Nexium is a good PPI. It is not significantly better than other PPIs for the great majority of patients. It does cost significantly more than other PPIs.

In a similar vein, SteveSC wrote:

One of the reasons big pharma spends so much competing with marketing is because so many of their drugs don’t differ much more than laundry soaps. The prevailing big pharma model is to focus on multi-billion dollar markets, tweak the active ingredient just enough to get a patent, copy the clinical trials that worked to get previous drugs on the market, and then pound away with reps and ads.

I’ve always been puzzled by the bad rap that me-too drugs get. On the one hand, some people complain that Rx drugs are too expensive. At the same time, they will often complain that there are too many me-toos. (Note that I mean some people in the abstract, not that db or SteveSC were making these complaints.)

What puzzles me is this: if two or more drugs are really me-toos — that is, they’re essentially interchangeable for a given patient group — then I’d expect there to be some price competition between them, even if each is proprietary. Such competition may well be imperfect, and may be skewed by marketing (as in the case of Nexium?). Still, it seems this should result in lower prices than if there was only one drug of that class. This should be a net benefit to the patient.

Of course, another possibility is that nominal me-toos aren’t really perfect substitutes. One drug in a class may be better for some subsets of patients, while another may be beter for other subsets. Perhaps a single drug would provide at least some benefit to all patients, but having several options to choose from may provide marginally better outcomes for the group as a whole. Here again, me-toos should be a net benefit for the patient.

I’d like to ask db: is this consistent with your experience in using me-toos? If you judge that two or more drugs are therapeutically equivalent for a given patient, do you consider price in selecting what to prescribe? How often do you find that supposed me-toos aren’t really equivalent, and that it’s useful to you and your patients to have several variations to choose from? More generally, what’s your feeling about the intrinsic benefits of having multiple me-toos in a class?

I realize this is something of a tangent to the original post. Maybe it’s worth discussing as a separate topic?

(Note: I realize one can also argue that me-toos are an inefficient use of resources that would be better allocated to developing drugs for greater unmet needs. I think that’s essentially what SteveSC is saying in point 3. I readily acknowledge that’s a legitimate concern, but that’s beyond what I’m trying to get at above.)

As for the rest of your points, I agree wholeheartedly. Although I bet firefighters and police officers would take a reimbursement system like that if it reimbursed at the levels you get. Their average income is likely 1/5 or less of a physician’s. And, never forget, you CAN opt out of that system if you so choose. It is not mandatory.

My biggest frustration with you guys is that you SEE the problem with your system, as you clearly point out. Yet the majority of your time and lobbying money is spent on malpractice issues. I don’t really get it.

What other profession allows a central government agency to DICTATE their income by mandate?

Hell even civil servants like police officers and firefighters dont have a national reimbursement system that dictates what kind of money they make.

Medicare controls 60% of the healthcare market, giving them sufficient market share to dictate income singlehandedly.

You want to claim that doctors supposedly have it so good because the national system provides them with patients, then you’d damn sure better recognize the HUGE downside of that model.

You are largely immune from having to provide metrics to judge quality to the public, and you are immune from competing on cost directly to the public. It has nothing to do with “ethical concerns” and everything to do with how you get your clients, because healthcare providers who aren’t tied to the insurance reimbursement market – dentists, optometrists, and plastic surgeons, all market extensively.

If all physicians had to obtain their clients based on their quality of service delivery, we would quickly see a rash of marketing by individual physicians, together with rating services , and probably a renewed focus on the manner and timeliness in which the customer is treated. That may be one nice byproduct of Wal-Mart and others getting involved.

Back to reality, the over commercialization of healthcare and hospital and physician advertising efforts are amongst some of the largest concerns in healthcare policy.

http://jme.bmjjournals.com/cgi/content/extract/32/1/26

The growing competition, as reimbursements fails to keep up with inflation, is actually probably increasing the pressure to market oneself as a physician.

Any comparative depression in physician marketing (versus the rampant use of it by pharm companies) is due solely to ethical concerns and not economic forces.

CJD, I have no idea how you came to the conclusion in your post above…

No one is “attacking” physicians, but talking about how companies that must survive in the free market shouldn’t market is easy for a profession that doesn’t have to market. If you didn’t have your current reimbursement system, you damn sure would be marketing like everyone else.

And really, if you don’t have the time to be the gatekeepers, and you don’t want the pharmaceuticals to market, who is going to get drugs sold?

A friend of mine, who has ulcerative colitis, told me that at his last support group meeting, a drug sales rep and a doctor came to talk to the group. It wasn’t clear if the doctor brought the rep, or the rep brought the doctor. To everyone’s delight, each patient got a coupon for a free 7-day trial of the drug the rep was pushing (oh, sorry, I meant educating everyone about).

Talk about targeting your audience. It’s ready made, and you get to pitch to the very people who will be taking your drug. What’s more, they’re all too open to your suggestions, and won’t have any nasty medical/scientific backgrounds that could gum up the works with pointed questions.

My friend was unaware that the sales rep wasn’t a licensed health professional, and that the rep didn’t have to have a science or medical background to get their job.

Separately, I think a more legitimate argument could be made for doing away with DTC advertising which hasn’t been around that long and does create incremental demand, often despite doctors’ advice to the contrary.