Pharmacy benefit brainstorm: Ultragenerics

The financial meltdown, recession, and growth in health care costs are a triple whammy, even for those with good insurance. As recently reported, mainstream patients are seeking out pharmaceutical company Patient Assistance Programs intended for the poor. Even generic drugs can be pricey if you have a lot of them.

But I think I have a solution: the Ultrageneric formulary. This plan would feature efficacious products with very favorable side effect profiles and ultra-low costs. There should be strong acceptance from physicians because they are already happily prescribing these products.

What’s the secret? My formulary would consist entirely of placebos. As the New York Times reports (Half of Doctors Routinely Prescribe Placebos):

Half of all American doctors responding to a nationwide survey say they regularly prescribe placebos to patients…

In response to three questions included as part of the larger survey, about half reported recommending placebos regularly. Surveys in Denmark, Israel, Britain, Sweden and New Zealand have found similar results.

The most common placebos the American doctors reported using were headache pills and vitamins, but a significant number also reported prescribing antibiotics and sedatives. Although these drugs, contrary to the usual definition of placebos, are not inert, doctors reported using them for their effect on patients’ psyches, not their bodies.

In most cases, doctors who recommended placebos described them to patients as “a medicine not typically used for your condition but might benefit you,” the survey found. Only 5 percent described the treatment to patients as “a placebo.”

I expect this new plan to be a smashing success.

October 24, 2008

2 thoughts on “Pharmacy benefit brainstorm: Ultragenerics”

  1. The study used a very expansive definition of placebo. Under this definition, advising use of bandaids or hot or cold packs would be classified as a placebo since these treatments don’t really do any good and are primarily a way of getting the patient to feel that something was done. One of the most consistent forms of feedback that doctors get from patients is “give me a plan” and in response doctors will give them something to do, even if there is nothing that would actually help.

  2. David – Interesting post. But when I first read you comment about “efficacious products with very favorable side effect profiles and ultra-low costs,” I thought – he must be talking about over the counter medicines. However, I must agree with the above comment, that the study’s definition of placebo is very broad. I wrote about the use of placebos in clinical trials and the practice of medicine last May (see and referred to an article in the Family Practice Journal that listed five criteria for when it is OK for clinicians to use a placebo with a patient. They are:

    1. There is a well-established, durable physician-patient relationship
    2. There is a concrete diagnosis that does not mandate or support the use of other “active” interventions
    3. The patient specifically requests that the physician provide some form of intervention
    4. The use of such agents is a consideration of last resort
    5. The use of such agents does not substitute for, or interfere with, diagnostic and therapeutic diligence

    Certainly antibiotics and some of the other types of medicines included in the study would be unlikely to meet all five of these criteria.

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