Lexapro's Marketing Plan Shows How Drug Maker Pushes New Drugs
The Senate just released 88 pages of a confidential 270+ page marketing plan by Forest Laboratories, created in 2004 and focused on how to get doctors to prescribe the antidepressant Lexapro over similar but cheaper alternatives such as Celexa. The New York Times notes that the line between marketing and education seems to be heavily blurred, which may not surprise you. There are, however, two interesting notes for consumers who may be taking Lexapro.
The first is that the FDA doesn't require Lexapro's makers to statistically back up their claim that Lexapro is more effective than Celexa, which is basically Lexapro's parent. (Forest Laboratories changed the molecular structure of Celexa, which was about to lose its patent protection, in order to create Lexapro in 2002.) In fact, Forest has even used this near-interchangeability to its financial advantage:
The F.D.A. views the two medicines as so interchangeable that the agency recently approved Lexapro's use in depressed adolescents based in part on the results of a study Forest conducted using Celexa.
The second is that sales of Lexapro are on the wane, and correspondingly Forest "has been recently raising the price." But, "Many doctors say they believe that Lexapro is the best antidepressant, so they prescribe the drug despite its cost."
"Document Details Plan to Promote Costly Drug" [New York Times]
(Photo: mandiberg)
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So peoples...list these in order of best scammers...
*car salesmen
*lawyers
*bureaucrats
*mattress salesmen
*pharmaceutical companies
*Nigerian boredom fighters
What's really wild about this is that Lexapro (generic: escitalopram) is actually a chemical derivative of Celexa (generic: citalopram). The odds are good that anyone for whom Lexapro works, will find that Celexa does, also. Suggesting that Celexa is somehow "inferior" to Lexapro is the pharmaceutical equivalent of shooting oneself in the foot!
Theoretically Lexapro has a smaller side-effect profile than Celexa, but in the real world this may not hold true. The bottom line is that Lexapro is best given to people for whom Celexa works, but who have intolerable side-effects from it, that Lexapro may not give them. My guess is that this is a very small number of people.
So, come the revolution, after the insurance company CEOs have been dragged away from the wall, we'll line up the Big Pharma CEOs.
So how about we up the penalty from just fines to throwing people's ass in jail when these drug companies pull this crap?
There have to be some great emails and internal memos so there should be a few people from Forest and Pfizer wearing orange jumpsuits.
I'd prefer the way the Chinese govt. handled the people in the melanine and lead cases (firing squad), but I'll settle 1/2 way for some nice loooonnng prison terms.
Another cost cutting exercise...
@EllenRose: I've got a prescription for Lexapro, and my pharmacy has always given me Citalopram, which I think is the generic Celexa. Once I was given Lexapro proper and asked why I didn't get Citalopram. A different pharmacist than I'd seen before said I couldn't get Citalopram because it wasn't the same as Lexapro. But all the other pharmacists give me Citalopram. I don't think my pharmacy always knows what's going on. o.O
No doubt there will be some Senators who will be getting less money from big pharma in future.
Hmmm who are the shareholders of the company?
I've been on Lexapro for a few years now, and have reached a 20 mg dose. This is as high as it goes. However, the cheaper generic form can go to much higher doses. My sister, who was also on it, had to be put on the generic form when the max dose of Lexapro was no longer effective for her. I'm waiting for that day to come for me too...
I've been on Lexapro for 2 years and was on Celexa for a couple of years prior to that. I had nausea, dry mouth and insomnia while on Celexa. Those side effects have been greatly reduced while on Lexapro.
Lexapro has been worth the additional cost for me.
@Wang_Chung_Tonight: You forgot politicians, environmentalists, oil company representatives, psychics, priests, meter maids, car mechanics, plumbers, the lottery, Native American casinos, the corn industry, NASA, and the state of Florida.
I had an issue with "the pill". When I started on it, the not-a-doc put me on a new tier 2 drug that ran me $40/month copay. I went back to the not-a-doc during that first month and demanded a pill with a generic. Then I requested a copy of my file. "The pill" has been around since the 60s. Why on earth do I need a brand spankin new tier 2 drug (that of course came with a cute little purse - that should have been my first tip-off) when there are perfectly fine drugs out there? I can't believe that after they pull a stunt like this, they are shocked when you have absolutely no trust in them and take your business elsewhere. Grrrr.
