Reserpine and the Medical Marketplace

THE COST of treating hypertension in the United States exceeds $10 billion per year,¹ most of which is spent on medications. Prescription drug costs are rising at three times the general inflation rate and are the largest out-of-pocket medical expense for three fourths of all elderly patients.² An important cause of rising drug costs is a shift in physician prescribing from inexpensive old drugs to expensive new drugs,³ which is driven to a considerable extent by new drug marketing. This sometimes includes active discouragement of the use of older drugs, as with diuretics,⁴ but often lack of promotion alone is sufficient to cause an older drug to fall into disuse.⁵ Inexpensive generic drugs are not advertised and are less likely to be discussed in symposia or by visiting lecturers or studied and reported on in industry-funded trials. Negative reports about these drugs go unchallenged, positive