Just because it's new doesn't mean it's best

Ethics Forum. Nov. 1, 2004.

How do you decide whether to prescribe a new drug?

Your patient has achieved successful pharmacological management of a chronic condition and reports negligible side effects from the drug. A new drug is introduced for the same condition and promoted with claims that it is more effective. The new drug is more expensive, but your patient's insurance will cover it. How do you decide whether to try your patient on the new drug?

Reply:

The simple answer to this question is, "Of course I would not use a more expensive medicine to replace an effective one with no side effects." But in fact such substitutions do occur, and frequently. The drug companies count on it.

Several issues invite consideration. Foremost among them is the fact that the physician is expected by the patient and society to make all clinical decisions for the benefit of the patient's welfare. Our profession embraces this principle; it is the bedrock of our ethical code.

Because there is a finite amount of money in the medical care system, spending more money on one endeavor leaves less for other efforts. It is in the best interest of both our patient individually and all patients collectively to spend less rather than more for an effective drug.

It may be difficult to decide if a new drug possesses novel desirable properties. We should and often do recognize information from drug companies for what it is -- advertising; biased information designed to promote purchase of the product. Also be wary of industry surveys or "consulting panels" that pay (often significant sums) for participation. They are virtually always marketing tools attempting to disguise themselves as education or information gathering.