[Ip-health] New York Time editorial: (Generic) Drug Resistance

[Thiru Balasubramaniam]

December 10, 2008
Editorial
(Generic) Drug Resistance

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=92t. 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=92s 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
=93comparative effectiveness=94 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.

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Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International (KEI)
thiru@keionline.org


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