New uses for existing treatmentsBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d907 (Published 09 February 2011) Cite this as: BMJ 2011;342:d907
- Fiona Godlee, editor, BMJ
Two months on from widespread media reports that aspirin reduces deaths from common cancers, are you encouraging your middle aged and older patients to take a daily aspirin? Are you taking one yourself? The reports were based on an impressive meta-analysis published in the Lancet by Peter Rothwell and colleagues (Lancet 2010;376:1741-50). They looked at individual patient data from randomised trials of daily aspirin versus control and found about a 20% reduction in deaths from cancer at five and 20 years.
You may remember that the BMJ’s editorial on the paper was more circumspect (BMJ 2011;342:5-6). In it, Paul Moayyedi and Janusz Jankowski questioned the number of cancer deaths actually prevented and estimated a rather larger number needed to treat of 200. They stressed the need to look at all cause mortality rather than just deaths from cancer, citing among other things the risk of gastrointestinal and other major bleeds.
Rothwell and colleagues felt that the BMJ’s editorial had misrepresented their paper. In their detailed response they explain why, and Moeyyedi and Jankowski have replied (http://bit.ly/ej5vZj). It’s a good discussion on an important topic. My take on it is that aspirin shows high promise in cancer prevention, but before we start recommending it to everyone over 50 we need more definitive evidence of its effects on all cause mortality. Luckily, as Rothwell explains, at least five major ongoing trials are currently focusing on exactly this.
Meanwhile, the Lancet paper got us thinking about whether other existing drugs might have unforeseen benefits. So we asked Allen Shaughnessy to take a look around (doi:10.1136/bmj.d741). He gives several examples of drugs that have found new uses—fluoxetine, sildenafil, thalidomide—and explains that computer technology is now powering the search for more. What used to be left to serendipity has become the object of a purposeful and increasingly rewarding trawl of the medical literature. The digital hunt is on for “co-occurrences” of drugs, diseases, side effects, and genes that might yield new applications.
As Shaughnessy says, an important byproduct of this initiative is the blurring of boundaries between industry and academia. Closely held industry information that can’t be commercially exploited is being redistributed to academic institutions that are more willing to explore older off patent drugs and treatments for rare diseases. Meanwhile, a News story reports that the industry also wants NHS doctors to engage more actively with drug studies (doi:10.1136/bmj.d896).
Drugs aren’t the only things that can learn new tricks. Also this week we report the findings of what seems an exceptional randomised trial in Africa (doi:10.1136/bmj.d346). Christopher Gill and colleagues found that traditional birth attendants in Zambia who were trained in neonatal resuscitation achieved substantially fewer infant deaths, most notably through fewer deaths from birth asphyxia. Supporting and extending the role of traditional healthcare workers looks likely to be a promising and even essential initiative for improving health in low resource settings.
Cite this as: BMJ 2011;342:d907