Brand Drug Smack-Down

Here are two neat follow-ups to the Doc Gurley article about safely Dosing Your Drug Dollars.

Skeletal formula of propranolol, the first cli...
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1) Despite good evidence showing their effectiveness, a lot of people (doctors and patients alike) still don’t feel comfortable with generic drugs – especially in some areas like heart medicines. So exactly why is that? This JAMA study looked at the actual total results of all journal articles, including editorials, on the effectiveness of generic heart medicine, by category of drug. Randomized controlled trials (RCTs) are the gold standard of research. Take a look at the authors’ results, especially the concluding sentence:
“RESULTS: We identified 47 articles covering 9 subclasses of cardiovascular medications, of which 38 (81%) were randomized controlled trials (RCTs). Clinical equivalence was noted in 7 of 7 RCTs (100%) of beta-blockers, 10 of 11 RCTs (91%) of diuretics, 5 of 7 RCTs (71%) of calcium channel blockers, 3 of 3 RCTs (100%) of antiplatelet agents, 2 of 2 RCTs (100%) of statins, 1 of 1 RCT (100%) of angiotensin-converting enzyme inhibitors, and 1 of 1 RCT (100%) of alpha-blockers. Among narrow therapeutic index drugs, clinical equivalence was reported in 1 of 1 RCT (100%) of class 1 antiarrhythmic agents and 5 of 5 RCTs (100%) of warfarin. Aggregate effect size (n = 837) was -0.03 (95% confidence interval, -0.15 to 0.08), indicating no evidence of superiority of brand-name to generic drugs. Among 43 editorials, 23 (53%) expressed a negative view of generic drug substitution. CONCLUSIONS: Whereas evidence does not support the notion that brand-name drugs used in cardiovascular disease are superior to generic drugs, a substantial number of editorials counsel against the interchangeability of generic drugs.”

Take Home Message? Generics are pretty freakin’ fabulous (but it’s nice to see the data by category so you can assess for yourself). And HEY, now we know why there’s a mixed message floating out there – hmm, could someone be taking Big Pharm money and coincidentally writing those negative editorials? Whadd’ya think?

2) Ta-da! Wal-Mart has come through with an exclusive deal with a pharmaceutical company (ReliOn) to sell an albuterol asthma inhaler that fits the new HFA rules for only $9. That’s less than most people’s co-pay. While Wal-Mart should certainly be applauded for their efforts, this move also shows just how much profit drug companies have extorted from asthma-sufferers by getting a generic drug (albuterol) retroactively re-patented (read: monopolized pricing) under the guise of “helping the environment.” Doc Gurley commentors from the U.K. state that the exact same Wal-Mart HFA $9 inhaler sells in bulk there for approximately 60 cents each. Wal-mart is a nice option for consumers here, but really, this whole inhaler thing is shameful.

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