As demand for these drugs continues to rise, I wondered how bioethicists think about prescribing drugs that patients may wind up being on for a lifetime when we have such paltry data about what that looks like — not just for Ozempic but for many drugs.
Does getting informed consent include telling people they may have to take a particular drug forever? How is a risk-benefit analysis done when the use of a relatively new drug is expected to go on for many years? And how can hurried, overworked physicians manage to have proper conversations with patients about a drug’s unstudied future?
I called Arthur Caplan, the founding head of the division of medical ethics at the N.Y.U. Grossman School of Medicine’s department of population health. He told me that in general, there are very few “long-term registry studies of the sample of the population” because they’re expensive and there are few incentives for drug companies to do them. “You have also situations where you don’t want to find adverse events if you’re the manufacturer because you want to keep selling” and it’s a liability. “So they’re not saying they won’t do it or couldn’t be forced by the F.D.A. to do it, but they’re not rushing to do it on their own,” he said.
But we need more and better studies, Caplan said, including for commonly used drugs. He gave the example of low-dose aspirin, for which research ultimately reversed the thinking behind years of recommendations. As The Times’s Emily Baumgaertner reported in July:
In the past, some doctors regarded aspirin as something of a wonder drug, capable of protecting healthy patients against a future heart attack or stroke. But recent studies have shown that the powerful drug has limited protective power among people who have not yet had such an event, and it comes with dangerous side effects.
In addition to better data about the long-term effects of frequently prescribed drugs, we need more medical professionals to have more upfront conversations with patients about what they think is the ideal length of time for using particular prescription medications, the desired outcomes for taking them and how to eventually get off them safely, especially the ones that can lead to dependence issues.
Travis Rieder, an associate research professor at the Johns Hopkins Berman Institute of Bioethics who has studied ethical and policy issues around the prescription of opioids, told me that one of the first rules of pharmacology is that “all drugs have unintended effects” and that even while everyone should keep in mind that there are no perfect drugs, that rule is “hugely important for thinking about responsible use,” and “the bar for risk-benefit should be pretty high before we just keep adding more things to our body.”