Back finally for a shortened version of Q&A. I have had too many trips recently, and Q&A needs quiet time at home. I will certainly get back to serious Q&A in 2 weeks.

How can I know in advance when a drug will be available as a generic? I saw a note at drugstore.com saying that Wellbutrin SR will be available as a generic soon but no date was given. I asked my pharmacist and she didn’t know.

I have a love / hate relationship with the drug companies. I know they have a lot of costs to cover but if you look at the actual prices there’s no way they’re priced to market; they’re priced to be sold to insurance companies. And the games they play with the patent system. It irritates me to no end.

The pharmacists are not much better. A couple of years ago I found out by chance — in Time magazine of all places — that an anxiety drug I was taking, Buspar, finally went generic after a bitter court battle. When I went for the refill she handed me the brand name and I asked for the generic. She was puzzled. There’s only an $8 difference. I insisted she put the generic in and she gave in.

Several interesting concepts here. The first questions refers to how you know when a drug goes generic. I do not know a specific source for this information. Perhaps an astute reader does. I learn ‘through the grapevine’.

Second, the reader comments on patent system games. He is correct. A down side of capitalism and government is that companies will always look for loopholes. They should from a pure financial viewpoint. But I can and should dislike their patent games.

What you don’t mention is that pharmaceutical companies systematically manipulate how physicians practice medicine by:

1) not doing the studies that doctors would like performed.

2) publication bias – they don’t report trials that are not favourable to selling their products.

3) many, many other ways.

The pharmaceutical companies have a goal – profits. Physicians generally (I will admit to some exceptions) have the joint goals of making money and helping their patients. Once one understands and accepts the pharmaceutical companies goals as a given, then one understands that they need not do studies unless they think those studies will result in a marketing edge. That is why I want a pharmaceutical tax which would fund the important studies.

Ok, I agree there are people in the drug industry who just want to do good.

But then there is.

The Journal of the American Medical Association on April 23 published the results of an incomplete clinical trial for a hypertension treatment developed by Pharmacia accompanied by a “scathing” editorial that criticizes the decision by the company to end the trial before its scheduled completion, the Los Angeles Times reports. In 1996, Pharmacia began to enroll participants in a clinical trial to compare the effectiveness of the hypertension treatment verapamil, marketed as Covera, to less-expensive diuretics and other treatments. About half the participants received Covera, and the other half received a diuretic or a short-term beta-blocker called atenolol. Pharmacia, which had spent about $50 million on the trial, decided to end the trial in 2000, two years early. Dr. Henry Black, dean of research at Rush-Presbyterian-St. Luke’s Medical Center in Chicago and the lead researcher of the trial, said that Pharmacia officials decided to end the trial for “commercial reasons.” Black said that Pharmacia ended the trial early because researchers could not determine the effectiveness of Covera compared to a diuretic (Maugh, Los Angeles Times, 4/23). According to the incomplete results of the trial, Covera proved no more effective than a diuretic in the prevention of heart attacks or stroke MacPherson, Newark Star-Ledger, 4/23).

This excellent comment needs no response. The sad thing about this episode is that no one is surprised.

I am schizophrenic with regards to the pharmaceutical industry as well. You’re right, every rep tries to ‘spin’ the evidence so that their drug is the best, and your ACE inhibitor example is apt as every rep I talk to is now trying to echo the ALLHAT study (or whatever it was) that said that drug X prevented stroke better than other ACEs.

My favorite example pro-pharmaceutical companies is the vagotomy. As in, ‘that surgery we used to do before H2 blockers and PPI’s came along.’ But when reps start pushing me to say their PPI is the best, I tell them, “You know, I like your drug, but I have to say I like all PPI’s. I remember what it was like before we had these drugs and they’re all miracle workers.”

And I can’t really play the outraged innocent, because I have been wined, dined and entertained at the expense of the industry many a time. That would actually make for a great rant. Do you accept such invitations, and what is your opinion of doctors who do?

Great comment, and I will respond to the last paragraph only. I have a $10 rule. I have decided that you cannot buy me for $10. Thus, I do eat drug company sponsored lunch at noon conference. I will not go to dinner a the drug companies expense. Nor will a play golf, or be a “consultant”. I have done a few of these in the remote past, but as I thought through my peronal ethics I have decided on this personal costs. The pharmaceutical industry understands influence. They try to influence me, and I try very hard to use less biased sources of information.

Define healthy food.

Here’s my problem, lowfat food almost always equal higher sugar food. If I switch my diet to a “healthy” diet I’ll be taking more insulin and thus gain weight.

I’m a teacher and our cafeteria provides food that is very high in both fat and carbohydrate. Certainly not very healthy for the middle-aged adult.

We need to do some changes in food labeling. We need to call a serving of server. Look at your average sport bottle of Gatorade. (unhealthy drink for me) the nutrition label is misleading the serving size is in small case and is usually around 2 1/2 servings. Who drinks 2 1/2 servings of the sport bottle of Gatorade. They drink the sport bottle has one serving. Bet people would stay away from it if true servings were on the label.

Same thing goes for any other packaged food. Very few label’s show true servings. And also would not hurt if restaurants started serving reasonable servings. Why is McDonald’s selling two of things? And try to get them to give you one during those promotions.

I’ll leave you with a funny… one of our assistant principals was eating candy, one of those large bags of cherry twists that are labeled a “no fat” food. It certainly wasn’t a “no sugar” food.

Excellent comment! I will ask my daughter (who wrote the post referred to herein) for her response. I would say that the challenge of a food tax is arbitrating which foods deserve the tax, and which foods deserve the subsidy. Should we regulate taxes based on Atkins, or Walter Willett, or Dean Ornish? Each expert would probably stress a different list. While I like the proposal’s concept, this comment does make us think about the potential problems.

That is it for this abbreviated Q&A. I hope everyone has a great week. Keep those comments coming – they certainly help focus my thinking and make this blog much better!!!