Just goes to show, newer and more expensive isn't always better. I was reading this paper in NEJM last night and shocked it hadn't gotten more press coverage once the embargo was lifted, well, now it is. The story is a drug, named aprotinin and made by bayer, has long been used to prevent excess bleeding during cardiac surgery.

The authors said that in light of their findings, and the fact that two other less harmful and far less expensive alternatives exist, it is no longer "prudent" for doctors to use the drug except in unusual circumstances. If they continue with the drug, the authors said, doctors have a moral obligation to inform patients about the risks.
...
Mangano's research, however, found not only a greatly increased rate of kidney failure, but also a 50 percent increase in heart attacks and an almost 200 percent increase in strokes. The study also found that two other generic drugs in a different class were as effective as aprotinin in stanching bleeding after surgery, were safer and cost less than one-tenth the price.

So, the question is, why wasn't the new fancy drug seriously compared to the generics it was replacing years ago? Could it be because no one wants to study generics? Because generics don't maximize profit? We should come up with a new medical saying for this effect, something like, "Newer! Less tested! More Expensive!"

I'd actually say that the probability is if there is a generic version of a drug that you need, not only will it be cheaper, but there is a good chance that it might be safer. **cough** Crestor **cough**. Certainly this is not a universal rule, but one that probably deserves attention when one prescribes, or is prescribed, a new drug.