Scott Hensley's article in today's WSJ underscores both the hypocrisy and inherent limitations of so-called evidence based medicine. J&J is hoping to launch a form of risperidal called paliperidone that is described only as being released over a 24-hour period of time and is therefore more tolerable to the liver in some people. One potentially important point Hensley left out of the story is that the form of risperidal JJ seeks to market is known to have a lower concentration of transmembrane transporter P-glycoprotein (P-gp) P-gp potentially limits access to brain tissue of psychoactive substrate which means that the lower concentration could make it more valuable to patients who don't respond well to Risperdal because of they way they metabolize the products. In other words, paliperidone could be a medicine for a small but clinically underserved group of schizophrenics. But JJ is going to have to do to the heaving lifting to demonstrate that is the case.
Meanwhile, Hensley cites the example of the HMO that simply decided it would stop paying for Medium because they are cheaper versions that are as effective. Where are the media skeptics demanding the source of the data for this decision? Isn't this a conflict of interest? What about the fact that the Roche Amplichip allows MDs to distinguish how well patients metabolize difference proton pump drugs? What if you can't handle Prevacid or Protonix? My daughter couldn't take either and she had to be prescribed Nexium. Why should she or anyone else be forced to pay out of pocket because she genetically unable to metabolize other PPIs? Isn't this a form of genetic discrimination?
So much for evidence based medicine. It's evidence when the HMO decides to dump a drug, but conflicted propaganda to promote a me-too drug when a drug company decides to bring a new medicine to market?