addressing a House

In addition to my affection for Project Runway, I also watch House. House, for those of you who have not yet tuned in, is a medi-drama about a rather abrasive yet somehow pleasing character, one Dr. House.

The doc is a diagnostician of the first water, and it is to his unpleasant self that all sorts of desperate people turn. He abuses them, calls them liars, and eventually diagnoses them. It's pretty good TV, actually.

One of House's favorite tricks is to take drugs and prescribe them for off-label uses, i.e., uses for which they were not intended or studied to prove efficacy. This is actually a not-uncommon medical practice, as I am told by a friend who is a blood banker, and finds herself handing out clotting drugs for patients undergoing surgery. Patients who, mind you, do not suffer from poor coagulation. She calls it sloppy. The Washington Post, however, is a bit more pointed in their analysis of the situation:

http://www.washingtonpost.com/wp-dyn/content/article/2006/01/17/AR2006011700884_2.html

I've always believed that, were a cure for hemophilia to be found, it would not be found by drug companies. Their research is focussed on finding an effective product, without understanding the details, the hows and whys of the way that drugs work. Thus the collapse in gene therapy, when clinical trials found the human body to be more complex and harder to tinker with than they'd expected.

So. Different drugs work for different people - why? Children have different metabolisms than adults, women are different than men...all of this is barely considered by drug companies in their rush to the market. I owe the makers of recombinant factor eight and yes, NovoNordisk, quite a lot. And is it their responsibility to know every effect, every possible use for their drug, or is it the responsibility of the doctor who prescribes it? And if so, where does that leave the consumer - practically speaking, given that the first does not do the research and the second isn't really in a position to do so.

Sigh.