The issue I have with statements like these is that people have different body chemisty and can react very differently to medication

Not to mention that they've probably found all the potential side effects for something that's been around for decades.

Nothing like hearing, "Hmm, I've never seen that before", from a doctor.

@edwardso: That's why they say ask your doctor.

@edwardso:

That is why there are so many drugs for the same condition. In some cases, drugs are used for off-label use as well. Over time they can be found to be useful for other things than originally intended.

@Rectilinear Propagation: Exactly. Once something has been around for long enough, its ill effects should be well-known - and any beneficial effects will be supported by more than just one or two studies claiming a small effect.

@Ben Popken: of course, but how many people are going to say "Oh, no you don't, I want the older, cheaper one"

Drug companies have to demonstrate that their drug provides some benefit beyond that of drugs currently on the market.

That being said, for many patients these benefits don't offer any real advantage. For example, a drug company may introduce a drug that only needs to be taken once a day vs. twice or three times per day. For some patients this is important (increased patient compliance), but for many patients, remembering to take a drug three times per day isn't a problem.

There is nothing wrong with asking your doctor to try out generic drugs first. For many people the added cost of the new drugs just isn't justified.

'tard

The primary reason for new antipsychotics being developed at such a feverish pace is that many patients don't have an antipsychotic that works (or works well). Sure, Zyprexa might cost 50 times more, but if thorazine doesn't work then it's worth it. Of course, the issue of docs prescribing new meds due to unethical cooperation with drug manufacturers is an important issue, but there are MANY cases of folks with severe psychotic disorders permanently hospitalized or in a so-called permanent halfway house because no med gets them healthy enough for release. Some schizophrenics find a lovely med that works for them over the long term and go to college and get married and have kids and are happy. Some, however, try the 40+ different configurations of modern antipsychotics and never get healthy enough to live even a little independently.

Of course, the same is true of all psychiatric conditions treated primarily with drugs (manic depressive, major depressive, OCD and other obsessive disorders) but I spoke specifically of schizophrenia because that's what's mentioned in the above post.

If you're diagnosed with a mental illness, talk to your doctor about first trying some older medications whose patents have expired (making them cheaper) but don't necessarily rule out taking some of the new generation - I've seen some of them do amazing things for formerly untreatable mental illnesses.

@edwardso: If someone is going to ignore advice from their doctor, they were probably going to do it, with or without the Internet telling them to.

@edwardso: The subset of the population that can think for itself and wants to save money.

@edwardso: Very true! On the other hand, I highly doubt my doctor has my body chemistry in mind when he fills out prescriptions for the latest and greatest thing every time I see him. When my doctor is openly cutting my visits short so his best buddy, Mr. Drug Rep, can take him out to lunch, something is up.

@Ben Popken: mostly, and also the subset that diagnoses conditions via webmd

@Rectilinear Propagation: I heard that from a surgeon years back on a problem he'd never seen. Intestines got twisted and perforated and he said he'd only seen that in pigs and never in a human. Though I only foudn out after being knocked out (long story short, they thought appendix and was not after running camera into me). Years later, I'm still having complications because of what he did. All because of those magical words "I've never seen this before".

Good times...good times.

The article also mentions generics, which may seem to be a no-brainer, but in some cases there are differences between the medications. For example, with the blood pressure med my fiance is taking, the brand name version is coated so that it doesn't start dissolving until it's past the stomach. The generic version doesn't have that coating, so it starts dissolving in his stomach and makes him very nauseous. The price difference is almost $100.

@Robobot: Time to find a new doctor.

@tard: A good example is the drug Fosolan (also known as Fosomax), an osteoperosis med. It's to be taken once a week, and afterwards you can't lay down, can't eat or drink anything but water (in fact, you have to drink a glass of water after taking it) and you have to take it before breakfast and before anything besides water. Screwing up this routine will lead to extreme acid reflux and even esophageal ulcers (!). That, together with the once a week thing, makes for a lot of 'selective memory' issues with patients (such as myself). So they came out with a daily version, except now I need to do the half hour thing every day! too much hassle...

If they could come out with a version without the hassle that I take every day, even if it had LESS efficacy, I'd take it.

