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Therapeutic Interchange, Pt. 1

Posted Jan 14 2009 7:47pm

This is the first of a two-part blog entry on “Therapeutic Interchange.” Part 1 gives an overview of the common medical practice of therapeutic interchange. Part 2, to be written sometime within the next week, will discuss how this practice relates to our discussions about the differences between generic pink Adderall (by CorePharma) and generic orange Adderall (by Barr Laboratories).

Tonight I came across this CBS News video about a shady—but apparently common—medical practice known as therapeutic interchange. Therapeutic interchange means swapping out one prescription drug for another when the two meds are reasonably similar. CBS News correspondent Sharyl Attkisson explains that hospitals do this in order to make money for themselves and the drug companies.

According to , the practice of therapeutic interchange places profit over a patient’s wellbeing, and ultimately costs taxpayers hundreds of millions of dollars. He calls therapeutic interchange “business-as-usual for the hospitals and drug companies in the United States of America today.” Dr. William LaCorte recently won a lengthy court case against a major pharmaceutical company, after “therapeutic interchange” sent one of LaCorte’s patients into a coma.

The doctor’s saga began over a decade ago in Louisiana, when he caught New Orleans’ Memorial Hospital modifying the prescriptions he’d written. Specifically, whenever LaCorte prescribed Zantac to his patients, Memorial switched it to Pepcid.

Pepcid and Zantac are similar in that both drugs are acid blockers, and both can prevent dangerous internal bleeding. At the doses recommended for Zantac, however, Pepcid is too strong for some people. One of Dr. LaCorte’s patients wound up in a coma, presumably as a result of the ill-advised therapeutic interchange.

When LaCorte inquired as to why his patients were consistently being given a different drug tfrom the one he’d prescribed for them, the doctor learned that Pepcid’s manufacturer (Merck) had entered into a “market share” deal with the Memorial Hospital. The drug company offered the hospital a significant discount on its products; in exchange, Memorial promised that 80 percent of the hospital’s antacid patients would be put on Pepcid.

Dr. LaCorte said the hospital tried to put nearly every patient who needed prescription medication on the Merck brand of whatever type of drug they needed.

LaCorte complained to anyone and everyone he could think of, to no avail. No one in the industry cared enough to do anything about it, or to follow-up. (We who have been having Adderall drama—with the pink generic brand, CorePharma—know what that’s all about). But finally, LaCorte called the feds, because as it turned out, this “market share” deal didn’t just hurt patients who suffered from taking the wrong medications. Finally, he got the feds involved, and charged Merck with defrauding taxpayers. Pepcid was twice as pricey as Zantac. Since many patients were on Medicare or Medicaid, taxpayers had to cover the difference.

William LaCorte waged a lengthy legal fight against Merck and this now prevalent medical practice. Only recently, after a twelve-year court battle, did Merck finally agree to reimburse taxpayers $650 million dollars for deals to get hospitals nationwide to favor their products over those of their competitors. Apparently, Merck was doing this not only with Pepcid, but also with Zocor and Vioxx. (You may recall that Vioxx had many harmful side effects and was eventually taken off the market.) Per U.S. law for whistleblowers, LaCorte can receive as much as 25-30% percent of whatever the government recovers.

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