The link isn't working for me.

Mmmm MMMM, product placin' your new sugar daddy.

But seriously, <3

Hmmmm I'll have to see if I can find one when I go home today.

This is a great idea for medicines with objectively measurable effects (cholesterol, blood pressure, etc.). however, how will you determine effectiveness for things like psychological drugs, where effectiveness is subjective, and varies from person to person?

This is really interesting. I like that they cover generics vs brand name myths and such in the comparative effectiveness research.

It is amusing that they offered a magazine about drugs while in Dupont Circle. I equate the people standing around the metro with how bodegas are portrayed in Half Baked.

Yo Alex.

The link (Best Drugs for Less) is bad - getting "The page you are looking for cannot be found. "

link and reply to comments not working for me

Well, if informing us about what are the effective drugs is "product placement for new sugar daddy" then daddy needs more product placement.

I guess part of the launch also included moving URLs that existed yesterday to different spots. I've updated the links, let me know if they disappear too.

Where, oh where, is the disclosure?

This is a really important issue, but I believe a frightening one as well. While cases like the medicated stents vs. drugs alone are clear cut, it may be that an individual case could indeed require angioplasty, or some other treatment. I'm worried, down the line, that procedures that are not approved by the giant government cost effectiveness study may become impossible to find, or that insurers will use the study as an excuse to not fund important but rarer procedures.

Please, regulatory people, consider the possibility of unintended consequences!

@Coles_Law: The UK does studies like this because the NHS has certain threshholds for effectiveness before it'll cover drugs.

Self-reporting isn't necessarily an awful way to do drug research -- even pain medication has a subjective effect. (And many side effects to many different drugs are very subjective.)

No one drug in ANY category works best for everyone, but the goal is typically to start a patient with the drug that is usually the most effective for his or her profile and that is well-tested and inexpensive. When that doesn't work, the doctor moves on to the next drug, and so forth.

One thing that came out of the Vioxx problem is that for the majority of people on Vioxx (a LARGE majority of people on Vioxx), plain old Advil or Aleve was fully as effective for their pain as Vioxx was, and Advil and Aleve were cheaper, safer, and far better-tested by years of use. A minority of patients were not helped by Advil or Aleve and legitimately needed to move on to Vioxx or whatever. A list like this can help us say "Okay, we'll start you with Advil, which provides relief for 80% of patients of your age and gender and is very safe with minimal side effects, and if that doesn't work, we'll consider the next drug, which is a little more dangerous and a little more expensive." It wasn't so much that Vioxx had dangerous side effects (although suppression of studies about them was bad), but that as many as 80% of the patients on Vioxx had NO REASON to be RISKING those serious side effects.

With something like an antidepressant it's obviously harder to find the right match, but data that tells us, "This drug provides relief for 40% of female patients 18-25 with the primary side effects of X, Y, and Z" is better than "Well, we've got 26 drugs out here that all do the same thing, let's pick one!"

Some of those options look logical but Ibuprofen for arthritis? Maybe in some minor situations but for serious problems or RA Ibuprofen isn't going to do much of anything. The massive doses also have some bad side effects. But Celebrex has some considerable risks too. There are still some older generics that work better than Ibuprofen but are not as risky as Celebrex.

I wish they had included medicinal marijuana as part of this "comparative effectiveness research" study. There are 13 states in which this would be a completely valid medication to include.

Of course, being federally funded, it never would have been allowed. The government can't go throwing stones at its own glass house. It's tough to find valid medical uses when you disallow research that might reveal them.

@bohemian: Keep in mind the majority of arthritis cases are osteoarthritis and, if you pay attention to the ads, a lot of the arthritis ads are aiming at that market (especially aging wealthy boomers who play lots of tennis, apparently). With a disclaimer about how it works great for RA and not so great for other forms of arthritis. :)

Thank you. Now to read up on the allergy meds. (I'm allergic to everything here. I'm so stuffed up I can't even taste the delicious boiled celery.)

Not to be picky, but Lexapro ≠ fluoxetine (Prozac). Lexapro is a later-generation SSRI antidepressant with far fewer side effects than Prozac. It also is far preferable for people who suffer from depression AND anxiety/panic disorders, as it is more sedating, while Prozac can increase jittery, panicky feelings.

