Good news! -- Zantac is available in a generic.

--
Dicky

Let me be clear:  If new medications have no advantage, then certainly
"old and cheap" (and proven track record) is preferable to me.  OTOH,
one will never know if a new medication is, in the real world, more
effective/has advantages unless it gets prescribed.

However, most of the newer medications that (we as) eye doctors
prescribe have clear real world (and theoretical) advantages to older
medications.

Cox-2 selective inhibitors (C2SIs), like VIOXX and CELEBREX, had/have
real world and theoretical advantages over, say, to use your example,
naproxen Na.

C2SIs have about a 50% less chance of peptic ulceration (PUD) over
other NSAIDs.  Also, CS2SIs were less costly than NSAIDs when you
factor into the cost the say, ZANTAC, that was needed to be prescribed
along with the NSAID in order to prevent PUD.

On 6/23/06 4:46 PM, in article krto92pevm1e9j2m52jrc3ki85j2m2r4il@4ax.com,

<snip>

Again, I am not medically trained but I hope I can think logically.

Why not take the engineering attitude, and I think of medicine as an
engineering like discipline, good enough is perfect! If an old and cheap
medication does the job without doing harm--why not? New and expensive,
think Vioxx although there are other examples, is no guaranty of of
effectiveness and safety. Compare to naproxen.

Bill

-- Ferme le Bush

[snip]

The newest generation of progressive lenses have been a welcome
addition -- "substantial improvement" here is quite subjective, but...

  I have patients who were unable to adapt in the past to older
  generations of progressive lenses (AO TruVision) able to adapt to
  newer designs (Varilux Panamic).

so to them it has been "substantial".

TRIVEX has been a welcome addition, supplanting polycarbonate in most
cases.  In a similar way, TRANSITIONS V is much better than older and
other photochromic products (granted some of these are not available
anymore).

The newest plastic A/R coatings (e.g., Crizal Alize, Vivix Stainless)
have been a welcome development over older ones.  These coatings do
not flake in short order with the vast majority of my patients.  I
cannot say that was the case with older coatings.

On what do you base this belief?

There are certainly financial reasons why new drugs are produced.  New
drugs are typically where pharmaceutical companies make their largest
profit margins.

However, there are some newer drugs that are truly breakthrough and of
great benefits to our patients.

I remember what a breakthrough topical beta adrenergics were for
glacoma when they came out.  Before that, we basically had miotics,
oral carbonic anydrase inhibitors and epipherine.

Another breaktrough were the prostaglandin analogs (e.g., XALATAN).
These weren't just "new drugs" but were a great addition to the
anti-glaucoma armenatrium.

Topical second-generations fluoroquinolones (e.g., CILOXAN) were
another godsend for eye care.  The fourth-generation (e.g., VIGAMOX
and ZYMAR) were very welcome and benefical too.  These drugs
revolutionized the (monocare) therapy of corneal ulcers.

Before these came out, many cases of bacterial keratitis were managed
using fortified antibiotics that had to be compounded at a pharmacy.
These drugs were expensive, not available at the vast majority of
pharmacies, couldn't be stored long at a doctor's office (hence the
need to be compounded at a pharmacy) toxic and beat up the eye.  More
patients required hospitalization back then than now.

Other examples in systemic, internal medicine of great drugs that were
truly needed are ZYVOX, imipenem/cilastatin, ACYCLOVIR, aztreonam,
SYNERCID, daptomycin, CIPRO, etc.  I could go on and on.

One reason is some generic medications have a poor reputation.  Many
neurologist will not prescribe generic phenytoin because of
inconsistent potency levels.  Likewise, generic prednisolone acetate
ophthalmic solution has a poor reputation for potency and many eye
doctors only trust brandname PRED FORTE.

BTW, I am still a fan of a lot of older medications.  I still
prescribe bacitracin, POLYSPORIN and erythromycin ointments all the
time.

LUMIGAN and TRAVATAN are usually a little cheaper than XALATAN.

If you don't mind qid dosage, pilocarpine is real cheap.  You could
ask him about that.  :^O

On 6/22/06 8:20 AM, in article ctcl92ldj9ent31i5b32t7qdnca4user34@4ax.com,

Now you are talking about a field in which I do have some expertise. I see
little new in ophthalmic corrective lens design that is a significant
improvement over old ones except for cosmetic purposes. There may be much
technology in cataract implants but it is in materials and mechanics rather
than novel optics. I have not been able to get a simple quarter-wave hot AR
coating applied to a glass lens that I would prefer over a plastic lens with
coatings that flake in short order.

I think new drugs come out primarily because old patents run out or to
compete with someone else's blockbuster drug. Much of the improvement is
that of marketing. If that were not the case how can brand names still
compete with generics after the patents have expired?

Again, in my case, I am using the newer, improved, drug Xalatan. I can
afford it. After this exchange, however, I might ask my ophthalmologist for
a cheaper alternative. I do not mind using the drops twice a day.

Bill

-- Ferme le Bush

I never meant to imply that.

I do, however, in general, tend to prescribe newer medications because
they have advantages over older medications.  Likewise, I tend to use
more modern lens designs/coatings, because they have advantages over
older designs.

[snip]

Usually there are good reasons when I prescribe a newer drug versus an
older one.  It can be it more efficacious, requires less frequent
dosing, less side effects, etc.  That is usually the reason new drugs
come out, because they have advantages over old drugs.

It is certainly also true that the newest drugs tend to cost the most.

Correct.

On 6/21/06 6:31 PM, in article gasj92l2fei23rr1n8rqtqvj2rbv5mkigf@4ax.com,

It is not clear to me that higher cost is an indication of better
medication. To mention one medication I have taken various NSAIDS over the
years. Daypro, Vioxx, and Celebrex are just three that were expensive and
useless (for me). I guess I lucked out that Vioxx and Celebrex were no good.
Not only did they not work for pain relief but they badly upset my gastric
system, the main justification for their high price. The most recent one
that was half way decent (for me) and reasonably expensive, is meloxicam. It
is available as a generic from Canada. If price were a problem for me,
naproxen is just about as good as meloxicam.

In my opinion, I am not medically trained, there is good reason for a
physician to stick to prescribing old cheap and well tested drugs unless
there is a reason not to! Best is not necessarily the latest.

Bill
-- Ferme le Bush

[snip]

I want to make it clear I think there is absolutely nothing wrong with
a doctor prescribing the very best medication among several potential
ones.  In fact, that's what I think doctors *should* do, it is what I
would want my doctor to do, and it's what I do.

It is up to the patient do let the doctor know if they prefer, say,
cost savings over a more convenient dosing schedule.

I thank all who responded. No one mentioned the ubiquitous (sp) drug
salesmen who are in to the the doctor every time I'm there.
I'll see what happens when I tell him (again) about the cost.
This is a very well known and competent opthalmologist.

My "answer?"

Does your drug plan allow you to lobby to have drugs *added* to the
formulary??

Many do.

Best of luck!

Neil

My eye doc has recommended that I swith from Timolol to Istalol for my
glaucoma.
Problem is that in my drug plan Timolol costs me $3 foe 90 day supply,
and Istalol is $76!!! It's not in their "preferred list".
Is it worth it? My pressure seems to be under control, consistently
about 18 in both eyes.