making discount deals with HMOs and other entities,  hurting your stock price . . .  Well, you get the picture.  So pharmaceutical manufacturers and holders of patents and rights on other forms of therapies are understandably reluctant to expose their products to the truth about their effectiveness, as compared to other products.

The issue really isn't rationing.  It is access to statistically valid information about the effectiveness of various therapies.  It will be difficult for a pharmaceutical company to convince the doctors at a pharmaceutical company lunch, or in its advertising, to prescribe its product when the objective evidence clearly favors another manufacturer's product (or maybe even no treatment). Your doctor often selects a drug for your treatment for entirely irrational reasons, not because your doctor is irrational, but because the system keeps accurate verifiable information from her. I met with a group of doctors and a drug company representative a few days ago and listened to information which omitted an important "black box" requirement which had just been implemented by the FDA

I get prescribing information from The Medical Letter On Drugs and Therapeutics to which I have subscribed for more than 30 years. Articles begin with the rationale for the FDA's approval of the subject drug, a review of its pharmacology, a review of clinical studies and adverse effects, an analysis of drug interactions and medically significant issues, and a conclusion, which often suggests that practitioners should delay prescribing the drug in question until more data becomes available. The Medical Letter is non-profit, has no advertisements, is neutral in tone, and provides reliable information.

By the way, until we have Comparative Effectiveness evaluations, why don't you ask your own doctor where he gets his information.  Is it impartial?  Is it truthful?  Is it complete? Does it come with a free lunch?