10 ms·

The Cold-Medicine Racket

103 points by Thevet 12y ago

rayiner 12y ago
This is such a great example to highlight how information asymmetry and choice overload act to undermine markets. > The difference in price between brand names and generics accounts for tens of billions of dollars "wasted" every year by Americans in pharmacies, according to the economics researchers. > Consumer confusion, or misplaced trust, is compounded by the fact that a drug store is likely to have upwards of 300 cold-and-flu products > One myth is that "brand-name drugs are made in modern manufacturing facilities, and generics are often made in substandard facilities." But, the FDA counters with the reminder that it "won't permit drugs to be made in substandard facilities." Imagine how much consumers would overspend on branded medications if they couldn't count on the FDA as a backstop. EDIT: By "backstop" I mean the FDA's role in ensuring that generics are bioequivalent and meet manufacturing standards. Imagine how much more effective brand advertising would be if some of the choices on the shelf really were manufactured in a dirty factory in Mexico.
- mmohebbi 12y ago
  While the FDA does a fantastic job of reminding the population of the process it uses to ensure generics deliver the same experience, there is still a ton of waste in the system due to brand-name drugs being chosen over generics. Part of the problem is the massive marketing efforts by pharma trying to convince patients and doctors that their brand-name drug is better. For details see: http://www.iodine.com/blog/do-people-prefer-under-patent-drugs/ http://www.iodine.com/blog/do-people-prefer-under-patent-dru...
  - deleted 12y ago
    [deleted]
  - cwzwarich 12y ago
    Part of the problem is that the name brand drug is sometimes better than the generic, and one generic brand is sometimes better than another. I have experienced this as a patient.
    - abfan1127 12y ago
      as a study of one, how do you know it isn't the placebo effect?
      - silencio 12y ago
        Problematic generics seem to come up often about extended release formulations when hanging around ADHD communities. Judging from this latest one I remember, it takes a big push for the FDA to start looking into it and ask questions: http://www.fda.gov/Drugs/DrugSafety/ucm422568.htm http://www.fda.gov/Drugs/DrugSafety/ucm422568.htm As consumers, we don't really have much of a way to test for placebo effects or when generics are actually subpar other than complaining until someone listens... so... it's a bit of a chicken/egg problem.
        abfan1127 12y ago
        I think that's my question, as an individual, you can't say that one is more effective than the other because, as an individual, you can't account for the placebo effect. Personally, if it works, it works, placebo or otherwise.
      - cwzwarich 12y ago
        If you search online, you can find isolated regulatory incidents, patient anecdotes, and even statements by doctors that they prefer patients not switching brands when something works for them. Beyond that, I'm not sure what is really known, or how you would go about studying this phenomenon in a scientific fashion. Even if it is a placebo, if two medications that are supposedly the same cause different effects on me, e.g. one has much more manageable side effects than the other, then why shouldn't I take the one that makes my life better?
        abfan1127 12y ago
        I'm a strong believer in the placebo. If it works, then stay with it...
      - 12y ago
- PhantomGremlin 12y ago
  The FDA does try, but it's ineffective and totally overwhelmed. Here's a recent story[1]: In January, FDA inspectors paid a surprise visit to the facility in Toansa, in a rural area north of New Delhi, and found broken equipment, windows stuck open and flies “too numerous to count,” ... Workers ran quality tests over and over until they got the results they wanted Just google around and you will find many many many stories like this. It's been an ongoing problem with generics (mostly from India) for quite some time. I don't know if brand-name drugs are any better, probably many of the same ingredients are sourced from the same suppliers. But at least the brand-name drug has a reputation, i.e. a "brand name" to protect. Edit: Just wanted to add: RTFA I linked to. My one quote doesn't do the situation justice. The culture at some companies is IMO really really bad. [1] http://www.bloomberg.com/news/2014-03-06/flies-found-by-fda-threaten-indian-town-built-on-generics.html http://www.bloomberg.com/news/2014-03-06/flies-found-by-fda-...
  - datasage 12y ago
    Stores like CVS and Walgreen's do have their store brand to be concerned about. So if brands do provide some guarantee of quality, buying from those stores is likely not worse than the branded products.
  - zaroth 12y ago
    Agree with everything about your comment, except I wouldn't characterize the FDA as "overwhelmed". Read the expose 'Dirty Medicine' on Forbes and you might choose a different adjective. :-/
- benbreen 12y ago
  It is indeed an interesting example of information asymmetry. An economic historian at LSE who I know actually traces the origins of modern advertising to the rise of "brand-name" medicines. Back in the late 17th century, early newspapers started running early ads for proprietary drug recipes that cured things like plague and gout. These were the earliest products to be sold via mass media and to be "branded" using the name of the preparer. I.e. in a world where a consumer would simply go to "Shoe Street" to buy shoes, these early apothecaries pioneered the idea of using mass media to persuade consumers not to buy a generic gout cure, but instead to go specifically to, say, Mr. Merck's shop to buy "Merck's gout elixir" (I use that example because the Merck corporation actually does trace its origins to a late 17th century apothecary).
- debacle 12y ago
  > information asymmetry and choice overload In the industry, we call it "patient education."
  - rwmj 12y ago
    Or "common sense". It's pretty easy, I just read the list of ingredients.
- discostrings 12y ago
  The information asymmetry and confusion factor are worst in that all these products have just a few ingredients, in my opinion. While the branded/generic price difference is an important issue, I think a larger one is that the huge volume of products takes attention away from the fact that there are only a few basic components, leading many to buy inappropriate products or products with too many components that can cause side effects that could easily be avoided. People without some prior knowledge of the basic drugs must have a very difficult time walking into a store and choosing the product with the drugs they need without some of the ones they don't. I imagine many people are totally overwhelmed by the product selection and they just pick something, which they then turn to each time they're feeling sick. It's more difficult than normal to perform an assessment of products at the store when you're sick, and the store presentation only makes things more difficult. Even knowing something about these products and knowing exactly what I want, I sometimes find it time-consuming to locate the single-ingredient products among all the endless combinations, especially when they're out of stock. Things would be so much simpler if stores posted some type of reference. I'm not an expert in the field, but it's such a pet peeve of mine that I've memorized the basics. Here's a start: Fever/pain -> Relieve: ibuprofin acetaminophen [avoid if you have liver problems] naproxen aspirin Nasal congestion -> Reduce: pseudoephedrine [quite effective, but the pharmacy must be open; prepare to provide identification, sign, possibly be questioned / receive a dirty look, and have your purchase be entered into a federal database] phenelyphrine [of questionable effectiveness] Coughs -> Make more productive at clearing congestion: guaifenesin Coughs -> Suppress: dextromethorphan Trouble sleeping / allergic sensitivity -> Relieve: doxylamine [slightly better for sleeping than allergies] diphenhydramine [slightly better for allergies than sleeping] The store could have a nice section of the products that contain just one of these drugs, making it easy to mix and match, with reference to the list. I don't think there's anything inherently wrong with the combination products, but it really seems their general effect confuses rather than clarifies, which seems to me to be part of the reason for the design and proliferation. The author of this piece seems to have similar feelings: > ...I can't see myself using it, because I usually keep generic single-drug products around. A family, or a sickness-inclined person living alone, could very reasonably keep the five aforementioned individual generic medications in their medicine cabinet and address the symptoms as they arise. I think that's easier than messing with combination products, and usually cheaper. Especially if you consider that you're not taking medications you don't need. > I tried to convince Angelotti that's the way to go, but she was adamant that many or even most people really like to take one pill that addresses all of their symptoms. "I don't know if people will be likely to have their own inventory of generic over-the-counter medications in their homes," she said. I think a simple list like this, preferably easily visible in the store, and some better organization in stores would do people a much greater service than the app the article discusses.
mmohebbi 12y ago
"The idea is to help everyone find exactly the right cold medication." http://www.iodine.com/cold-and-flu http://www.iodine.com/cold-and-flu I work at Iodine (our Cold and Flu tool is featured in this article) and we're watching this thread. Feel free to ask medication related questions of our clinical team or technical questions of our engineering team.
- stupandaus 12y ago
  What's the medical consensus on Cold-EEZE?
  - amandalotti 12y ago
    Hey, I'm an MD at Iodine. Basically, zinc works. A Cochrane meta-analysis from 2013 showed that zinc lozenges reduce the severity and duration of common cold symptoms. It’s the closest thing we have yet to a cure for the common cold. Get the lozenges in particular (other forms don’t seem to work as well), and take ‘em on a full stomach or you can get really nauseated. http://summaries.cochrane.org/CD001364/ARI_zinc-for-the-common-cold http://summaries.cochrane.org/CD001364/ARI_zinc-for-the-comm...
    - benjohnson 12y ago
      You advice on the lozenges seems really good as there seems to be a problem with Zinc in the nasal passages blunting the ability to smell. http://www.webmd.com/cold-and-flu/news/20100719/study-links-zinc-nose-sprays-loss-smell http://www.webmd.com/cold-and-flu/news/20100719/study-links-...
      - makmanalp 12y ago
        I'm actually curious about this too - I've had pretty great success with zinc lozenges, but was off-put by this. Although the study is for some very specific intranasal products from a specific brand, I think. edit: Link to original study: http://archotol.jamanetwork.com/article.aspx?articleid=496489 http://archotol.jamanetwork.com/article.aspx?articleid=49648... It talks about "homeopathic zinc gluconate gel" and some patients reported a burning sensation while applying it.
ToastyMallows 12y ago
This reads like a big ad for Iodine.com
- mmohebbi 12y ago
  Well, we are trying to counter all the pharma ads! But really, we hear from users all the time that they get confused in the cold and flu section of the pharmacy. We hope to help address this problem.
- AnodyneComplex 12y ago
  I thought the author actually had a pretty skeptical take on things. The ending quote is pretty hilarious: "It's a press release, Mary. The iodine algorithm saved your husband from the brink of ruin. His newfound sense of consumer empowerment was so invigorating to his spirit that he no longer needed any Mucinex at all."
Detrus 12y ago
I think the real racket is that people are taking medications to suppress cold symptoms in the first place. A healthy adult should be out no more than a week from a strong cold/flu. That wouldn't be a big deal except people get so little time off from work they don't want to waste it on a cold. Wether they spend $10 on symptom suppressors or $50 is besides the point. Taking medications for what your body should be capable of handling with proper nutrition and rest cannot be healthy.
- benjohnson 12y ago
