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An Industry Under Fire by Jon Palfreman
Palfreman is the producer of FRONTLINE's "The Other Drug War" and spent eight months researching and reporting on the high cost of prescription drugs for Americans. In this article he offers his reflections on the powerful and closed pharmaceutical industry and weighs the five most common arguments heard against it.

+ Argument 3. Marketing "me too" drugs

A third argument holds that, in recent years, drug companies have reduced their efforts to discover breakthrough drugs because such medicines are simply too risky (and therefore too expensive) to develop. Increasingly, critics claim, drug companies prefer to copy successful products already on the market. An articulate exponent of this view is Marcia Angell, former editor of the New England Journal of Medicine. In her view, "The drug companies have found that the best way to make money at low cost is by turning out drugs that are imitations of other companies' blockbusters. These are called copycat drugs, or "me too" drugs. And that's their major business now. It's very hard to launch a "me too" or copycat drug, because you have to convince doctors and the public that they are somehow different and better from all of the other copycat drugs already on the market. And so that's why their marketing costs have to be so high."

Evaluating this argument:

What are we to make of this argument: that instead of looking for breakthrough drugs, the companies increasingly prefer to imitate a competitor's successful blockbuster. Superficially this criticism appears to make sense. Pick any therapeutic class and you will find not one but several drugs manufactured by different pharmaceutical companies. For example, there are at least five statins (Mevacor, Pravachol, Zocor, Lipitor, Lescol,) five proton pump inhibitors (Aciphex, Prevacid, Protonix, Prilosec, Nexium), five Selective Serotonin Reuptake Inhibitors(Celexa, Luvox, Paxil, Prozac, Zoloft). While there are currently only two so-called Cox 2 inhibitors (Vioxx and Celebrex) others are expected to reach the market soon. Surely, this is ample evidence of the existence of "me too" drugs?.

But a little reflection shows this argument is bogus. The problem is time. It takes an average of 10-15 years to get any new drug to market. Vioxx, for example, started development in 1990 and didn't get to market until 2001. Lipitor started life in 1983 and reached the market in 1997. The long, tortuous process of drug development and FDA approval does not permit rapid imitation of a competitor's product. It's simply impossible. The reason most therapeutic classes contain several brand name drugs is, I suspect, more prosaic.

The more likely explanation goes something like this. A number of drug companies notice a promising new drug target. Perhaps the idea comes from a piece of academic research published in a widely read medical journal. Perhaps several researchers have the same idea more or less at the same time. Several companies set out on the road to produce what they hope will be their next blockbuster. While all of the companies hope to win this race and be first to market, in practice they reach the finishing line at different times, on average some ten to fifteen years after they start. The drugs are similar because they are based on a common scientific theory of disease, but they are not identicalăin fact some are more potent than others, others have fewer side effects. Pfizer's blockbuster Lipitor was in fact the fourth statin to reach the market place. Partly because Lipitor lowers cholesterol more effectively than the statins which arrived before and after (and partly also, I suspect, because of aggressive marketing), it has gone on to become the market leader. A future "me too"statin may well displace Lipitor.

In fact, it can even be reasonably argued that multiple drugs offer a possibility of competition on efficacy and price that favors purchasers.

This one goes to the drug industry.

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posted june 19, 2003; last updated july 8, 2003

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