origins of "the gold standard"?

[boann]

if anyone's interested, i was poking around this weekend and discovered something i think is interesting about the origins of the term "the gold standard" with respect to levodopa.

Who Coined the Term "The Gold Standard" for Levodopa? (http://anukets-crusade.blogspot.com/2006/10/who-coined-term-gold-standard-for.html)

if anyone knows whether there is anything one can do when one discovers a crucial disclosure was not make in a paper published 10 years ago, please let me know.

boann

[Stitcher]

boann, I found some information in the middle of the night last night...one of my absolutely no sleep nights...but because of the source, I felt I should ask for permission to use the content.

I hope to have a reply today. I will let you know if the answer is no. If it is yes, I will post the content.

[boann]

hi carolyn,

can you tell me if it is the sort of thing where i should take down my post until i see it?

also my apologies for not having answered your question regarding clinical trials - i started several times - just never finished it, partly because i began to feel like it was a) impossible, and b) something that would interest no one but me.

i have derived other stats from my analysis that i may share - we'll see.

thanks,
boann

[Stitcher]

I don't see the need to take down you post. I don't think I will answer you questions, but I did find a bit of infomation that I can post...if permission is given.

You have a question, maybe someone else will have an answer, maybe not.

[boann]

Hi Carolyn,

Thank you! Which questions do you mean? the one about whether there is anything one can do about a 10-year old apparent failure to disclose?

Boann

[olsen]

following is excerpted from:
http://www.cbc.ca/health/story/2006/10/17/drug-studies.html#skip300x250

"Last week, a study published in the British Medical Journal found reviews of drug studies funded by pharmaceutical companies reached similar conclusions to similar reviews done without industry support.

But studies backed by drug companies tended to recommend an experimental drug without reservation compared with the independent Cochrane reviews, Peter Gotzsche of the Nordic Cochrane Centre in Copenhagen, Denmark, and his team found.

"Industry supported reviews of drugs should be read with caution as they were less transparent, had few reservations about methodological limitations of the included trials, and had more favourable conclusions than the corresponding Cochrane reviews," the Danish team concluded.

The researchers looked for bias in meta-analysis reviews that combine the results of multiple studies. To make a fair comparison, the researchers used studies that were published within two years of one another and looked at the same drugs and diseases."



the following is sumarized from an article in "new scientist" Oct 14, 2006, p 6:
article begins with this sentence: "money talks, and the drug industry's dollar talks loud and clear through the pages of leading medical journal"

this team was looking for bias in meta-analysis, comparing multiple drug sudy results to determine if the experimental drug is as effective as drugs already in use.--they matched studies that were published within 2 yrs of one another that looked at the same drugs used for the same diseases. The studies that did not have drug industry funding reached the same conclusions as did this team. studies that were funded by the pharm industry recommended the experimental drug without reservation, even though the effects of treatments of older drugs were similar to the experimental one--
this team found the reviews done with industry $$ were biased in their methods--they would only use studies held in the company's own data bank--the author maintains he now ignores any meta analysis funded by drug cos.

[olsen]

i do not think the medical journals demanded disclosure from all authors of studies/articles they penned except in the past few years. Dr. Marcia Angell instituted this practice at the new england journal of medicine during her tenure as editor in chief from 1999 -2000. I have often wondered if her termination of employment at the NEJM had anything to do with this new directive. you might be interested in her book:"the truth about the drug companies: How they decieve us and what to do about it".

[CTenaLouise]

best guess - the drug company who makes Sinemet? ;)

you could go to -ask a patient -

http://www.askapatient.com/index.asp

or read -

absorption and drug development - by alex avdeef

[ZucchiniFlower]

1: Trends Pharmacol Sci. 2005 Jul;26(7):341-4.Click here to read Links
The 'magic' of L-dopa: why is it the gold standard Parkinson's disease therapy?

* Mercuri NB,
* Bernardi G.

Clinica Neurologica Universita di Roma Tor Vergata and IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Roma, Italy. mercurin@med.uniroma2.it

The chronic treatment of Parkinson's disease with L-dopa is often associated with fluctuations of motor response and dyskinesias. Therefore, to overcome the adverse effects of the long-term use of L-dopa, directly acting dopamine receptor agonists have been introduced. However, L-dopa remains the most effective treatment of the slowness of movement, increased muscle tone, and tremor that are typical of Parkinson's disease. Why is this so?

In this article, we discuss evidence that suggests that dopamine produced from L-dopa has a larger number of actions compared with dopamine receptor agonists. In addition to stimulating D1- and D2-like dopamine receptors, dopamine might also activate adrenoceptors, novel dopamine sites, the dopamine transporter and trace amine receptors, all of which might contribute to the superior effect of L-dopa in Parkinson's disease.

PMID: 15936832 [PubMed - indexed for MEDLINE]

[boann]

hi there

hard to tell from your post, do you think levodopa is rightly termed the gold standard? do you agree with the characterization of it as the best symptomatic therapy for parkinson's?

curious,
boann

[boann]

hi ctena,

ding ding ding ding!!! (that is the sound of you winning the prize)

the term "the gold standard" regarding ldopa appears first in 1996 and the second time in 1997. the lead author is the same for both studies, and his affiliation is listed as being with a company called cytotherapeutics.

however, in 1992, he published a paper and his affiliation was bristol myers squibb. i found another in 2003, and in 1997, he published a paper in which he states affiliation with both.

bristol myers squibb/dupont/merck makes sinemet.

the fact that levodopa managed to be ensconced as the gold standard is huge.

my personal feeling is that if my choices were a) a drug that would work at a level of improvement of, say, 50%, for 20 years with no really severe (read: dyskinesias, wearing off, on/off fluctuations) side effects, and b) a drug that would provide 75% to 100% improvement for 2 to 10 years, but then would start causing severe (read: dyskinesias, wearing off, on/off fluctuations) side effects, that required the use of more and more drugs and ultimately brain surgerey....

call me crazy, but i would choose A.

the best of levodopa being held up as the gold standard (dopamine agonists are, to me, evidence that it is only the best of levodopa to which other treatments must be compared) means that chances are, drug A gets tossed.

and levodopa continues to make a lot of companies a tidy sum of money, what with all the adjuncts the same companies so nicely also make for us.

boann

[ZucchiniFlower]

hi there

hard to tell from your post, do you think levodopa is rightly termed the gold standard? do you agree with the characterization of it as the best symptomatic therapy for parkinson's?

curious,
boann

Hi there. Dyskinesias scare me, so I'm trying to postpone using sinemet as long as possible. I'd rather take azilect which may slow progression. But it means I have to abandon my tricyclic doxepin, and celexa, which I don't want to mess with right now.

Also, it depends on each individual which drug is best. We have different symptoms and are at different stages and have different needs. I think it's a very individual thing. For some, an agonist is all they need for relief. Some need to feel totally normal, and others can cope with some disability. It's different for each patient.

I don't like the term gold standard because it's simplistic.