I know whereof I speak, so don't tell me I've swallowed the drug manufacturers' Kool Ade on this!

@EricaJoy: Not sure what you're looking for a disclosure of, but the "about" information at [www.consumerreports.org] includes methodology and points to DERP [www.ohsu.edu] as the source for its information.

@floraposte:
Um, I think she's referring to the fact that Consumerist is now owned by Consumer Reports, and this could be viewed as, essentially, an advertisement for Consumer Reports.

@ElizabethD: Yeah, you can't just switch out antidepressants. Their effectiveness and side effects can vary from person to person. If you find one that works, it's best to stick with it.

@ElizabethD: I'm not seeing where they're saying it is, though--is there a specific spot you're looking at? They recommend the generic (and thus older) anti-depressants as Best Buys, but they're not saying that the new more expensive ones are necessarily identical, from what I can see, and they're not claiming that nobody's better served by the more expensive stuff (I've got a few "worst buy" entries in their listings myself). I think it's mostly to equip people to ask their doctors if they can try/start out on/whatever the affordable medications that have comparable efficacy records. The complicating factor of anxiety, for instance, would change the therapeutic picture right there.

The actual DERP stuff is pretty fascinating, too--I'm looking through the reports at [www.ohsu.edu]
and they're still accepting comments on a bunch of them, too. So have a look and and see what you think.

@Hank Scorpio: Me too. It appears the Loratadine from Walmart is the best. Unfortunately, I can't get more than a 7 day supply of Loratadine with Pseudoephedrine at once in this state.

@Hank Scorpio: I believe FloNase to be the world's greatest allergy miracle drug. :D

If this were a Saturday night and they had this for Ecstasy...
*cough* For a friend, I mean.

Arrg - reply link broken again!

Anyway:

@HarcourtArmstrong: Loratadine doesn't seem to do anything for me. (You should just get it without the psuedophedrine in it - lousy meth-heads, ruining it for everyone else!)

@Eyebrows McGee: I haven't tried that yet. Maybe I'll ask my doc next time I have a checkup.

@Hank Scorpio: Ah, sorry, good point. I'm so used to that fact that I didn't notice it wasn't made explicit.

@Hank Scorpio: Another vote for Flonase here. Breathing is good.

@floraposte:

Go here, and scroll down to "depression" on the comparison chart. It sure looks to me as if CR is equating the two.

[www.consumerreports.org]

As someone who both deals with psychiatric drugs personally and who was a medical writer, I think we need to take this list with a really gigantic grain of salt since the info is pretty damn misleading. Framing Lexapro vs. Fluoxetine as "Most antidepressants are available as generics" implies, pretty damn heavily, that Lexapro = non-generic Fluoxetine. It isn't. Why was perphenazine chosen, a drug odd enough that even I hadn't heard of it, to go up against Seroquel?

Perhaps CR need to find and slap around its medical editor before it gets into trouble?

@ElizabethD: They seem to be fairly clearly contrasting the top-selling drug with the drug that is showing to be most effective -- and typically a lot cheaper. It's not a "this is that" chart ... or even a "substitute this for that" chart.

A few days ago I emailed a tip to the editors about a drug price comparison site called medtipster.com that shops the price at all the big chains, they should put that in the CR site since we are now part of CR.

@Hank Scorpio: For me it was pollen/grass/mold allergies in the south, where my entire respiratory system just gave up under the quantity of allergens present. :) I don't know if it's any good for, like, pet dander or whatever, but a lot of the transplants to the south I went to law school with SWORE by it.

I liked it because a) it worked like magic and b) I had basically no side effects. Zyrtec worked for me, but not as well and the side effects I had were AWFUL. But obviously both vary by person!

@ElizabethD: I'm not reading the chart like that, because none of the other medications are neatly equatable either (though they're all legitimate medications for their named conditions, which is what I think CR is meaning there). It also looks to me like the panic/anxiety thing becomes a problem because fluoxetine isn't approved for generalized anxiety disorder and escitalopram isn't approved for panic disorder, so they probably can't compare on off-label uses.

But somebody below is reading it the same way you are, so that suggests to me they really could make the chart clearer.

