Smoke & Mirror Marketing (& Other Clever Big Pharma Tricks)

The pharmaceutical industry engages in many clever tactics to sell Americans its overpriced "new" drugs.

One of the most outrageous is what we call "smoke and mirror marketing." Here’s how it works: Pharmaceutical companies market a "new" patent-protected brand-name drug that is chemically identical to an older generic drug that they replaced. The "new" drug does not work any better and it is no safer than the generic drug it replaces. This scheme is so successful, in fact, that a number of these drugs are among the most frequently prescribed in the U.S. and account for billions of dollars in sales.

In 2003, we informed our readers of this practice and provided a list of drugs that were nothing more than mirror images of older, less expensive drugs (see Table 1). In this article, we revisit the 2003 list and introduce a category of products that are actually old drugs that have been broken down, or metabolized, by the liver to what are technically new patent-protected products.

Selling isomers

Many drugs are 50:50 mixtures of a chemically identical compound that are mirror images of each other. All of the atoms in the drug molecule are the same, only their spatial orientation is different.

An isomer is a molecule containing identical atoms to another molecule, but arranged differently: a mirror image, to be precise. Consider two isomers of a certain molecule to be like a pair of gloves — same number of fingers, just arranged differently.

Separating one of the mirror images that comprise an old drug and selling it as a "new" drug has been a successful business model for pharmaceutical companies, not a strategy to improve public health, because isomers do not work better or produce fewer side effects than the original molecules.

A quick look at the profits of the six isomers we discussed in 2003 proves this point. In particular, the maker of heartburn drug esomeprazole (NEXIUM) has been a big winner. This isomer of omeprazole (PRILOSEC) ranked No. 2 in both the lists of the most frequently prescribed drugs and in sales in 2008.

The weight-loss drug dexfenfluramine (REDUX) was pulled from the market in 1997 for safety reasons. Dexmethylphenidate (FOCALIN, FOCALIN XR), escitalopram (LEXAPRO), levalbuterol (XOPENEX, XOPENEX HFA) and levofloxacin (LEVAQUIN) remain in the Top 200 list of most frequently prescribed drugs in 2008 and together accounted for more than $4.8 billion in sales in the United States.

Since our 2003 article on smoke and mirrors drugs, two new isomers have been marketed as "new" drugs (see Table 1).

Takeda Pharmaceuticals has begun marketing the heartburn drug dexlansoprazole (KAPIDEX — soon to be renamed DEXILANT) in 2009 to replace lansoprazole (PREVACID), which will lose its patent protection soon. Lansoprazole was worth more than $3.3 billion in U.S. sales in 2008. To protect this sizable amount of money, the company will convince physicians and patients that dexlansoprazole is better than lansoprazole in protecting against heartburn.

The antihistamine levocetirizine (XYZAL) was ranked No. 141 on the top 200 list in 2008, and its counterpart cetirizine (ZYRTEC) was No. 168 for that year. Levocetirizine is the left-handed part of the left-right combination drug cetirizine, and there is no evidence that levocetrizine has different effectiveness than cetirizine.

Selling active metabolites

The drugs listed in Table 2 could be called do-it-yourself "new" drugs, because they are actually just a partially metabolized product of an older drug.

For example, when you take the antihistamine loratadine (CLARITIN), your liver turns it into desloratadine (CLARINEX). Similarly, when you take the antidepressant desvenlafaxine (PRISTIQ), your body produces venlafaxine (EFFEXOR, EFFEXOR XR), and when you take the antipsychotic paliperidone (INVEGA), your body produces risperidone (RISPERDAL).

What You Can Do

If you are prescribed one of the "new" drugs listed here, you may be able to save some money at the pharmacy by asking your health care provider to prescribe its corresponding older, now generic version instead.

Table 1. Optical Isomers Sold As New Drugs

* Do Not Use on WorstPills.org
** Limited Use on WorstPills.org

Table 2. Active Metabolites Sold As New Drugs

* Do Not Use on WorstPills.org
** Limited Use on WorstPills.org
*** Do Not Use Until Seven Years After Approval on WorstPills.org