Saturday, May 29, 2010

Strepsils: The big gorilla of head-clearing medications

I have had my fair share of sniffles, colds and flu over the years so in the last 60 years I have consumed a LOT of head-clearing and throat soothing products. And there used to be a lot of different ones. But now there is not. In my local supermarket here in Australia, there are only umpteen variations of Strepsils. And in my local pharmacy, it's much the same, though there is a tiny corner where they stock a few of the "old" medications.

How come? Are Strepsils any better than the others? Not as far as I can see. It all seems to be a triumph of marketing. Strepsils are made by Reckitt Benckiser, a British company headed by Bart Becht, a livewire Dutchman. And, partly by providing so many variations of his product, he seems to have convinced retailers that they meet all consumer needs by stocking and displaying Strepsils exclusively.

I don't like that for a variety of reasons and it is a real wonder to me that the other manufacturers haven't used the anti-monopoly laws to slow down Meneer Becht. Some of the "squeezed out" products below:

The fascinating thing is that all four of the above products are made by Nestle, who are another big gorilla in various fields. One would think that they had deep enough pockets to take on Meneer Becht in the courts. I wonder if the two firms have come to an agreement not to encroach on one-another's territory? Such an agreement would be illegal under trade practices laws in most countries so I guess we may never find out about any such agreement.

I also note that on my Strepsils packet there are NO details of what the pharmaceutical ingredients are. I would have thought that that too would run foul of labelling laws, particularly in a pharmaceutical prouduct. Meneer Becht sure must be a sharp operator.


I note that the alternative prouducts ARE in fact available in my local supermarket -- but in the confectionery department rather than in the medications department. That is still pretty clever as a person with a cold would be much more likely to head for the medications department rather than the confectionery department.

I imagine that Meneer Becht has managed to get privileged placement for his product on the grounds that Strepsils contain an antibacterial agent. But even on the Strepsils packet it admits that the benefit of the agent "has not been clinically established".

So people are maneuvered into buying Strepsils when a cheaper product would be just as good.

Drug offers new hope on brittle bone disease

A cheap six-monthly jab offers hope to thousands of women with the crippling bone disorder osteoporosis. Successful trials of the drug Prolia show it dramatically cuts the number of spine and hip fractures in women, and helps bones to regrow.

The drug, which costs the equivalent of £1 a day, could provide a new option for the one in four women who cannot tolerate existing medication because it causes serious side effects, such as digestive problems. Some 170,000 women a year are unable to take bisphosphonates and instead risk their bones deteriorating without treatment.

The new drug, also known as denosumab, is licensed for use from yesterday, but is still being assessed for NHS use by the National Institute for Health and Clinical Excellence.

It cuts the risk of suffering a spinal fracture by two-thirds, according to trial data on almost 8,000 post-menopausal women having an injection twice a year. There was a cut of 40 per cent in the risk of a hip fracture and a 20 per cent reduction in the chances of other broken bones.

A National Osteoporosis Society spokesman said: 'The main treatments used for osteoporosis are not suitable for all, so we welcome denosumab as a new option to help prevent unnecessary, disabling fractures.'

'Up to a quarter of patients can not use the most common treatments, bisphosphonates, due to side effects, like digestive problems. 'Denosumab works in a brand new way avoiding some of these side effects and requires only two injections under the skin each year. 'It has the potential to be administered by GPs which means that it could cut down on hospital visits for some.'

The drug, developed by Californian biotechnology company Amgen, can also help men with prostate cancer taking hormonal therapy, which raises the risk of bone loss.

In a separate trial of 1,400 patients, injections over three years resulted in a two-thirds cut in the risk of spinal fracture compared with 'dummy' treatment. There was a 'significant reduction' in the risk after just one year of treatment, and an increase in bone density.

At least 120,000 people a year suffer fractures in the vertebra of the spine and 60,000 others break their hips. At least 5,000 men each year are treated with hormonal therapy for prostate cancer.

Prolia works in a different way to existing medicines as it stimulates patients' immune systems to block a protein called rank ligand, which regulates the activity of cells that break down bone. The drug reduces the activity of these cells throughout the body, increasing bone density and strength.

Professor Juliet Compston, bone medicine and honorary consultant physician at Cambridge University, said as many as two out of three women stop using medication within a year because it is difficult and inconvenient to take. Those on bisphosphonates have to take them on an empty stomach and remain upright for 30 minutes before eating and drinking.

Prof Compston said 'Having an injection once every six months is convenient and should improve adherence to the long-term treatment that is required for osteoporosis.' At £366 a year, the cost is similar to other new treatments but more than bisphosphonates at £27 a year.

Prolia is currently being assessed for NHS use by the National Institute for Health and Clinical Excellence (Nice) which recently brought in severe restrictions for patients needing more expensive treatments.

Dr Bowring said Nice must take into account women who can't take bisphosphonates. She said 'All we want is for patients to have access to a range of treatment options, all of which are cost effective, all of which can help to prevent fractures. 'Fractures due to osteoporosis cause thousands of deaths every year. Many of these fractures can be prevented with appropriate diagnosis and treatment.

'Given the immense suffering and huge financial costs caused by hip fractures, which could be prevented by effective treatments, the imperative is to treat individuals with a drug that works.'


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