We know that the U.S. spends twice as much per person on drugs as other advanced countries and has worse health. People sometimes have to choose between drugs and food, while drug company profits soar. But why? Why do drugs cost so much, and what can we do about it?
Newer and More Expensive
The journal Archives of Internal Medicine reports that spending on diabetes drugs increased by 87% between 1994 and 2007, from $6.7 billion to $12.5 billion. Much of the increase came from doctors prescribing newer, brand-name drugs such as rosiglitazone (brand name Avandia) instead of older generics such as metformin (Glucophage and others).
This would be fine if the newer drugs worked significantly better than the old ones, but they usually don’t. Marcia Angell, M.D., in her book The Truth About the Drug Companies, shows that the U.S. Food and Drug Administration (FDA) only requires that new drugs work better than placebos. They don’t have to be better than existing drugs. So generics get pushed aside for new, vastly more expensive brand names that usually don’t work any better.
The new drugs are often not as safe, either, because they haven’t been around long enough for the long-term problems to become known. We saw this recently with Avandia being implicated in heart attacks. But there are hundreds of other examples. The arthritis drug rofecoxib (Vioxx) was recalled for contributing to heart disease. Other drugs in this class, the “COX-2 inhibitors,” were also implicated.
But when those drugs came out, they were called miracle drugs that would basically end arthritis pain forever. Drug companies called them “superaspirins,” and Jerome Groopman, M.D., a highly-esteemed physician and science author, wrote in The New Yorker that “the drug represent[s] a quantum leap forward in the therapy of arthritis but, if some promising research is borne out, it may even play a role in preventing or treating a host of other conditions, from cancer to Alzheimer disease.”
Dr. Groopman forecast a possible ten billion dollar market for celecoxib (Celebrex), the first COX-2. He looked forward to being able to play tennis without pain and without even having to apply ice or heat to his knees. Sorry, Jerome. Outside of marketing campaigns, no scientist even claimed that the new drugs were more effective than ibuprofen or aspirin. They were just easier on the stomach. Unfortunately, they were harder on the heart, and billions of dollars were wasted on them.
Sometimes Newer is Better
In reply to Tara Dairman’s Oct 31 blog entry on drug costs (“The Rising Costs of Treating Type 2”), CalgaryDiabetic wrote, “I found using the long lasting insulin ‘Lantus’ much easier and possibly even less expensive overall, when you include less BG testing than when using the older NPH.” Basal, or long-acting, insulin analogs really are an improvement in treatment. They are still much more expensive than older insulin products, however. (You can read about why there are no generic insulin products on the market here.)
Drug innovation is worthwhile, and we don’t want to stop it by taking all the profitability out of drug research. It’s true that drug studies are very expensive to run, so companies need some reward. But new drugs’ advantages are oversold. Pharma’s marketing hype is like a Spielberg movie—very impressive, but not particularly believable. Most new brand name drugs are no better than old ones—in fact, they are often the same exact drugs in slightly different combinations!
What Can You Do?
I think it’s better to stick with generic drugs unless they’ve proven not to work for you. It’s better to wait until a new drug has been out a couple of years, because nasty, even fatal, side effects might not show up until then, as with Avandia, Vioxx, the Crohn Disease drug natalizumab (Tysabri), and many others.
Even if safe, a new brand name drug may not work any better, so be careful. Familiarize yourself with the treatment guidelines, like the new American Diabetes Association ones for treating Type 2. But be aware that the guidelines may not work for you, either. People with Type 2 diabetes tend to get overloaded with drugs, because insulin resistance may also contributes to high blood pressure, bad cholesterol, and depression. Doctors may medicate all these symptoms, leaving patients overmedicated and broke.
If this is you, discuss with your doctor what drugs you can do without. See some other tips about saving money on drugs here.
Don’t be afraid to try new drugs, but don’t get too excited either. Most generics work just as well for pennies on the dollar. And please let us know your experiences with new drugs by commenting here.