Generation Rx

Sitting in a hotel room, reading Generation Rx by Greg Critser, it is very disconcerting to see out of the corner of your eye the topic of the book - the ad for the "purple pill", the generic pretty people running through the field, and the very strange two bathtubs-on-a-cliff ad...

ok, so I know what the third one is for, but why are there two bathtubs, and do these ads really work on the east coast in winter? Also, I have got to check what I'm viewing, I'm just not in those demographics...

Generation Rx (Mariner Books ISBN-13: 978-0-618-77356-5 is a nice little book.
It rambles a bit, dipping into anecdotes and abbreviated "journalistic" biosketches that try to add colour rather than inform. Characters and companies flit through, but the final conclusion is the same: the US pharamceutical industry has had a good run for a decade or two but in the process is setting the stage for its own ruin in no small part by undercutting its customer base.

The basic goal is laudable - the industry needs patent protection and income to sustain its research base; getting drugs tested and through trials is expensive, many fail, and many of those which make it through then show long term complications leading to withdrawal and ruinous lawsuits.
Worse still, just as a drug gets widely adopted and really profitable it falls out of patent and some cheap generic sweeps the market, without its manufacturers having to contribute to the enormous sunk development costs.

The solution was manyfold: speed up FDA approval; reduce regulation,;allow staggered patents for different uses and prescription for off-label uses; direct-to-consumer advertising (see above); and aggressive recruiting of doctors.

In principle much of this is fine - for example more information is better, patients should know of new alternative treatments with potentially less side-effects or higher efficacy; it is good to have drugs that people actually take through the full treatment, and which improve the quality of peoples' lives as well as treat the causes of illness.

But, what we have is a flood of long term medication, often inappropriately or overprescribed, which people stay of for a long time; and then they start taking more, interacting meds, some to counteract the effects of previously prescribed meds. And the long term (decadal) effects of all this medication is essentially unknown.

The author notes that this is cross-generational: in addition to seniors with chronic conditions taking long term meds to manage their conditions, middle-aged people take life style medication for discomfort rather than actual clinical problems, and young people are put on drugs to control them.
One of these mass prescribed meds is going to bite society really hard one of these decades if we don't learn fast enough how to properly handle medication of people and predict side effects.

No Free Lunch says "Just say no to drug reps" (and hand in your swag, it makes you psychologically vulnerable)

The AMS's PharmFree initiative has much the same goal for academia

and Beers list makes a start on figuring out which meds not to take in combination with which

Some solutions are proposed - the great hope on the horizon is individual pharmacology, bases on genetic susceptibility and reaction to drugs. Expensive for now, but given some early adopters and considerable economic pressure, it is likely to be tremendously useful in the medium term.

In the meantime it sounds like post-mega merger pharm labs are in a slump, with few new drugs on the horizon, and the fundamental problem remains:

which would you rather have? a $10 pack of pills that cures a fatal illness that 10 million people are going to get each year? Or, a $1 per day maintenance drug that 3 million people want to take each year for a uncomfortable but non-fatal condition?

If the cost of bringing each drug to the market is $300 million, then you don't even have to an evil big pharma CEO to see the problem.

Fortunately both politicians, lawyers and pharmacy marketers have families - so there is still hope for a rational process to emerge, eventually.

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I have read that big pharma actually spends more on advertising than it does on drug research. I have no idea whether that's true.

Hard to get consistent figures.
US pharmaceutical sales seem to be in the $2-300 billion per year, and growing rapidly.
Not sure if that includes over the counter meds or just prescriptions.

Marketing costs a few years ago were about $25 billion, or about 10% of revenue by these figures, but standard claimed figure for research costs is 20% of revenue.

But, for example, pharmaceutical companies sponsor most of the cost of "Continuing Medical Education" is the US, arguably some of that cost should be counted as marketing.

Also some clinical research is really push-sales to doctors to get them comfortable with particular new maintenance meds.

So, same ballpark, certainly; I'd hope research costs are still higher...