« Childish diddling in California | Main | Public Service Announcement »

New heart failure drug. Whoopee.

The FDA has just approved Pfizer's aldosterone antagonist Inspra (eplerenone) for the treatment of heart failure. It had already been approved for treating hypertension.

Please forgive me if I don't get up and dance for joy.

I'm not saying it isn't a good thing to have a new, more effective drug on the market if you're suffering from congestive heart failure. I'm also glad Pfizer is continuing to introduce new drugs for the treatment of life-threatening conditions, rather than limit itself to lucrative "lifestyle" drugs like Viagra.

But I am reminded that our country's approach to medicine, drug development, and public health succeeds in some ways by failing in others.

Inspra isn't going to be cheap. For the well-heeled and well-insured suffering from congestive heart failure, the drug will be a good thing because it will be available. But for the rest of us, Inspra may not only be unavailable, but may also contribute to rising health-insurance premiums and force more of us to drop our health insurance altogether.

Insurance companies offering policies that include new drugs like Inspra in their formularies have to recoup the costs somehow. Since new brand-name drugs tend to cost more than the average drug in a formulary (which includes many inexpensive generics), offering the new drug increases the average cost of all medications. All else being equal, premiums have to go up. As premiums go up, more people find themselves unable to afford the coverage. The ranks of the uninsured grow.

And as more people become uninsured, more people do not receive any treatment at all for their heart failure, let alone the newest and best wonder-drugs. The cost of treating some people with Inspra, in our current system, is undertreating others with the same condition, or not treating them at all.

Here is where the public policy arguments begin. Some argue that this result isn't a bad thing. Over time, the overall sophistication of the treatment available to everyone increases because we encourage private pharmaceutical firms to innovate and to reap the financial rewards. In this sense, American medicine is the "best" in the world.

I don't buy it.

First, I don't agree that it's any better to sacrifice the basic health care available to some people for a marginal improvement in the advanced treatment available to others.

Second, I don't accept that we face an all-or-nothing choice between developing new drugs under our current system, and halting the advancement of medicine by altering that system to make it more equitable. But that's exactly what the pharmaceutical companies argue when anyone suggests policies aimed at reducing drug costs.

Given the pharmaceutical industry's profitability, it would seem that there is plenty of room to reign in drug prices while preserving the incentives the drug companies need to develop new drugs. That's just common sense.

In the meantime, we can celebrate the introduction of Inspra and other marginal improvements in the treatment of heart failure and other ailments. We can also cross our fingers and hope that we'll continue to be able to afford our insurance premiums, and that we'll be able to see a doctor and buy some basic medicines if we get sick.


We introduce more new drugs than any other country, but the incremental advances associated with most of those drugs is ... well, small at best.

I was going to post lots more, but then realized I was selfish and just decided to blog it myself. :)