Despite Spending $50 Billion Per Year In R&D, Pharma's New Drugs Less Effective Than Drugs Developed 40 Years Ago
from the the-future-is-yesterday! dept
More bad news has arrived for consumers. The drugs don't work. Or, they don't work as well as they used to. Despite the exorbitant prices charged for new medications and despite the industry's claims that expensive R&D efforts are driving these prices up, the fact remains that newer drugs cost more and do less, riding a decades-long slide from peak potency.
Research published on Monday showed that the effectiveness of new drugs, as measured by comparing the response of patients on those treatments to those taking a placebo, has plummeted since the 1970s...
The new study in the journal Health Affairs examined 315 clinical trials that compared a drug to a placebo and were published in four of the world's top medical journals (BMJ, Journal of the American Medical Association, Lancet and New England Journal of Medicine) from 1966 to 2010. The drugs targeted the full range of human ills, from cardiovascular disease and infections to cancer, mental disorders and respiratory illness.
In the early years, drugs easily beat the placebo: They were, on average, 4.5 times as effective, where effectiveness means how well they lowered blood pressure, vanquished tumors, lifted depression or did whatever else they were intended to.If this disappointing (albeit somewhat unsurprising) news wasn't damaging enough for an industry many people have developed a healthy distrust for, the passing of the national healthcare plan will make it even worse.
But the trend line was inexorably downhill, found Dr Mark Olfson of Columbia University and statistician Steven Marcus of the University of Pennsylvania. By the 1980s drugs were less than four times better; by the 1990s, twice as good, and by the 2000s just 36 percent better than a placebo. Since older drugs were much superior to placebo and newer ones only slightly so, that means older drugs were generally more effective than newer ones.
The law established an independent research institute to compare the effectiveness of different treatments for the same condition. That way, patients as well as private insurers and government programs such as Medicare can stop paying for less effective therapies. If the new analysis is correct, then "comparative effectiveness research" could conclude that older drugs, which are more likely to be generics, are better than pricey new brand names that deliver the most profits for drugmakers.Well, this part is good news for consumers, or at least beneficiaries of the new health plan. If the most effective drug is also the cheapest, everyone wins... almost. Pharmaceutical companies won't be happy, but this really is their own fault. They often tout the (often inflated) high dollar cost of R&D but fail to mention this outlay is routinely outweighed by marketing and administration costs.
There are a few reasons effectiveness may have declined over the past forty years, not all of which are tied to self-interest and profit chasing. One possible factor is that the low-hanging fruit of the pharmaceutical world was plucked first, generating effective medications for simpler ailments. It also could be that those volunteering for clinical trials are increasingly people not having success with currently available drugs. Another factor mentioned in the article is the fact that the quality of clinical trials has increased over the years and the additional scrutiny to detail has narrowed the definition of success.
Despite these factors, many scientists feel there is an underlying truth to the overall claim that older drugs just work better.
While experts agree that tougher trials and similar factors explain some of the decline in drugs' reported effectiveness, "something real is going on here," said Olfson. "Physicians keep saying that many of the new things just aren't working as well," and therefore prescribe antidepressant drugs called tricyclics (developed in the 1950s) instead of SSRIs (from the 1980s), or diuretics (invented in the 1920s) for high blood pressure instead of newer anti-hypertensives.Then there's this:
"The way the drug regulatory system is set up, even if you have just a small advance, if you market it right it can be very profitable," said [Dr. Aaron] Kesselheim.The profits-over-effectiveness factor cannot be denied. Marketing budgets routinely meet or exceed R&D budgets because they have to. Pharmaceutical companies are not nearly as interested in breakthrough medication as they are in pushing minor variations or incremental advances. [See also: this "Brain Candy" clip.] Without a ton of marketing, these interchangeable drugs will never find purchasers.