  >>Taking medications for what your body should be capable of handling with proper nutrition and rest cannot be healthy. Could you explain a bit more as I can think of a case where this seems to be false: While my child's body can eventually handle colds and flus, if his temperature goes above a certain level there's a significant chance for brain-damage, so I counteract the bodies natural fever with medication.
  - ceejayoz 12y ago
    It should be noted that a low fever appears to be helpful for the immune response. http://www.nbcnews.com/health/health-news/sick-feverish-suffer-through-it-get-well-faster-docs-say-f1C6436878 http://www.nbcnews.com/health/health-news/sick-feverish-suff... If you're running a 101 degree fever, it may be more effective not to suppress it.
    - amandalotti 12y ago
      yeah i wrote a pretty comprehensive blog post about this - ie when it's better NOT to treat a fever http://www.iodine.com/blog/should-you-treat-a-fever/ http://www.iodine.com/blog/should-you-treat-a-fever/
  - Detrus 12y ago
    I did say healthy adults. Not that most adults are healthy.
  - evilduck 12y ago
MiguelVieira 12y ago
But branding does have an impact on the effectiveness of some over-the-counter medicines (because of the placebo effect): >The effect of branding--that is, the labelling and marketing--of a well-known proprietary analgesic used to treat headaches was studied in a sample of women given a branded or unbranded form with either an inert or an active formulation....The findings showed that branded tablets were overall significantly more effective than unbranded tablets in relieving headaches. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1505530/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1505530/
smacktoward 12y ago
I wonder how much of that wasted money could be saved by taking an approach with brand-name drugs similar to the one taken with cigarette packages: require them to carry a big-ass label. Something to the effect of "THIS PRODUCT IS MEDICALLY EQUIVALENT TO [ insert name of generic here ]" in great big, bold type. Of course that would cut into pharma's profits, so it would never in a million years actually happen.
- MichaelGG 12y ago
  Except generics aren't guaranteed to be equivalent. Indian pharma companies have been incredibly corrupt, outright lying about their products: http://fortune.com/2013/05/15/dirty-medicine/ http://fortune.com/2013/05/15/dirty-medicine/ I'd be very hesitant about buying medicine from such companies. But I agree that if the regulators could assure quality, then yes, pointing out equivalence would help a lot of people.
  - mikeash 12y ago
    Are they any less guaranteed than the name brands?
    - MichaelGG 12y ago
      The Indian companies had s very hard time getting their EU and American employees to go along with this kind of stuff. From my personal experience in Central America and what I've heard from first person accounts of India and other places in the world, outright corruption and total disregard for safety or QA seems less likely to affect North/Western countries. I'm trying to phrase that politely, but yes, there seems to be much reason to trust the main name brands over those generic companies.
      - mikeash 12y ago
        Are the name brands never manufactured in India and similar places?
throw7 12y ago
I've been waiting for awhile to catch a cold so I can try a neti pot. My usual goto is zinc lozenges as soon as the cold hits/gargling with hot salt water/staying well hydrated/and resting.
- GFK_of_xmaspast 12y ago
  remember not to use water fresh out the tap.
- cortesoft 12y ago
  Try to do it first thing in the morning before you blow your nose. I have found that blowing my nose drives the mucus two directions... out my nose and up into my ears.... this prevents the neti pot from being able to properly clear out your nose, since it can't reach the mucus that has been driven up into your nose.
PaulHoule 12y ago
The most pernicious recent development is the widespread use of phenylephrine to replace pseudoephedrine. Neither personal nor clinical evidence support the effectiveness of phenylephrine, but it is very clear that phenylephrine causes a dramatic increase in blood pressure in many people. There are some pseudoephedrine products on the market which are supposed to be diversion-resistant for methamphetamine production but it seems if you stop people from making meth they will just order up some other sympathicomimetic amine from China.
- debacle 12y ago
  Just get yourself an ephedra plant and steep your own tea. Pseudoephedrine itself does bad things to some people.
  - iQuercus 12y ago
    Surely you jest. Let me skip the well regulated, well-tested, reliable, precisely dosed, quality controlled and impurities-removed, time-released (if you so desire), mass-market product in favor of a plant that I have to take care of, and cross my fingers when the time comes that it delivers what I need, without potentially dangerous impurities, in the proper dosage and assume that it will be safer? It would be like ripping out the perfectly functional seatbelt in my car and replacing it with a home-made duct-tape based mechanism for reduced side effects.
    - debacle 12y ago
      Ephedra is a meager little shrub that doesn't have a lot of needs and has been drank as a tea for thousands of years. Ephedrine is also much safer than pseudoephedrine with fewer side effects. I grow a lot of medicinal herbs and have never had to worry about dangerous impurities or quality control, except for the occasional spider web. I'm not a homeopathic nut, but certain things (mint, ephedra, thyme, sage, peppers) are easy to grow and provide tangible, scientifically confirmed benefits.
      - deleted 12y ago
BorisMelnik 12y ago
I would love to see this represented in an infographic or some sort of visual aid. The biggest racket in my opinion is the whole Tylenol / generic or ibuprofen / generic the prices can be ridiculously different. One thing about the pain relievers is the quality of the shell or coating you are getting. Some of the generics come broken up into tiny pieces while you won't see that with brand name meds.
edw519 12y ago
Good: Brand Better: Generic Best: Nothing "If takes about 1 week to get over a cold if you don't take medicine, but only 7 days to get over a cold if you take medicine."
- relaytheurgency 12y ago
