By Abby Van Voorhees, MD, May 01, 2015
Part of the art of keeping one's cool when in battle is realizing that victory is not always inevitable. I recently read a biography about Stonewall Jackson; it was quite striking that he understood this paradigm well. Some battles went for the Union, while others for the Confederacy, but it seems that he kept his cool regardless. It is said that his great talent was the ability to respond on the fly in the midst of what must have been quite a confusing landscape. While I personally believe that our country is much the better for the northern success, I think that we can learn much from Jackson about handling pressure under fire.
Many of us see ourselves in a battle against the escalating costs of generic meds. Normally I don’t think much about my age, but I feel a bit old when I remember the cost of generics when I finished my training. Doxycycline at six cents a pill was affordable for almost everyone and tetracycline was even cheaper. Treating acne was not an expensive undertaking. Not so today. As our feature on this topic explains these same pills, without further research and discovery, have increased anywhere from 7000-18,000 percent! I feel a bit like my grandmother who used to tell me how during the depression a cup of soup cost five cents. I’m sure your patients are complaining just like mine. Read our piece to understand the possible causes: material shortages and consolidation of the pharmaceutical industry leading to fewer companies making generics are on the table. It is mysterious to me that some generics have remained inexpensive...why is clobetasol more expensive than betamethasone diproprionate, for example? As a consequence of these costs the number of generics that I use is growing smaller and smaller. Like Jackson, I think we need to figure out how to respond to this issue and documenting what we are all seeing is a good start. We should be sending Adam Rubin’s AAD Regulatory Policy Committee our examples and telling them of our ire.
Some of our battles have become unqualified successes. If you want to feel good, then read the piece on sunscreens. We’re finally seeing the FDA speeding up the review process which we hope will grant us access to better sunscreen products. It will be nice to not have to mention to my patients traveling to Canada for a summer holiday that it might be worth their while to pick up sunscreen as part of their souvenirs! This battle to get the newer sunscreen ingredients approved in this country has been long fought and, therefore, the fruit of this labor is especially sweet. I, for one, can’t wait to see some new sunscreen ingredients hit the market.
So while one battle on sunscreen ingredients starts to wind down, the next on costs of generics winds up. This, like many of our issues, is best not fought alone. Happily we are not the only prescribers of the tetracycline family of meds...they can be helpful for MRSA infections amongst other things. Stonewall Jackson ultimately was killed by friendly fire. Let’s not make that the model for our fight. Let’s hope that all of us in the house of medicine are on the same side on this one.
Enjoy your reading.