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November 10, 2004

Paying more for pain relief than necessary

Holman W. Jenkins' WSJ ($) Business World column this week explores how the miplaced incentives of America's health care finance system contributed to Merck over-marketing -- and doctors over-prescribing -- Vioxx despite its well known side-effects:

[Vioxx was never supposed to be] a better pain reliever. Its unique selling proposition was simply a lower incidence of stomach bleeding, a real benefit but one mainly relevant to the 15% of arthritis sufferers who can't safely take conventional pain relievers.

Merck pulled the drug two weeks ago based on a study showing that, after 18 months of daily use, Vioxx subjects began experiencing heart attacks and strokes at twice the rate of a placebo group. Yet, on balance, this might have seemed mildly less alarming than the 2000 study that kicked off the Vioxx controversy. Also done by Merck, it showed that Vioxx users, from day one, suffered two or three times as many cardiovascular "events" as a control group using naproxen (the ingredient in Aleve).

. . . [But] Merck is in hot water now not because Vioxx was excessively risky but because the wrong people were taking it -- a problem for which doctors and the insurance system are also to blame.

. . . Marketing alone doesn't cause patients to shell out $2 for a pill that doesn't work any better than a five-cent aspirin. Bruce Stuart of the University of Maryland has showed that the biggest determinant of whether a patient takes a Cox-2 or a cheaper drug is whether an insurance company is paying.

Likewise, we've heard two schools of complaint from patients since Vioxx was yanked. Some patients are irate at Merck for depriving them of a drug they found genuinely useful, but others are mainly irate at their doctors for never mentioning that Advil or Tylenol work just as well.

The Vioxx debacle is symptomatic of a system that shields consumers from price signals and sometimes actually discourages them from making the right health-care choices. Forget pain relievers. In certain common breast cancers, women opt for expensive, risky, miserable chemotherapy even though it doesn't significantly improve an already high survival rate. They have a hard time waving it off, though, precisely because an insurer is picking up the tab.

In any case, Big Pharma is well along in being corrupted by third-party payership, just like the rest of the health-care industry. Drug makers increasingly aim their development efforts at the aches, pains, insecurities, heartburn and erectile dysfunction of price-insensitive, over-insured baby boomers because that's where the money is.

Read the entire piece.

Posted by Tom at November 10, 2004 7:28 AM |


While the gist of the article is on point, there is one statement with which I should take issue.

The author states (paraphrasing) that a $2 Vioxx did not work better than a 5 cent Aspirin. That is not exactly correct. What he should have said was that Vioxx offered no more anti-inflammatory effect than Aspirin when the latter was used at anti-inflammatory doses, which is 2 adult strength tablets (325mg each) taken 4 times per day. However, it is the rare patient that can tolerate the GI side effects of this high of a dose of ASA.

I guess it would be most correct to say that $2 worth of Vioxx offered no more effect than 40 cents of Aspirin (5 cents times 8 tablets). It would be up to the patient (or more likely the patient's prescription coverage benefit) to determine if the once-daily convenience and purported GI safety of Vioxx was worth the extra $1.60 per day.


Posted by: Jim Bob Baker at November 10, 2004 5:43 PM

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