  The medicine isn't supposed to improve your recovery time, it's supposed to lessen the ill effects of having the cold. Your comment doesn't make sense in that context at all. "It takes about 1 week to get over a cold if you don't take medicine. It still takes 1 week to get over a cold with medicine, but you'll feel much less hindered by the effects of the cold itself."
gmarx 12y ago
Agree in general but remember the case of Ranbaxy? FDA oversight is not uniform and becomes weak outside the US
VLM 12y ago
An interesting analogy of the situation which didn't make the article is a good analogy of the cold medicine racket would be, imagine if liquor stores were not able to legally sell components of mixed drinks. So a liquor store could only sell tens of thousands of different ready to drink products such as screwdrivers, old fashioneds, rum and cokes, mint juleps, but it was practically impossible if not illegal to buy plain old vodka in a bottle. And for marketing and trademark reasons you had to study the fine print to figure out what is in each bottle. So you can't buy a bottle of ready to drink screwdriver, you have to look in the fine print for "Slammer Canadian Lite Extra Dry Extreme" to figure out its a bottle of screwdriver. I'm not suggesting I want bulk generic powder guafenisien but life would be a lot simpler if it was more like the produce aisle, OK I got runny nose and cough so take one of pseudoephedrine and one of dextromethorphan and call it good, instead of the "confuseopoly" system we currently have, which I'm sure reduces everyone's quality of life while increasing profits.
- maxerickson 12y ago
  One of the points made in the article is that you can buy single drug generics and combine them as needed. So for your analogy, the liquor store would have to have a small shelf of mixers and giant coolers full of premixed stuff. But flavor is easier to deal with than medicine, so people won't put up with it, so liquor stores mostly sell ingredients.
JoblessWonder 12y ago
This reminds of of the time I sat the cold/flu aisle looking at cough medicine for so long... Through the haze of my head-cold I finally figured out that there were three different products by the same company that had the exact same dose method, dose size, and active ingredients. The only difference was the name of the product and the price. *EDITED: Front: http://i.imgur.com/ZkcPiEY.jpg http://i.imgur.com/ZkcPiEY.jpg Back: http://i.imgur.com/gOj5uYK.jpg http://i.imgur.com/gOj5uYK.jpg
- mmohebbi 12y ago
  This is amazing- we hadn't noticed this! It feels like they are A/B testing different boxes. I particularly like the MLB logo in the corner of one of those boxes.
  - JoblessWonder 12y ago
    Yeah... That is probably be the case. But as someone who hadn't slept more than a few hours at a time due to my cold I was pretty sure I was losing my mind. If/when I go to the cold aisle this year I'll check and see if the packages are still there.
zaroth 12y ago
If I actually trusted the FDA to do their job properly maybe I could spend less time staring at brand names in the cold aisle. If we all trusted the FDA implicitly, then the next logical step could be to actually ban the entire concept of applying brand names to off-patent pharmaceuticals and rework the entire cold aisle into a patient-education + active ingredient grab bag. In such a world, phenylephrine is phenylephrine, guaifenesin is guaifenesin, and all shoppers would care about is the form factor and dosages. I've read on HN about exactly how many fucks the FDA gives these days when billion dollar pharma is forging test results while they knowingly pump crap generic meds with zero quality control out of their dirty factories. See, for example, https://news.ycombinator.com/item?id=8468099 https://news.ycombinator.com/item?id=8468099. So that leaves us with the flimsy fallback of hoping brands like Mucinex believe good QC is absolutely essential to maintaining their market position. TFA claims American consumers waste "tens of billions" on brand name pills. I'm sure this stat isn't just cold/flu meds, but probably including blockbusters like Lipitor vs generic as well. That's like a $10 billion tax because we can't fully trusted the quality and bio-equivalence reviews the FDA is tasked to enforce?! By comparison, the total FDA budget is $4.5 billion.
- zaroth 12y ago
  To give a specific example of where this works in practice, take buying a good piece of steak. While some chains try to brand their beef one way or another, all you really want to look for is "USDA Prime". The USDA... they really, really know how to grade a cut of beef. I trust them implicitly, when I see "USDA Prime" I know exactly what I'm going to get. Now imagine having that same level of trust in the FDA. "Guaifenesin 1200mg 24 Hour - FDA Prime" would be all I need to see, and I'm grabbing that bottle. Spend a cool $5 billion setting up that program for the Top 100 generics, and you save Americans, what, maybe about a trillion dollars over the next 30 years? Just like with beef, this isn't about controlling production, or subsidizing the factory, but simply establishing public trust in an inspection process.
jopython 12y ago
I use a netipot with lukewarm water and a pinch of salt to flush my sinus if I have any cold symptoms. I never had any real cold since 2007. Never took any cold medication.
kbutler 12y ago
Here's another racket: "decongestants" containing phenylephrine as the active ingredient (most U.S. over the counter decongestant products). "Phenylephrine was not significantly different from placebo in the primary end point, mean change in nasal congestion score at more than 6 hours (P = .56), whereas pseudoephedrine was significantly more effective than both placebo (P < .01) and phenylephrine (P = .01)" http://www.ncbi.nlm.nih.gov/pubmed/19230461 http://www.ncbi.nlm.nih.gov/pubmed/19230461
- hkarthik 12y ago
  yup, that data was very obviously suppressed to keep the DEA happy and prevent meth labs from easily obtaining large amounts of pseudo-ephedrine. Ask any seasonal allergy sufferer, we all look to find out where the 24 hour pharmacies are so we can get access to the "good stuff" when sinus trouble inexplicably hits and you need the behind the counter pseudo-ephedrine to get through it.
snarfy 12y ago
I learned all about this stuff from some pill popping raver kids. 300 brands and about 6 different ingredients. One of the ingredients only purpose is to make you vomit.