@MaelstromRider: Sure, but remember - even docs can be victims of advertising. A long series of ads and lectures can convince a doc that this new med is amaaaazing. This isn't unethical on the part of the doc - it's just human.

@edwardso:
I did. The blood pressure med that my doctor prescribed for me was not on my insurance company's formulary list. I was paying $70 for 3 months supply. I checked my insurance company's website and it listed 2 other drugs that were in the same class that were on the formulary list. So I asked my doctor if we could change. Now I pay $12 for 3 months supply.

@edwardso: I think you're overstating here, and I'm having a hard time imagining what alternative you're proposing: consumers, never inquire about your medications, and ignore the fact that there are choices? Yes, people can think they know more than they do, but I don't really think there's evidence that overall consumers are worse off from knowing that they have this kind of choice.

@MaelstromRider: technically aren't those different medications (not just different versions of the same med?)

@edwardso: I'd say the exact opposite is much more likely-people demanding newer drugs.

@edwardso: Also, all other things being equal (which they never are, but go with me), the doctor is ethically *supposed* to start with the oldest, best-understood drugs that adequately treat your condition first. If your arthritis can be treated with Advil, the doc should be starting there, not with a Cox-2 inhibitor. If your headaches can be managed with tylenol, the doc should start there, not with brand new high-end migraine medication with as-yet undiscovered side effects.

Few new drugs are true revolutions in treatment that are DRAMATICALLY better than past-generation drugs; most are merely another tool in the arsenal to FIND that right match of drug and body chemistry. While searching for that match, it's typically safer to start with older, well-understood drugs -- which also tend to be less expensive -- unless the newest drugs have significant gains in safety or efficacy. (The twin principal is that generally you start with a lower-impact drug and move up to higher-impact ones, which is often, but not always, the same path you'd take starting with an older drug and moving to a newer one.)

Pregnancy was actually a pretty interesting look at older drugs; since you can't do drug studies on pregnant women, they're fairly confined to prescribing "things people have taken since the beginning of modern medicine" and "things we used to dose pregnant women with before we stopped running experiments on them."

@floraposte: I certainly don't think that taking one doctors opinion as gospel is a great idea in most situations. But to use this site as an example, everytime there is an article on perscription drugs people make comments on what medication you should NEVER use etc. I guess I'm not really suggesting an alternative other than to take the internet advice with a grain of salt

You have to remember that even if a new drug is expensive, it might still be cost-effective to a major health care payer or provider. Imagine a drug that reduces cholesterol but causes a non-curable but treatable heart condition for 1 out of every 10,000 patients. Then a second company comes out with a newer drug in the same class that has comparable efficacy, but it reduces the frequency of the heart disease side effect to 1 in 100,000 or even removes the risk. Even though the drug is far more expensive, not having to treat for the heart disease might be cheaper in the long run.

@MaelstromRider: Plus there's often not "the" generic, in the sense that it's just from one company making the generic the way there is the patented drug, and inert ingredients and production processes will vary from company to company.

@extremenachos: Exactly so...

I think I know what older drug they're talking about when they refer to "a decades-old, inexpensive diuretic [that] does as good a job preventing fatal and non-fatal heart attacks as some newer high blood pressure medications."

A few years ago, I had kidney problems. I was prescribed a thiazide diuretic, hydrochlorothiazide, that is also used as a blood pressure medication. Last year, with no warning at all, I was diagnosed with diabetes. While researching causes of and approaches to diabetes, I read that thiazide diuretics have been known to actually cause diabetes. (Woo-hoo. Where's my class action lawsuit?)

I'm now on a different, newer blood pressure medication that doesn't have the same side effects.

@MaelstromRider: That's such a crappy decision to have to make, The more expensive pill makes you feel better, but the less expensive on is, well, less expensive.

@nagumi: Not according to the stupid health insurance formulary. It's automatically substituted for the brand.

Exactly why my MD prescribes LEVORA, 21 day supply X 3 refills, @$8 copay rather than SEASONIQUE, 90 day supply X 1 refill, @ $145 copay. Older drug, similar formulary = BIG savings for me.

@Eyebrows McGee (now with more baby!): That's quite a blanket statement, as there are so many drugs for so many conditions. New psychiatric drugs can be better than older versions. Prozac for example was the first SSRI and it did wonders for many people with depression.

