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From the article > Other epinephrine injectors have been approved before, but they struggled to gain market share against a brand that used lobbying and market
by forkerenok 8y ago
From the article
> Other epinephrine injectors have been approved before, but they struggled to gain market share against a brand that used lobbying and marketing to establish a virtual monopoly on the market.
This got me thinking that consumers are at fault as well. But then I read the following from the linked article[0].
> “Their most brilliant maneuver, clearly, was giving them [EpiPens] away to schools and making it the thing that they could say, ‘Well, the nurse knows how to use it,’ ” said R. Adams Dudley, a pulmonologist at the University of California at San Francisco. “What are the parents afraid of? Their child will be away from them, and they won’t be there to use it. If they can say the school nurse knows how to use an EpiPen; she’s never seen an Adrenaclick ... It’s just a fear thing.”
With such (understandable) absolute risk averseness what is the way out?..
[0] https://www.washingtonpost.com/business/economy/2016/08/25/7f83728a-6aee-11e6-ba32-5a4bf5aad4fa_story.html https://www.washingtonpost.com/business/economy/2016/08/25/7...
- gameswithgo 8y agoThere are at least two other products on the market and they are easy to use. Just quit buying epi pens. Tell your doctor/school you won't be using it and deal with it.
- cryptonector 8y agoThe school may not want to accept that...
- lilott8 8y agoWhatever medicine I give the school to administer to my child at the appropriate times has to be observed; the school cannot wantonly withhold the medications I provide them, especially when provided a Dr's note. If I send my child to school with an "off-brand" epipen with a doctor's note and direct the school to use this instead, they have to observe it -- a nurse is in no way capable of making a drug administration decision without the consult of a licensed medical doctor.
- grahamburger 8y agoBut what if they fuck it up and your kids dies? That's the (not totally irrational) fear - parents want the nurse using something they are already familiar with.
- patejam 8y agoOr they fuck up, prick themselves with epinephrine, and die (or at least not have a very good time).
- raverbashing 8y agoIf the school nurse is that incompetent you have bigger problem
- traek 8y agoI don’t think an incompetent school nurse would be a bigger problem to me than my child dying.
- lev99 8y agoThe bigger problem is how many other children receive substandard care.
- DanBC 8y agoIn England the protected title is "Registered General Nurse" or "Registered Mental Health Nurse" - a registered nurse is qualified to a certain standard and has a professional registration. Nurse isn't a protected title, so it's possible a school nurse has minimal qualification and no professional registration. I dunno if it's similar in the US.
- paulie_a 8y agoI had an EpiPen and various other stuff when I was in 5th grade. I was taught to use it. If a nurse is incapable of administering it properly that person needs to find a new line of work. It honestly is a completely irrational fear.
- kamonrye 8y agoWhat are some other alternatives? "Just quitting" EpiPens would be awesome if there were some known alternatives for those who need them to live.
- SmellyGeekBoy 8y agoNot to be rude, but in the time it took you to write this comment you could've just typed "epipen alternatives" into Google.
- greydius 8y agoThe same strategy used by Microsoft, Mathworks, and drug dealers: Get 'em hooked and you'll have a customer for life.
- microcolonel 8y agoThe way out is for these companies to also educate the public about how to use their autoinjectors. If the half dozen medium-small companies who marketed the EpiPen managed it well before Merck got involved, surely almost anyone else can do the same (if they are not too lazy to do the basic due diligence).
- Mediterraneo10 8y agoHow much are school nurses in the USA still a thing? I had read recently that many schools have done away with nurses for cost-saving reasons. Instead, there is only one roving nurse for an entire set of schools or the whole district.
- TwiztidK 8y agoThis was my experience throughout my K-12 education and I graduated in 2010. Every time I was sick or injured the nurse was at different school, so they'd just send me home. The only exception was when my gym teacher suspected I had a concussion and the nurse drove from another school to examine me.
- barneygumble742 8y agoThey sent you home because they didn't want to be responsible for your health/safety.
