The pipeline problem is, I believe, well illustrated by two items from recent Medical Letter issues (May 2 and May 16):
- Duloxetine (Cymbalta), basically an antidepressant but one that has been viewed as having a specific anti-pain component, has just been approved for treatment of chronic musculoskeletal pain. ML notes that the mechanism by which duloxetine might relieve pain is unknown, and that the studies supporting its efficacy were all performed by employees of the manufacturer. All studies are placebo-controlled; there is no comparison with either commonly used over-the-counter analgesics, or with other (cheaper) antidepressants. A 30-day supply of Cymbalta costs $160. The reviewers conclude that if duloxetine has any superiority over placebo, it seems to be "modest at best."
- Medoxomil (Edarbi) is the 8th drug of the angiotensin receptor blocker class to be marketed. (There is one, losartan, that is now available generically, but interestingly its cost is not that much lower than all the brand name drugs.) Like all other ARBs it works for hypertension. ML admits that medoxomil "might" be more effective than some other ARBs for that condition. But it also has a major practical disadvantage--the tablets are sensitive to light and moisture and so cannot be taken out of their original container until you swallow them. Just why we need yet another ARB, and one that is so difficult to use to boot, is never explained.
I think these examples highlight what the drug industry is up against, due to the lack of real breakthrough drugs these days. While we might have some pity for the poor marketers who have to convince us that these pigs look good in lipstick, that still does not justify the shady marketing practices that we discuss in this blog practically every week.
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