@bitslammer: Better solution - dissolve patents that encourage this sort of behaviour. That way no one is killed.
What's in the other 200 pages?
@harvey_birdman: I'm unlcear as to how cutting patents would make this better.
We're talking about drug companies pushing sales of product without proper (or even any) science to assure the safety and efficacy of the use of the drugs. Dropping patents may only add to more companies wining and dining physicians to try and get them to push more and more expensive drugs onto the public.
@me and the sysop: Citalopram is the generic of Celexa. Lexapro may offer additional (if intangible) benefits that Celexa does not, however, the most apparent difference is strength. There is a 2:1 ratio of potency in Lexapro (e.g. 10mg is equivalent to 20mg of Celexa).
My dollars would go to Citalopram and not Lexapro. Further, any doctor that felt it necessary to require Lexapro over Citalopram has questionable common sense, and/or is playing the kickbacks game.
@sleze69: Blank pages except for one line of text that reads, "This page was intentionally left blank."
@admiral_stabbin: Actually, it's about a 4:1 ratio of citalopram to Lexapro (escitalopram). I was on 10 mg/d of Lexapro and asked my doc if I could switch to the 40 mg/d for the citalopram, seeing as how it was on the non-preferred list for my insurer. He obliged and imagine my surprise when I was able to get my entire amount of Celexa covered with NO copay. My doc, who had recommended the Lexapro with the additional breaks in costs (free meds and discounts), was okay with the switch. All I had to do was ask, and he said the only real difference is the fact that the molecule is slightly bigger in citalopram.
Now, if they could only do something about getting my other meds to generic. I mean, I react well to methylphenidate (for ADHD), but the issue here is the delivery mechanism (which is covered by the stupid patent).
@harvey_birdman:
Politicians
Bureaucrats
Psychics
The lottery/casinos
Nigerian boredom fighters
Oil company reps
the corn industry
car salesmen
lawyers
drug companies
For the rest, scammers are a small enough fraction that they don't make the list.
I remember talking about these drugs with my doctor when I was on anti-depressants. I had no insurance so he gave me some free samples of Lexapro (cuz that's what he had) and a prescription for the generic Celexa.
I never noticed a difference when I switched from one to the other. Just that the generic is $4.
The article mentions the continuing medical education seminars which are sponsored by the drug companies. All expenses paid, usually for both the doc and the spouse, and they are always in places like the Bahamas. The "education" may actually include a lecture or two if anyone wants to attend. Otherwise, there is ample instruction on the golf course. These costs are passed on to the consumer, of course. The lunch program is also a frequent tool. Most drug reps will include all office staff and it's normally a bit better than Mickey D's. The rep gets to pitch the drugs he wants to pitch and will generally hand out samples.
What really starts to get to me is the direct marketing to the consumer for drugs that I can't buy without a doctor's prescription. The cost of a tv ad could fund research for months.
@sleze69: Forest Laboratories requested that they not be released to the public because they contained sensitive information, and the Senate committee acquiesced.
People just need to stop being mopey babies and get off the antidepressants.
@bitslammer: Lexapro is a replacement for Celexa produced ONLY because the patent on Celexa ran out. Celexa is now a generic, which can be produced by anybody. Forest Laboratories owns the patent on Lexapro and thus has a financial incentive to lie to people that it is better than Celexa. Remove the patent, then anybody can manufacture Lexapro, and the incentive to lie about the efficacy of one pill over the over disappears.
@EllenRose: I've noticed absolutely no difference between Lexapro and citalopram....except about $52 for a month's supply under my health plan.
I hope this ends up in a class-action lawsuit over unfair trade practices - the patent provides no therapeutic benefit to most people.
"Forest Laboratories changed the molecular structure of Celexa, which was about to lose its patent protection, in order to create Lexapro in 2002."
Just want to point out that this statement is incorrect as written. Lexapro (Escitalopram) is an enantiomer, or mirror image of Celexa (Citalopram). The only thing Forest Laboratories discovered was chiral chromatography to separate the two.
@harvey_birdman: I would admit that Lexapro is a chemically superior pharmaceutical - simply because they were able to create a chemically pure version of the active ingredient, versus simply a racemic mixture of an active drug, and something that's not as active (or even inert.)
Fewer drugs should yield fewer side-effects. Still, if Celexa's well-tolerated dispite this theory, it's pretty practical to choose Celexa over Lexapro.
@lawnmowerdeth: Smne nds dsmvwlng!
