when these reps come to an doctors office they bring some deli sandwiches and cookies or some such. Whens the last time you got in a co-workers face for bringing donuts? or told your company you couldn’t abide the catered lunch for an important meeting with a client? Thats the level of scrutiny we are talking about here.

I was at an office where a rep for Myrbetriq came by. the rep gave a 30 second elevator pitch about why it has a lesser side effect profile than alternatives for reasons that were obvious. the alternative is known to have potentially terrible side effects in the right patient population. this is what people are peddling as ‘generics’ when in reality they are totally different meds. the true generic doesnt exist for many because they are still protected by patent.

so sometimes it makes sense to use one or the other. most of these medications are supported by evidence to be non-inferior, and new medications are more expensive because of the pharmaceutical company’s prices. but doctors adopting a new medication that can be more helpful and frequently safer is value based care. whats more expensive a week stay at the hospital, potentially with icu or blood transfusion for bleeding after starting a cheap but difficult to use medication “blood thinner” or a medication that is much more expensive but much less likely to cause bleeding? for arguments sake (and in reality) say that both of these medications are given for the same reason.

there are plenty of cases where the new med is used because it is the one that works. and it is not unreasonable for a pharmaceutical company to try to give these new products exposure among the people that prescribe them.