That Owl Rexall Drugs store in the post photo looks just like the one near my apartment back when I lived in Berkeley. Hmm...couldn't be the same one, could it?

@Ben Popken: I have noticed that most doctors go right to the brand new expensive drug first. Of course these are what the drug reps are pimping and giving perks for prescribing them. Coincidence?

I have had a few doctors get really annoyed at my asking if certain older medications would be an option or asking how much this spiffy new superdrug costs. If they can give me valid medical reasons why the new one is needed or a better option I will agree to take it. But without a valid medical reason forget it.

Older drugs seem to have far fewer and less severe side effects too. The idea of paying over $100 in copays for something that will make you grow a 3rd nipple while gambling naked in your sleep is a pretty big hurdle to overcome.

Big Pharm should NOT be allowed to advertise directly to consumers. This is part of the problem. A lot of patients walk into the Dr.'s office saying they want X drug because they saw it in a commercial. The Dr. should be a final arbiter to see who get what drug, not the patient.

@Eyebrows McGee (now with more baby!): About the only experimenting on pregnant women I'd condone is substituting B&J's mint chocolate chip when she's requested chocolate chip cookie dough too often.

@edwardso: WebMD (and other online sources) gets a bad rap. The problem is when people go hypochondriac or don't bother to check with a doctor to see if their guess is right.

So far I have caught things doctors couldn't figure out 3 times by researching medical journals. These were later confirmed to be correct guesses.

@Jonbo298: You're having complications because they thought it was your appendix or because they screwed up with the camera?

Either way, YIKES!

@edwardso: I'd expand that to any advice, including doctors'. That's basic critical thinking, as well as active consumerism.

@Rectilinear Propagation: There seems to be a trend of putting drugs on the market and then admit to the nasty side effect and damage after the fact. It appears to be intentional.

Last year, with no warning at all, I was diagnosed with diabetes.

@speedwell, avatar of snark: My mom was watching something (she didn't say what) and a doctor was saying that the rise in diabetes was alarming and he blamed HFCS.

The thing is not everyone getting it is overweight. Professional athletes (current too, not retired) have been diagnosed with it.

@nagumi: This is why money needs to be going to cures rather than chemical band aids for chronic medical problems.

Many older drugs, have worse adverse effects. Older anti psychotics work just as well as the new ones, but have more adverse effects,with some that can stay after you are done the med. So would you rather take a med that would help you get better, that is cheaper, but has horrible side effects that could possible never go away? I'd rather pay more..

@Antiks:
But only a Doctor can write a script, so they still are the final arbiter.

I see where you are coming from, but its still the doc's choice.

@bohemian: Exactly. I mean, even assuming no nefarious intentions, *recency* is a key factor in what people remember. The drug reps are busy telling the docs about the newest pills and that's going to influence what drug the doctor thinks of when it comes time to prescribe for that ailment.

I got pretty sick over a few weekends ago and ended up going into an urgent care place since my regular doc was off. The doc I saw at the urgent care place was very much old school (he was in his 60's or 70's). He talked about this during the exam saying how he doesn't understand why all of these younger docs have to prescribe only the newest medications. He said if they've been around for 20 or 30 years there is a reason. He prescribed me an "older" medication, not only was it $4 at the pharmacy, but it did the trick in short order.

.

@Antiks: A lot of those commercials also advertise new drugs for conditions that may have not been easily treated previously. i agree that they probably market too heavily, but someone still needs to see a doctor and discuss it before they can get a prescription.

@edwardso: I completely agree. I, for instance, can only breathe ammonia in an argon atmosphere. Please don't prescribe I take two of these with water when I really should take two of those with pressurized liquid methane.

@Antiks: That's why I didn't make it as a blanket statement but carefully circumscribed what I was saying. :)

I said that FEW new drugs were miracles and dramatically better. Not NO new drugs. SSRIs are an excellent example of a dramatic improvement over an older generation of drugs.

@Antiks: Actually, I prefer that the drug be determined by the doctor and patient in consultation with each other. That's why I always check the PDR when the doc wants to give me something different. They're human too, they make mistakes, and I'd rather not have the adverse reaction.