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Comment by MBCook | Hacker News Reader

Nothing. But why prescribe the generic Lowpainex when the new Nopainatall is proven to be 0.5% more effective? Plus the Nopainatall guy gave you some pens and pads and toothbrushes, and there are ads on every night telling people to talk to their doctor about the newest breakthrough that leaves old drugs behind.

Your patients don't want the old drug, do they? They don't want some pain, they want none.

Of course, Nopainatall is just Lowpainex combined with Tylenol... but that's inconvenient to take separately.

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They don't just hand out pens and pads. They pay for vacations thinly disguised as business trips, they pay for equipment, whatever it takes. One company selling generics paid doctors 5% of the cost of each prescription, they just send them a check. The latter was just ruled legal by the highest regular German court, basically saying that it's corruption, but there's no law in the books that forbids this particular kind of corruption.

I can't imagine these things are hugely different in the land of the free.

similar. my mom is a physical therapist and her building also has some doctors. a few years ago her employer/state laws banned accepting gifts (like lunch, pens, and pads of paper, &c.) from drug reps, but I still have a massive box of clicky pens with weird drug names on them from before the ban a few years ago.

My mom has a strict no-gifts-from-reps policy-- she won't even take a card, as far as I know. There's been one exception to this: At one point, a rep found out it was her birthday, and delivered a huge cake. To the unit.

Of course, she wanted to refuse it-- but after they walked it all the way down the wing, how could she tell her staff that they weren't actually getting any cake?

They are scumbags, for sure.

> ads on every night telling people to talk to their doctor

One wonders how many doctor-hours per year are spent by the consumers/patients initiating such conversations.

Don't most insurers these days require you to take the generic if one is available? So it shouldn't really matter whether the doctor prescribes the brand name or the generic. Or does that generic-if-possible rule not work here because the brand name one is ever so slightly different?

Thats exactly the point, if the drug is covered under patent there is no generic. So if the doctor prescribes the newer yet not better drug, there will be no generic alternative.

Yes, the new drug is different, so there is no generic for it.

Another class of "patent extender" is to take two existing good drugs, package them together, and then trial and sell it as a new drug. The combined product is not the same as the two off-patent generic parent drugs.

I'd love to see an example of this. I'm not saying I don't believe you but I'd really like to see an example and then look to see what Kaiser (a medical insurer and provider here in CA for the non-CA and a few other state folks) does since I don't think they would go for that.

Caduet (new) = Lipitor (off-patent in 2011) + Norvasc (patent protection ended 2007 after a suit). Zocor (2006) + Zetia = Vytorin.

There are hundreds of examples -- this is a totally standard patent expiration strategy in medicine. This whole area is called "ever-greening".

The weirdest one is getting an existing drug approved for a new use. This can be used to extend patent protection.

Here's another example (I think): http://en.wikipedia.org/wiki/Desloratadine an antihistamine used to treat allergies.

In Germany, 100 pills desloratadine are about 50 EUR. 100 pills loratadine are 10 EUR.

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