@Eyebrows McGee (on Twitter: LPetelle): Minor quibble: Vioxx was actually supposed to have FEWER side effects than other NSAID drugs like Aleve and Advil. A major point of Vioxx was the hope that it wouldn't affect the gastrointestinal system like other NSAIDs. So until some of the other evidence came out (and while I agree that suppressing studies was bad, I think the risks of Vioxx were overblown in the media and courts way beyond the scientific evidence), many doctors might have thought it was a SAFER option. It wasn't just for better pain relief that they were prescribing it. So I'm not sure that's the best example.

Not all the drugs in the generic list were the best and cheapest available. Citalopram is almost the exact same as Lexapro yet generic and cheaper, it's the racemic form of Lexapro and simvastatin would be a better alternative than mevacor due to it's better cholesterol lowering ability. In all but the worst cases simvastatin is able to lower just as well as Lipitor and Crestor.

@opsomath: Knowledge alone doesn't mean that those things will happen. Expanding scientific knowledge is never a bad thing, and can't be stopped anyway. We just need to ensure that good policy is made to use that knowledge properly.

I do agree that there is a danger in applying population statistics to individual cases sometimes, but I also think that there is great value in this research. Right now, we aren't getting the benefit of knowing what is most cost-effective for most people OR what will work best in an individual case. We need to know what the norms are before we can start understanding when it's appropriate to deviate from the norms.

@Eyebrows McGee (on Twitter: LPetelle): There is a difference between "most effective" and "most cost effective". And I do think it's suggesting a substitution, which would be inappropriate in many special cases.

I bet their top ten drugs list is all Japanese drugs. AMIRITE?

@Bathmat: I agree. There is some pretty misleading advice in here. Switching to an identical generic is one thing, as is switching from one drug to another when both are nearly equally good, but switching to a far older drug that has been PROVEN to not be nearly as good is another and is really poor advice. Yes, drug costs are a problem...but should we really be recommending drugs with lots more side effects just because they're cheaper? Even generic Paxil (paroxetine (sp?)) would be much better than switching to fluoxetine, and probably almost as cheap. I have to question the wisdom of some of these recommendations.

@floraposte: My main problem with a chart like this aimed at consumers is that it greatly oversimplifies the issues associated with picking drugs. Yes, people should be informed about cost-effectiveness...I have no problem with that. And of course they would need to discuss this with their doctor. The problem I have is that this promotes the idea that drug selection is something that the layman can do. Yes, in many cases, doctors mindlessly prescribe the most expensive drugs available...but many other doctors don't, especially when they are aware of financial difficulties for the patient such as lack of insurance (which you should definitely bring up when your doctor is picking a drug for you). There are a lot of factors that go into that decision that the patient might not be aware of if they just relied on a chart like this.

More broadly, I question the whole idea of consumers making major medical decisions such as this in order to save money. If you're not informed enough to actually know what all the risks vs. benefits of different drug options even are, you're most definitely not informed enough to make an intelligent decision about weighing the financial cost vs. the benefits. That's why we have doctors instead of just selling all drugs on the shelf at Wal-Mart.

So I think that while cost is definitely something that people should be discussing with their doctors if it's an issue for them, I don't think that it's really appropriate for most people to be getting into the nitty gritty of picking specific drugs for themselves based on cost. I think people make bad decisions when they do that.

@johnva: "There is a difference between "most effective" and "most cost effective"."

I agree and ...

"And I do think it's suggesting a substitution, which would be inappropriate in many special cases."

I disagree. :) It seemed clear to me that the chart is meant to show that the most-prescribed one over a large population is NOT the one that's shown to be the most effective (or most-cost-effective) over a large population. I simply don't see the chart as saying, "You! Over here! Take this drug instead of that one you're on!" But pointing out that the most-prescribed drugs aren't necessarily the "best" drugs. There's a widespread misconception that the newest drugs are "better" drugs, when frequently they're simply alternatives for people who can't take the standard drug, or for a small number of people who don't respond to the standard drug, etc. Not that many new drugs are actual "miracle" drugs.

But then, we talk a lot about this when I teach medical ethics, so maybe I'm bringing too much outside knowledge to the chart. :)

@johnva: "If you're not informed enough to actually know what all the risks vs. benefits of different drug options even are ..."

your doctor shouldn't be prescribing the drugs because there's a total lack of informed consent?

