Follow the Evidence

Today’s Journal of the American Medical Association offers dramatic confirmation of the value of conducting comparative clinical trials. Two years ago, the federal government released the results of an $80 million, eight-year trial comparing blood pressure control medications. Lo and behold, generic diuretics proved to be just as effective as more expensive (because still on patent) ACE inhibitors and calcium channel blockers, the drugs doctors most often prescribe.

Michael Fischer and Jerry Avorn of Harvard Medical School decided to match those findings against what physicians are doing in the real world, where pharmaceutical industry marketing and not “evidence-based medicine” drives physician prescribing decisions. They reviewed records for over 133,000 patients treated for hypertension in 2001 under one state’s drug assistance program. Had physicians in the program used evidence-based guidelines, nearly 40 percent of the patients could have been switched to a cheaper medicine. It would have saved the program over $11 million or nearly a quarter of the government’s expenditures.

The authors then extrapolated their findings nationwide. Their conclusion: “Adherence to evidence-based prescribing guidelines for hypertension could result in substantial savings in prescription costs for elderly patients with hypertension that would amount to savings of about $1.2 billion nationally.”