I call them the “drug of the week.” I’ve been in practice long enough to see patterns of patients that come into my office. There are times when it seems like every other patient coming into my office is on a hot new drug. Many times the condition they are put on the drug for is not really what the drug was originally approved for.
A pretty strong glaring example that I remember distinctly was Neurontin (gabapentin). Within a period of a few months, I saw a surprising number of patients who were given this prescription, and none were for the indicated use of the drug (originally seizures, then post-herpetic neuralgia, which is when the boom started). I remember a particular patient who was put on this by her PCP for sciatic pain. Two problems…it wasn’t sciatic pain (it was meralgia paresthetica and responded well in a few visits), and, even if it was, this is a very poor use for Neurontin.
So, when the prescriptions go up, I am usually thinking it’s the drug reps doing a great job. In the particular case of Neurontin, this is a vast understatement. The entire marketing and study of Neurotonin beyond the approval of its use for post-herpetic neuralgia was a massive scam on a massive scale. The company netted billions.
Here’s how it worked. The was a study named the STEPS (Study of Neurontin: Titrate to Effect, Profile of Safety). This study was what is referred to as a seeding trial (we saw this before on a very large scale with Vioxx and Celebrex).
In a seeding trial, the goal is NOT to gather information, but to get patients and providers used to prescribing the drug so it becomes habit. The providers are frequently paid to participate in the trial, so there is incentive to start the habit.
The problem? The drug company Pfizer cared little about the science of the study and how the drug may or may not have benefited patients. They cared little about the side effects. This trial was developed, in part, through the MARKETING department, not the research department. This is an exceedingly unethical method of marketing a drug by masquerading it as science.
And the medical community was deceived as well and went for it hook, line and sinker. This is just one of many documented examples that have come out as a result of lawsuits that put documents of drug companies into the public domain.
This just exemplifies why our society’s heavy reliance on drugs to fix our woes is so problematic. The entire system is based on weak, questionable and, as in this case, unethical evidence.
Lifestyle, however, is the way we were designed. No one needs a study to determine that eating more fruits and vegetables are good for us.
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