"The Truth About the Drug Companies" by Marcia Angell

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Matt Beckwith - 24 Apr 2005 22:07 GMT

This is an interesting book. I don't agree with all of it, but for the
most part it's educational. Talks about how much money drug companies
really spend on research (most of it's done by universities and the
NIH, but the drug companies reap the profits), me-too drugs,
drug-company-sponsored educational events (which are just
brain-washing), introduction of new drugs which have no proven benefit
over existing drugs (head-to-head trials being almost unheard-of).

The issue of me-too drugs being largely unnecessary is of interest,
because it's an area where doctors can save American consumers some
money. All we need to do is not prescribe me-too drugs when less
expensive drugs which are just as good (or even nearly as good) will do
the trick.

Another idea is to always go generic when appropriate.

I've always justified prescribing brand-name drugs by saying that the
patient's co-pay is what matters. I've considered a second-tier copay
as acceptable, and a third-tier copay as unacceptable. But even if the
patient's copay is low, by prescribing a mercenarily motivated me-too
drug I'm just reinforcing the wasteful spending of the drug companies.
And a first-tier copay is better than a second-tier copay.

So, here's a start at an algorithm:

1. Don't prescribe a second- or third-tier drug when a generic drug
will do as well:

a. Start with paxil or prozac for depr/anx.
b. Start with amoxicillin, penicillin, erythromycin and Bactrim for
mild infections.
c. Lisinopril for an ace inhibitor.
d. Atenolol or Metoprolol for a beta blocker.
e. Prilosec and Zantac for PPI and H2-blocker.
f. Lovastatin as first-line statin.

2. When prescribing a second-tier drug, steer away from me-too drugs
which are optical isomers or active metabolites and therefore have no
logical benefit over their parent drugs:

a. Nexium.
b. Lexapro.
c. Clarinex

3. When prescribing branded drugs, give preference to those which have
proven superiority via head-to-head trials:

Anybody know of any examples? I can't think of any. :-)

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Hawki63@sbcglobal.net - 05 May 2005 16:16 GMT

> This is an interesting book. I don't agree with all of it, but for the
> most part it's educational. Talks about how much money drug companies
[quoted text clipped - 44 lines]
>
> Anybody know of any examples? I can't think of any. :-)

Ironic expose on drug companies from a doctor who has a website with a
calendar for drug reps to schedule "free lunches" with said doctor...

you mr beckwith are a hypocrite

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Pumbaa - 05 May 2005 17:09 GMT

Once the drug algorithm is approved and tested in actual clinic treatment
the drug selection could be done by a computer. It would be double checked
by the physician. If the patient data is entered correctly, the error rate
would be less than that of the human prescriber. The real problem in
medicine is to establish a correct diagnosis. Then if a treatment is
available it can be prescribed. Many of us have gone to various doctors for
years before one actually discovered the cause of the problem.

Does a doctor see enough patients to really evaluate one type of statin
verses another? Does he have at least five thousand patients he is treating
with statins and is it done in double blind fashion? No. If I buy a Honda
automobile it might be a "lemon". However all consumer groups including
"Consumer Reports" have found that Hondas are very well built vehicles. I
should not conclude that a Honda is a piece of junk based on the ownership
of just one specimen.

Did you see the article on page #8 of the "AARP Bulletin / May 2005"? An
article published earlier this year in the "Annals of Internal Medicine"
analyzed 99 published studies to determine whether a doctor's age or years
in practice affect quality of care. "More than 70 percent of the studies
showed declines in performance over time!" If I was a doctor I would take
all the BS that the drug salesmen (a more truthful title than "company
representative") with a large helping of absolute disbelief. They are there
to make money for the drug companies and by an oral presentation it is hard
to control what they may say about a certain product. So perhaps you should
wear ear plugs when getting a free lunch out of a drug salesmen. It may be
that the more a doctor relies on drug salesmen for drug information the
dumber he becomes. Maybe continuing education programs for doctors are
being canceled out by drug company propaganda.

> > This is an interesting book. I don't agree with all of it, but for the
> > most part it's educational. Talks about how much money drug companies
[quoted text clipped - 49 lines]
>
> you mr beckwith are a hypocrite

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getsumonya - 05 May 2005 17:36 GMT

One of the common blames for high and increasing drug prices is third party
payers. Theory being that drug companies couldn't charge such high prices if
the end user was paying instead of a third party (insurance company). This
theory is based on normal market economics.
While this may be true, I would be willing to bet that if all prescribers
wrote for generics only and reserved brand name for only the unique drugs,
that generic drug prices would begin to go thru the roof. There is already a
trend of increasing prices for generics, particularly former "blockbuster"
drugs.

Brad

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