April 28, 2012

Molecules to Medicine: Public Health or Impaired Penises?

Today's news starkly juxtaposed this countries' priorities. First was news of the approval of yet another look-alike drug for erectile dysfunction, avanafil (Stendra).

By Judy Stone

This article was published in Scientific American’s former blog network and reflects the views of the author, not necessarily those of Scientific American

Today’s news starkly juxtaposed this countries’ priorities.

First was news of the approval of yet another look-alike drug for erectile dysfunction, avanafil (Stendra).

Then “From First Cold To Grave: How Two-Month-Old Brady Died Of Pertussis.” Brady was too young to have been protected by receiving immunizations, but there are strategies for protecting newborns from pertussis, or whooping cough. One effective technique is called “cocooning.” In this strategy, the newborns are protected by instead vaccinating their family members before the baby is discharged from the hospital.

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Estimates are that almost 75% of pertussis cases result from exposure to family members who are not known to be infected. (This was not reportedly the source in this case). In California, which has been experiencing an outbreak of pertussis, the mother is vaccinated during pregnancy, to provide the baby with protective antibodies that cross the placenta. This is a safe, effective and relatively low-cost method of protecting newborns.

Hospitalization is required in 60-70% of infected infants less than one month old, and deaths occur in ~2%. The cost per dose of Tdap vaccine administered is estimated at $40; for the babies at Ben Taub, a large public hospital which employs the cocooning strategy, this totals about $800,000/year. While expensive, studies have shown cocooning or prenatal maternal immunization to be cost effective.

A major impediment to immunization for adults is the cost, as these adult vaccinations are not a routine part of maternal care payments, and are thus generally not covered by insurance. Unless a hospital provides the vaccination, as Ben Taub did, the cost is prohibitive for many families.

In contrast, the cost of drugs for erectile dysfunction is paid as a covered benefit by most insurers. These phosphodiesterase 5 (PDE5) inhibitor drugs (Viagra, Levitra, Cialis, and now Stendra) cost up to $9 to $11 per pill. By 2005, Medicaid alone spent $15 million annually on these drugs.

According to the University of Miami, US men “spend $1.7 billion dollars a year on products to improve their sexual function.” And although the laws changed with a ban on Medicare and Medicaid payment for “lifestyle” drugs in 2007, $3 million was paid for Viagra in 2007-8. The military continues to provide PDE5 drugs as a “core” benefit.

So, what should we, as a society, choose? Saving babies from pertussis or providing “lifestyle” drugs for aging men?

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Images: Viagra, by SElefant on Wikimedia Commons; boy coughing with Pertussis, by Jmh649 on Wikimedia Commons.

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Previously in this series:

Molecules to Medicine: Clinical Trials for Beginners

Molecules to Medicine: From Test-Tube to Medicine Chest

Lilly’s Shocker, or the Post-Marketing Blues

Molecules to Medicine: Pharma Trumps HIPAA?

Molecules to Medicine: Should pepper spray be put on (clinical) trial?

Molecules to Medicine: FDA at a Crossroads–a Tough Place to Be

Molecules to Medicine: Plan B: The Tradition of Politics at the FDA