No one wants to take a pill that won't work or—worse—is harmful. But who can judge good medicine from bad when today's wonder drugs so often become tomorrow's pharmaceutical mistakes? We spoke to three women who investigate the tablets and capsules we swallow in the name of health.
Marian McDonagh Principal investigator, Drug Effectiveness Review Project, Portland, Oregon
McDonagh spends her days sifting through the available data to see how a new drug stacks up against others in its class: Is it more effective? Is it safer in the long run?
When McDonagh is surprised, it's not usually by something she finds but rather by something she can't find—like studies showing long-term safety for kids taking ADHD drugs. Also lacking, she says, is hard evidence that ADHD drugs improve academic performance. "Do the kids keep up with peers as they advance through school, so they graduate at the same rate?" she asks. She calls the data "abysmal."
McDonagh admits she's now a skeptic about new drugs, which aren't necessarily superior to what's already on the market. Check reports on science-backed Web sites like ohsu.edu/drugeffectiveness, www.fda.gov/cder, and cochrane.org to see if there really is a difference in results between the new drug and others in the same class. Also note how long the pill has been studied; if it's less than a year, some side effects may not yet be apparent and you could be safer with medications that have been on the market awhile.
continues... Alice Lichtenstein Director, Cardiovascular Nutrition Laboratory, USDA Nutrition Research Center on Aging, Tufts University, Boston
Wondering if you should take that omega-3 supplement? Want to know if soy really is good for you? Lichtenstein is your woman. Her beat is getting to the bottom of food and supplement claims.
What excites her is when science comes up with a clear answer, even if the accepted wisdom turns out to be wrong—for instance, that beta-carotene supplements protect against heart disease (they don't, and may do more harm than good) or that chromium enhances glucose metabolism, reducing body fat (wrong again).
Her findings have affected her own choices. "I make sure I include fish in the family's diet," she says, pointing out that the evidence for omega-3 is pretty good—but in food, she stresses, not supplements. And that's true across the board: The most proven way to get your nutrients is through healthy eating. "If you take fiber and you sprinkle it over a hot fudge sundae," she says, "the benefits won't negate what's in the sundae."
Debbie Kubota-Sako Formulary pharmacist, Drug Information Services, Kaiser Permanente, California
Working with ten other investigators, Kubota-Sako gathers evidence to help the HMO giant decide which drugs should be on its list of preferred medications. By scrutinizing the scientific studies, Kaiser has frequently been ahead of the curve in recognizing problems with drugs, she says. For instance, they picked up on the dangers of COX-2 inhibitors such as Vioxx and Celebrex long before the FDA issued warnings and decided early on that these drugs should be used only in very specific types of people. "Often in these studies," Kubota-Sako warns, "the study population doesn't apply to the population at large."
One of the most important lessons she's learned from nine years as a drug sleuth is that every single medication has risks. When you get a prescription, aside from doing your own research online (don't depend solely on Web sites sponsored by the drug company), make sure to grill the doctor and pharmacist about possible side effects.