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My wife has become a coupon maven recently.  This is a good thing, as we are saving quite a bit of money and I have always wanted to be married to a maven.  One of the unexpected consequences has been the regular appearance of packages in the mail.  We get free samples of everything from cookies to laxatives (not to be used in combination).

Last week we got a package from Gillette, and it had my name on it.  Cool.  I love getting presents.  It's probably not lost on any of you that Gillette and Schick have been in a battle of one-upmanship in the razor arena.  For a long time, double-bladed razors were the standard, with each pushing the advantage of their model.  "The first blade stretches the hair, while the second razor cuts it at the skin," was the commercial I remember from my youth (which was parodied on the very first Saturday Night Live episode, by the way).

Stick with me, folks.  This has a point.

So the latest razor is what greeted me as I excitedly tore into my unexpected package.  It's called the "Fusion Pro Glide," and it's their latest and greatest.  Here's what this baby packs: it has 5 blades for regular shaving and one for trimming.  It's also battery powered so it can vibrate when you shave.  Sounds pretty fancy, eh?  There's more.

Cynics among you may point out that the Gillette Fusion razor (that Tiger Woods advertised) had all of these features.  What makes this different?  Here's the press release explaining why the ProGlide is so much superior.  It has:

  1. Re-engineered Low Cutting Force Blades with 15% thinner, finer edges and our advanced low-resistance coating enabling the blades to cut effortlessly through hair with less tug and pull.
  2. A Blade Stabilizer to maintain optimal blade spacing for comfort while allowing the blades to adjust to the contours of a man’s face.
  3. A streamlined Snowplow Comfort Guard which channels excess shave prep to help maintain optimal blade contact, stretching the skin for a close, comfortable shave.
  4. An Enhanced Lubrastrip™ , 25% larger than before, infused with mineral oil and lubricating polymers, enabling the razor to move smoothly over skin even on repeat strokes.
  5. An improved Precision Trimmer including an enhanced blade, a comb guard to better align long hairs, and new rinse-through slots.
  6. A Redesigned Handle with bigger, more ergonomic grips for better control, enhanced weight and balancing and improved transition between front and back shaving surfaces.
  7. An innovative Microcomb, exclusively on Gillette Fusion ProGlide Power, that helps guide hair to the blade.

OK, I have to confess I was cynical myself.  Sure it's cool to have a snowplow and microcomb, but clearly Gillette has to find a new way to get us to dole out money to keep their shareholders happy.  This is the "new and improved" ploy used ever since Samuel wrote 2nd Samuel.  It's an old ploy.  So when I got the chance to use it the next morning, I was holding my expectations at arm's length.

But here's the funny thing: it was much better than my previous razor.  I hate to say it, but it was actually the closest shave I have ever had.  Babies' butts were jealous.

So what's the point?  Am I now replacing Tiger as the spokesman for Gillette?  They have yet to approach me on that, but my agent is keeping his ears open.  The point of my tale is this: sometimes new is really improved.

OK, so what's that got to do with the price of mangos?  Nothing, but it does have lots to do with the pharmaceutical industry.

Huh?

In recent posts I have mentioned the need to use expensive drugs on occasion and bemoaned the burden this puts on Medicare patients.  While privately insured patients can get expensive new drugs at a discount, Medicare patients are often left to bear the full burden of the cost because it is illegal to give Medicare patients discounts. In the comments on these posts, some have suggested I have a rose-colored view of Pharma and their motives.  Others have suggested that there are always inexpensive alternatives to the expensive drugs out there.

Wrong, and wrong.

I don't think Pharma is any more altruistic in their motives for introducing new drugs than Gillette is motivated by facial smoothness.  These companies want to make money, and they introduce new products to make more.  Businesses have a crazy motive: they try to make money.  But there are times, like with my happy facial encounter, that pharma (gasp) also brings break-through products to the table.  Sometimes new is really improved.

The skepticism is warranted, however.  Most of the "new and improved" products are just minor changes that allow patents to be extended (which I wrote about previously).  When Ambien CR came out, the reps told me how much it was better than the old Ambien.  This was a problem, since a few weeks earlier they were pitching to me how good the regular Ambien was.  Changing to an isomer, changing the dosage schedule, or finding a new indication for the medications are ploys the companies use to get docs to prescribe them over the generic.  It's our responsibility as docs to see through these ploys and keep costs controlled.

But sometimes the razor does make your face smooth.  A good example is the biological class of medications for rheumatoid arthritis.  These medications are a huge advance over the old, highly toxic medications we were forced to use.  Is prednisone or Methotrexate an alternative to Enbrel?  Sure, but the patients don't have as good of outcomes and suffer more toxicity.  There are plenty of other examples of real advances in drugs for diabetes, hypertension, and other common problems.  Patients who don't have access to the new drugs are at a disadvantage.

There are several important differences between razors and drugs:

  1. You don't need a barber to decide which razor is best for you.
  2. People who can't afford fancy razors will just by the cheaper kind and live basically normal lives (with rougher skin), while people who can't afford certain fancy new drugs will have shorter lives and/or more suffering.
  3. Razors don't cost $1000 per month.

Reason #3 is key, as the degree of need is always balanced by the outlandish cost of drugs.  The cost of drugs is what makes this whole discussion significant.  We wouldn't spend time debating if the difference was $10 per month.  How are drug prices set when there is no direct competition to many of them?  What is a fair price to charge for something that can change (or save) a person's life?

Unfortunately, the decision often falls into the doctors' hands.  Is length and quality of life a fair trade for less cost?  Where is that balance?  We don't have to foot the bill of the prescriptions we write, and we don't control that cost.  But we do have the knowledge of how well the razor works.  We are the ones best positioned to tell the difference between true advances and fancy repackaging.  This decision isn't always easy or clear.

Sometimes the shave is incredibly close without the nicks and cuts normal razors leave.

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