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Thursday, July 22, 2004

Ban Me-Too Pills? Ban Me-Too Chocolate?

A commenter from Western Mass. charges that I''m being unfair to "public interest types" when I "say that they do not criticize the marketing of casinos or candy. These are both important public health campaigns." He also says that there's a much better case for a paternalistic policy towards pharmaceuticals, because consumers, not being medical experts, aren't in a good position to judge which drugs are best.

Obviously there's something to these points, but I don't think they're as important as the commenter does. As to campaigns against candy and casinos, sure they exist, but the general criticism is that these things are harmful in excess. Some activists (including me) would like to see fewer casinos, keep candy machines out of school, and generally make them less available.

The critics of me-too drugs are making a far more radical case. They admit me-too drugs are beneficial, but they still want to ban them, unless there's strong proof that they're better than the old drugs. Nobody says that we have too many types of similar chocolate bars, and no more should be allowed unless they are proven to be more delicious. Nobody says that Las Vegas should ban "me-too" casinos, to save on construction expense.

The commentator would answer, I think, that consumers are perfectly capable of judging chocolate bars, but not blood-thinning pills. Instead, by allowing too many similar blood-thinning pills on the market, we're just allowing drug company marketers to overcharge for something that's no better. As I argued in a previous post, I think that more competition drives prices down, even in health care, not up.

I also don't believe that me-too drugs are exactly identical. Given that a doctor tells me I need a blood-thinner, I might very well be able to determine which one works best for me. The pills might have different side effects, and I can perfectly well judge that one pill makes me nausous, and another doesn't. I also think that people's reaction to medicine are diverse: some people might respond better to one me-too pill than another. I don't know if there's any evidence for this, though I suspect that determining who is likely to respond better to which drug is a very difficult and expensive question to answer. Those who would ban me-too pills seem to think that we're sure that the additional atom in the molecule doesn't make any difference, and I don't believe that we're sure at all.


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