Sunday, October 16, 2005

pharma chameleon

Last week, I had an appointment with a physician to get a refill of a prescription drug that I take for a chronic condition I have.* The physician seemed friendly and competent enough. But when it came to writing the prescription, she recommended that I take a brand-name version of the drug that I was used to taking in the generic. The brand-name version was, she said, "often better tolerated" and "sometimes more effective" in patients than my generic. She also just entered the prescription into her computer rather than writing it on a prescription pad so that I could just pick it up in the downstairs pharmacy.

Because She's The Doctor, I didn't question any of this until after I left the office. But then:

Why did she switch me to a brand-name drug, exactly? Even if the brand-name really is better tolerated and possibly more effective in more patients, I wasn't having any problems with either the effectiveness or tolerating the drug I was taking. I just wanted a refill. And where did she get this information that the brand-name drug was better? I mean, the brand-name drug is made by a major pharmaceutical company with presumably a small army of reps providing "education" to physicians, while the generic likely has very few folks, if anyone, out there specifically pushing it. And, by not giving me a prescription, she pretty much guaranteed I was going to fill the prescription there, which means her organization gets the markup for the prescription rather than somewhere else. The brand-name prescription only cost me $5 more, but the online prices for the drug suggest that the difference covered between me and my insurer is a little over $40. If I refilled the same drug at the same place over the next year, that's $500 more in revenue.

So, I mean, maybe this physician's changing the prescription really was the best thing in terms of my health interests, and, even if not, it could still be that she really, truly believed it was the best thing in terms of the information that she's been given. But it also happens to be that her actions increased the amount of revenue the pharmaceutical industry and her provider organization made from our appointment. What to think? What to do?

I presently have the luxury of having been specifically told that it is a perfectly good expenditure of time from the standpoint of my employer to spend serious time reading about health policy. And so, I've been on a bender this past week reading books about the dark side of the pharmaceutical industry (here and here and here and here). I've personally never had much affinity for the phrase "Big Tobacco" and sequels thereof--it seems like, you know, name-calling or whatever--but the set of corporations that get called "Big Pharma" really are large and powerful and have a set of incentives and legally-available-lines-of-action that do not align well with my sense of what the public interest is. Moreover, everything after the "really are" in that last sentence seems a ridiculously massive understatement.

As much as I know y'all only read my blog for bacon photos and conversations about raw butter, but don't be surprised if I post more about this.

* No, what specifically I take and why is none of your concern. And it's not what I imagine you would guess, either.

15 comments:

Anonymous said...

I haven't had your experience with a pharmacist, but I know what my response would be. I'd follow my doctor's recommendation, unless she/he specified 'no substitution' — ie 'no generic' — on the order. I'd thank the pharmacist very much and say 'I'll definitely look into that with my MD and request the change, if need be. Until then, let's just go with prescription. But do I appreciate having the information'.

Anonymous said...

more bacon please!

Rhymes With Scrabble said...

He didn't have the experience with a pharmacist, he had it with the physician. She didn't even write a prescription.

A+ said...

Not that this makes me an expert or anything, but my ex is a pharmacist, and I distinctly recall him saying that per FDA requirement, generic drugs have exactly the same pharmacological effects as brand-names. From the way he said it, the reason why brand-name drugs cost so much is because the start-up costs (developing the drug and marketing it) are so damn high. SO they're essentially trying to get that money back (and, uh, bleed you dry). Anyway, like I say, not that it makes me an expert, but that's what he told my dad when my dad bugged him at a party for like 20 minutes about his high blood pressure medication.

Big Pharma Whistleblower said...

A lot of doctors also get incentives from Big Pharma to write scripts for their brand name drugs, rather than for generics. It could be something as simple as discounts on supplies or something as crass as, say, $100 per script.

jeremy said...

Ang: Generic drugs are the same as the drugs they are generics of. In my own case, the brand-name drug was a different version of the drug that I was taking as a generic, although the difference I believe is in the coating rather than the active ingredients. It's an even grayer area when there are generics of drugs that have been slightly improved by other drugs that are still on patent, like what has been in the NYT the last few days about Lipitor, which is on patent until 2011 but will be soon facing competition from a generic of an earlier drug of nearly equivalent effectiveness.

As for the question of whether drug companies prices reflect the costs of development, that's exactly the issue I've been obsessively reading about.

shakha said...

I hate to start a comment with, "my dad's a doctor", because really, that has nothing to do with me. But anyway, my dad's a doctor who bitches constantly about big pharma bastards (as he calls them). Turns out they create incentives for physicians to prescribe their drugs. While not exactly kick-backs or bribes (such things would be illegal!), they are kick-backs and bribes. Reps will come to his office and "promote" the value of their drug over generic brands. Part of the promotion includes free Red Sox tickets. In fact, one drug manufacturer (when it was still a wonder drug) repeatedly offerred to have my father "lecture" on the benefits of their drug for post-operative patients to a group of doctors in Hawaii. In short, they were offerring to pay for a two-week vacation for my family if he agreed to only prescribe their drug as pain relief for his patients (and give a 45 minute talk). And this case, while extreme, is not that unique.

Fucked up? Yes. A small part of why drugs and healthcare are so damn expensive? perhaps. The reason why your physician prescribed you a "brand-name" drug? I have no idea. But these things do affect the practice of physicians. Although in my folks case, their house is a viritual pharmacy (they've got problems!) and there's not a brand-name drug to be found.

jeremy said...

Shakha: Can your dad get me Red Sox ticket? I'll take whatever medications are needed to score them (so long as it doesn't carry a substantial risk of, say, priapism).

A+ said...

Priapism? That's what pops into your head?

jeremy said...

I took a prescription drug a few years ago that had priapism as a possible side effect, and, when the doctor mentioned this, it was the strongest visceral reaction I've ever had to any mention of a side effect for something I've taken.

shakha said...

Tickets for next season are in the mail! I actually know a bunch of folks who look to unload some of their season tickets. So if you're serious about getting some, I can probably hook you up. But you'd have to pay. Then again, a few bucks may be worth it given that it won't come with the risk of priapism!

Corey said...

Jeremy,

I just used your experience as a case-study in my criminology class. We were talking about occupational crime generally, fraud specifically.

My students voted 4:1 that this is fraud.

So there you have it.

jeremy said...

Indeed. Can't argue with democracy.

Anonymous said...

I typed 'peripatetic' and 'priapism' into google and it led me here. Thought you'd like to know. I have a dog by the way. I bought it yesterday from my Uncle's fiancee. Its a german shepherd. Male. Need some name suggestions though. Was thinking perhaps 'Sroth' or 'Bumblestoat'...? Either of those grab you?
Its very lonely here, where do you live. I'm from Crowthorne. I wasn't born there but thats where I have to live now. Come visit!!! Please. Bring a hamper.

Peter Sutcliffe said...

I am in jail in England for supposedly killing 13 women in and around the South Yorkshire area in the late 70s. I didn't do it though.
It was about 10. Which is a lot less, so I've been done. Anybody want dialogue? Jeremy I can see you are in quite a pickle! Damn those naughty pharma guys. if I was free I'd definitely help you slaughter them. Then we could drive to your house on the lake, dump the bodies and swim naked before getting heavy. I have a dream Jeremy, do you?
Peter S
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