The most recent newsletter of Therapeutics Initiative (April–July 2006) continues a long and noble tradition of tunnel vision. That tunnel vision maligns the ethics of the pharmaceutical industry, with little regard for patient care and apparent obliviousness to the many other areas of drug therapy that should be addressed.

This letter chooses to attack so-called “me-too” drugs. The authors disregard the fact that all drugs within a class are not equal for all patients. If it were not so, should we all be using hydrochlorothiazide and discarding furosemide? Non-steroidal anti-inflammatory agents were shown early on to vary in their effectiveness for different individuals, even if they each were effective for the same total percentage of patients. The tumor necrosis factor blocking agents for rheumatoid arthritis all block the same peptide, but we know from experience and from clinical trials that one may work when another has failed.

The letter does concede that, “New drugs do have a role in some situations and for some patients.” But if they are not available, how are they to play a role?

Why do the individuals of Therapeutics Initiative never focus on the generic drug industry? Here are a group of companies that have no price regulations applied to them, and essentially are entirely a “me-too” drug industry. They do not contribute “breakthrough” pharmaceuticals, and are not obligated to carry out large studies on their similar, but not identical, products. Then there is a highly dubious practice of payments from the generic companies to individual pharmacies to encourage the dispensing of specific generic drugs.

Still more egregious is the failure of Therapeutics Initiative to tackle the disgrace of neutraceutical and herbal therapies. Despite the virtual vacuum of research as to either efficacy or safety, the repeated reports from Health Canada as to the toxicity of various products, and the numerous instances where such products are shown to contain little or none of the active ingredient on the label, the Therapeutics Initiative seem disinterested in this area. Yet Canadians spend millions of dollars each year on such nostrums.

—Barry Koehler, MD
Richmond