Alfred Miller, MD – Rheumatologist, private practice, retired
San Antonio, Texas
From the Editors: The patient in Dr. Shoenfeld’s article was seen in Israel, where Lyme disease is not endemic, and so it was not factored in as a possible diagnosis. For patients who live in or visit areas where Lyme disease is common, this infections etiology should be considered among possible diagnoses.
High Cost, but Is There No Benefit?
I read with interest the article entitled, “High Cost, No Benefit” (July 2011, p. 12). While I agree that the promotion of some “generics-plus” medications may be wasteful of already limited healthcare resources, I do believe there is occasional benefit to reinventing an old drug with a new twist.
Dr. Abeles cites an example of the many faces of diclofenac. Over the past several years, three topical formulations of diclofenac have come to market—Flector Patch, Voltaren gel, and most recently, Pennsaid. In our current clinical environment where oral NSAIDs are often taboo for our patients who need them most, these topical diclofenac variants with limited systemic absorption are welcome alternatives. I use them frequently (and sparingly) in my patients with renal disease, gastrointestinal disease, and cardiovascular disease, including those on anticoagulant and antiplatelet therapies who could not otherwise take oral NSAIDs. I find these particular “generics-plus” medications to fulfill a significant unmet need for my patients.
Thus, I believe the pharmaceutical industry should continue to strike a balance between research and development for novel therapeutics and creative innovation of currently available medications to make them more tolerable and useful for our patients. That being stated, I wholeheartedly agree that we should not be prescribing luxury generic drugs in lieu of their more economical alternatives, when clinically suitable. In my practice, insurance-mandated step therapy usually precludes such prescribing, anyway. I believe that our collective clinical judgment ultimately dictates the market for which “generics-plus” medications are useful versus wasteful.
Deborah R. Alpert, MD, PhD – Clinical Assistant Professor of Medicine Section of Rheumatology, Department of Medicine Jersey Shore University Medical Center
Neptune, N.J.
