Healthy Skepticism Library item: 14816

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

(Generic) Drug Resistance
The New York Times 2008 Dec 10
http://www.nytimes.com/2008/12/10/opinion/10wed3.html?_r=1

Full text:

Health care reformers have high hopes that the relentless rise in prescription drug costs can be slowed by replacing brand-name medicines with cheaper generic versions. Unfortunately, so many physicians are so captive of the drug industry that it would take a huge effort to persuade more patients and doctors to use generics.

That discouraging lesson can be drawn from a recent report by Andrew Pollack in The Times. He reviewed how a big clinical study organized by the federal government found that a generic drug costing only pennies a day lowered high blood pressure more effectively than did newer, far costlier drugs.

While many experts expected that finding to set off a stampede to the cheaper option, it didn’t. The percentage of hypertension patients taking the cheaper drugs, known as diuretics, rose from 30 to 35 percent before the study to 40 percent afterward. Then it remained flat.

To blunt the study’s impact, pharmaceutical companies initiated heavy marketing campaigns and paid doctors to tout their costlier products. Newer drugs also came along that were not included in the original study, rendering its findings dated. The waters were further muddied when some specialists found fault with the design or interpretation of the study and a smaller Australian study reached a different conclusion.

This history sounds a caution to reformers who want to rely on “comparative effectiveness” studies to determine which drugs or treatments work best and which are worth paying for. That is no reason to abandon these studies, but it suggests the need for deep thought on how best to design them and implement the findings.

Another report, published recently in the Journal of the American Medical Association, compared the effectiveness of generic and brand-name drugs in treating cardiovascular disease and found no evidence that the brand-name drugs were clinically superior to their generic counterparts. Yet, discouragingly, most of the editorials written about these studies in medical journals took a negative view about substituting generics for the brand-name drugs.

The researchers speculate that the experts who wrote the editorials may have been influenced by anecdotal experience or by financial ties to the brand-name companies. Either way, it is disturbing that medical opinion leaders were so reluctant to accept the finding that generic drugs worked as well as their costlier competitors.