From 2000-2007, 667 new drugs were approved by the FDA. Of those, only 75 (11%) were new molecules that were much better than what we already had. In fact, over 80% of all drugs approved were no better than what we already had. Those are "me-too" drugs. Why do the pharmaceutical companies spend so much on marketing? Because you have to really promote drugs that really have no benefit over others that already exist. You have to convince people to buy those.Taking this route has worked for years, at least in terms of profitability. There's no reason to change it now. The results of this research paint a rather unflattering picture of the pharmaceutical industry, but as usual, its representatives seem blithely unconcerned.
You know what needs no promotion? Awesome new drugs that save lives. When was the last time you saw a commercial for chemotherapy? For epinephrine? For steroids? Those drugs need no promotion - doctors just know to use them. But I bet all of you know about Nexium. Or Cialis.
The drug industry says it isn't worried. "Our sector is not concerned about objective, high-quality patient-centered comparative effectiveness research," said PhRMA's Burkholder. "We believe the substantial value of our products will continue to be demonstrated."Frankly, I'm inclined to believe that first sentence. The sector doesn't seem to care what research says about its new, expensive, ineffective drugs. It already has plenty of compliant doctors, paying customers and an exploitable patent system in its corner. That makes the second sentence extraneous. If the market's tied up, the industry doesn't really need to worry about demonstrating value. All it needs to do is maintain course.
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The intent of much research is to make the drug less effective, but more precise. My pain pills are a good example: the most recent version has a better release cycle in the body, so I get to function physically AND mentally at the same time. The generic is almost the same molecule and does, in fact, help the pain better, but the side effects are much much stronger. I'm totally zonked on those. Lesser effect, but better focused: less side effects, almost the same desired effect, repeat until you need to make it stronger again and upping the dosage doesn't do.
The intent of much more research is also to get a new patent on anything you can and money gouge, but I thought I'd mention that counter-point.
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2. on top of that, a LOT of so-called R&D money is actually bullshit marketing fluff in disguise: 'research' on whether viagra should be a blue or red pill; 'research' on whether you'd sell more if it was a caplet or a capsule, etc...
3. these are NOT altruistic organizations working 24/7 to provide comfort and relief to the afflicted, these are soulless korporations whose SOLE purpose is to part you from your money...
art guerrilla
aka ann archy
eof
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Stating the Obvious
There is no money in cures. There is lots of money in treatments. There is OBSCENE money in treatments that are barely effective.
Now that we understand the ground-rules, we can proceed. Sorry that it obviates most of your article, but there it is.
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Re: Stating the Obvious
Suppose you cure, say, a condition where an opponents treatment has cornered the market. Now, on a long enough timeframe, you're going to come down with something no matter how healthy you are.
So,
1. opponent gets less money
2. You're getting some money for a cure
3. More people live due to your cure, and more illnesses will occur later down the road, some of which may require treatments you control.
4. Less medical issues on areas you don't control reduces intersectional population of conditions which leads to more money available for your products & extended lifespan of patients already getting your treatments.
Seems like open research would solve this problem. (Since you kinda usually need the research that went into the treatments to make a cure)
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Re: Re: Stating the Obvious
All indications say yes.
How many decades has it been since the last cure was publicly available?
Open research? - What are you, a commie red basturd?
The job creators need astronomical profits hidden off shore in order to provide minimum wage no benefit jobs for all us yobs. They call it the jobs for yobs program.
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Re: Stating the Obvious
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nature vs man-made
willow bark - aspirin
fungi - penicillin
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Re: nature vs man-made
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Funny how that works.
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Hmmm..
Wages? $40,000 each sounds like a nice wage dont it..
1,250,000 jobs..
I DONT THINK SO..
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Drug effectiveness is irrelevant: If they can show that they gave it to 1,000 people and 32 people got better (instead of the 31 who got better on [that cheaper drug]) well that's good enough, don't you think? Approve that thing.
