Patients are systematically given inferior treatments because better alternatives are off-patent and unprofitable. This pattern is pervasive across virtually every therapeutic area.
The Patent Cliff Problem
When a drug goes off-patent, its price drops by 80-95% as generic manufacturers enter the market. Pharmaceutical companies respond by:
- Developing slightly modified versions of the drug (new formulations, new dosing schedules) that can be re-patented
- Funding research that makes the old drug look bad and the new drug look good
- Paying physicians to switch patients to the new, patented drug
- Funding patient advocacy groups to lobby for the new drug
The result is that patients are systematically switched from cheap, effective generic drugs to expensive, marginally different patented drugs.
Examples
Aspirin vs. Plavix: Aspirin has stronger evidence for cardiovascular prevention than clopidogrel (Plavix) in most patients, costs pennies per day, and has been used safely for 120 years. Plavix costs $5-7 per day and has no meaningful advantage over aspirin for most patients. Yet Plavix was one of the best-selling drugs in the world.
Aspirin has stronger evidence for cardiovascular prevention than Plavix in most patients, costs pennies per day, and has been used safely for 120 years. Yet Plavix was one of the best-selling drugs in the world.
Niacin vs. Statins: Niacin (vitamin B3) has better evidence for cardiovascular benefit than statins — it raises HDL, lowers triglycerides, and reduces cardiovascular events. It costs pennies per day. Yet statins — which cost $100-300 per month — are prescribed to 40 million Americans.
Natural progesterone vs. synthetic progestins: Natural progesterone has a much more favorable risk profile than synthetic progestins (medroxyprogesterone acetate). Yet synthetic progestins were used in the Women's Health Initiative, which found increased cancer and cardiovascular risk — results that were then incorrectly applied to natural progesterone.
The Mechanism
The mechanism is straightforward: pharmaceutical companies cannot profit from off-patent drugs. They therefore fund research that makes off-patent drugs look bad and patented drugs look good. They pay physicians to prescribe patented drugs. They fund guidelines committees with physicians who have financial ties to the industry.
What Patients Can Do
Patients should ask their physicians:
- Is there a generic alternative with equivalent evidence?
- What is the absolute risk reduction of this drug (not just the relative risk reduction)?
- What are the long-term risks of this drug?
- Is there a non-pharmacological alternative?
