What Does a Diet Drug Have in Common with a Swiffer?

The following was originally posted to Thought Broadcast.

What does the new anti-obesity drug Contrave have in common with the Swiffer?

Yes, I'm talking about that Swiffer, the cleaning tool that is essentially a dry mop with disposable dusters that attach to a dispensible handle.

When the Swiffer was first introduced, it was a revolutionary product. And it remains a top seller for Procter & Gamble, its manufacturer. But in reality, it's not exactly a revolutionary idea. In fact, my mother, in fact (an expert cleaner in her own right, much to my childhood chagrin) used to remark that she could have become a millionaire if she had marketed her own idea for a "homemade Swiffer": wet paper towels or dryer sheets wrapped around a broom head. The Swiffer is one of those miracles of "good design"--- an idea that is elegant in its simplicity but surprisingly effective in its application, and I'm sure it has led thousands of housewives (okay, and househusbands, too) to lament, "why didn't I think of that?"

Enter Contrave. What exactly is Contrave? It's a weight loss drug being developed by Orexigen Pharmaceuticals, Inc. It's not available yet, but you may have read about it in the business pages a few weeks ago, when Orexigen's stock price (symbol: OREX) took a 72% nose dive in a single day after the FDA rejected it, recommending further study of the drug to rule out cardiac toxicity.

Like the Swiffer, Contrave is nothing terribly new; it's a re-packaged "combination drug" consisting of two commonly used medications that psychiatrists and other doctors have been prescribing for years: bupropion and naltrexone. Bupropion (more commonly known as Wellbutrin or Zyban) is frequently used for the treatment of depression (and has been shown to cause some weight loss on its own). Naltrexone (ReVia or Vivitrol) is an opiate antagonist and has been used in the treatment of alcoholism, opiate dependence, and impulse-control disorders.

In a clincial trial published last year, the combination of 360 mg bupropion (a respectable dose for depression, although not a dose most doctors would start with, right out of the gate) and either 16 or 32 mg naltrexone (a slightly lower dose than we use in alcohol dependence), was associated with an average 5.0% or 6.1% weight loss, respectively, over a one-year period (vs. 1.3% in the placebo group). A related study, whose results were submitted for FDA approval, used similar doses and found that half of the patients taking Contrave lost >5% of their body weight.

So here we have a novel agent that shows some efficacy in a notoriously hard-to-treat condition, but which is not really a novel agent at all. Just like the Swiffer is a "gee-whiz" product that is clever, remarkably useful, but conceptually quite simple.

But this is where (in my opinion) the similarities should end. Very few people would blame Procter & Gamble for developing a product that fills a niche but is really an overpriced combination of some readily available (and much cheaper) materials. Frugal consumers can pass on the Swiffer and make their own, while plenty of others are willing to pay the premium for the convenience of the name-brand product. And I think we'd all agree that people can spend their money on household cleaning supplies in whatever way they see fit.

But in medicine things are different. When a product receives FDA approval for a given indication (especially a disease as prevalent as obesity), it's an automatic market; plenty of doctors will prescribe it, and insurance companies & public insurers like Medicaid will cover it. Simultaneously, you can bet that a well-orchestrated promotional campaign will rally millions of customers to "ask their doctor" about this "brand new diet drug" they saw on TV. And Orexigen will most certainly charge a hefty premium over the component costs of bupropion and naltrexone alone, to recover the costs of clinical trials and to return a profit to its shareholders. To be sure, as doctors learn that Contrave is actually a combo of two cheaper drugs they can easily prescribe, they might prescribe less of it, but not before a huge market is created and exploited.

Ingenuity is a wonderful thing, especially when it's brought to bear on problems that are notoriously difficult to solve, whether it's the obesity epidemic or that mess on your kitchen floor. However, when a manufacturer repackages old products under a new name and charges a hefty premium for it, we need to be aware of this, and make decisions accordingly. While most consumers don't mind paying an extra few bucks for the convenience of a Swiffer, we should think twice about allowing our cash-strapped medical system to shell out the billions for a "blockbuster" drug like Contrave.