103 points by Thevet 12y ago

This is such a great example to highlight how information asymmetry and choice overload act to undermine markets. > The difference in price between brand names and generics accounts for tens of billions of dollars "wasted" every year by Americans in pharmacies, according to the economics researchers. > Consumer confusion, or misplaced trust, is compounded by the fact that a drug store is likely to have upwards of 300 cold-and-flu products > One myth is that "brand-name drugs are made in modern manufacturing facilities, and generics are often made in substandard facilities." But, the FDA counters with the reminder that it "won't permit drugs to be made in substandard facilities." Imagine how much consumers would overspend on branded medications if they couldn't count on the FDA as a backstop. EDIT: By "backstop" I mean the FDA's role in ensuring that generics are bioequivalent and meet manufacturing standards. Imagine how much more effective brand advertising would be if some of the choices on the shelf really were manufactured in a dirty factory in Mexico.

mmohebbi 12y ago
While the FDA does a fantastic job of reminding the population of the process it uses to ensure generics deliver the same experience, there is still a ton of waste in the system due to brand-name drugs being chosen over generics. Part of the problem is the massive marketing efforts by pharma trying to convince patients and doctors that their brand-name drug is better. For details see: http://www.iodine.com/blog/do-people-prefer-under-patent-drugs/ http://www.iodine.com/blog/do-people-prefer-under-patent-dru...
- deleted 12y ago
  [deleted]
- cwzwarich 12y ago
  Part of the problem is that the name brand drug is sometimes better than the generic, and one generic brand is sometimes better than another. I have experienced this as a patient.
  - abfan1127 12y ago
    as a study of one, how do you know it isn't the placebo effect?
    - silencio 12y ago
      Problematic generics seem to come up often about extended release formulations when hanging around ADHD communities. Judging from this latest one I remember, it takes a big push for the FDA to start looking into it and ask questions: http://www.fda.gov/Drugs/DrugSafety/ucm422568.htm http://www.fda.gov/Drugs/DrugSafety/ucm422568.htm As consumers, we don't really have much of a way to test for placebo effects or when generics are actually subpar other than complaining until someone listens... so... it's a bit of a chicken/egg problem.
      - abfan1127 12y ago
        I think that's my question, as an individual, you can't say that one is more effective than the other because, as an individual, you can't account for the placebo effect. Personally, if it works, it works, placebo or otherwise.
    - cwzwarich 12y ago
      If you search online, you can find isolated regulatory incidents, patient anecdotes, and even statements by doctors that they prefer patients not switching brands when something works for them. Beyond that, I'm not sure what is really known, or how you would go about studying this phenomenon in a scientific fashion. Even if it is a placebo, if two medications that are supposedly the same cause different effects on me, e.g. one has much more manageable side effects than the other, then why shouldn't I take the one that makes my life better?
      - abfan1127 12y ago
        I'm a strong believer in the placebo. If it works, then stay with it...
    - 12y ago
PhantomGremlin 12y ago
The FDA does try, but it's ineffective and totally overwhelmed. Here's a recent story[1]: In January, FDA inspectors paid a surprise visit to the facility in Toansa, in a rural area north of New Delhi, and found broken equipment, windows stuck open and flies “too numerous to count,” ... Workers ran quality tests over and over until they got the results they wanted Just google around and you will find many many many stories like this. It's been an ongoing problem with generics (mostly from India) for quite some time. I don't know if brand-name drugs are any better, probably many of the same ingredients are sourced from the same suppliers. But at least the brand-name drug has a reputation, i.e. a "brand name" to protect. Edit: Just wanted to add: RTFA I linked to. My one quote doesn't do the situation justice. The culture at some companies is IMO really really bad. [1] http://www.bloomberg.com/news/2014-03-06/flies-found-by-fda-threaten-indian-town-built-on-generics.html http://www.bloomberg.com/news/2014-03-06/flies-found-by-fda-...
- datasage 12y ago
  Stores like CVS and Walgreen's do have their store brand to be concerned about. So if brands do provide some guarantee of quality, buying from those stores is likely not worse than the branded products.
- zaroth 12y ago
  Agree with everything about your comment, except I wouldn't characterize the FDA as "overwhelmed". Read the expose 'Dirty Medicine' on Forbes and you might choose a different adjective. :-/
benbreen 12y ago
It is indeed an interesting example of information asymmetry. An economic historian at LSE who I know actually traces the origins of modern advertising to the rise of "brand-name" medicines. Back in the late 17th century, early newspapers started running early ads for proprietary drug recipes that cured things like plague and gout. These were the earliest products to be sold via mass media and to be "branded" using the name of the preparer. I.e. in a world where a consumer would simply go to "Shoe Street" to buy shoes, these early apothecaries pioneered the idea of using mass media to persuade consumers not to buy a generic gout cure, but instead to go specifically to, say, Mr. Merck's shop to buy "Merck's gout elixir" (I use that example because the Merck corporation actually does trace its origins to a late 17th century apothecary).
debacle 12y ago
> information asymmetry and choice overload In the industry, we call it "patient education."
- rwmj 12y ago
  Or "common sense". It's pretty easy, I just read the list of ingredients.
discostrings 12y ago
The information asymmetry and confusion factor are worst in that all these products have just a few ingredients, in my opinion. While the branded/generic price difference is an important issue, I think a larger one is that the huge volume of products takes attention away from the fact that there are only a few basic components, leading many to buy inappropriate products or products with too many components that can cause side effects that could easily be avoided. People without some prior knowledge of the basic drugs must have a very difficult time walking into a store and choosing the product with the drugs they need without some of the ones they don't. I imagine many people are totally overwhelmed by the product selection and they just pick something, which they then turn to each time they're feeling sick. It's more difficult than normal to perform an assessment of products at the store when you're sick, and the store presentation only makes things more difficult. Even knowing something about these products and knowing exactly what I want, I sometimes find it time-consuming to locate the single-ingredient products among all the endless combinations, especially when they're out of stock. Things would be so much simpler if stores posted some type of reference. I'm not an expert in the field, but it's such a pet peeve of mine that I've memorized the basics. Here's a start: Fever/pain -> Relieve: ibuprofin acetaminophen [avoid if you have liver problems] naproxen aspirin Nasal congestion -> Reduce: pseudoephedrine [quite effective, but the pharmacy must be open; prepare to provide identification, sign, possibly be questioned / receive a dirty look, and have your purchase be entered into a federal database] phenelyphrine [of questionable effectiveness] Coughs -> Make more productive at clearing congestion: guaifenesin Coughs -> Suppress: dextromethorphan Trouble sleeping / allergic sensitivity -> Relieve: doxylamine [slightly better for sleeping than allergies] diphenhydramine [slightly better for allergies than sleeping] The store could have a nice section of the products that contain just one of these drugs, making it easy to mix and match, with reference to the list. I don't think there's anything inherently wrong with the combination products, but it really seems their general effect confuses rather than clarifies, which seems to me to be part of the reason for the design and proliferation. The author of this piece seems to have similar feelings: > ...I can't see myself using it, because I usually keep generic single-drug products around. A family, or a sickness-inclined person living alone, could very reasonably keep the five aforementioned individual generic medications in their medicine cabinet and address the symptoms as they arise. I think that's easier than messing with combination products, and usually cheaper. Especially if you consider that you're not taking medications you don't need. > I tried to convince Angelotti that's the way to go, but she was adamant that many or even most people really like to take one pill that addresses all of their symptoms. "I don't know if people will be likely to have their own inventory of generic over-the-counter medications in their homes," she said. I think a simple list like this, preferably easily visible in the store, and some better organization in stores would do people a much greater service than the app the article discusses.

