Meet the new drug; same as the old drug

I just discovered yet another site I’m going to have to become a regular visitor of (there’s really just way too much good information and analysis out there on the internet)– the Accidental Economist.  Anyway, here physician Austin Carroll has a really nice post about just how absurd some of the “new” drugs are and how we keep using them anyway.  For example, the oldest and cheapest blood pressure medication is the most effective, yet still routinely ignored for newer, more expensive (and much more marketed) medications.  Especially discouraging is the use of drugs in which the pharmaceutical companies simply take half the molecule of of a drug and patent and market it as a new drug:

However, in many other instances, new drugs are just sleight of hand “changes” to old drugs that have no expectation of being better.  When creating drugs through organic synthesis, mirror image molecules are created.

So, if drug D is created, in the last step you wind up with half D and half D’(the mirror image of D).  The mirror image is usually inert and has no effect on the drug or the individual taking the drug, but it is left in because there is an expense to remove it.  Years ago, the drug companies hit upon a brilliant idea.  If they removed that non-working, mirror image part of the pill, they could claim they devised a new drug!

Think this is rare?  Ever heard of Nexium (“the purple pill”)?  Nexium is just Prilosec, with the mirror image part removed.  And Prilosec is an effective, and now generic, drug for heartburn.  Prilosec is P + P’; Nexium is just P.  There is no reason to believe that equivalent amounts of the two drugs are not the same – and research supports this.  Four head-to-head studies compared 20 milligrams of Prilosec to 20 or 40 milligrams of Nexium.  But you have to remember – half of Prilosec is P’(filler)!  So these studies really compared 10 milligrams of P to 20 or 40 milligrams of P.  Shouldn’t more be better? One would think so, but it was barely so, and only in half the studies.  And, of course, none of the advertising stated that you could get the same improvement just by taking more Prilosec.

AstraZeneca, the maker of Nexium and Prilosec, isn’t the only drug company to do this.  Lexapro is “half” of Celexa (Forest Pharmaceuticals).  Nuvigil is “half” of Provigil (Cephalon).  Xyzal (Sanofi-Aventis) is “half” of Zyrtec (Pfizer).  Lunesta is “half” of Imovane (Sepracor).  Levaquin is “half” of Floxin (Ortho-McNeil Pharmaceutical).  Focalin is “half” of Ritalin (Novartis Pharmaceuticals).  And so on and so forth. In fact, since 1990, the proportion of these “half” drugs, among approved new drugs worldwide, has become greater than half of those new approvals.

I suppose I don’t blame the companies too much for this, but what in the world are doctors who should know better doing prescribing these things?  If any doctor ever tried to prescribe me Xyzal and 100 times the cost of my OTC generic Zyrtec, I would find another doctor immediately.  You think this is bad, here’s Carroll’s ultimate example:

These aren’t even the worst offenders.  In the worst cases, all that the drug companies change is the color of the pill.

Sarafem, marketed by Lilly for premenstrual dysmorphic disorder, is exactly the same molecule as that found in Prozac.  The only difference, besides the cost, is that Prozac has a green coating, and Sarafem’s is pink.  That’s it.  There is no reason you couldn’t just buy cheaper generic Prozac (Fluoxetine) and color it pink for the exact same experience and effect.

Again, this is nuts, but it only works so long as physicians are willing to write prescriptions for Sarafem instead of generic prozac.  The fact that apparently many are willing to, is the problem.


Friday Book Post (Game Change)

Yeah, I know, I’ve got a real problem with actually getting these out on Saturday.  Anyway, so I wanted to assign a fun and interesting read on the 2008 election for the Campaigns & Elections class I’m teaching this semester.  Despites my skepticism, several people suggested I consider Game Change by John Heilemann and Mark Halperin.

My students will not be reading this book.  My skepticism (based on various things I read when it came out) was most definitely warranted.  Sure, the book was filled with fun little observations and anecdotes (e.g,. Elizabeth Edwards screaming and ripping off her blouse in an RDU airport parking lot), but that’s ultimately all there was.  It was just detail after detail with almost no perspective or meaningful analysis.  It was the view of the campaign from 6 inches, when it would have been useful to also include the view from 1000 feet.  It also struck me as an almost perfect embodiment of the pathologies of modern political journalism.  Everything in the book was explained by the actions of various candidates and political actors.  The authors seemed oblivious to the fact that factors beyond the actual campaign (e.g., the demographic bases of each candidate’s support and how these varied across states) could have explained the results.  I don’t entirely regret reading this book, as there were some fun and interesting anecdotes about all the candidates (especially enjoyed the ones about Palin), but ultimately it does depressingly little to actually educate the reader.

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