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The all-too-often daunting task (for you and your doctor) of deciding which medication to take

This morning, in the L.A. Times’ monthly column “The MD,” preventive medicine specialist Dr.

This morning, in the L.A. Times’ monthly column “The MD,” preventive medicine specialist Dr. Valerie Ulene explains why the decision about which medication to take — whether it be for hypertension, high cholesterol, depression, or even erectile dysfunction — is no easy task.

Writes Ulene:

There’s no surefire way to ensure that the best possible medication will always be prescribed. Sorting through the scientific literature and trying to make sense out of drug studies is a daunting task even for physicians; it’s out of the question for most patients. Doctors and patients can approach the decision by working together, with doctors keeping in mind that the most effective medication isn’t always the right choice; some people may find its side effects intolerable or its price tag too high. And patients should be prepared to question their physicians about why they recommended a specific drug.

Here are some of the hidden obstacles that get in the way of making the best decision about what meds to take:

  • “For starters,” Ulene writes, “many drugs work in identical ways. … New medications don’t have to be unique or innovative to receive approval from the Food and Drug Administration [FDA]. About 4 out of 5 new drugs provide only minor, if any, therapeutic benefit over existing medications, the agency acknowledges. In fact, some may not even be as good as drugs that are already available.”
  • “Even when real differences exist,” she adds,  “the evidence to prove which drug is best might not. Studies comparing medications’ effectiveness are performed much less frequently than they should be.” Ulene points to a study published earlier this year that found that most studies of drugs hoping for FDA approval only compare the new drug to a placebo or to no treatment at all. Few (less than one-third) of the drug studies analyzed attempted to compare a new drug with an old one to see which was more effective. 
  • “Even when research has identified the best drug choice, doctors don’t always prescribe it,” writes Ulene. “… Some physicians can’t keep up with all of the new drug information. Others simply prescribe medications out of habit; they may learn to use one drug during their medical training and, if they have good experiences with it, continue to use it for many years.”
  • Doctors’ choices are heavily influenced by the pharmaceutical industry (whether the doctors realize it or not). “Many drug companies provide physicians with medication samples, and the availability of these samples can dramatically alter doctors’ prescribing patterns, studies have shown,” writes Ulene. “It can lead physicians, in short, to dispense and prescribe medications that wouldn’t otherwise be their first choice.”
  • Of course, drug companies also spend huge amounts of money advertising their products directly to consumers. “And it works,” writes Ulene. “Patients’ requests for specific drugs have a significant effect on what doctors ultimately dispense.”

Ulene recommends that consumers do as much research as they can about therapeutic guidelines. (“The National Heart, Lung and Blood Institute, for example, recommends thiazide-type diuretics over other blood pressure medications as initial therapy for most people with hypertension,” she points out.)

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And when there’s not a clear answer? “[S]erious consideration should be given to going with what’s tried and true,” she writes. “… Falling into the trap of believing that newer medications must somehow be better is a huge mistake; frequently they’re just more expensive.”