Unfortunately, regulators and prescribers do not seem to have learnt from the rosiglitazone saga. Consider the case of the newest diabetes agents, dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide 1 (GLP-1) agonists. Regulators approved these agents relatively quickly, trusting the manufacturers to conduct cardiovascular safety trials. While these agents’ mechanisms of action excite diabetologists, marketers tout their favourable short term features, including low risk of hypoglycaemia, neutral or favourable effect on weight, and ease of administration. Dipeptidyl peptidase 4 inhibitors accounted for more than 14% of the diabetes drug market in 2010 even though not one study supports the long term efficacy (in reducing diabetes complications) or safety of these agents.10
Effective and efficient evidence based tools are freely available for patients and clinicians to compare the available antihyperglycaemic options (http://kercards.e-bm.info).11 Armed with unbiased information patients can consider these agents in light of their own goals and circumstances (although patients are the target of intense drug marketing in the US). Current guidelines do not recommend involving patients (or the use of decision aids) in decisions about drugs for treating diabetes.12 Yet, becoming engaged and informed seems to be the way for patients to avoid harm.
The rosiglitazone story says much about how healthcare has become less about promoting patients’ interests, alleviating illness, promoting function and independence, and curing disease, and much more about promoting other interests, including those of the drug industry. Has the corruption of healthcare advanced so far that it is unreasonable, even naive, to expect responsible drug companies, enlightened regulators, and thoughtful prescribers?
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