Killing Head Lice With An (Expensive) Sledge Hammer

After studying in several institutions of higher learning in several nations, I always feel strange when I learn something from television.  Especially network daytime television.

When my husband attended elementary school in rural Kansas, he tells me that the school nurse checked the kids for head lice. In mine, in suburban Boston Massachusetts, it would have taken the school nurse a whole year.  So in third grade, when I happened to be in public school for a little bit, my humongously obese but friendly schoolteacher checked the whole class and found two kids out of about thirty and sent them to the nurse.  Me, she told me to brush my hair a lot because my curly frizz got tangled.

Recently I saw, in the early morning light, a commercial for this recently FDA approved stuff to treat head lice. Now there are a few things we need to know to put this in context. Even though head lice are uncomfortable for the young kids who are most likely to get them, this is not an illness that kills or incapacitates people. There already exists an over-the-counter (non-prescription) medicine that works for this, that may work in one application or may have to be applied again in a week. As a matter of fact, there are lots of fact sheets with differential diagnosis of this sometimes overdiagnosed disease, designed to assuage parents’ worries. Here is the official FDA news release, which confirms we are treating not a threat to life or limb but “itchiness and stigma.” It is interesting to note that the drug has been approved on the basis of two clinical trials.  As a former researcher who dealt with drug companies and the FDA – not to mention university research organizations – I know about instances where a company conducted multiple trials, and then cherry-picked the best two when they present a drug to the FDA. As to the specific two trials for this head lice treatment, I can’t yet locate either (or any of several) of these clinical trials by searching the databases where I find the usual suspects.

I can’t say for sure that this drug is not better than the others, I cannot remember ever hearing about getting a drug approved for this indication.  So that leads me to conclude – and my guess is a highly educated, professionally based —  with an educated guess that it was compared to an over the counter treatment.

Especially if it got — reported on the first article – 86% instead of 44% cure in one week. In other words, as far as I can tell — this is the only PRESCRIPTION drug for this condition. It does not take a lot of neurons to figure out why the folks at Parapro, LLC came up with this one.  To their credit, they do tell us it was compared to permethrin.  Prescribing information does not look terribly complete, but may actually be enough for a topical treatment (one that you rub on the scalp, rather than a pill you swallow). Head lice seem, as far as I can tell, to hit kids who are not exactly affluent and grow up in large families.  Many of them (I would bet my computer  — and it’s a nice new one my loving husband bought me on Black Friday) are probably on Medicaid or its equivalent (like Medi-Cal) in some states where the sales force of this teency drug company I never heard of before are doubtless convincing government insurance plans to make this reimbursible. Somebody is likely to be making a lot of money from this one. Someone is also catering to the busy mom, who would probably like it if she were more likely to apply something just once. Me, I remember in the day when I was involved in clinical trials, there were a few major multinationals and it was estimated that 80% of all drug development was being done in psychiatry, so it was not that hard, at least in theory, for a type like me to find clinical trials to run. Now I don’t wish any kid head lice — neither itching nor stigma. I would love for drug companies to work on developing drugs to defeat things that kill or damage kids. But there are a lot more children with head lice than with horrible and fatal diseases.  A free market system is not a bad thing.  It is a curious thing. I think of what this is doing to the cost of health care. As opposed to an inexpensive over the counter treatment, now we crank up the price of the drug and add the cost of a doctor visit. I see drugs coming out that are cheaper to develop, with just two studies.  I have even seen compound drugs, those combinations of elements of which have already been FDA approved. What I want to see is human life recognized, in its length and quality, as the world’s most precious commodity.

I am still waiting on that one.