1. I was asked if there is an existing generic statin. Lovastatin is available as a generic. It does seem to have inferior properties to simvastatin and atorvastatin.
2. My commenting friend – Chlorthalidone man – comments:
Don’t forget the “me too†drugs like ARBs. They work essentially the same way.
Of course even Medrants gets suckered in my clever advertising.
No my friends, ARBs are just non-generic ACE-I.
No value.
As often happens, Chlorthalidone man takes a complex issue and asserts its simplicity.
ARBs are a bit different from ACE inhibitors. Most important they have a different side effect profile.
In nephrotic syndrome, one sometimes can decrease proteinuria to a greater extent by using a combination of an ACE-I plus an ARB.
I generally use ACE-I as my first line therapy – but am glad to have ARBs as an alternative under 2 major situations – intractable cough and angioedema.
So I think the point that Chlorthalidone man really wants to make (and here I used editor’s license because after all this is my blog!) is that ARBs rarely should be used prior to failing ACE-I. But I do not consider them me too drugs, but rather second line drugs (to replace poorly tolerated ACE-I). The exception is in proteinuria when the combination excels.
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{ 5 comments… read them below or add one }
Ohhhh Sure …. change your story under pressure !
Just kidding.
So, I’d say your ARB/ACE-I plan makes sense, as best I can tell, according to the best evidence I can find. Just don’t tell the cute ARB pharma girl that brings lunch ! And flirts too ! Dont worry I know your pharma stance.
I agree they (ARBs) aren’t exactly “me too” drugs, but effectively they are according to your usage plan. If you really follow through on your outlined plan, you’ll find you rarely use ARBs. I surely do hope you practice what you preach! (BTW, that is harder than writing a blog).
Another wee point I’d like to bring up is the “ACE-I cough” is really blown out of proportion. The ARB pharma marketing of “switch to ARBs for any cough with ACE-I” was brilliantly done. If I had a nickle for every 60+ patient of mine that had “semi-pronounced semi-daily cough” I’d be a rich man. I challenge you not to “screen” for cough on ACE-I. If you attempt to screen you’ll bias ARB use needlessly. (Patients love to answer “Yes” to any doctor question). The true “ACE-I cough” will show itself down the road – DON’T circumvent the natural patient process with overscreening !
Keep in mind, the “outcome data for ACE-I” is much more solid that ARBs. It’s not worth needlessly killing patients because you overscreened for ACE-I cough.
/end rant
I do appreciate your explanation. I’ll have to put your Respect rating back up to 11/10.
If you read Richard Horton’s (Editor of The Lancet) comments about the pharma industry he’ll tell you that the biggest problem in pharma today is that there aren’t many new drugs to find. Most of them have been found. ARBs target the same pathway as do ACE-I’s, so really the drugs are pretty much the same.
‘Chlorthalindone man’ appears to have the attitude that all ‘me-too’ drugs are worthless. This argument is not only wrong, it potentially lowers the quality of healthcare for many people.
Leaving aside the issue of marketing (I agree that many drugs, me-too or otherwise, could be more ethically marketed) me-too drugs provide needed options for medical care. As Dr. Centor remarks, there can be differences that make the second or third similar drug to reach market a real improvement over the first.
Second, even if a me-too drug is not significantly better for the majority of the population, it may be better for a select subgroup. To use an analogy from a different industry, why do we have so many different kinds of cars? Why don’t we just have black four door sedans like the Soviets did? It sure would be more efficient and theoretically the price could be lower. But many people like the choices (and are willing to pay for them) and others need certain features. For example, a person in a wheelchair needs a two-door model because they need to be able to pull in the (folding) wheelchair behind the driver’s seat before they close the door–not possible in a four door model. Someone with a bum knee needs an automatic because they cannot use a clutch, etc.
Without a system that provides options these people would not be able to drive. Similarly, in a system that did not allow me-too drugs some patients would just have to do without.
SteveSC,
Reading your post is painful.
Your analogy is about as far off as analogies get.
Different ARBs are not like different cars at all. Another ARB is really just the same car with maybe 3% larger tires.
You conjure up images of “Soviet-times” with “bad cars” as to create the idea that Me-Too drugs are really all that helpful. They aren’t.
Obviously you are easily fooled by pharma advertising. You believe all these lame irrelevant “small n” studies that should ARB#1 is 6.5% better tolerated than ARB#2. These studies are of such poor quality their data is meaningless.
Except to market to you.
And apparently it works.
I strongly suggest you migrate over to http://www.nofreelunch.org and read the entire site.
and wait don’t tell me, the esomeprazole rep lady’s got you RX’ing the purple pill non-stop and you love dishing out esocitalopram as well.
This maybe isnt the correct place to put this, but I’m a pharmacy school student, have worked both retail and hospital. In terms of “me too drugs” they are helpful because many times a slight change in the molecular arrangement of a molecule can have a large effect on metabolism, distribution, and lipophilicity. My main point is why are doctors so hesitant to consult with pharmacists over drug information? We have extensive education dealing with drug properties and drug usage, but whenever pharmacists talk to doctors regarding possible prescribing errors or drug interactions, we get either blown off or anger vented on us. Just looking for some comments on this.
The “cute ARB pharma GIRL“?
God, I hope I never end up in your office, Chlorthalidone Dick! You’re not only ill informed about ACEIs and ARBs, but you’re stupidly sexist and probably get most of your Rx info from your pharma reps.
“Doctors” like you should be kicked out of the profession.