mmohebbi 12y ago

"The idea is to help everyone find exactly the right cold medication." http://www.iodine.com/cold-and-flu http://www.iodine.com/cold-and-flu I work at Iodine (our Cold and Flu tool is featured in this article) and we're watching this thread. Feel free to ask medication related questions of our clinical team or technical questions of our engineering team.

stupandaus 12y ago
What's the medical consensus on Cold-EEZE?
- amandalotti 12y ago
  Hey, I'm an MD at Iodine. Basically, zinc works. A Cochrane meta-analysis from 2013 showed that zinc lozenges reduce the severity and duration of common cold symptoms. It’s the closest thing we have yet to a cure for the common cold. Get the lozenges in particular (other forms don’t seem to work as well), and take ‘em on a full stomach or you can get really nauseated. http://summaries.cochrane.org/CD001364/ARI_zinc-for-the-common-cold http://summaries.cochrane.org/CD001364/ARI_zinc-for-the-comm...
  - benjohnson 12y ago
    You advice on the lozenges seems really good as there seems to be a problem with Zinc in the nasal passages blunting the ability to smell. http://www.webmd.com/cold-and-flu/news/20100719/study-links-zinc-nose-sprays-loss-smell http://www.webmd.com/cold-and-flu/news/20100719/study-links-...
    - makmanalp 12y ago
      I'm actually curious about this too - I've had pretty great success with zinc lozenges, but was off-put by this. Although the study is for some very specific intranasal products from a specific brand, I think. edit: Link to original study: http://archotol.jamanetwork.com/article.aspx?articleid=496489 http://archotol.jamanetwork.com/article.aspx?articleid=49648... It talks about "homeopathic zinc gluconate gel" and some patients reported a burning sensation while applying it.

ToastyMallows 12y ago

This reads like a big ad for Iodine.com

mmohebbi 12y ago
Well, we are trying to counter all the pharma ads! But really, we hear from users all the time that they get confused in the cold and flu section of the pharmacy. We hope to help address this problem.
AnodyneComplex 12y ago
I thought the author actually had a pretty skeptical take on things. The ending quote is pretty hilarious: "It's a press release, Mary. The iodine algorithm saved your husband from the brink of ruin. His newfound sense of consumer empowerment was so invigorating to his spirit that he no longer needed any Mucinex at all."

