Billy's Dad's Drugs

Billy's father was just sprung from the hospital after a five-day stint for an acute GI bleed. First time he has ever experienced this, father Rubin came in after about four days of constant cajoling by his wife as he had looked pale and sick long before a stethoscope came within a mile of him. When he showed up at his primary care physician's office, his blood pressure was 80/40 and his hematocrit turned out to be 15.8. For the non-specialists out there, to give you an idea of just how low 15.8 is for a crit, think of it this way. A normal crit for an adult male runs about 39-45. For patients with coronary (heart) artery disease--which he has--physicians usually don't get worried or think about transfusing until the crit falls below 30. For anyone, doctors get nervous when a crit falls below 24 (actually, they get nervous a good deal before then, that's just the threshold at which they normally transfuse patients). Pop got down below sixteen! Way to ignore your wife there, big guy! As I told him once he recovered, I have never seen anyone get that low acutely and live to tell the tale. He's unbelievably lucky.

I mention this because my father's drug list prior to this episode was virtually medical poetry: a beta-blocker here, a little hydrochlorothiazide there, a nice TZD-class drug for his diabetes. Looking at the list I liked his physician's style, though I had never spoken with him until last week. The over-the-counter med he uses for his arthritis and that was at least partially responsible for his bleeding, naproxen, would have to be stopped. And to prevent a recurrence of bleeding in his stomach and duodenum, he would be given a medication called a proton-pump inhibitor to prevent his stomach from producing so much acid.

After my father's condition moved into calmer waters I headed back for home and a few days later mother Rubin called me on the phone and were discussing dad's discharge plans. What's the new med for dad, I asked.

"Nexium," says mom. "It cost us fifty dollars! The pharmacist says it costs four hundred overall."

Well...you bet it's fifty dollars! Nexium is one of the great swindles perpetrated on an unsuspecting public that believes good things about the pharmaceutical industry. As the patent on Prilosec was running out, Astra-Zeneca needed another cash cow, and their solution was to take the molecule that made up Prilosec (which comes in two versions of the exact same molecular form, both mirror images of one another) and separate out just one of the two forms and test, patent and market it under a different name. Amazingly, this little scientific chicanery allows a company to keep on charging those insanely-high prices for which patented drugs are notorious. Nexium is really just the left-handed version of the two-handed Prilosec.

Mind you--Nexium is not a bad drug. Indeed it's a good one, as its parent, Prilosec, is as well. But it's a completely unnecessary drug! Prilosec does just fine in a situation like my father's. But how much does Prilosec cost? About 25 bucks, total. That's a lot less than Nexium's 400-dollar bill.

Now you tell me: is it the fault of the drug company to pull off this clever little piece of flim-flam to produce such a drug, or is it the fault of the physician who prescribed it? And what can you conclude about the system when you see something like this happen?
--br