The pharmaceutical industry may not be “evil,” as some have suggested, but it is just as dedicated to profit-making as any other business, and consumers should never forget it.
The drug Vytorin has hit the headlines today because a new study in the New England Journal of Medicine shows it is no more effective at reducing LDL (“bad” cholesterol) and arterial plaque than older, cheaper drugs. This should come as no surprise, since study results released in early January showed that Zetia, one of the components of Vytorin, is ineffective.
Vytorin is a combination of Zetia (ezetimibe), a Merck/Schering-Plough Pharmaceuticals product and Zocor (simvastatin), an older Merck & Co. product that is now available in cheaper generic form.
There are several important points to be made here. The first is that doctors could have saved their patients some money by prescribing generic simvastatin and Zetia, rather than Vytorin, the newer, more expensive, but no more effective combo drug. The only difference is taking two pills instead of one. Got that? Same drugs, same effect, but you pay more for Vytorin. Vytorin doesn’t benefit patients any more than the older drugs, but it puts a lot more money into the pockets of the pharmaceutical companies.
The second point has just been illustrated. When a drug company introduces a new drug, it gets to charge big bucks for it. That company is, after all, entitled to recoup its research and development costs. However, the timer is running on its patent and its exclusive right to market that drug. As soon as the drug goes “off-patent,” generic companies can and do start producing it and selling it more cheaply, usually under the drug’s chemical name.
Knowing this, the drug company tries to extend its profit-taking by introducing new forms of the original drug; each of these forms can be patented and marketed as a “new” drug. Combining the older off-patent drug with another drug and marketing the result as “new” (e.g.,Vytorin) is one technique. Another is producing the old drug in a new form; an old 4-hour drug is now available in a new, long-acting 12-hour form. A liquid form of what was once available only in tablets can be marketed as new. An adult drug comes out in “new” child-size doses. These new forms of existing drugs may offer certain conveniences to consumers, but they are also a way to keep the profits rolling in for the pharmaceutical companies that have lost their patents on the original drugs.
Be aware that these same marketing techniques are applied to over-the-counter (available without prescription) drugs. For example, Actifed, a cold and allergy medicine, is simply a combination of Sudafed (pseudoephedrine HCl), a decongestant, and Chlor-Trimeton (chlorpheniramine maleate), an antihistamine. Convenient when both an antihistamine and a decongestant are needed; undesirable if the consumer wants to avoid or doesn’t need one of the two drugs. Why pay for two drugs if one is all you need?
Smart consumers should read labels. Know, or at least read, the chemical/generic names of drugs, both prescription and OTC. Look at the chemical names, not just the brand names, when comparing drugs. Know when a “new” drug is just a combination of existing drugs. Do you need or want everything in that combo? Read labels. Read package enclosures. Read online.
Yes, those chemical names are long, intimidating, and often unpronounceable. But they are what tells you the difference between Brand A and Brand B, or if there even is a difference. Talk to your doctor or pharmacist if you have questions, and remember, they are human too. Rarely, they can make mistakes or be unaware of new or reformulated drugs.
It’s not uncommon for doctors to learn about new drugs from pharmaceutical reps who visit them in their offices. The reps hype the drugs and leave literature and samples. It can be a valuable service to doctors, or it can be nothing more than blatant lobbying that includes, say, lunch for all the employees. Most doctors know the reps are just there to sell a product and take that into account when evaluating a drug. On the other hand, a lot of doctors refuse to see reps at all because it takes time away from patients.
Pharmaceutical companies contribute tremendously to the welfare of the world, and they cannot be commended enough for the good things they do. That said, consumers should never forget that Big Pharma, like any other business, never takes its eye off the bottom line — profits.
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(Your avatar again did something funny on my blog. It turned itself into a bluish grey square maybe to suggest yet another snow storm.)
I must have told you that as a translator I worked for the Basle pharma industry. The influence they exert on doctors is much larger than is known out there. For instance, there are congresses where young scientists who are willing to participate with a “paper” get all their expenses paid. These congresses invariably take place in pretty postcard places.
Another slightly uglier way is to ask a scientist to have a look at a scientific publication. In the case I remember best the company put together a wee little lousy dictionary of scientific terms and then they most generously paid a known psychiatrist to just have a look at it. He was not even asked to be mentioned as a co-author of the publication. The publication was maybe not even published, was only a way to make the pay check less humiliating. That psychiatrist was in charge of some of the company’s psycho drug test programs.
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I probably wouldn’t be aware of it either if I hadn’t worked with doctors for so long. Also, my dad was a doctor. So many studies that are published are funded by the pharma companies. Not only is their new drug fantastic, but the study confirms it! Surprise, surprise.
