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About
Pharmaceutical Advertisements
Since the late
1990’s, pharmaceutical companies have been allowed to advertise
prescription drugs directly to consumers.
This has resulted in the now familiar slogan “Ask your doctor
about…”
While
this kind of marketing has increased awareness about psychiatric
conditions, it has also lead to some misunderstandings. The advertisements
suggest that their medicine is uniquely
effective in a certain condition, such as Zoloft for social anxiety, or
Lexapro for depression. They also give the impression that a break-through
has been made or that newer medications offer more benefit than the older
versions.
In
reality, most conditions have many good treatment options and no one stands
out as the best. Why then are drugs
advertised this way? The answer is
that the Food and Drug Administration (FDA) only allows companies to
promote medications for the conditions they are approved for. To get this approval, a drug must be safe
and effective for the condition.
“Effective” does not mean better than other medicines;
it means it worked better than a placebo, or sugar pill, in at least two
clinical studies.
Many
drugs meet the FDA’s basic requirement but have not been approved
because the approval process is very expensive. Once a drug is generic, there is little
financial incentive to seek this approval or to advertise the
medicine. Also, some brand-name
medicines are effective for many conditions, but are advertised for only
one as a marketing strategy.
Are New
Medicines Better Than Old Ones?
New
medications sometimes represent a major breakthrough in treatment, but this
is not always the case. Some new
medicines are simply variations on established ones. For example, after the popularity of
Prozac, other SSRIs were developed by making small changes in
Prozac’s chemical structure.
Although these new SSRIs are just as good as the original ones, it
is helpful to have several options because people will sometimes have a
better response to one SSRI over others.
Other
times what is new is not the medicine but the preparation. Examples include timed-release versions
of paxil, wellbutrin and stimulants.
These advances offer once-a-day dosing and sometimes have fewer side
effects, but the medicine itself is unchanged.
Another
type of new medicine is comes from isolating part of the old medicine. Most drugs contain two compounds that are
mirror-images of each other – called the “right-handed”
and “left-handed” sides.
Sometimes one side is more effective than the other, and a purified
version of that side is released with a new name. Examples include Lexapro, purified from
Celexa, and Focalin, purified from Ritalin.
Usually these versions do not offer significant advances in
treatment or side-effects.
Other
“new” medications are actually not so new. They may have been used in Europe for a
long time before appearing in the U.S., such as Celexa and Clozaril. Some may have been used for research
purposes for many years before finally being released, such as Strattera
and Ziprasodone.
A
potential problem with new medications is that they may not be as well
tested as older ones. Although all
medicines are studied carefully in large populations before being released,
it is always possible that rare side effects are not picked up until the
medicine is in wide-spread use.
Are There
Differences Between Generic and Brand-Name Medicines?
There is no reason to believe that generic products
are not as good as brand-name products.
Generic drugs have the same chemical structure as
brand-name versions. There may be
differences in how they are prepared by the manufacturer – in other
words the type pill or capsule it’s in. Since the chemical structure is the same,
the question is whether generics pills disolve in the stomach and enter the
blood stream the same way as their brand-name alternatives. To be sold in the U.S., generic
manufacturers have to prove that blood-levels for their drug are the same
as for the brand-name version. In
proving this, the government allows a 10% difference, so that in reality
generic drugs may cause blood levels that are 10% lower or higher than the
brand-name versions. This difference
should be safe; it is similar to the kind of difference you might expect a
brand-name drug to have depending on how your stomach is acting when you
take it.
How Does a Drug
Become Generic?
About 7-12 years after a medicine is released, its
patent expires so that generic versions can become available. Companies will sometimes develop new
preparations such as the time-released Paxil CR, Wellbutrin XL and Effexor
XR, and these new preparations have their own patents. In these cases the generic will be
available, but not as a time-released form.
Initially, generic compounds do not differ much in
price, although you may notice a drop in your insurance copay. The generic manufacturers start with a
high price so they can recoup their investment in making the drug. After a few years the price tends to fall
dramatically due to competitive forces. Although generic medications are
less expensive, they are usually not available as free samples or through
patient-assistance programs for those with financial hardship.
Updated 6/25/4 by Chris Aiken,
M.D.
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