Drug safety is also irrelevant: "Liver damage? Well, yeah, there were 164 of the 1,000 who had liver damage, but we removed them from the study as being 'non-typical'. If we'd reported them in the main results, the FDA might not have let us sell the drug!"
The only thing that really matters these days is, "Who can we pay at the FDA to let us sell this?" We've truly returned to the days of snake-oil salesmen.
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There are a few reasons why the placebo effect could be stronger now, including greater trust in pharmaceuticals brought on by their success, particularly with antibiotics. If I take a drug now, I have 100% confidence that it has been researched, developed and correctly administered to cure what ails me. Whether that's true seems to be less relevent.
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Dunno where you're getting all that confidence from. Are you not from the US? Over here we see commercials for legal firms on TV all the time, advertising for lawsuits against the pharmaceutical companies. "If you or a loved one have taken that medicine that came out last year, call the law offices of So-and-So. You may be entitled to a cash settlement." It's been like that for at least a decade.
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http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect
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This is really weak. Not only did you not provide any substantiation for your hypothetical claim, but even if it were supported by data the conclusion is based upon a casual correlation. May I remind you of the graph which shows a decrease in pirates vs an increase in global temperature.
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But I sure don't, and most of the people I know don't. Skepticism is particularly high with the newer drugs.
Still, it's an interesting point. I wonder if anyone's studied the overall confidence people have in the safety and efficacy of drugs?
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Amusing piece
Let's toss a few out there: drug resistance, desire to narrowly target the drug, minimizing side effects...
Let's not forget the old "low hanging fruit" issue. 40 years ago, it was much easier to develop a new drug, there were large areas that had not been touched. There are plenty of reports out there that will tell you that the current drug technology will pretty much run it's course within most people's lifetimes, as the bacteria becomes more resistant, and as researchers realize that they are at the end of the line for developing new drugs in the current fashion.
So nice try Tim, but perhaps you should get informed on the subject a bit before parroting someone else's "research".
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Re: Amusing piece
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Re: Amusing piece
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Re: Amusing piece
Let's toss a few out there: drug resistance, desire to narrowly target the drug, minimizing side effects...
Let's not forget the old "low hanging fruit" issue. 40 years ago, it was much easier to develop a new drug, there were large areas that had not been touched. There are plenty of reports out there that will tell you that the current drug technology will pretty much run it's course within most people's lifetimes, as the bacteria becomes more resistant, and as researchers realize that they are at the end of the line for developing new drugs in the current fashion.
So nice try Tim, but perhaps you should get informed on the subject a bit before parroting someone else's "research".
I agree, though it's undeniable Tim's douchebag pill is working. I just hope he doesn't develop the same gynecomastia side effect that Masnick did taking that prescription.
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Re: Amusing piece
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Today, we are trained to "take a pill and get better" so the placebo effect would be huge. Under the right circumstance you can sell lead as gold, right?
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Apparently that is not the case in recent studies.
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http://listverse.com/2013/02/16/10-crazy-facts-about-the-placebo-effect/
Placebo effect in canine epilepsy trials.
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Re: Re: Amusing piece
Distributed healthcare.
It become cheaper to actually manufacture and produce the things you need than to "buy" it.
Computer miniaturization has come a long way and you can actually produce almost any drug in your kitchen and you actually can test it to see if it is good or not.
If people have to pay for million dollar treatments sure they can buy million dollar equipment.
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Generic prescribing
Branded drug prescribing is way down while the rate of generic prescribing is steadily climbing. Generics now make up about 80% of all prescriptions in the US. Insurance companies regularly send physicians report cards based on their percentage of generic prescribing. Each Doc is kept aware of his/her position relative to both regional and national averages. Furthermore, the pharmaceutical companies no longer dole out any of the free trinkets or junkets that once poured out of their marketing departments. Yes there have been new regulations that have impacted marketing practices, but I think a lot of us in medicine suspect that no small part of the disappearance of pharmaceutical marketing is due to the fact that they just don't have anything really new or useful in their pipelines to replace numerous drugs that have gone off patent.
