Leading Article: Old medicine is good medicine

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Go into any surgery and you can hardly miss the pressures that doctors are under from drug companies. On the walls will be a calendar bearing the logo of the latest wonder cure. Look around and there will be paperweights, notepads, pens, pencil holders, mugs, perhaps a briefcase and even an umbrella - all pushing drugs. Doctors no longer have to thumb through a thick tome to prescribe a treatment: they just have to open their eyes to their surroundings.

Yet many of these drugs, though tested, remain a relative mystery. We report today, for example, that a group of top-selling drugs may in fact increase the risk of a heart attack in some patients. Although more research is necessary, the study suggests that the drugs, which include the popular nifedipine (also known as Adalat) may give some users a 60 per cent higher risk of heart attack than older and cheaper alternatives. This is particularly worrying because established treatments are rapidly being discarded in favour of more fashionable drugs, thanks to the barrage of publicity to which doctors are subjected.

We cannot know all the effects of a drug until it has been prescribed for many years. Only then can we be sure of its efficacy, success in reducing mortality and what side-effects may accompany its use. So, although the drug companies want doctors to prescribe expensive, newer formulas, the best interests of patients may not be served by having the latest treatment. Equally, the costs to the NHS may be unnecessarily inflated by the prescription of drugs that may be no better than those already available.

Drug companies will attack suggestions that further constraints should be placed on their innovations and profitability. But the dangers of using too many new drugs are clear. No one expected that taking Thalidomide would lead to deformed babies: that side-effect was discovered too late for too many. The widespread use of new antibiotics poses a different problem. The more they are prescribed, the more quickly will bacteria become resistant to them, so reducing the limited arsenal that we have against increasingly dangerous bugs.

The answer is for doctors to resist pressure from drug companies and remember that familiarity has its own rewards. But it is also time that the NHS followed Norway's example and laid out a strict national formulary of drugs that offer good value for money and have a long record of safety and effectiveness. Britain has already moved some way in this direction by limiting the number of drugs doctors can prescribe. But pressure from the pharmaceutical lobby has prevented more robust measures. This latest research should prompt a rethink. We should not be afraid to buck the fashion for new drugs. It is up to the suppliers to prove their products hold no hidden threat.

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