THE COST of treating hypertension in the United States exceeds $10 billion per year,1 most of which is spent on medications. Prescription drug costs are rising at three times the general inflation rate and are the largest out-of-pocket medical expense for three fourths of all elderly patients.2 An important cause of rising drug costs is a shift in physician prescribing from inexpensive old drugs to expensive new drugs,3 which is driven to a considerable extent by new drug marketing. This sometimes includes active discouragement of the use of older drugs, as with diuretics,4 but often lack of promotion alone is sufficient to cause an older drug to fall into disuse.5 Inexpensive generic drugs are not advertised and are less likely to be discussed in symposia or by visiting lecturers or studied and reported on in industry-funded trials. Negative reports about these drugs go unchallenged, positive
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