Detrus 12y ago

I think the real racket is that people are taking medications to suppress cold symptoms in the first place. A healthy adult should be out no more than a week from a strong cold/flu. That wouldn't be a big deal except people get so little time off from work they don't want to waste it on a cold. Wether they spend $10 on symptom suppressors or $50 is besides the point. Taking medications for what your body should be capable of handling with proper nutrition and rest cannot be healthy.

benjohnson 12y ago
>>Taking medications for what your body should be capable of handling with proper nutrition and rest cannot be healthy. Could you explain a bit more as I can think of a case where this seems to be false: While my child's body can eventually handle colds and flus, if his temperature goes above a certain level there's a significant chance for brain-damage, so I counteract the bodies natural fever with medication.
- ceejayoz 12y ago
  It should be noted that a low fever appears to be helpful for the immune response. http://www.nbcnews.com/health/health-news/sick-feverish-suffer-through-it-get-well-faster-docs-say-f1C6436878 http://www.nbcnews.com/health/health-news/sick-feverish-suff... If you're running a 101 degree fever, it may be more effective not to suppress it.
  - amandalotti 12y ago
    yeah i wrote a pretty comprehensive blog post about this - ie when it's better NOT to treat a fever http://www.iodine.com/blog/should-you-treat-a-fever/ http://www.iodine.com/blog/should-you-treat-a-fever/
- Detrus 12y ago
  I did say healthy adults. Not that most adults are healthy.
- evilduck 12y ago

MiguelVieira 12y ago

But branding does have an impact on the effectiveness of some over-the-counter medicines (because of the placebo effect): >The effect of branding--that is, the labelling and marketing--of a well-known proprietary analgesic used to treat headaches was studied in a sample of women given a branded or unbranded form with either an inert or an active formulation....The findings showed that branded tablets were overall significantly more effective than unbranded tablets in relieving headaches. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1505530/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1505530/

smacktoward 12y ago

I wonder how much of that wasted money could be saved by taking an approach with brand-name drugs similar to the one taken with cigarette packages: require them to carry a big-ass label. Something to the effect of "THIS PRODUCT IS MEDICALLY EQUIVALENT TO [ insert name of generic here ]" in great big, bold type. Of course that would cut into pharma's profits, so it would never in a million years actually happen.

MichaelGG 12y ago
Except generics aren't guaranteed to be equivalent. Indian pharma companies have been incredibly corrupt, outright lying about their products: http://fortune.com/2013/05/15/dirty-medicine/ http://fortune.com/2013/05/15/dirty-medicine/ I'd be very hesitant about buying medicine from such companies. But I agree that if the regulators could assure quality, then yes, pointing out equivalence would help a lot of people.
- mikeash 12y ago
  Are they any less guaranteed than the name brands?
  - MichaelGG 12y ago
    The Indian companies had s very hard time getting their EU and American employees to go along with this kind of stuff. From my personal experience in Central America and what I've heard from first person accounts of India and other places in the world, outright corruption and total disregard for safety or QA seems less likely to affect North/Western countries. I'm trying to phrase that politely, but yes, there seems to be much reason to trust the main name brands over those generic companies.
    - mikeash 12y ago
      Are the name brands never manufactured in India and similar places?

throw7 12y ago

I've been waiting for awhile to catch a cold so I can try a neti pot. My usual goto is zinc lozenges as soon as the cold hits/gargling with hot salt water/staying well hydrated/and resting.

GFK_of_xmaspast 12y ago
remember not to use water fresh out the tap.
cortesoft 12y ago
Try to do it first thing in the morning before you blow your nose. I have found that blowing my nose drives the mucus two directions... out my nose and up into my ears.... this prevents the neti pot from being able to properly clear out your nose, since it can't reach the mucus that has been driven up into your nose.

PaulHoule 12y ago

The most pernicious recent development is the widespread use of phenylephrine to replace pseudoephedrine. Neither personal nor clinical evidence support the effectiveness of phenylephrine, but it is very clear that phenylephrine causes a dramatic increase in blood pressure in many people. There are some pseudoephedrine products on the market which are supposed to be diversion-resistant for methamphetamine production but it seems if you stop people from making meth they will just order up some other sympathicomimetic amine from China.

debacle 12y ago
Just get yourself an ephedra plant and steep your own tea. Pseudoephedrine itself does bad things to some people.
- iQuercus 12y ago
  Surely you jest. Let me skip the well regulated, well-tested, reliable, precisely dosed, quality controlled and impurities-removed, time-released (if you so desire), mass-market product in favor of a plant that I have to take care of, and cross my fingers when the time comes that it delivers what I need, without potentially dangerous impurities, in the proper dosage and assume that it will be safer? It would be like ripping out the perfectly functional seatbelt in my car and replacing it with a home-made duct-tape based mechanism for reduced side effects.
  - debacle 12y ago
    Ephedra is a meager little shrub that doesn't have a lot of needs and has been drank as a tea for thousands of years. Ephedrine is also much safer than pseudoephedrine with fewer side effects. I grow a lot of medicinal herbs and have never had to worry about dangerous impurities or quality control, except for the occasional spider web. I'm not a homeopathic nut, but certain things (mint, ephedra, thyme, sage, peppers) are easy to grow and provide tangible, scientifically confirmed benefits.
    - deleted 12y ago

BorisMelnik 12y ago

I would love to see this represented in an infographic or some sort of visual aid. The biggest racket in my opinion is the whole Tylenol / generic or ibuprofen / generic the prices can be ridiculously different. One thing about the pain relievers is the quality of the shell or coating you are getting. Some of the generics come broken up into tiny pieces while you won't see that with brand name meds.

edw519 12y ago

Good: Brand Better: Generic Best: Nothing "If takes about 1 week to get over a cold if you don't take medicine, but only 7 days to get over a cold if you take medicine."

relaytheurgency 12y ago
The medicine isn't supposed to improve your recovery time, it's supposed to lessen the ill effects of having the cold. Your comment doesn't make sense in that context at all. "It takes about 1 week to get over a cold if you don't take medicine. It still takes 1 week to get over a cold with medicine, but you'll feel much less hindered by the effects of the cold itself."

