Primatene Mist, the Undead Asthma Medicine

By Dr. Paul Ehrlich

In a season that saw the opening of a movie called “Abraham Lincoln Vampire Hunter” I suppose no one should be surprised that someone is trying to pull the stake from the heart of Primatene Mist and let it out of the crypt.

Just to recap, Primatene was pulled from the market last December on a timetable set by the Bush Administration according to a protocol begun in the Reagan Administration because it was propelled by chlorofluorocarbons (CFCs), which were deemed harmful to the ozone layer high above the earth where it protects us from ultraviolet rays, a known cause of cancer.

As I wrote last October in a piece on the economics website NewGeography.com, I had my doubts about banning medical CFCs because they were such a small part of the problem and we had done a poor job of finding an alternative. However, I had no such doubts about the medical rationale for banning inhalable epinephrine, which acts on the heart as well as the lungs without doing anything to control the underlying inflammation, something that has been known for decades.  This is reason enough to get the stuff off the pharmacy shelves.

According to David Doniger of the National Resources Defense Council, “Primatene’s manufacturer apparently misjudged the declining market for its product and found itself with stocks of inhalers on its hands after the deadline. So now the company is lobbying Congress to pass a special bill to put those stocks back on the market.” The bill is called “Asthma Inhalers Relief Act”.

Doniger quotes Dr. Monica Kraft, professor of Medicine at Duke University and current president of the American Thoracic Society thusly: “If the intent of the legislation is to restore a safe and effective asthma drug to the market place, then this legislative effort is misinformed. Inhaled epinephrine is not a safe drug for the treatment of asthma. The adverse side effects of epinephrine are serious and well documented. No current clinical practice guideline for the diagnosis and treatment of asthma recommends the use of epinephrine. In fact, asthma guidelines specifically recommend against inhaled epinephrine for treating asthma.”

In that same NewGeography article I said, “Many who decry the passing of Primatene believe the ban was contrived to squeeze more money out of those who can least afford it. They probably have a point. I would love to see the FDA memos and transcripts from 2006 when the Primatene decision was made, or from 2008 when the fuse was lit, not to mention those of the current owners when they decided to acquire the drug. Even without access to these secrets, we know that drug makers like to tweak existing medicines and bring them back on the market at higher prices than they command over the counter, and that investors sometimes buy up the rights to older drugs with exactly this in mind.”

Clearly, that kind of financial gamesmanship continues beyond the grave. The fact that they had produced enough of a surplus to have meaningful stocks on hand when the regulatory deadline came around means they always thought it could be bent, and of course to sell them now makes a mockery of the whole idea of expiration dates. Put that stake back in Primatene’s heart and keep it there.

* Vlad III, Prince of Wallachia (1431–1476), was a member of the House of Draculesti, a branch of theHouse of Basarab, also known by his patronymic name: Dracula. He was posthumously dubbed Vlad the Impaler because of his practice of impaling his enemies, and was a prototype for the most famous vampire of them all.