Profits of Fear

Article excerpt

Every closet in my medical office is suddenly filled with samples of Ciprofloxacin, an ordinary antibiotic intended primarily for use with bladder infections. This week, every patient phone call I receive and almost every patient visit to my office includes a request for this antibiotic. Physicians as well as patients are stockpiling the drug. One of my patients returns home to his wife, and she relays to me that instead of reassuring her with news of his normal test results, he instead brags, "I've got it. I've got it," brandishing his hoard of Cipro samples that he must have smuggled from my closet. Another patient calls me from Philadelphia to ask whether she can take Cipro to prevent anthrax. "Not unless you live by a certain building in Boca Raton," I reply. Five minutes later she calls me back frantic--her neighbor is returning from Boca wheeling her possibly contaminated luggage down the hall. "No," I groan. "No Cipro."

Bayer, the Cipro manufacturer, is stoking this frenzy and playing into public hysteria by promoting the drug. The drug reps drop off hundreds of sample cartons at my office without saying what for, though I can see them frowning when they hear me say, "I am not prescribing Cipro for anthrax."

Why Cipro? What the drug company is not telling either patient or doctor is that Cipro was originally tested as an alternative treatment for anthrax only for penicillin-allergic patients. Antibiotics have never been properly tested for prophylaxis, so Cipro's usefulness for prevention is speculative, though there is clearly some rationale for prophylaxing patients with close exposure. But doxycycline, a generic, is just as effective and costs one-tenth of what Cipro costs. A month's supply of Cipro costs more than $300; the equivalent amount of doxy is $32. In fact, there are multiple antibiotics available with similar efficacy, many of which are cheaper.

Which is not to say that any of these antibiotics should be prescribed. Prolonged use of Cipro, for example, without a real treatment target or reasonable endpoint, could cause significant side effects--including diarrhea, rash, colitis, gastrointestinal bleeding and insomnia--in a large population. …