Angry Doctor

Wednesday, November 09, 2005

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 However, because of complications related to the drug, Vioxx was withdrawn from the market.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.

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5 Comments:

  • 1. Even though the drug is 'old', the data is new.

    2. "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."

    "Cost effective" is relative, depending on who foots the bill. Otherwise, unless one deals with these interventions on a regular basis, it's difficult for the infallible to imagine what the press and patients can.

    By Anonymous Anonymous, At November 10, 2005 8:40 am  

  • I think both the press and the lay public need to grow beyond the stage of thinking "the newest must be the best for everyone including ME" and "if it worked for one person it must work for ME too".

    That kind of thinking usually benefits only the people selling the drugs...

    I hope the ST letter has some effect on educating people.

    By Blogger angry doc, At November 10, 2005 9:06 am  

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    By Anonymous Perceval, At October 17, 2012 12:10 am  

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    The hairs he took don't grow well at all. They never have. He should have taken the hairs at least on inch higher. Everyone agreed that I had plenty of donor hair but Dr Agnesi didn't bother to take the best hairs. He just rushed through the job and took the wrong hairs at the base of my skull.

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    By Anonymous Anonymous, At April 29, 2013 10:54 am  

  • My hair transplant surgery was ruined by Dr Nicholas Agnesi of Hairline Clinic in Akron and Independence Ohio. He disregarded my specific wishes, wiped the pattern that I drew off my head, and got the hairline all wrong. He also harvested the wrong hairs from the base of my skull.

    The hairs he took don't grow well at all. They never have. He should have taken the hairs at least on inch higher. Everyone agreed that I had plenty of donor hair but Dr Agnesi didn't bother to take the best hairs. He just rushed through the job and took the wrong hairs at the base of my skull.

    When I let Dr Agnesi know what he did wrong, he said that he might be willing to replace the bad hairs after I talk to the president of Hairline Clinic Rob Hoffman. It had to be his call. But when I talked to Rob Hoffman at the Akron location, he refused to even look at the bad work. He just pretended everything was fine and refused to do anything about it. No fix. No refund.

    I knew those hairs would never grow well so I was left with no choice but to rip all those bad grafts out myself before they healed. It was a nightmare but I got it done. Now I'm out thousands of dollars and I have nothing to show for it but a bad memory and a nasty scar at the base of my skull.

    Dr Agnesi also works for Advanced Hair Restoration of Ohio.

    Now I'm talking to an attorney and trying to find a new HT doctor who will do what I wish and pay attention to detail.

    By Anonymous Anonymous, At April 29, 2013 10:54 am  

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