gmarx 12y ago

Agree in general but remember the case of Ranbaxy? FDA oversight is not uniform and becomes weak outside the US

VLM 12y ago

An interesting analogy of the situation which didn't make the article is a good analogy of the cold medicine racket would be, imagine if liquor stores were not able to legally sell components of mixed drinks. So a liquor store could only sell tens of thousands of different ready to drink products such as screwdrivers, old fashioneds, rum and cokes, mint juleps, but it was practically impossible if not illegal to buy plain old vodka in a bottle. And for marketing and trademark reasons you had to study the fine print to figure out what is in each bottle. So you can't buy a bottle of ready to drink screwdriver, you have to look in the fine print for "Slammer Canadian Lite Extra Dry Extreme" to figure out its a bottle of screwdriver. I'm not suggesting I want bulk generic powder guafenisien but life would be a lot simpler if it was more like the produce aisle, OK I got runny nose and cough so take one of pseudoephedrine and one of dextromethorphan and call it good, instead of the "confuseopoly" system we currently have, which I'm sure reduces everyone's quality of life while increasing profits.

maxerickson 12y ago
One of the points made in the article is that you can buy single drug generics and combine them as needed. So for your analogy, the liquor store would have to have a small shelf of mixers and giant coolers full of premixed stuff. But flavor is easier to deal with than medicine, so people won't put up with it, so liquor stores mostly sell ingredients.

JoblessWonder 12y ago

This reminds of of the time I sat the cold/flu aisle looking at cough medicine for so long... Through the haze of my head-cold I finally figured out that there were three different products by the same company that had the exact same dose method, dose size, and active ingredients. The only difference was the name of the product and the price. *EDITED: Front: http://i.imgur.com/ZkcPiEY.jpg http://i.imgur.com/ZkcPiEY.jpg Back: http://i.imgur.com/gOj5uYK.jpg http://i.imgur.com/gOj5uYK.jpg

mmohebbi 12y ago
This is amazing- we hadn't noticed this! It feels like they are A/B testing different boxes. I particularly like the MLB logo in the corner of one of those boxes.
- JoblessWonder 12y ago
  Yeah... That is probably be the case. But as someone who hadn't slept more than a few hours at a time due to my cold I was pretty sure I was losing my mind. If/when I go to the cold aisle this year I'll check and see if the packages are still there.

zaroth 12y ago

If I actually trusted the FDA to do their job properly maybe I could spend less time staring at brand names in the cold aisle. If we all trusted the FDA implicitly, then the next logical step could be to actually ban the entire concept of applying brand names to off-patent pharmaceuticals and rework the entire cold aisle into a patient-education + active ingredient grab bag. In such a world, phenylephrine is phenylephrine, guaifenesin is guaifenesin, and all shoppers would care about is the form factor and dosages. I've read on HN about exactly how many fucks the FDA gives these days when billion dollar pharma is forging test results while they knowingly pump crap generic meds with zero quality control out of their dirty factories. See, for example, https://news.ycombinator.com/item?id=8468099 https://news.ycombinator.com/item?id=8468099. So that leaves us with the flimsy fallback of hoping brands like Mucinex believe good QC is absolutely essential to maintaining their market position. TFA claims American consumers waste "tens of billions" on brand name pills. I'm sure this stat isn't just cold/flu meds, but probably including blockbusters like Lipitor vs generic as well. That's like a $10 billion tax because we can't fully trusted the quality and bio-equivalence reviews the FDA is tasked to enforce?! By comparison, the total FDA budget is $4.5 billion.

zaroth 12y ago
To give a specific example of where this works in practice, take buying a good piece of steak. While some chains try to brand their beef one way or another, all you really want to look for is "USDA Prime". The USDA... they really, really know how to grade a cut of beef. I trust them implicitly, when I see "USDA Prime" I know exactly what I'm going to get. Now imagine having that same level of trust in the FDA. "Guaifenesin 1200mg 24 Hour - FDA Prime" would be all I need to see, and I'm grabbing that bottle. Spend a cool $5 billion setting up that program for the Top 100 generics, and you save Americans, what, maybe about a trillion dollars over the next 30 years? Just like with beef, this isn't about controlling production, or subsidizing the factory, but simply establishing public trust in an inspection process.

jopython 12y ago

I use a netipot with lukewarm water and a pinch of salt to flush my sinus if I have any cold symptoms. I never had any real cold since 2007. Never took any cold medication.

kbutler 12y ago

Here's another racket: "decongestants" containing phenylephrine as the active ingredient (most U.S. over the counter decongestant products). "Phenylephrine was not significantly different from placebo in the primary end point, mean change in nasal congestion score at more than 6 hours (P = .56), whereas pseudoephedrine was significantly more effective than both placebo (P < .01) and phenylephrine (P = .01)" http://www.ncbi.nlm.nih.gov/pubmed/19230461 http://www.ncbi.nlm.nih.gov/pubmed/19230461

hkarthik 12y ago
yup, that data was very obviously suppressed to keep the DEA happy and prevent meth labs from easily obtaining large amounts of pseudo-ephedrine. Ask any seasonal allergy sufferer, we all look to find out where the 24 hour pharmacies are so we can get access to the "good stuff" when sinus trouble inexplicably hits and you need the behind the counter pseudo-ephedrine to get through it.

snarfy 12y ago

I learned all about this stuff from some pill popping raver kids. 300 brands and about 6 different ingredients. One of the ingredients only purpose is to make you vomit.