Here’s some thought-provoking reading this Friday…
Dr. Douglas Perednia on off-label drug use:
The other day, I happened to be talking to Mark, a sales representative from one of the pharmaceutical companies. He’s the type of rep that many doctors don’t mind seeing – someone who is careful of your time, is happy to hunt down the answers to questions that come up on the medications his company makes, and brings by useful information about new drugs that seem to be practice-appropriate. He looked slightly drawn. I knew that he was covering a bigger geographic area because so any of his colleagues have been laid off in the past few years.
“I’m glad to see you.” I said. “I wanted to ask if you knew anything about the use of [drug X] in acne. I was reading somewhere the other day that it might be useful in some tough-to-treat cases that tend to scar.” Mark’s normally warm smile disappeared in an instant. Something akin to terror flashed in his eyes. He backed away just a bit.
“I can’t … I can’t tell you anything about that,” he stammered. “It’s not an FDA-approved use of the drug. I could lose my job if I say anything about it.”
And so he could. Despite the fact that using his company’s treatments for this purpose is perfectly legal and, according to a number of good studies, both safe and effective. My simple question had run afoul of one of those regulatory potholes that characterize the Road to Hellth. This one has to do with the “off-label” use of medications.
Megan McArdle on “Me-Too” drugs:
I've never really understood the objections to "me-too" drugs. Somehow, the topic of health care makes otherwise sensible people forget everything they ever knew about economics and start spouting Victorian-era Socialist rhetoric about wasteful competition and superfluous duplication. These same people would think you were crazy if you started ranting about how many societal resources are wasted by having three kinds of unsalted butter available in the supermarket.
And yet, this is the same argument.
And yet, this is the same argument.
Nonetheless, it does seem to bother a lot of people that we have more than one SSRI or anti-platelet drug on the market. In their telling, companies barely bother to do research any more; they mostly just wait until someone else discovers a drug, and then they generate a cheap knockoff, like those guys on the street corner in Chinatown.
