So drug company wins either way, particularly if they're competing against a similar product made by another company that doctor might choose instead. In fact, all it takes for everyone to be happy is a breakable tablet. Admittedly, some pills are difficult to break in half (but not excessively difficult, or else drug company wouldn't capture low-end market). This is where pill-cutters come in handy. Every drugstore has them. They're cheap because they're made out of nothing more than plastic and razor blades. They're better at splitting pills than your thumbs or a paring-knife because they break pills more evenly, and pieces don't go skittering across counter.

In author's practice there are some pill-splitting overachievers who even manage to break quadruple-strength pills into quarters. Imagine savings in doing that.

In fact, only obstacle to saving patient money is if drug company puts their product into capsules, because capsules can't be split. Would a drug company do such a mean-spirited thing? You betcha.

Lexapro was sixth so-called serotonin-reuptake-blocker to come on market, so it had to compete with all earlier drugs in its class. But first serotonin-reuptake-blocker to come on market had first-mover advantage and was able to retain market-share even after competing products arrived. This first-mover was world-famous Prozac brand of fluoxetine, made by Eli Lilly Company.

So what did Lilly do after competing products appeared? They stone-walled consumer by never ever putting their product into anything other than a capsule. Moreover, for entire time their product was still patent-protected, they never produced a higher-strength capsule. So if you needed a higher dose of Prozac, you had honor of paying for two or three capsules per day. Why did they choose such a consumer-unfriendly approach? Because they could. (Everyone now turn toward Indianapolis and wave to nice people at Lilly.)

My medical students look at me strangely when I start talking about publicly traded companies and market forces while I'm supposed to be teaching them about medicine. But way I look at it, if you don't understand market forces, then you'll never understand why things in medicine are way they are.

(C) 2005 by Gary Cordingley