"If you're not informed enough to actually know what all the risks vs. benefits of different drug options even are, you're most definitely not informed enough to make an intelligent decision about weighing the financial cost vs. the benefits."

The ONLY person qualified to make the decision about the costs -- including financial -- and the benefits is the patient.

I agree with your basic premise that patients need to discuss this with doctors, and that we see doctors for their specialized medical knowledge and expertise. But if patients ARE as uninformed as you're suggesting, not only are they uninformed consumers, but they're dangerously uninformed patients.

(And patients make major medical decisions on the basis of cost savings all the time.)

@Eyebrows McGee (on Twitter: LPetelle): I'm aware of all that, and it's definitely worth pointing out to people that newer is often not better, especially when it comes to cost-effectiveness. I know this is a vague-sounding complaint, but I just don't like the concept of a comparison chart like that for different drugs being given to people not educated on the issues as a "buying guide". My issue is mainly with the presentation of it rather than the actual information. I think we'll have to agree to disagree on this one.

@johnva: Well, as I said, it's entirely possible I'm bringing too much outside info to the chart -- it's obviously been confusing/misleading to other people in the thread. :)

@Eyebrows McGee (on Twitter: LPetelle): Yes, I do believe that MANY, MANY, patients are dangerously uninformed about their medical needs and care. That's a problem, but it's not something that can really be addressed by a chart. The basic problem is that a lot of people just don't have the educational background necessary to understand modern medicine at all.

Also, I don't agree that it's unethical for a doctor to prescribe something to someone who doesn't understand all the options. In my opinion, it would be equally unethical to withhold treatment because someone refuses to or is incapable of informing themselves. Doctors deal with these issues of noncompliance and ignorance all the time, and it's not a neat ethical decision that they can make that necessarily has one right answer. For example, my mom works at the VA, and deals with a lot of patients who are addicted to various recreational drugs in addition to having numerous major health problems. In many cases, her patients lie to her about their drug use, even though it could make certain drugs they are being prescribed dangerous. What do you do in a situation like that? Withhold the drug because you think they are smoking crack and the prescription might kill them in conjunction with that? Or withhold the prescription and let them die of their health condition?

I'm aware that patients use cost as a major factor in making major medical decisions all the time. I don't think that's a good idea in the case of people who aren't very informed, because what you see all the time is people making poor or even dangerous medical decisions for this reason (such as skipping days or taking half-doses of drugs to "stretch" them, etc). Often times, that lack of knowledge means that people are actually worse off than if they didn't take the drug at all, because what they're doing makes it ineffective even though they're still paying for it. People should always follow what their doctors tell them to do as far as treatment, while discussing it with them if finances are a problem.

@johnva: And I should add that a lot of this is why I support single-payer healthcare. Cost shouldn't have to be a factor in how individuals make healthcare decisions. Costs should be managed society-wide, rather than by people who can't afford their meds.

@johnva: "Also, I don't agree that it's unethical for a doctor to prescribe something to someone who doesn't understand all the options. In my opinion, it would be equally unethical to withhold treatment because someone refuses to or is incapable of informing themselves. Doctors deal with these issues of noncompliance and ignorance all the time, and it's not a neat ethical decision that they can make that necessarily has one right answer"

I was being a little bit flippant, and I agree, it isn't a neat issue, and you can't refuse to treat people for being stupid. But to say that patients SHOULDN'T have a say in the drugs, or can't make informed decisions, etc., is just as bad. I actually left a doctor who made a very bad diagnostic and drug decision that I knew was clearly wrong. I'm not a medical professional, but I've lived in this body for 31 years, I'm intelligent, I listen to what my doctors tell me, and what he was telling me was bullshit and, worse, dangerous bullshit. My next doctor was pretty horrified. (And, incidentally, chose the drug I had thought, through my research, was probably the best option.)

But this is why I now pre-interview doctors and choose ones who discuss treatment options and rationales with me. :) I try not to be a complete pain in the ass and to be deferential to the doctor's professional expertise, but I'm pretty sure the whole point of them explaining a diagnosis to me is so I'll recognize it next time. (One of the things I've really liked about obstetric care is that it's so patient-doctor cooperative ... changes are 999 in a thousand that doc won't be right there when I go into labor, so *I* need to know how to make those decisions when that happens!)

Zyrtek has been OTC and generic for months, how old is this survey?