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Re: Generic prescribing
I know at least here in Australia, the Doctor just prescribes the actual drug, like Codeine, then when you go to the Chemist, if there is a generic equivalent, he asks you if you prefer the origan or are happy to accept a generic.
The choice is not the Doctors, he just prescribes the drug he has decided for you, you get to choose if you would like to pay a little less for a generic, as you are fully aware that the generic drug is by law exactly the same, contains the same active ingredient, and as described about is exactly the same as the brand name.
My research shows this applies also to Doctors in the US.
By law a generic is exactly the same as the original, no better no worse, EXACTLY THE SAME.
By definition if it is not exactly the same it is a derivative drug, and it is not generic.
Generic drugs are made and sold a lot more cheaply because THEY ARE EXACTLY that same, and as such can use the original clinical trials, testing and evaluation as the original drug.
If it is different, it has to go through it's own set of testing and trials, and is therefore not generic, but a new product, generic companies do not have the resources to perform pre-clinical trials, clinical trials, and regulatory approval to market the drugs.
Nor, do generic companies have to accept the very high attrition rates of new compounds.
about 1 in 10,000 chemical compounds identified to treat a disease will be approved for marketing.
a study in 2006 showed that the cost of development of a new compound to marketing stage is between $500 million and $2 billion dollars.
Journal Health Economics in 2010 estimated approx. $1.2 Billion.
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Drug effectiveness
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Add to this the fact that many (possibly most) Phase 2 and Phase 3 trials these days don't actually have a placebo arm (due to obvious ethical issues when the patients have serious diseases or conditions that need to be treated). Rather, the control arm of many clinical trials will be whatever the gold standard in therapy happens to be, with the endpoint being either non-inferiority or superiority to that gold standard. How does this study take into account those trials, or does it simply leave them out?
I know the pharma industry is a rather popular punching bag (and I've got plenty of criticism I can level at the industry myself despite working in it), but it doesn't do anyone any good to simply parrot criticisms that may very well be based on a lack of understanding of the science involved, or in some cases even an intentional misrepresentation of the data.
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you raised some very valid points too I might add.
also are they repeating the original drugs clinical trials, or just using historical records, and how do they account for drugs there simply were not available or had not been developed in the 70's ?
The people who 'write' for TD are not interested in unbiased 'reporting' of the facts, they are looking for "the hook", the catchy headline (some would call it 'click bait'), not boring, messy 'FACTS'!!!
that amounts to torturing the data until it confesses (to whatever conclusion they were aiming for).
Love that line !!!!
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It's worse than that...
So you may have 4 trials that show no effect, and one that shows a small effect. You publish the one that shows the small effect and not the others... and then have it retracted ten years down the line when the patent runs out.
Neat huh?
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Re: It's worse than that...
1 in 10,000 chemical compounds identified to treat a disease makes it to market, that means 9,999 resulted in "negative" trails.
I can understand that there is no need to prove a negative, and it would be an unnecessary burden to product the results of every negative experiment, and stupid.
example HPV vaccine, research was started in the mid 1980's for the vaccine, US FDA approved the first preventive HPV vaccine in 2006. People could of spent their entire career working on this one vaccine, and you are saying the price for the development and approval of this drug is high ??
You don't think 20 years of development would be expensive ?
Or that a HPV vaccine is not something that has saved many thousands of lives ?
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Re: Re: It's worse than that...
You do five or six trials on the SAME product, and only report the ones that show a positive result.
You are referring to something completely unrelated.
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Re: Re: Re: It's worse than that...
So you would expect there to be much testing for conditions that are not helped by this compound, and you would expect the drug companies to accept that, and not have to say that "aspirin helps headaches, but does little in promoting bone growth in a broken arm".
