nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Thursday, April 21, 2011

The Best Seller List....Pharmaceutical, That Is

WHAT'S on the list is less interesting than the comparison between the "most prescribed" and the "most sales revenue" lists.

As usual, most of the most popular and expensive items are those you would expect from a modern, immensely prosperous society:  drugs to combat eating too much, being anxious, and suffering from various aches and pains.  You can see the most-prescribed list here, and the most-revenue list here.

----From the most prescribed list,

-Vicodin (#1), an opiod derivative for moderate to severe pain.  The marketing niche is (1) less nausea and stomach upset than codeine--from which it's derived, and (2) cough suppression.  Addiction is a hazard.

-Simvastatin (#2), lowers cholesterol, raises HDL.  A solid statin, that's generic and cheap.  As good as the high-priced spread...but suffers from not being the "designer" drug of choice.

-Azithromycin (#6) and amoxacillin (#7).  Antibiotics that cover most common infections, like strep throat, etc. cheap.

-In the top 25 most-prescribed, there are 4 pain pills, 7 blood pressure pills, and 4 psychiatric agents.

An addendum on blood pressure pills:  At #10 hydrochlorothiazide, old as the hills, dirt cheap, and the first choice for BP, is holding it's own in the middle of the pack.

The Weirdness Award goes to Prilosec (#6) for acid reflux.  It's estimated that over half the people taking it wouldn't need it if they didn't eat a bund of tacos or pizza within hours of bedtime...and lost a few pounds.  Nexium, the high-priced spread on the revenue list (#2), is for the same thing, and has no therapeutic advantage over Prilosec.

----From the best-seller list (by $$billions spent):

-Lipitor (#1) the high-priced spread for cholesterol  (#12 on the prescribed list above).  Lots of sex appeal.  $7.2B

-Crestor (#8), a newer and still expensive cholesterol drug, has jumped onto the list with almost 200% increase in revenue over the last five years.  Could be that Lipitor is losing it's sex appeal, according to columnist Matthew Herper.

-Three drugs for rheumatoid arthritis and other auto-immune problems:  Enbrel, Humira and Remicade (#12, 18, and 11, respectively).  Bio-engineered products, fusion protein or monoclonal antibody.  All together $9.5B


I would love to do a study on the psychosocial aspects of drug sales and prescribing.  How much of the drug use above is reasonable, giving the individual patient's needs?

Doc D

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