When I used to be in training, a pricey mentor of mine declared, “I never use a drug unless it has been on the market for 20 years.” I used to be so young then that I couldn't imagine being a physician for 20 years, let alone waiting twenty years for a latest drug for use. As my profession has progressed, I actually have seen many latest drugs released into the market. Some of them are truly miraculous, bringing people longer, healthier and more productive lives. Many of them haven't stood the test of time. More than a couple of have even been taken off the market. Although the Food and Drug Administration fastidiously reviews each latest drug before it's approved to be used, we frequently learn so much a few drug after it's released to the overall population.
As I read, I reflected on this memory. A recent editorial I New England Journal of Medicine (NEJM) on insulin resistance. In his editorial, the writer tells us concerning the “long, strange journey” of a category of medicine called thiazolidinediones, which help individuals with type 2 diabetes or prediabetes develop into more sensitive to the insulin their bodies make. . (Many diabetes medications help reduce the body's resistance to insulin in other ways.)
When they were first released, these drugs were widely accepted and adopted. We have, in any case, an obesity and diabetes epidemic within the United States, and so they appear to work pretty much for people. They gave the impression to be a fantastic alternative to insulin, which needs to be injected. Then, after about 6 years available on the market, these drugs began to be linked to liver disease and heart failure — and perhaps even cancer. Although long-term studies didn't show a definite risk of heart attack or cancer, these drugs became unpopular and fell into disuse. We weren't willing to take a likelihood with our patients after we had other good options.
And yet, some researchers proceed to wonder if there may be a secure role for these highly potent drugs with their many positive effects, despite the concerns. The same NEJM issue because the editorial cited above also contained a study showing that some fastidiously chosen patients did, in reality, experience increased heart rate in the event that they took a drug called pioglitazone, which is within the thiazolidinedione class of medicine. , could also be less liable to stroke. Interestingly, the patients on this trial were already on a really comprehensive stroke prevention regimen—and even now They reduced the chance of future stroke by 24%. These patients, all of whom were liable to developing diabetes, also had a slower progression of diabetes.
What grabbed me about this story? First, plainly the drugs in query are neither panaceas nor pariahs. Pioglitazone may, in reality, be a excellent drug for stopping stroke. In a ___ A really select population.
But, can we explain this select population? This would be the most interesting story of the past a long time. Twenty years ago, we could only predict whether a drug would work based on a patient's specific characteristics. Today, we all know that some people's genetics make them higher candidates for certain drugs than others. We are near having the ability to tailor medicine to a patient at the extent of their genes. When we're capable of do that effectively, safely and efficiently, we'll have the option to deliver truly personalized medicine. As a clinician, I find this really interesting. It can be great to say to a patient, “This drug may have the following side effects – but I know they won't affect you!”
My teacher will need to have been right that it takes 20 years to find out how a drug works and for whom it really works. He is not going to be surprised by the strange story of thiazolidinediones. They will little doubt be delighted to know that the laboratory and clinical research of the past 20 years has brought us a lot closer to really personalized care.