So for Aspirin they would test it's efficacy for a range of conditions, and by a process of elimination and selection would then be able to determine, what conditions are assisted by this new compound.
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Re: Re: Re: It's worse than that...
A negative result is a positive result as it helps to exclude (or include) what the compound does (or does not do).
Without that testing, (and negative results) you have no way of knowing if it is good for something else, or for that!! for that matter.
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Re: Re: Re: Re: It's worse than that...
How will you know if something is good or bad if the idiot trying to get approval hides all the bad results from the testing?
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Side Effects?
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Re: Side Effects?
how can you compare these kinds of things when years ago, there was no drugs at all for many of these conditions.
There were no drugs for smallpox, malaria, HIV/AIDS, cervical cancer, stomach ulcers, so how can the efficacy of those drugs be compared to years ago, when there were no drugs to compare ?
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As well as the progressive improvements in the reporting of specific effects of new drugs compared to what was performed in the 70's for example.
For example VRE (Vancomycin Resistant Enterococci)
or
Vancomycin resistant Staphylococcus aureus
HIV drug resistance occurs when microevolution causes virions to become tolerant to antiretroviral.
The drugs ARE getting better, but so are the dieses.
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noun, plural di·e·ses
Origin:
1350–1400; orig., any of several musical intervals smaller than a tone (for which a double dagger was used as a symbol); Middle English < Latin di ( h ) esis < Greek díesis literally, a sending through, equivalent to die-, base of diïénai to send through ( di- di-3 + hiénai to send) + -sis -sis
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What we really need.
The problem, crazy regulation and monopolies create an environment where exploitative/abusive practices can flourish, is cheaper today to fly to New Zealand to have surgery than it is to have it in the US or Europe, it created an entire industry that people call healthcare-tourism, but even that is out of reach for many, further there are negative bias against subgroups that lead to less than optimal care, people discriminate against criminals, races, religion and just about anything they can think of, if you were a doctor would you treat a pedophile or rapist with great care? probably not, bias is hard to root out.
So seeing how pirates work I realized that we shouldn't be trying to force anybody to give us care, we should instead be teaching people how to take care of themselves and create the know how on how to build and produce the things people need to achieve that so each and every person will be able in their own group to make it happen, that is the fucking best safety net everybody can have.
Pirates don't depend on others to distribute anything, they can do it by themselves and they do it exceptionally well, pirates can defeat the most intricate "security features" created by people who you can say are literally rocket scientists or on par with them, meaning they actually have great understanding of the subject they pay attention to.
Instead of pirating movies and exercising their brains on ways to hack "security measures" maybe is time to hack healthcare and start equipment local clinics everywhere with the tools they need to give first class care to everyone for free.
Those clinics need cutting tools made of metal, how many people here know how to forge a knife?
Could we use spinning-metal techniques to produce cheap functional stethoscopes out of an steel or aluminum can?
How would we test if to see if they do what they are supposed to do?
Using audio spectograms?
Could people make scalpels out of aluminium cans?
Chest spreaders for surgery?
Gauze using wooden looms?
How to test the metal after a pouring?
I know people use gas spectrometry to test the composition of metals and CT-Scans to check integrity of the metal inside, but also sound testing that could catch brittle pieces since they sound different and can be viewed by a computer.
Drugs can be produced too, basically drug producing is like cooking food, most drugs today are produced using engineered bacteria that then are "fermented" then tested to produce the desired substance which is them "distilled", then tested to be then tested again at the end.
Most tests in chemistry are done by chromatography and mass spectrometry.
How would we connect with others to see what they are doing and get feed back about stuff?
Using something like "patientslikeme.com" that can predict how drugs test trials will come out before they are out?
This is not pie in the sky, this is actually very doable, making things require knowledge on how to make it and how to test it to see if it is doing what is suppose to do it.
And hacking healthcare actually could make life less scary for all of us.
I would like to see big pharma drag a cancer patient to court for infringing their patents and the Judge ask the guy, why did you did it?.
