Word: sandoz
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Clozapine was developed by the Swiss pharmaceutical giant Sandoz as an alternative that avoids most of Thorazine's side effects. As a major bonus, it at least partly reduces the passivity of schizophrenics as well as their more blatant symptoms. In contrast to the Thorazine family of drugs, clozapine primarily blocks the neurotransmitter serotonin, though it also inhibits dopamine transmission to some degree. The fact that it influences both neurotransmitters may help explain its greater effectiveness. Still, "nobody completely understands why clozapine is a superior drug," says Dr. Luis Ramirez, chief of psychiatry at Cleveland's VA hospitals...
...reported that eight patients taking the drug had died of agranulocytosis, a sudden loss of infection-fighting white blood cells. In the U.S., the Food and Drug Administration halted even preliminary tests. "We assumed it was a dead product," recalls psychopharmacologist Gilbert Honigfeld, who helped develop the drug for Sandoz and is now in charge of marketing it in the U.S. American and European research eventually showed that agranulocytosis occurred in 1% to 2% of clozapine patients and that it could be detected and nipped in the bud by conducting blood tests on a weekly basis...
...approved clozapine for patients who failed to benefit from Thorazine-type drugs, but required the weekly blood testing. Then Sandoz, with the agency's approval, added an unprecedented stipulation: only its representatives could administer the blood tests. Technicians representing Sandoz were prepared to travel hundreds of miles to draw a single patient's blood if necessary. The policy boosted the drug's price tag to an astonishing $8,944 a year and raised a fire storm of protest from families, mental-health advocates and state mental-health-department officials, who argued that local technicians could perform the blood tests...
...Americans who have been treated with clozapine have died from the condition. Although that is considered a low fatality rate, it is still enough to make mental-health professionals nervous. They worry that the uncertainty and risks might jump in 1994, when Sandoz loses its exclusive license to manufacture clozapine. The appearance of generic versions of the drug may be a boon for cash-strapped families, but it raises the specter of fewer controls -- and more deaths...
Several state attorneys general are investigating Sandoz for possible antitrust violations, while a handful of advocacy groups have launched lawsuits to force Medicaid to pick up the clozapine tab. But to patients with schizophrenia, these legal and legislative maneuverings mean little. All that matters to them is an impossible price tag standing between their current mental anguish and a productive life...