Fear, Loathing, and Natrecor At The Cleveland Clinic 
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 Fear, Loathing, and Natrecor At The Cleveland Clinic

Another marvelous tale of unbridled greed in US medicine:

In 2001 the US FDA approved Natrecor (a.k.a. Nesiritide) a drug that is
administered (at $500 or so a treatment) during episodes of acute heart
failure to help patients breath easier.  This is a good thing.  However,
nitroglycerin is almost as good at doing the same thing
( http://www.***.com/ ),
and has a much-better-established safety record than does Natrecor - and
costs, at most, a few dollars per treatment.

Much more expensive... roughly as good... sketchy safety record... we
have a winner! Of course, Natrecor went on to become wildly prescribed
by American physicians.  More than 600,000 patients have been treated
with Natrecor, and sales this year were projected to pass $600 million.
  Scios, the company that brought Natrecor to market, was purchased by
Johnson & Johnson for $2.4 billion.

Well, some researchers finally did take a look at the longer-term safety
of Natrecor, and the news is bad.  Studies indicate that patients
treated with Natrecor are almost twice as likely to die within 30 days
vs. patients treated with "old-fashioned", less-expensive {*filter*} (7% vs.
( http://www.***.com/ )
.  Patients fortunate enough to survive face a dramatic risk of
substantially-worsening kidney function
( http://www.***.com/ ).

Given the popularity of Natrecor, this adds up to a lot of excess
deaths: by my quick calculations, 19,200 early deaths.  19,200 deaths,
and hundreds of $millions in extra medical costs.  Pretty bad stuff by
any reasonable standard.

The cardiology department at the Cleveland Clinic tried to take what one
would think is a smart  position: a committee of almost 50 of its
cardiologists, including some of the best-known folks in the business,
voted to stop using Natrecor.

Of course, they were overruled.

"Bad idea!" said a committee of non-cardiologists that overturned the
cardiologist's ban.

Let's walk through this again: Natrecor is only approved for use in
cardiological conditions.  It's killed a lot of people and wounded many
more, and a safer, cheaper substitute is available.  The cardiologists
decided to stop using it.  But they were overruled by a group of

The chairman of the overruling committee, Dr. James B. Young, also the
Cleveland Clinic's Chief of Medicine, has very, very close ties to
Natrecor, including being lead investigator in one of the studies that
got Natrecor approved.  (He did recuse himself from voting.)

Is Dr. Young's committee just a lot smarter about cardiology than the
cardiologists?  Or was his committee simply being careful to prop up
their leader and keep the pharmaceutical cash gravy train going?

You be the judge.
A daily chronicle of honest medicine

"God Heals, and the doctor takes the fees"
-Ben Franklin

Fri, 26 Oct 2007 19:18:08 GMT
 [ 1 post ] 

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