Notes from The Cornered Druggist: Xerese, another useless FDA-approved drug

(While listening to public radio this morning, I was struck by its discourse on language and its various paths of evolution.   The combination of the letters “GM,” for example, can mean "genetically modified," "General Motors," or my first name when spoken in Alabama. But I digress...)

Yesterday, I received an order from a dentist's office for a product called Xerese, something we have never stocked, and a product that was listed as available from my wholesaler for the princely sum of $1085. This certainly warranted further exploration.

It turned out that this five (5) gram tube of an ointment contains a combination of 5% acyclovir and 1% hydrocortisone.

Acyclovir, a long-generic antiviral treatment for herpes, comes in capsules of 200mg for about 10 cents each, and hydrocortisone has also been available as an ever-the-counter product and can be found at a dollar store for, well, a dollar.

Five grams of Xerese contains a total of 250mg of acyclovir (a 5% concentration means 5 grams in 100 grams, so using the cross-multiplication process in algebra -- oh heavens, this note contains math! -- 250mg is in 5 grams, after the proper conversion of grams into milligrams -- oh my head, more math).

This means Valeant, the makers of Xerese, is taking raw materials that cost at most $1.10 and is charging $1085 for the product, wholesale.

So you may wonder why I just don't make this product by scratching together the ingredients,
investing about five minutes of mix and label time, and pass it on to the patient at a huge savings.

The answer is this - I am forbidden to do so by federal law. The FDA has given the license for this combination to Valeant of Canada, and for me to create the combination is to violate the directives of the FDA, and in so doing, would be dispensing a non-FDA approved product.

You may recognize the name Valeant, by the way, one of the recent collection of gouging pharmaceutical companies.

However, I can get a prescription for 8 acyclovir capsules from that dentist, see that the patient charge is no more than $5, then instruct the patient to get a one dollar tube of hydrocortisone ointment from my shelf, and then, by demonstration, show the patient how to mix the two products, how to put the combination into a one-ounce ointment jar, and then possess not just five grams, but thirty grams of homemade "Xeresel” with a wholesale value of over six thousand dollars.

To put it in context: Xerese costs $217/gram.   Gold (as of 3 March 2017) costs $39.70/gram.

Sadly, the WMU prescription benefit actually covers this product with a $40 copay to the patient. I will be aggressively petitioning them to correct this oversight.

First Compilation - Uncle Stan's Profusely Illustrated World #1

 OK, it's lulu press, but it's finally done.  Another three expected in the series before the scanner fries....

(c) 2013 The Animating Apothecary

36 pages, black and white illustrations at Lulu Press
http://www.lulu.com/spotlight/UncleStan

Here's the cover for the second set of sketches, assembly complete at at LULU:

http://www.lulu.com/spotlight/UncleStan

Why There Are Few Real "New" Drugs

(c) 2003 Animating Apothecary/Jim Middleton



(c) 2003 The Animating Apothecary/Jim Middleton

A Rather Disturbing Trend in 'Medicine'

A recent link from "Physician's Money Digest" is as follows.   I find it at least disturbing that the article celebrates the profits that can be had in treating cancer, and how it can offer the information to physicians who might be willing to benefit from judicial investments.  I contend that a logical sequel to this would be a listing of the 10 Most Profitable Mortuary Chains.
Here's the article:
 
10 Best-Selling Cancer Drugs

Right now oncology is the main attraction, which makes sense considering ASCO is just two weeks away. But oncology drugs have always garnered a lot of attention because the diseases they treat are so scary for the patients, plus they can be quite costly. (italics mine)

But the good thing (for the pharmaceutical companies) is that these drugs aren’t facing generic competition like some other drugs have to. As a result, expensive and older treatments are contending with low-cost generics for sales, meaning they’re still bringing in a pretty penny for the company. (emphasis mine - again, what are we celebrating here?  More effective treatments?  Or more expensive - and thus, profitable - treatments for drug companies?  And are any of these treatments more effective, or just more profitable?  And isn't it just about the creepiest thing to consider success not by outcomes, or benefits to the patients, but as profit from sales of these drugs.... what a world, what a world... )

FiercePharma released a list of the top 10 best-selling cancer drugs based on how much they brought in U.S. sales over the last year. (My interruption again:  they also have a nice discussion on whether drug company CEOs get paid enough!!! So far their newsletter is free, so go there and get the daily scoop on what PharmaLand is doing behind the curtain)....

(And look how the information is presented, like it's some Top Ten on the David Letterman Show)

10. Tarceva
Company: Genentech
2011 sales: $564.2 million
FDA approvals: Non-small cell lung cancer, 2004; pancreatic cancer, 2005; NSCLC maintenance therapy, 2010.

9. Xeloda
Company: Genentech
2011 sales: $647.6 million
FDA approvals: Metastatic colorectal cancer, 1998; metastatic breast cancer, 2002; adjuvant colon cancer therapy, 2005.

8. Velcade
Company: Millennium Pharmaceuticals, a unit of Takeda Pharmaceutical Industries, in partnership with Johnson & Johnson
2011 sales: $692.7 million
FDA approvals: Multiple myeloma, 2003; mantle cell lymphoma, 2006; first-line multiple myeloma, 2008.

7. Erbitux
Company: Eli Lilly, in partnership with Bristol-Myers Squibb
2011 sales: $703.3 million
FDA approvals: EGFR-positive colorectal cancer, 2004; second line in head and neck cancer, 2006; first line in recurrent or metastatic head and neck cancer, 2011.

6. Alimta
Company: Eli Lilly
2011 sales: $1.04 billion
FDA approvals: Malignant pleural mesothelioma, 2004; non-small cell lung cancer, 2008; NSCLC maintenance therapy, 2009.

5. Eloxatin
Company: Sanofi
2011 sales: $1.2 billion
FDA approvals: Colorectal cancer, 2002; adjuvant use in colorectal cancer, 2004; new formulation, 2005.

4. Gleevec
Company: Novartis
2011 sales: $1.51 billion
FDA approvals: Chronic myelogenous leukemia, 2011; gastrointestinal stromal tumors, 2002; Philadelphia-chromosome positive acute lymphocytic leukemia, 2006; dermatofibrosarcoma protuberans, 2006; certain myelodysplastic/myeloproliferative diseases, 2006; hypereosinophilic syndrome/chronic eosinophilic leukemia, 2006; aggressive systemic mastocytosis, 2006; adjuvant GIST treatment, 2012.

3. Herceptin
Company: Genentech
2011 sales: $1.66 billion
FDA approvals: Metastatic HER2-positive breast cancer, 1998; adjuvant in early-stage HER2-positive breast cancer, 2006; additional adjuvant approvals, 2008; HER2-positive gastric or gastroesophageal junction cancer.

2. Avastin
Company: Genentech
2011 sales: $2.66 billion
FDA approvals: Metastatic colorectal cancer, 2004; non-small cell lung cancer, 2006; breast cancer, 2008 (revoked in 2011); kidney cancer, 2009; brain cancer, 2009.

AND HERE'S NUMBER ONE - The drumroll, please!!!!
1. Rituxan

Company: Genentech
2011 sales: $3 billion
FDA approvals: Non-Hodgkin lymphoma, 1997; rheumatoid arthritis symptoms, 2006; rheumatoid arthritis disease progression, 2008; chronic lymphocytic leukemia, 2010; Wegener's granulomatosis and microscopic polyangiitis, 2011.

Ka- CHING!!!!!!