Seriously, clinical depression and anxiety disorders are real, and they have significant effects on human performance in daily life.
I think the best analogy would be the NASCAR restrictor plate - clinical depression in my case is a chemical barrier to my performing to the best of my abilities.
It isn't "moping" or being sad.
@admiral_stabbin: "Lexapro may offer additional (if intangible) benefits that Celexa does not"
Just because it is more expensive does not mean it is at least as good. It could be worse in every aspect. We just don't know.
@admiral_stabbin: You're completely right about the 2:1 ratio of potency, and my doctor has corrected for that. My chief problem was side effects from Paxil (which I wanted to get off of) so she moved me over to Lexapro (which she said had as few side effects as anything she knew). I hope the sailing continues as smoothly with Celexa as it has so far.
The main difference is that Celexa has two mirror isomers. One of them does all the work. So Lexapro has only the isomer that does the work. Sensible, but expensive.
@lawnmowerdeth: Not everyone on Lexapro is depressed. Some of us take it for PMS. Without this drug, it takes a monumental effort to overcome the urge to strangle everyone. With Lexapro, I have no desire to strangle anyone, not even you!
@varro: I'm not picking on those with actual problems, but when the statistics say prescriptions have tripled over the years, that's people over medicating.
I'm on lexapro and have been for several years. The medication saved my life and I swear by it.
When I had broken up from a bad relationship, every morning I would wake up and throw up, have chest pains, be riddled with anxiety, and the doctor gave me lexapro. Three months later, very gradually, I was able to get on with my life, and I have that medication to thank for it.
In defense: It's called marketing, people. It's easy to point the finger when you don't suffer from an anxiety disorder.
The active part of Citalopram is EXACTLY the same as Lexapro. Citalopram contains 2 forms of the key chemical, in almost exactly 50/50 ratio, 1 of which does nothing for your body (you just pass it).
So 20mg of Citalopram = 10mg of Lexapro + some inert stuff.
Other than that, they are IDENTICAL (other than the price, of course).
@lannister80: That's a common practice in the pharma biz. A new drug will come out with one or more isomers, then the isomer that actually provides the benefit will be isolated and re-marketed as a new product. Since the other isomers also tend to produce most of serious the side effects, they can legally claim the new product is safer.
FDA regs need to take this into account and force pharmas to treat this sort of shenanigans as an improved product but not a new one with patent rights.
In short, you, me, and the general public. Biggest shareholders include Wellington (huge fund mgmt company), Clearbridge (also a huge fund mgmt company), Barclays Global (index funds), State Street (index), Vanguard (index), BlackRock (index).
For some women, "the pill" isn't "the pill" - the side effects from various versions can be significantly different.
@dewsipper: "The Pill" is not the same for every brand. What works for 1 woman might fail for another. You do not want to be on the pills of the '60s, either. There's a staggering dosage difference, as well as newer and safer synthetic hormones.
@PsiCop: @PsiCop: Welcome to, among others: Pristiq and Effexor (desvenlafaxine and venlafaxine); Nexium and Prilosec (esomeprazole and omeprazole); Kapidex and Prevacid (dexlansoprazole and lansoprazole); and so on, and so on. It's dubious whether any of these drugs really cause fewer side effects like they claim.
@riverstyxxx: This is sort of irrelevant if you haven't tried Celexa/citalopram as well. Yes, Lexapro works. It IS a medication that is prescribed to people. Our point is that in most cases, it's unnecessary to prescribe it over Celexa.
My advice to anyone that needs to be on any drug and doesn't have insurance is to get a written prescription from your doctor and research how much your drugs are through a Canadian pharmacy. Some drugs that don't have a generic available in the US have generics available through a Canadian pharmacy and the name brand drugs are typically the exact same ones as you would buy in the US, right down to the looks of the pills and all.
@lawnmowerdeth: Some people have a hard time making it through the day without them. I was fine until my wife nearly died during childbirth. That stress seemed to have knocked something out of whack in my brain. Without them I was unable to function and I could not sleep...always feared I was going to die before making it through the next day. Taking generic Paxil has balanced me back out.
People making blanket statements like you haven't got a fucking clue.
My doctor had me on Lexapro, but when the insurance refused to cover it, we fell back to the generic version of Celexa. It's been a couple weeks, and so far, I haven't noticed a difference. Except for the price, which is considerably lower.