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Invited Commentary | Health Care Reform

Transforming Trial Results Into Practice Change: The Final Translational Hurdle:  Comment on “Impact of the ALLHAT/JNC7 Dissemination Project on Thiazide-Type Diuretic Use”

Jerry Avorn, MD
Arch Intern Med. 2010;170(10):858-860. doi:10.1001/archinternmed.2010.125.
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The connection between clinical research and typical patient care presents a frustrating paradox. Many well-documented advances in therapy are not adopted widely or quickly, whereas other, unimpressive new treatments are taken up in epidemic proportions, their use often fueled by marketing campaigns that are far more powerful than the medicines being advertised.1 As a result, patients are frequently exposed to new therapies that may be less effective or less safe than the older regimens they replace. For example, ezetimibe (Zetia and Vytorin; Merck/Shering-Plough Pharmaceuticals, North Wales, Pennsylvania) may not prevent atherosclerosis as well as the statin-only regimens it displaces for many patients; rosiglitazone maleate (Avandia; GlaxoSmithKline, Philadelphia, Pennsylvania) increases the risk of cardiovascular disease in patients with diabetes mellitus; and rofecoxib (Vioxx; Merck & Co Inc, Whitehouse Station, New Jersey) nearly doubled the occurrence of myocardial infarction or stroke in patients who took it, while offering no greater analgesic efficacy than older nonsteroidal anti-inflammatory drugs, such as naproxen sodium. The lavish promotion that drives such overuse is reserved for the most expensive drugs, because only a high-priced product can provide its manufacturer with the economic benefit to justify a big marketing campaign. Patients are left to bear the burden of the mediocre efficacy or increased risk of these products, while all of us get to pay for their high cost.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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