english.prescrire.org > Positions > Therapeutic progress > Back to basics

Theme: Therapeutic progress

New products or techniques are only worthwhile if they translate into better care for patients. Clinical data may mean little in terms of improving patients’ health, and lives. How can we know genuine progress when we see it? 

Back to basics

Choosing and administering a new drug is less and less likely to provide better care. The process of innovation is running on empty. We need to demystify new drugs, and to rediscover essential drugs that are still useful. And seize the opportunity to return drugs to their rightful place in treatment, with both humility and ambition.

Our society expects a lot from drugs, to solve numerous medical problems.

But there are an increasing number of disappointments. Choosing and administering a new drug is less and less likely to provide better care. The process of innovation is running on empty. Thus, for the first time since their creation in 1981, the 2008 Prescrire Awards did not include either a "Golden Pill" winner or even an "Honours list” mention. The three drugs that are none the less singled out, in a more modest way, are based on substances that have been around for decades. On the other hand, in 2008, Prescrire rated 23 new products "Not Acceptable", the most since 1981.

This lack of innovation puts financial pressure on pharmaceutical companies, pressure they pass along to society. The price of new drugs remains high, despite the limited benefits they provide. The overmedication of existence is being shamelessly promoted, despite the risks it creates.

In 2008 direct, over the counter sale of certain drugs for "self-medication" has been authorised in France, without the need to consult a physician or pharmacist. There have been a lot of disappointments here as well. Most of these drugs provide little or no health benefit, or may even be harmful. Several of these drugs are cited in Prescrire’s Packaging Awards, but only as examples of what not to do in terms of safety and information.

What is the solution?

Of course, it is useful to maintain pressure on the authorities to fulfill their responsibilities of overseeing pharmaceutical companies, and conducting research (based on clinically relevant questions and solid pharmacology). Keeping in mind that it will take years to see the results of reorganisation.

We need to demystify new drugs, and to rediscover essential drugs that are still useful. And seize the opportunity to return drugs to their rightful place in treatment, with both humility and ambition. With humility, since drugs are often of little use in the prevention and treatment of many diseases. And with ambition, since as long as drugs are of some use, it is worth taking a serious interest in their limits, and making the most of their advantages.

Patients and healthcare professionals who follow these principles and work together will be in the best position to succeed.

©Prescrire 2009

Source: "Redécouvrir l'essentiel" Rev Prescrire 2009; 29 (304): 81.
More information:
Declaration on
therapeutic advance
in the use of medicines
ISDB 2001,