Tuesday, January 29, 2008

Seeing the Forest for the Trees

I have mentioned my aggravation with Forest Pharmaceuticals before in the context of their excessive promotion of Namenda, a drug to "delay the progression" of Alzheimer's disease. While Namenda is effective, the drug reps I've talked to have a tendency to really push it as being significantly better than it actually is, especially since we're looking at doubling the cost per patient and increasing "pill burden" for patients or their caretakers. There's nothing more depressing to me than seeing families spending a fortune on medications for Alzheimer's while watching their loved ones deteriorate despite treatment.

On the other hand, Forest's Lexapro is a follow-on drug that's actually been demonstrated to be better than its parent. So maybe they aren't all bad.

Then they released Bystolic.

Bystolic is a beta-blocker. The market is positively overflowing with beta-blockers. Metaprolol, atenolol, propranolol...a dozen or more drugs. Granted, they have subtle differences, but Bystolic doesn't bring anything new to the table.

Beta-blockers reduce adrenergic (adrenaline-mediated) stimulation of the heart and blood vessels, slowing heart rate and dilating arterioles to decrease blood pressure. B-blockers aren't as good at lowering BP directly as some other drugs, but they are quite useful in preventing further damage to the heart after a myocardial infarction (heart attack) and in treating irregular heartbeats. Intriguingly, propranolol can even be used to prevent migraines, though the precise mechanism of action is not well-understood.

Bystolic is only approved to lower high blood pressure, but Forest is hoping to get it approved for patients with heart failure as well. Unfortunately for Forest, we already have a great cousin drug that has both indications--carvedilol--and it's available generically as of last year.

I realize that sometimes drugs get stuck in the research pipeline and the company gets so far into development that not releasing the drug is a bad financial move even if the drug is not likely to "sell." But Forest has likely spent enough money producing Bystolic that they must find a way to get physicians to prescribe it despite the fact that Bystolic is a "useless" drug. Sure, it works, but no sane clinician is going to prescribe it given a myriad of equally effective alternatives that cost one-fourth as much.

Unless, of course, Forest sends out their reps to promote it. Which means that it's a safe bet that Forest is going to spend a lot of money to advertise a drug that you'd have to be incredibly foolish to prescribe. Drug research and development costs are very high, but pharmaceutical advertising inflates prices beyond what is reasonable. And if given a sufficiently convincing sales pitch, many physicians might prescribe the drug anyway. Many doctors just don't know how much drugs cost. I have personal experience in the matter; I make a lot of phone calls when I'm working to ask physicians to switch to cheaper alternatives or to permit generic substitution when they've signed something "dispense as written" for no good reason (dermatologists, I'm looking at you).

Come on, Forest. You can do better than this. I know I saw your vague, almost viral ads in pharmacy magazines and got a little excited about your "new development in the treatment of hypertension." At least throw us another direct renin inhibitor instead of trying to pass off a totally underwhelming drug as the next big thing.

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