The sight of feral MAGA supporters taking to the streets in an attempted mass extinction event, protesting their constitutional right to dumb it down, has me musing on US vs Australian psyche. CoVID-19 new case rates here have dropped 9-fold after mandated stay-home ‘unless …..’, and we’re meekly compliant. However the USA’s outstanding effort to hold #1 spot in having the most fatalities isn’t world leadership to aspire to. Likewise, mandatory seatbelt laws beginning in 1970 were proven successful in dropping our roadtoll, whereas in 16 of 50 States Americans still can’t be pulled over by police for not wearing one.

There’s a flipside. Medication harms are hardly ever brought to our TGA’s attention by consumers, and the Database of Adverse Event Notifications (DAEN) is worthless. For the #1 worst drug for numbers of reported side-effects in the USA in 2015, Xarelto, the DAEN lists 123 Australian complaints for their beloved dying as a result of it. The US FDA site at fis.fda.gov is a simple dashboard, and shows 15,557 died – most bleeding from their arse. Bummer!

With a 13:1 population difference (and ignoring prescription rates for now), Americans are ten times more likely than ‘Strayans to cry ‘bloody murder’ at their doctor. For the choice to prescribe Xarelto is difficult to justify.

Old-school anti-coagulant warfarin, in use since 1954, and likewise clopidogrel, are each still prescribed three times as much as Xarelto in 2017, have a fraction the number of adverse events. They’re roughly 20 times safer, and even the newer alternative of Eliquis is killing Xarelto in the marketplace – but at a slightly lower rate in the hospitals. So why was an older friend suffering a leg clot just put onto Xarelto as first option? Lacking the transparency brought by Obama’s Sunshine Act, I can’t comment on whether pharmaceutical company sponsorship influences Australian Dr’s prescribing patterns. It’s fair to speculate that Johnson and Johnson had to adopt aggressive marketing tactics in order to overcome the hits to business from vaginal mesh implants, and opioid & Risperdal (anti-psychotic inappropriately promoted as a sedative in nursing homes) damage.

Partnered with Bayer in marketing Xarelto, J&J last year settled out-of-court for $USD775m for failing to adequately forewarn of bleeding risk.

*Disclaimer. The author didn’t even study biology at school, but a sense of smell for rat (o/dosed on warfarin?) developed doing a Master of Clinical Research at Pfizer’s partner Monash Uni.