Wednesday, July 20, 2005

The Next Big Health Crisis: Insomnia

Since I cannot sleep, I thought I would blog a bit about an AP story on the ensuing ad campaign for sleep aids, "Ad War Looms in Crowded Aid Market." It should be clear to those of you who read my blog regularly that I have a lot to say about Big Pharma and, particularly, SSRI drugs. In general, I am all for good technological innovations for health problems. And, I don't think that Big Pharma is wholly evil. In fact, one of my most brillant students is working his tail off now at Harvard to become a innovative drug maker someday, hopefully he will have his own company (I am rooting for him). But, what I was talking to "brillant student" about today is the problem with "me too drugs." We were debating the problems of Big Pharma R&D dollars being spent on manufacturing isomers or variations of already existing, innovative drugs--such as Ambien in the sleep aid market or Prozac in the antidepressant class. "Brillant student" made a a good point in favor of "me too" drugs :

"However, according to my father, as a physician, having a number of drugs for the same indication makes being a doctor much easier. Paraphrasing here, but some people just don't respond to some drugs, but they do respond to other in the same class. So there is certainly some utility in me-too pharma."

Fair enough. But, let's remember that the incentive for pharmaceutical companies to make drugs in the same class is to capture some of that billion dollar market. And, let's look at the sort of drugs that Big Pharma is rushing manufacture. They are not exactly for treating "diseases," but rather "lifestyle ailments" : erectile dysfunction, cox-2 inhibitors, statins, hair loss treatments, etc. (I am sure someone will debate me on this!)[Side note: The 1951 Humphrey-Durham amendment made many drugs "prescription only," and specified they had to be treatments for diseases.]

Now we are about to face on onslaught of Direct-to-Consumer (DTC) ads for drugs that treat "insomnia." While I am more than sympathetic to folks suffering from insomnia, I am suspicious of these sorts of claims:

the new insomnia medications are aimed at people who have gone largely untreated and may be unaware of new treatment options.

What he have here is another case of Big Pharma marketing a "disease." And, they make all this money by getting third-party payers (medicare, private insurance, managed care, etc.) to cover the cost of these over-priced drugs. Big Pharma claims that they need to recoup their massive drug development costs--and, sure, some of that is true. But, here companies like Sepracor, Inc., who wants to spend 60 million bucks to sell Lunesta aren't exactly making a "breakthrough" drug.

I proposed to "brillant student" David Healy's argument that we simply make these lifestyle drugs over-the-counter, rather than "prescription only" status. That way, I argued (appealing to "brillant"'s free market nature), the price of these drugs will reflect market forces and consumers will have to decide how much they really need Lunestra, which might cost, let's say 300 bucks for a months' supply, when they could spend the same amount on massages, gym membership, Kava Kava root or what have you. There are lots of treatments for insomnia--including, reducing stress, insane deadlines, and demands on your life. We can also make social changes, things like getting rid of big-ass-bright-car-lot lights that keep my neighborhood artificially lit up every night.

"Brillant student" is skeptical of my suggestion. He is not sure that average folks will make good decisions about which drugs to take in the absence of a physician. But, part of my response is, why would the physician be elminated? Right now physicians tell me all the time to purchase a certain matress for my back problem or look into this sort of air filter for my allergies. When I had a weird bump on my arm, a doctor told me to go by hydrocortisone. All of these things are OTC, right?