I have been going through old mail this morning. It has been a busy time, so I decided to set aside a few hours to sit at my desk in front of my office window and peruse the inbox with a hot beverage while watching the snowfall.

The magazines on my desk are all wrapped up like Christmas presents. The glossy teal-colored paper that you have to tear through to open them is emblazoned with one word: Pristiq.

This is a new antidepressant named desvenlafaxine. It was released by Wyeth just as the patent on venlafaxine (Effexor) was about to expire. Venlafaxine was a blockbuster antidepressant that generated about $100 billion over its patent-protected lifetime. If you are wondering what the difference is between venlafaxine and DESvenlafaxine, don’t hold your breath. There is none.

One of the unfortunate absurdities of this sad era of medicine in the hands of the pharmaceutical industry is the fact that doctors treat patients based on carefully calculated studies that are more about marketing than medicine. I did a quick literature review on desvenlafaxine and found an impressive number of double-blind clinical trials (nine, to be exact), telling me that Pristiq is better than placebo for the treatment of depression.

OK, so the new drug is better than nothing. But is it better than the old drug? Not a single one of these trials compared DES-venlafaxine to venlafaxine. I did not check every single one of them, but I am willing to bet my left leg that they were all sponsored by Wyeth. Why didn’t Wyeth compare the new drug to the old drug? Because it probably isn’t any better.

Nine out of ten times, new drugs are not better drugs. They are just different. Barely different, but different enough to patent them for another 20 years. And heavily promote them by plastering the drug’s name on every medical journal, website, conference handout, pen, notepad or free meal that are handed out to the doctors who prescribe them. And reap another $100 billion of your tax dollars and insurance premiums.

I struggle with the fact that my patients have to pay for what I do. Not because I don’t think it is worthwhile, but because there are so many billions of dollars wasted on a healthcare system that is spiraling out of control primarily because of rising drug costs. Our politicians and regulators are putty in the hands of the pharmaceutical industry and the physicians, researchers and lobbyists who are on their payroll.

A medical student and I are in the process of publishing a research study that summarizes the most effective evidence-based natural medicines for the treatment of depression. They include St John’s Wort, SAMe, 5HTP, folic acid, exercise, mindfulness-based stress reduction and meditation. None of those approaches will ever become mainstream as long as people have to pay for them … and those same people can get their drugs for free.

Ironically, in the rest of the world, where expensive drugs and surgery are not free, alternative medicine is the medicine of the rich. Here, the pharmaceutical industry has created a system where the only medicines that doctors learn about are drugs, the only pressure that Health Canada gets to pay for medicine comes from drug company lobbyists … so drugs are the only treatment that working people can afford.

I don’t think the system will ever change … until it breaks down. And many healthcare economists believe that may happen sooner than we think. Meanwhile, we’ll keep doing what we do, trying to shine a little light in these strange, dark times.

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