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Intervention by Denise Caruso Read Intervention by Denise Caruso, Executive Director of the Hybrid Vigor Silver Award Winner, 2007 Independent Publisher Book Awards; Best Business Books 2007, Strategy+Business Magazine

ALLHAT, NO CATTLE?
SCIENCE, POLITICS AND PHARMA

by ~ December 4, 2008.
Permalink | Filed under: 21st Century Risk, Hybrid Vigor, Policy and Decisions.

Maybe my imagination is getting the best of me, but I laughed out loud when I read last Thursday’s New York Times article about the minimal impact of a big hypertension study published in 2000 that compared various blood pressure drugs.

The study was called the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, or ALLHAT. And while I’m sure the authors would never admit it, I desperately want to believe someone built that big ol’ clunky name around the classic cowboy insult “all hat, no cattle,” describing someone that’s all talk and no substance (in this case, the blockbuster drugs).

I do hope that’s what they had in mind, anyhow. It’s not just hilarious; it also makes sense, given what the Times article revealed about why the ALLHAT study had so little impact.

Its findings showed that cheap diuretics were at least as effective at treating high blood pressure as the expensive and heavily promoted drugs like beta blockers and calcium blockers — but that doctors were still prescribing the pricey stuff at a much higher rate.

One reason, according to Curt D. Furberg, a public health sciences professor who was the first chairman of the steering committee for the study, was that “The pharmaceutical industry ganged up and attacked, discredited the findings.”

The Times piece notes that Furberg eventually resigned “in frustration” from the steering committee, while another committee member went on to receive more than $200,000 from Pfizer, largely in speaking fees, the year after the Allhat results were released.

“There’s a lot of magical thinking that it will all be science and [there] won’t be politics,” Sean Tunis, a former chief medical officer for Medicare and an advocate for these kinds of comparative-effectiveness studies, told NYT.

I suspect there’s a lot more hat than cattle for a lot of the expensive drugs doctors are prescribing today to treat chronic conditions. And while of course drug companies are free to sell anything they’d like, I don’t really want to have to pay for the most expensive drug just because my doctor got seduced by the sales rep.

As the Times article noted,

The Allhat experience is worth remembering now, as some policy experts and government officials call for more such studies to directly compare drugs or other treatments, as a way to stem runaway medical costs and improve care.

You can read more on the controversy at the Alliance for Human Research Protection, in a post about the evidence gap in current prescription practices.

But this issue has much broader scope than health care. While the Bush administration gets well-deserved criticism for its outrageous disregard for scientific evidence (just one well known example here), there has never been a shortage of scientists who are adept at contextualizing evidence to their own ends, whatever those ends might be. As a result, citizens/consumers (whatever you want to call us) often don’t know about the range of equitable choices that are available to them.

I deconstructed the problem of evidence and alternatives at great length (in the context of biotech) in Intervention (Chapters 8, 9 and 10), and again more generically in my recent piece on cost-benefit analysis in Strategy+Business. Olivia Judson wrote about it from a slightly different angle on Tuesday in her NYT blog.

I hope the new administration in Washington will take up the fight as well. Comparing the effectiveness of alternatives is a big issue, and giving it serious consideration could have real, salubrious effects on both the quality and the cost of today’s expensive health and environmental interventions.

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