Monday, 6 September 2010
Panorama Highlights Drug Danger to Diabetics
The controversy over Avandia continues to rumble on, and the BBC have at last picked up, that it can cause heart failure in patients, despite the fact that it's makers continue to defend its use. John Briffa, as you see, has warned about this before. But as usual, the machinery of control in the UK, the Medicines and Healthcare Regulatory Agency is once more on a 'go slow' as regards it's withdrawal. Meanwhile more Diabetics may die or be harmed by it's use and Diabetes UK sits on it's hands (Some surprise).
The sad story of Avandia started in 1999 and it was approved for EC use in 2000. It belongs to a group of drugs in the usual 'me too' ranges marketed by 'Big Pharma', called rosiglitazones. They are thiazolidinediones or TZD's (a lot quicker to say, so let's do that). TZD's are PPAR-gamma angonists, which simply put, increase fat cell generation, as means of increasing glucose disposal. Pause a moment there, because are we not always told, that glucose, is not responsible for fat, but that fat is? So the excess of glucose, probably borne of the excess carbohydrates, you are told to consume as a Diabetic, is being metabolised, more rapidly by gist of this medication, and the mechanism it uses to achieve this is to make you fat! And this is to lower the risks associated with being Diabetic?
At this point I and my few readers may wish to lie down in a darkened room and ponder the logic of such a protocol. So I did and I still cannot see the sense in such a stupid idea, but 'Big Pharma' seems incapable of going beyond treating symptoms, with measures that bring about others, usually to the detriment of the poor souls who consume the drug. Well, as far back as 2004 there have been rumblings about the drug, with calls for the US FDA to ban it, and 'black label' warnings have been applied to the packaging, warning of the possibility of fluid retention (oedema) which in turn can cause heart problems, but an outright ban has not been invoked
The NEJM of June 14th 2007 (New England Journal of Medicine) highlighted the fact that Avandia was associated with a high risk of MI, which was some time ago but as usual little to nothing was done and millions of prescriptions continue to be filled, both in the US and Europe including the UK. The ACCORD Trial was halted due to safety concerns over this, and similar drugs and a number of clinicians are at last raising serious doubts about the validity of all drugs trials, due to the incestuous nature of the (often) authors links with the drugs industry, the grants paid, structure of trials and the withholding of essential data to enable proper independent peer reviews. Well, no shit Sherlock! An increase of 43% of heart attacks, in people that took Avandia for 24 weeks seems pretty conclusive to me!
I also find it unprincipled and alarming, that in most trials, the only way that the full data can be accessed is by paying for for it! The BMJ has a lot to answer for in this by having a pay wall between it and most data other than the (often) 'piss poor' abstract. This is often manipulated to give a 'slant', that is not borne out by the data in the full document. Most if not all trials are in fact paid for directly or indirectly by the drug companies who have vested interests in specific outcomes, and adverse results are often 'buried'. Some principled Doctors and Scientists have condemned this. Perhaps tonight's Panorama programme will delve more deeply into this aspect of 'Big Pharma's' persona. I'm not holding my breath however.