Medicine: drug companies stick heads between tails, run away

Two drug company disasters in as many days.

First, CATIE-II gets published, and suggests that perphenazine, a typical (high potency) antipsychotic off-patent, is probably as good a place to start as any atypical antipsychotic for schizophrenics. Which isn't to say that psychiatrists are ready to throw atypicals out the window. Instead, tons of skepticism, in the face this cost-effectiveness report, will start spewing forth from the managed care folks, who (we're scared, at least) will try to justify restrictions on atypicals. Bad day for drug companies, great day for managed care, and an unclear day for psychiatric patients.

And then, even more importantly for poor lil' Pfizer, clinical trials for torcetrapib have been halted. What is torcetrapib, you might ask? Only the most important drug (from a stock holder's perspective) in the last ten years for any major drug company. Lipitor only has a few more years on-patent, and pravastatin will probably be off patent in the next year or so, i.e. insurance companies will probably do everything they can to get physicians to switch their Lipitor-taking patients into generic pravastatin-taking patients. I'm interested to see how far Pfizer's stock might plunge, as probably nothing could have been more devastating for the company.

None of the doomsday articles point to Roger Newton's new cholesterol drug, an infusable HDL-variant shown to reduce plaque sizes substantially (yes, 4% of a plaque is SUBSTANTIAL). Now, last I heard, most indications pointed towards the use of the infusable for stabilization after plaque ruptures, but after hearing Newton talk about Esperion's goals, I have to believe that Pfizer (who aquired Esperion for 1.3 billion in 2005) has more anti-cholesterol strategies up their sleeve than news articles suggest.

But still, losing torcetrapib, which Pfizer contemplated pairing with Lipitor to blackmail folks into continuing to take their proprietary statin, suggests that the blockbuster model of drug development might really be dying faster than we thought.

Obviously, Pfizer should pair Lipitor and Geodon and send them to sub-Saharan Africa. Maybe the Africans could trade the drugs to the Russians to get the AIDS drugs they need.