I remembered you said you were a translator, but don’t think you mentioned the company before. (I think the avatar thing happened because I got booted off WordPress as I was writing, and had not logged back in when I entered the rest of the comment.)
At my child’s last Dr. Appt. I saw a woman get out of her car. She was wrestling with the biggest, prettiest, fanciest gift basket I’ve ever laid my eyes on. Looking at her car, she had as many as she could pack in there. I went inside. She brought it in along with other goodies and gave to the office and was then led to the back. That’s appalling. It’s bribery in my opinion.
Everything at the office staff’s workstations was laden with pharmaceutical names. Rx names on the tissue box, the hand sanitizer, pens, pencils, everything.
They should not allow that whatsoever. I’m feeling a naive – wondering now if the Dr. is prescribing an Rx to my child for the illness based on what’s best (and most cost effective for the family) for him/her- or is it based on what gifts were the best?
I pray it’s for my kids health. Also, it could mean the difference for a $15 co-pay for the Rx vs. a $50- co-pay. I just hate it when I get up to the pharmacy counter and it’s $50 for one Rx (OMG, imagine if you didn’t have Rx coverage?).
I have to remind myself when they give an Rx to any of us, to ask, “Is this the cheapest drug that will work? Because I am on a budget and want to take care of this the best way possible”
Such an interesting post PT-30-
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Thanks, Lumpy. Most doctors will presecribe a generic drug if an appropriate one is available; they know medical costs for patients are sky-rocketing. But I’d be sure to ask each time, just in case.
There has been controversy in the past about whether generic drugs are as safe and effective (“bioequivalent”) as brand names, especially where very precise dosage was critical, and that might still be true (even though the FDA is supposed to be watching generics as well), but dissing generics is certainly an idea that benefits Big Pharma. My more recent concern is generics manufactured outside this country, even though there are regulations about individuals bringing in foreign drugs. The FDA (see: http://www.fda.gov/importeddrugs/) emphasizes they cannot ensure the safety of such drugs (nice protection for American drug companies, isn’t it?).
As for the reps, nothing frosts me more than watching drug reps (usually attractive women in spiffy business clothes pulling wheeled black suitcases) trail out of my doctor’s office while I’m still cooling my heels in the waiting room. (That’s happened the last two times I was there, and I’m switching to another doctor this month.) I’ve also sat in waiting rooms reading year-old magazines while listening to the staff in the back whooping it up over pizzas that a drug rep brought in.
Smart doctors will at least send the reps out the back door, not through the waiting room, and schedule them at the end of the day or some other time that won’t interfere with patient appointments. If the reps just want to provide samples to be given to needy patients, they can jolly well use UPS.
And the rep joke?
A representative called at a doctor’s, and the doctor invited him in saying: You know I would not normally receive you in the morning. I simply don’t have time. Today there were seven here, and I sent everyone of them home.
Yes, said the Rep, I know. Those seven, that’s me.
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Do you know a Herald Tribune writer called William Pfaff? He is the only journalist that I have been reading for years. He was the first to predict what would happen to the US in Iraq. He might also have been the first to launch the name of Obama, long ago. — The Herald Tribune is published by the Washington Post and the New York Times together mainly for Americans living abroad.
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I’m not familiar with Pfaff. I’ll look for him, though, next time I check the Herald Tribune. (I think the whole world knew what would happen to us in Iraq, except George Bush.)
As for the drug reps, I’ve heard it’s a very lucrative career. The doctors ought to just tell em, “l’ll have my people call your people,” and refuse to see them. (Sadly, we all love freebies. Even doctors.)
God some people are naive. If you genuinely believe your doctor can be swayed by pizza and pens, maybe you should change doctors. Being a pharma rep is not as glamourous as it seems, it requires a lot more than gifts and food to succeed. The fact that your narrow minded view is only allowing you to see this suggests that you haven’t a clue what you are talking about and do not see the real value that reps add to a surgery. Did you know that 80% of GP’s gain all of their medical continuing education through seeing reps? They are kept up to date and on top of new developments in treatment, safety and what is best for your children. It is not just a junket, I can assure you of that.
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I never said being a pharma rep was glamorous or easy, and I did say they provide a useful service. In a well-run office, however, patients should never be kept waiting while reps schmooze with the doctors. As for medical education, doctors are required to take certified CME courses every year or two to keep their skills and knowledge up to date. Reps should be teaching only about products they sell. I’d have serious reservations about any doctor who relied primarily on biased sales reps for his medical education.