Who Knew About the Inexpensive Sleeping Pill?

We've all seen the ads for sleeping aides like Ambien and Lunesta. We've all heard the stories about the woman who woke up in the middle of the night, guzzled a bottle of wine and got arrested after urinating in the middle of a nearby intersection after taking one of the new pricey sleeping pills.

But who knew about the cheap generic pill (10 cents versus $3 for Ambien) that's been around since the 1950s and has almost no significant side effects? Not me, and I pay a lot of attention to these things (in part because I don't sleep much, but that's another story). An op-ed in today's New York Times by Daniel Carlat, the editor in chief of the Carlat Psychiatry Report, lays it all out.

The ostensible target of this op-ed (subscription required) was published review articles, paid for by Sepracor and Sanofi-Aventis, which make the two drugs, that sought to cast doubt on the efficacy of trazodone, the generic sleeping pill. His solution is to "mandate fuller disclosure of links between drug companies and authors" and require disclosure of "the exact nature of a doctor's involvement in preparing a sponsored article, as well as the dollar amount of his or her fee."

Now, I'm all for disclosure. But that hardly solves the problem. This is a classic example of the core fallacy behind "consumer-driven health care," which most conservatives see as key to holding down "waste" and "excessive spending" in our health care system. How will consumers learn about the trazodones of medicine when the entire weight of the health care complex's marketing machine is aimed at forcing compliant patients to demand and use the most expensive, and sometimes less effective, choice?

As the political season heats up, legislation to deal with the health care mess is popping up on Capitol Hill (medical malpractice bills -- again -- the non-answer to a non-problem; and insurance pools for small business are leading the pack). Meanwhile, numeous health care proposals are pouring out of the think tanks in Washington. From what I've seen so far, none are dealing with the core problems that are sending health care costs skyward without a concommitant improvement in the nation's health.

Health care may be a winning issue for the Democrats in the fall. But like the boost they'll get from public disaffection with the war in Iraq, rhetorical flourishes or two-bit tinkering are not substitutes for a program that will actually solve the mess. I think Americans are ready for some bold proposals. I'll review the various ideas floating around later this week. Got to run to work.