But then, Vioxx

I've used that phrase a few times on this blog when I wanted to caution against enthusiasm for a new drug because of the hype.

This letter on the ST Forum today discusses another 'new wonder drug'.

New drugs must be used with caution

WE THANK Ms Chua Mui Hoong ('Costly, but put wonder drugs within reach'; ST, Oct 29) for sharing her insights on her battle with early-stage breast cancer. We are happy that she is satisfied with the treatment she received.

We would like to clarify Ms Chua's concerns on the use of Herceptin in Singapore.

Herceptin was licensed in Singapore in 1999 as an anticancer drug and has been available for use by our doctors since then for the treatment of patients who have advanced-stage breast cancer that has spread to other parts of the body and in which the cancer has an excess of Human Epidermal Growth Factor Receptor 2 (HER-2).

Recently, in experimental trials, this drug has shown effectiveness in patients with early-stage HER-2 positive breast cancer.

Data from the trials showed that Herceptin could improve the survival rate at four years by five percentage points (from 86 per cent to 91 per cent).

The figure for patients alive and disease-free is more promising.

But the benefits of Herceptin must be weighed against the estimated risk of heart failure. Based on data from the same clinical trials, up to 4 per cent of patients treated with the drug developed severe heart failure and another 14 per cent were noted to have a drop in heart function.

International regulators such as the United States Food and Drug Administration and the European Medicines Agency have not licensed the use of Herceptin for early-stage breast-cancer patients as they need to make an independent assessment of the trial data.

New drugs must be used with caution. The experience with Vioxx should be a lesson for all to heed. There was enthusiastic anecdotal endorsement of Vioxx by many patients. However, because of complications related to the drug, Vioxx was withdrawn from the market.

Therefore, before we endorse the widespread use of any new drug, as a routine practice we must evaluate all the information carefully and be cognizant of the clinical limitations and possible long-term effects of the drug.

Otherwise, we could inadvertently be putting our patients at risk.

Karen Tan (Ms)
Director
Corporate Communications
Ministry of Health

The press sometimes sensationalise so-called 'new' drugs which promise to revolutionise treatment of one disease or another, when in reality that drug had been in use for several years overseas. The public, unaware of the approved indications, would then pester their doctors for this 'new' product, which may or may not be useful for them. Why the press or the patients would imagine that the doctors will not prescribe these drugs to their patients if it were indicated or cost-effective is beyond me.

I think the Vioxx case is a victory on the part of the consumers against a pharmaceutical industry that has come to put a quick buck above the safety of their customers, but here's another view from an excellent blog.