Media Mangles AHQR Report, But So Do It's Authors

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  • 07/16/2007
"Older, cheaper diabetes drugs are as safe and effective as newer ones, concludes an analysis that is good news for diabetics and may further hurt sales of Avandia, a blockbuster pill recently tied to heart problems.

The clear winner: metformin, sold as Glucophage and generically for about $100 a year. It works as well as other diabetes pills but does not cause weight gain or too-low blood sugar, the analysis found. It also lowers LDL or bad cholesterol.";_ylt=AjRpOmAY4PhCXhkEvojSg37VJRIF

I guess AP was just reading the press release and not the report or even the exec summary which carried these important tidbits:

The study only focused on monotherapy while the trend in diabetes care is towards combination therapy to maintain glycemic control, blood pressure, cholesterol. Hence, Avandia or Actos will be used in combination with Glucphage or insulin, not one or the other.

The study ignored many important clinical endpoints for which combination therapies are used, hyperinsulinaemia, for instance or fat build up.

The study acknowledges that combo therapy works better than monotherapy.

It also acknowledges that the supposed superiority of weight loss associated with metformin could be due to removing a prior drug used in head to head comparision trials so that the weight loss is an artifact of an experiment not the medicine. Oh.

So why did the authors not make these caveats in their statements to the media and so eager to push metformin as the....cheapest and best? Here is what the authors siad in their article in the Annals of Internal Medicine: Drugs like metformin "lower cost, longer use in practice and more intensive scrutiny in long-term trials" But the trend is towards combination therapy. Do I detect a bias, a falling into line with a ideological bent beyond what the data suggest? Is this ALLHAT and CATIE redux?

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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