- wtallis 8y agoMy local school district has about three schools per nurse overall, but the ratio is a bit different between elementary, middle and high schools. One of the largest parts of their job is training the TAs and other school staff to administer the medications their students need, because it's far too big of a job for the nurses to handle. Our local government has made a halfhearted attempt to fund a new school nurse position for every new school they build, but it hasn't been working well so far.
- da_chicken 8y ago> This got me thinking that consumers are at fault as well. It's also partially the doctors. If a doctor writes a prescription as "EpiPen," then the pharmacist has to provide a drug with the brand EpiPen. The doctor has to specify "EpiPen or generic equivalent" on the prescription in order for the pharmacist to be able to fill it with a generic. If doctors don't realize that EpiPen is a name brand -- and "EpiPen" is so ubiquitous as to be nearly genericized at the point -- then doctors may not realize the issue.
- dev_dull 8y agoIt’s so ubiquitous in fact I’d say it should probably forfeit its protection as a trademark. Same as fax machine, cell phone, etc.
- qeternity 8y agoDoctors are well aware. But pharma reps treat them well and give them perks so that they don’t write generics. It’s a big kickback scheme.
- mikeyouse 8y agoThis isn't typically true -- If a doctor writes a Rx for Lipitor, it'll almost never be filled with the Brand Name Lipitor. All insurance and most formularies expect that the generic will be provided. Doctors have to write "DAW" or "Dispense as Written" on the Rx for the patient to receive the brand name when a generic is available. AJM Confirming that all states have Generic Substitution laws to lower drug costs: https://www.amjmed.com/article/S0002-9343(10)01087-9/abstract https://www.amjmed.com/article/S0002-9343(10)01087-9/abstrac...
- delecti 8y agoEvery prescription I've received in the last several years had two signature lines. If the doctor signs on one, it's "dispense as written", and if they sign the other it's "substitution permitted". So it's not like they have to do something special to get DAW.
- 8y ago
- rexpop 8y ago> This got me thinking that consumers are at fault as well. When is this ever the case? Especially when the decision results in a comparative loss?
- dfsegoat 8y agoThere is no monopoly. Many other epi autoinjectors have entered the market, and were withdrawn - or have clung on without many people know they even exist... People forget there is also a human factors element: If the pen is not easy to use, it could lead to an inability to deliver the medication simply because the person can't read the directions while their airway is closing up. For instance: 1 pen on the market now has a speaker built into the pen which gives voice directions for anyone to be able to administer a dosage to someone who needs it [0]. If the pen mechanism itself is not robust, and delivers inadequate or overdosages - then this is also bad, and is also where other competitors have failed [1]. The EpiPen itself is actually a bit of a work of art because it gets most of these things right on - this is why they've dominated. 0 - https://www.auvi-q.com/ https://www.auvi-q.com/ 1 - http://www.twinject.com/ http://www.twinject.com/
- maxerickson 8y agoEpiPen was literally granted market exclusivity by the FDA, there was a government enforced monopoly on the particular mechanism, one which was granted on what, as far as I can tell, was a superficial improvement to the safety cap. Mylan continues to try to restore their exclusive rights. https://www.accessdata.fda.gov/scripts/cder/ob/patent_info.cfm?Product_No=001&Appl_No=019430&Appl_type=N https://www.accessdata.fda.gov/scripts/cder/ob/patent_info.c...
- dfsegoat 8y agoI think you are misunderstanding "Market Exclusivity" vs. monopoly: Yes the EpiPen mechanism is patented, and people cannot knock it off directly - this is not a monopoly, because competitors have been allowed to create new designs for a long time. [1] The fact that Auvi-Q, TwinJect and many other Epi-autoinjectors are allowed on the market as New Drug Applications (Non-generic) shows us that the FDA has allowed healthy competition from other Autoinjector designs -- they simply have not been as effective, safe or simple to use, leaving EpiPen as the standard. 1- https://www.fda.gov/drugs/developmentapprovalprocess/ucm079031.htm#What_is_the_difference_between_patents_a https://www.fda.gov/drugs/developmentapprovalprocess/ucm0790...