Pharmaceutical companies spend huge amounts of money on direct to consumer advertising for their new, expensive brand name products. That spending does not benefit you. It benefits stockholders and executives. The ads promote medications that don’t work as well as proven, inexpensive generic medications that we have decades of experience with. Let’s look at a specific example.
Farxiga (dapagliflozin) is a drug for type 2 diabetes. The ads promote the drug for better kidney protection in diabetes and indeed, it does that. There was about a 40% reduction in the decline of kidney function in patients with type 2 diabetes and chronic kidney disease. Medications of this type produce kidney protection whether the patient is diabetic or not because they activate a master genetic survival switch that protects all cells and organs. Farxiga is a very good medication but the cash price is $605 a month.
Increasing drug prices are part of the reason that medical care consumes 20% of all spending in this country. In Singapore, that number is 5%. “The U.S. pays the highest prices for drugs in the world, and we put more of our health care costs toward prescription drugs than any other country. Seventeen percent of total national healthcare spending goes for prescription drugs. Analysts who advise Congress expect the share to rise over the next ten years, because drug costs are expected to outpace those of all other services like doctor visits and hospital care.”
This is a great example of how our health system is irrational. If you have type 2 diabetes, the question is not which single drug provides the best protection. It is which combination of treatments for sugar, pressure and cholesterol protect you from the heart attacks, strokes, and chronic kidney disease that cause death and disability in patients with diabetes. Drugs in the same class as Farxiga lower the risk of chronic kidney disease progression by 37% for $640 dollars a month.
Using generic medications for sugar, pressure and cholesterol reduces progression to dialysis six-fold. That’s right. Six times as many people go on dialysis if they get the care that most people receive compared with a combination of lisinopril for hypertension, atorvastatin for cholesterol, metformin for diabetes, aspirin to prevent clot formation and not smoking. That is the best practice medical treatment for type 2 diabetes. Clinicians call it optimal medical therapy (OMT). Like Farxiga, these medications activate the master metabolic survival switch (AMPK) to protect all cells and organs. The drug costs for that entire protocol is somewhere between thirty and forty dollars. That means that the combination of drugs is 16 times more effective than Farxiga alone. Farxiga is 16 times as expensive as that generic combination. The proper test for Farxiga would be to test its benefit when added to OMT. My bet is that it would not add much. That said, if OMT plus carbohydrate restriction and exercise don’t adequately control the blood sugar, then a drug from the same class as Farxiga is the next step on our protocol.
That is why you can’t afford healthcare anymore. You can’t get reliable health information from sources that accept medical advertising. I accept no advertising on this site so that there are no conflicts of interest. Hopefully some of you will decide to move to a paid subscription to support unbiased information that you can count on.
This post provides important information. I also worry about Doctor's receiving kickbacks for prescribing certain drugs. Is that a valid concern?