Comparing old and new drugs

Originally published in the North Lake Tahoe Bonanza (link), October 26, 2010. Each year, the pharmaceutical industry convinces us to spend $300 billion on prescription drugs, generating $50 billion in profits. Although many drugs they sell are wonderful, others are just higher priced versions of drugs also available in generic form. The drugs you see advertised are the ones producing the most profits, not the drugs offering you the most benefits.

Although we expect these biases in advertising, they exist in research as well. Almost all studies are paid for by pharmaceutical companies and are structured to find benefits for new products. Drugs soon to go off patent are slightly modified and then tested in hundreds of categories against the original drug. Chances are, if enough different things are measured, the researchers will manage to find ways in which the new drug is better.

These differences will be touted as the new and “improved” drug is launched. A tell-tale sign of statistical chicanery is when ads prominently display reduction in risk as a percent improvement. GI upset might be 50 percent less likely, but do you really care about the difference between 1.6 percent and 0.8 percent? How about something which is twice as good using the same actual numbers? It might be better, but don't be hoodwinked — look at the base numbers before you decide that one is really better.

The cycle of directed research and advertising intensifies as a drug nears its patent expiration. Once a drug goes generic it loses most of its profitability. A current example of this is the looming expiration of the patent on Lipitor, the best-selling drug of all time.

Lipitor, a statin, or drug that lowers cholesterol, goes off patent in June 2011, with the first generic tablets hitting the market a few months later under the name Atorvastatin. A patient currently spending $170 per month should be able to buy the generic medication for $50. Other people will be tempted to switch from other patented statin brands to save money.

The pharmaceutical hype machine is currently shifting into high gear, encouraging patients to switch to a newer drug that will continue to sell at the $170 price point. They've even coined a new term, “superstatin,” implying that although generic Atorvastatin may be an adequate substitute for one of the older drugs it will be no match for the newer, more expensive ones.

Ads aren't out yet, but wait and see the risk reduction numbers they'll be promoting. View these with a critical eye and decide if the differences are as significant as suggested.

There's one last thing to consider when comparing old and new drugs. Even if a new drug may appear more effective, is it worth the risk of abandoning a treatment with an established safety record? Problems associated with new drugs often become clear only after longer periods of use.

Even if cost is not a consideration in your choice, discuss with your doctor all likely risks and benefits before making a change. Unless a new medication has a clear benefit to you over your current regimen, consider waiting. In other words: Let impatient people be your guinea pigs.

—Dr. Rebecca Gelber is an Incline Village resident and graduate of The Johns Hopkins School of Medicine. She is an adjunct professor with the UNR School of Medicine and practices locally at Tahoe Aesthetic and Integrative Medicine, 775-298-1750 or