Monthly Archives: October 2017

Drug Pushers in Nursing Homes

This report out from CNN

http://www.cnn.com/2017/10/12/health/nuedexta-nursing-homes-invs/index.html

It’s a long story but sadly a repetitive one.  It has all the elements of a modern pharmaceutical success story (if you are a investor).

  1. Find some old generic drugs lying on the shelf not being used too much anymore
  2. Combine 2 of them into a “New” drug
  3. Find a rare “disease” to treat
  4. Fund a small study showing it sort of works, possibly, maybe.
  5. Hire a bunch of good looking sales reps to court doctors into pushing the drug
  6. Have the doctors overdiagnose the aforementioned rare disease
  7. Hire the doctors and pharmacists to give talks about how you can prescribe this “new” medicine for all kinds of “off label” problems too
  8. Sell your small company to a mega company for billions
  9. Quit before the FDA and News media catch on to  your scam

 

This particular version involved an old, almost never used, cardiac drug called quinidine and a cough suppressant called dextromethorphan.  Quinidine was a crappy heart drug that we used years ago when we didn’t have anything better.  It was supposed to stop heart arrhythmias but often made things worse and had a lot of interactions with other drugs.  Dextromethorphan is the right handed molecules of an opioid type molecule that really doesn’t work that great for coughing anyway but does have a nice sedative effect.  That’s probably why Nuedexta “works.”  It’s probably just a sedative!

The rare disease they decided to push is REALLY rare.  I’ve NEVER seen a case and I’ve been doing this for 25 years!  Pseudobulbar affect even sounds fishy!  Maybe a “pseudo” disease?  The company states there are 1.8 million patients.  I find that hard to fathom. OK maybe there are a few real cases but not enough to warrant medicare spending tons of cash ($9,198/yr) on a barely palpable effect other than sedation.

Moral of the story is if your friend/relative is in a nursing home and you want to be their advocate, get a real doctor that you trust to look over the med list and get out the pharmacologic pruners.  Just because a wandering, company funded psychiatrist is trolling the halls with a prescription pad and a kickback scheme doesn’t mean you have to take it.