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Commentary

The New Pill Isn't Always the Best Pill
Sally Satel, MD, National Review Online, 9-28-05

Satel, a practicing psychologist and senior fellow at the American Enterprise Institute, weighs in on the findings of a schizophrenia study published last week in The New England Journal of Medicine. The study compared an older, cheap generic drug, perphenazine, to four new, branded drugs, called “atypical antipsychotics.” The study found that the generic performed as well as the newer drugs on some measures, though Satel cautions that “the study, unprecedented in its scope, has much more data to yield.” She does, however, draw “two important conclusions” based on the current findings:

First, older drugs such as perphenazine deserve respect. Contrary to the notion among many mental health workers, they are not pharmaceutical relics. Some patients do very well on them. And the price can't be beat (a boon to the use of these drugs in the developing world).
Second, we must remember that research is about averages while clinical practice is always about the individual in the doctor's office. Balancing symptom relief with side effects is a delicate and idiosyncratic process. More data to come from CATIE will likely help guide it. Regardless, physicians must retain the freedom to discover what is best for their patients.


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