Therapeutic drug interchange: the battle heats up.

THERAPEUTIC INTERCHANGE! The battlelines have been reconnoitered and the major protagonists and antagonists are headed for the front. The old nemesis "substitution" has been dressed up as "interchange:' ~hey are in fact equivalent terms in this therapeutic field of battle. As health professionals we are so used to making war on cancer, battling AIDS, holding the line ?~ arthritis, ,and bombarding malaria-infested jungles, It IS no surpnse that we struggle tenaciously for a limited health care turf and love to do a little interprofessional skull-bashing on Saturday nights. Therapeutic interchange is a far more explosive issue than generic interchange, which still causes propaganda ~arfare after almost 20 years of enabling state legislanon encouraged by the American Pharmaceutical Association (APhA). Generic interchange occurs only after patent expiration. Therapeutic interchange can result in the substitution of another chemical entity, on or off patent, for a substance still under patent protection, even a newdrug just reaching the market after costly research and development. Expensive sales forces, clever and extensive marketing strategies, and decades of company image-building can be thwarted overnight, the pharmaceutical industry fears, if therapeutic substitution is carried to its possible conclusion. The debate has suddenly escalated an order of magnitude due to a position taken by the American Association of Colleges of Pharmacy (AACP), a respected organization representing academic pharmacy, many of who~e memb~r~ are generally pro-industry and supportive of positrons taken by the Pharmaceutical Manufacturers Association (PMA). The following is from the AACP News: