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Dr. Bill's Commentaries

A very expensive antibiotic   (September 6, 2009)

Until last week, I really hadn't heard of the antibiotic Zyvox (linezolid). But when a bug-bite on my left calf got inflamed, and my leg turned red and swollen, my physician recommended it for me to use. According to the label, it seems a good choice for diabetic foot infections: the cure rates in one clinical trial were 83% (159/192) and 73% (74/101) in the linezolid- and comparator-treated patients, respectively. And during the past week, my leg has slowly and steadily improved, with rest, elevation, and Zyvox.

But back to the date of my doctor's visit. Since I was feeling pretty lousy, my wife picked up the prescription at our local pharmacy, and she was shocked. The copay was $215. The pharmacist mentioned to her that the cost of the prescription including the insurance company's share was $800. For 14 tablets. That's $57.15 per tablet.

Interestingly, if you Google Zyvox this past week, you also find lots of discussions about Pfizer, the manufacturer of Zyvox. (Full disclosure: I previously worked for Pfizer, and own shares of Pfizer stock.) For example, FDA: Pfizer ignored warnings, gets record fine. In brief, Pfizer had been promoting Zyvox and other drugs for unapproved indications, then in 2005 received a warning letter from the FDA, and thereafter continued such promotions despite the warning letter.

A press release from a legal firm, Sheller, P.C. Attorneys Instrumental in Largest Pharmaceutical Whistleblower Settlement in History: Pfizer to pay $2.3 Billion in Part for Marketing Their Drug As Better Than Generic, Defying FDA Warning Letter, points out that approximately $4.4 billion worth of Zyvox was sold from 2000 to 2008, according to the company's annual reports. Two-point-three billion dollars. A huge fine, but balanced against $4.4 billion in sales, not so much.

It's interesting to read Pfizer's take on the situation at their website, Pfizer Concludes Previously Disclosed Settlement Agreement With U.S. Department Of Justice Regarding Past Promotional Practices. They quote one of their in-house attorneys, saying "These agreements bring final closure to significant legal matters and help to enhance our focus on what we do best - discovering, developing and delivering innovative medicines to treat patients dealing with some of the world's most debilitating diseases... We regret certain actions taken in the past, but are proud of the action we've taken to strengthen our internal controls and pioneer new procedures so that we not only comply with state and federal laws, but also meet the high standards that patients, physicians and the public expect from a leading worldwide company dedicated to healing and better health. Corporate integrity is an absolute priority for Pfizer, and we will continue to take appropriate actions to further enhance our compliance practices and strengthen public trust in our company."

But Pfizer doesn't say anything about their pricing policies.

No mention that the pricing for Zyvox is outrageous, especially as there are zillions of antibiotics.

And no mention that there's a national debate on health-care reform, and a large part of the debate centers around the fact that costs have gotten out of hand.

As a shareholder in Pfizer, and a user of one of their products, I just want to say it's a sad state of affairs that Pfizer can continue to price products so high, and then turn around and pay enormous fines for unscrupulous behavior. And blandly ignore the impact of their behavior on us, the patients who are forced to pay outlandish prices for their products. Corporate integrity, hah!

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Dr. Bill Quick began writing at HealthCentral's diabetes website in November, 2006. These essays are reproduced at D-is-for-Diabetes with the permission of HealthCentral.

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