No. of Recommendations: 1
DTB: good points, and both ones I considered for my initial post. I didn't because I thought I was bumping up against the TL;DR threshold. Besides, I was hungry.
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First, the easier one: phentermine/fenfluramine. About the only thing it had going for it was a catchy name ("phen/fen") and a completely wide-open field from the outset i.e. no magic weight loss pills out there.
...the fen-phen drug that Wyeth produced, that looked like it would be a homerun until 5 years after its introduction, when cardiac valve problems completely dissolved the franchise
However, I disagree that from the provider trenches it ever truly looked like a home run. Yes, it was prescribed by a few providers (for a lot of patients). My recollection was that locally it was principally written for by a TV doc and a midlevel who later went into property development. 'nuff said there.
But for the large majority of primary care docs, the drugs looked scary from the outset (when no one was yet suspecting the mitral valve issues). Short term weight loss? Via a blood-pressure-increasing stimulant? Nontrivial risk of drug dependency (not weight loss dependency, but amphetamine-like dependency)? Summary: no careful, excellent docs that I knew routinely prescribed it. Crickets.
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Second, what could be a thesis-level post: drug patents.
My impression goes something like this: every time a new drug class comes along, there is an initial molecule or two, then a bunch more, at which point Darwin steps in and ultimately leaves maybe three. Elapsed time from growing clinical enthusiasm (not development pipeline) to maturity - maybe fifteen years +/-.
In the last two generations, unique new drug classes following this script have been: beta blockers; ACE inhibitors; histamine antagonists (e.g. cimetidine); protein pump inhibitors; calcium channel blockers; benzodiazepines. Widen the definition and timelines a bit and you could add halogenated anesthetics, cephalosporins and...you get the idea.
And yes, half or more of the patent protection clock may have run out by the initial surge of enthusiasm, arguing for backing the second drug out of the gates.
But there is obviously enormous in-house economic pressure on the drug companies to modify their own molecules to come up with a unique patent for a just-different-enough successor. In this, they have the in-house expertise as well as the trial support team to get a newly-patented successor molecule to market as less toxic, more efficacious, and/or approved for a new indication...while the patent-protection clock gets reset.
It will be a bit of a swamp. But, it's going to take awhile for Lilly to stagger, I think.
I absolutely wouldn't commit to this for ten years, but if I commit at all it won't be less than two years, and probably around fiveish. Or fourish, or sixish. And if during that time, NVO staggers while BMS or ABBV or MRK or whoever comes up with something clearly better, than I'll probably get into the vault just long enough to switch horses (and metaphors)
This could go on, but at this point I'm starting to bore myself. Never a good sign.
--sutton
