Research:Article #1

What is a Brand Name Drug and what is a Generic Drug?

Why Brand Name Drugs?
   While FDA is right in approving the pharmacological effects of the generic drugs to the brand name drugs, clinicians in all medical specialties are well aware of the manner in which patients react to the changes in these drugs.  One recent example was the change of Keppra to generic Levitracetam, Depakote to Valproic acid, or Lamictal to Lamotrogine. These drugs are commonly used by Epilepsy patients.  After the change, there was a sudden surge in Emergency room and urgent care  visits.  I hope FDA or the proponent of the brand name drugs calculate the cost associated with such visits.  Breakthrough seizures disappeared when the brand name drug was restarted.
   This week I had a patient who was taking Topamax for migraine prophylaxis.  She noticed that her headaches were not under control.  Once the patient insisted and the Pharmacist changed it back to brand name drug, she learned that her headaches were once again under control.  Now remember in this case the patient was willing to save money but was unable to because controlling her headaches was most important.
   There are millions of examples that can be sited by patients and physicians alike, but I have a different reason in defending brand name drugs.
   I came to the United States with a dream.  That dream included providing the best healthcare to my patients.  Since Mr. Bush introduced the Medicare D and soon after AMA and AARP endorsed drug coverage, patients have the constant  problem of getting their prescriptions while insurance companies and other drug coverage plans are making huge profits.  If we were really caring caregivers, we should have voiced to get those profits back to the patients, rather than letting those “savings” go to pharmacies and Insurance companies.
   There are many times where a Physician will  prescribe a drug and the insurance companies will force the Physician to prescribe the generic form of that drug.  This practice is very much alive and is progressively getting worse.
TODAY’S GENERICS ARE YESTERDAY’S NAME BRAND DRUGS.
   A few months ago NBC hosted a gentleman from AARP, who was informing people to purchase generic brand prescriptions (this is the same NBC Physician who advised people to avoid the ER if they experienced Swine Flu Symptoms).  It is unclear what NBC was trying to promote, but we should be cautious of the message we are sending. As a modern Nation, we need to support Name Brand Drugs..  The Obama Administration seems to have the same views as the AARP  Representative on NBC.  Those who discourage Brand Name drugs need to be informed that by doing so, we set our progress back by a hundred years.  We are supposed to be the leader and the best in the world.  Discouraging innovation will eliminate the future of new drugs.  Without Name Brand drugs today, we would not have generic forms tomorrow.  In my opinion, war funding needs to be cut and the emphasis needs to be focused on research and innovation.
   Had we not supported Inderal years ago, Propranolol would not be available today.  That is an example of a Name Brand drug giving life to a generic form.  Had we not supported Depakote, Valproic acid would not exist.  We have roughly 20 new generic drugs for seizure disorders today compared to about 4 in the mid 1990’s.  All generic brand drugs exist because of the brand name drugs in the past.  We need to avoid selfishness  and protect the future of our children.
 I urge all physicians to defend innovation.  The best defense is to support them and at the same time urge the new drug manufacturers to be generous and keep their price reasonably affordable.  I want to mention an example of generic drugs.  I had to purchase Promethazine 25 mg #40 for my wife.  I paid a copay of $25.00 and was shocked by the price.  I rarely have to purchase medication for myself so this experience was like placing myself in my patients shoes.  As a curiosity I asked the Pharmacist how much my insurance will cover and she told me they would cover $27.00.  I know that I have not been to Pakistan in a while, but with the maximum inflation and currency devaluation, I am almost certain that I could purchase the same prescription with the same origin (China) for roughly $0.50.  Generic drugs make huge profit margins for Pharmacies.  In return, the patient ends up spending more.
This is an addendum. There is a group of certain pharmaceutical companies who have influential political support and their main business is selling generic drugs. I have noticed that they have forced or collaborated with Insurance companies to use their generics (or non-generics) as the first line of drugs before we can prescribe other drugs  even for some serious illnesses that can have debilitating effects to patients. I know few names but I will not mention it now because I need to practice few more years. Truth can bite us some time.
Gulf Neurology
4325 Downtowner Loop N.
Mobile, AL 36609.
Research:
Two Gene Locations Linked to Multiple Sclerosis Discovered
   Science Daily (June 16, 2009): Australian and New Zealand researchers have accelerated research into Multiple Sclerosis by discovering two new locations of genes which will help to unravel the causes of MS and other autoimmune diseases.  Their findings will be published today in the Journal of Nature Genetics.
   “For decades the cause of MS has remained a mystery.  This discovery reveals important new insights into the genetic susceptibility to the disease,” says Professor Trevor Kilpatrick, Director for Neurosciences at the University of Melbourne, who with Dr. Justin Rubio of Florey Neurosciences Institutes coordinated the international study.
   “The newly discovered gene locations  in chromosome 12 and 20, offer very promising targets which indicated susceptibility to MS.” says Professor Kilpatrick.
   “They also reveal a link between genetic susceptibility to MS and other autoimmune diseases including Type 1 Diabetes, Rheumatoid Arthritis and Graves Disease and also the potential involvement of Vitamin D metabolism in the risk of developing these diseases”.
   “These results are like the key in the door, leading us to where to look for MS susceptibility,” explains Professor Trevor Kilpatrick.
   The research was conducted by members of the ANZgene consortium, more than 40 investigators from 11 institutions in Australia and New Zealand.
   The three year study utilized the MS Research Australia (MSRA) Gene Bank and involved scanning the DNA of 1,618 people with MS and 3,413 people without MS (control group).
   Using a genome-wide association scan (GWAS), researchers scanned the entire human genome in broad brushstrokes, looking at genetic landmarks in the genome and them progressively narrowing down their search to individual genes.
   Dr. Justin Rubio who coordinated the GWAS says these genetic discoveries are a major advance for the field.  “We expect that within 1-2 years we will be able to fine map these new regions and identify the genetic changes that underpin these findings,” says Dr. Rubio.  “Our next steps incude studying how changes in these target genes might influence the development of MS.  This work could provide insight into the development of novel therapeutics,” says Dr. Rubio.
   MS affects some of 2.5 million people worldwide and almost 20,000 in Australia.  It is a devastating autoimmune disease as it occurs at the prime of life and mostly in young Caucasian women.  “This Australian team is competing on a global scale to unravel the complex genetics of MS.  “This is a significant discovery” says Professor Jim Wiley, Chairman of the ANZgene consortium.  Mr. Jeremy Wright, Executive Director of MS Research Australia says, “we are thrilled to have been funding this study with the Australian Research Council and helping in its coordination.  It is central to our mission of accelerating MS research to identify susceptibility in individuals so that we can potentially prevent the onset of the disease, and develop better ways to treat it.”