"Your honor, I had no money and no insurance, I would die without the drug and I found out how to make it by myself and it only cost me pennies, without those drugs I wouldn't be standing here today, so that is why I did it, because I wanted to live, I am sorry that my will to live override my obedience to the rules."
Crowds can produce nearly every little bit doctors need to treat anybody, from gaze to CT-Scanners today.
Maybe is time to start helping ourselves instead of begging for others to be sensible and have some empathy. Knowledge is unbiased it doesn't care who is using it, it doesn't discriminate against criminals, gays, religion, it doesn't care if you have insurance or not, it doesn't care if it is lawful or not, if it is right or wrong, those things people care, knowledge can be acquired by anyone, it is cheap, free and light but can change your life forever by freeing you to do it yourself when others try to negate anything to you.
Did people know that there are only four or five classes of antibiotics in the world?
You just need to produce five types of antibiotics to have everything a big hospital has.
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Re: What we really need.
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Re: Re: What we really need.
I rather go make a spear to keep the Lion away.
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Re: Re: What we really need.
This is the difference between the people who have the knowledge and people who don't.
You can wail your arms all you want that nice lion there still gonna eat you, on the other hand the dude with the spear probably will eat the lion tonight.
The spear in healthcare is the drugs and instruments,
A person who knows how to, can make a dialysis machine from scrap to save a life.
BBC: 'DIY' kidney machine saves girl
or print a piece of plastic to safe yet another life.
NPR: 3-D Printer Makes Life-Saving Splint For Baby Boy's Airway
Knowledge is the spear, kill the lion or wail your arms at it, you choose.
I want more drama, I want more knowledge, but I will not force you to do it, you have to chose, you have to be the one responsible for taking the path you need and you need to deal with the consequences of those choices.
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Its in the math
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That keeps people sick/in pain for longer
People need to keep buying the drugs
Big Pharma profits big time
It's all about the almighty dollar.
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Drug companies started focusing on profits over effectiveness long ago. Care to take a guess as to why? The article eludes to it. Health Insurance! Everyone (OK, many) thinks Universal Healthcare will be the cure to health care costs. It only exacerbates the problems. Health Insurance gives everyone the ability to pay almost regardless of what the costs are. Health Insurance makes people think they can go to the doctor with no real symptoms and demand an MRI or a prescription, after all the cost to them is minimal.
Every time I go to the doctor he wants to give me some new drug. The main office I work in has a doctors office right across the parking lot. At least 3 times a week I see drug company reps taking in boxes of samples or new drugs AND lunch for the entire staff. I'm not talking Subway either.
Advertising for drugs, at least to the public, should be illegal. The general public doesn't have the knowledge to be able to determine if a drug is the correct drug for them, but they see it advertised, or hear from word of mouth how 'great' it is and then they demand it from their doctor, if the doctor won't write the script, they just get another doctor who will.
Bottom line is your right, it isn't about helping the people it is about the almighty dollar.
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Next thing you say !!!!
With many of the newer drugs the side effects are often far worse than the initial problem the drug is meant to treat.
Where did you get that from, from your honest open mind ??
THEN THIS GEM:
The focus isn't on creating a better drug, it is on getting another patent and marketing the drug so patients will tell their doctors to write a script for that drug.
Again, this is from an honest, open mind ?
Honest, open but with no basis in fact, or reality.
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Are you saying the NY Times lied about their articles on big pharma modus operandis?
Are you saying that all those, paid for by pharma companies, big events are not there to be used to make doctors use their drugs?
Are you saying that kickbacks to doctors for sales doesn't happen?
Are you saying that hospital administrators are not target by sales people?
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Its common knowledge, for any who look, that for years drug firms try to re patent drugs or even just combine two drugs together, brand them with a new name, and sell them for 10 or more times the price of each separately. Both practices should be banned.
Its also true that many if not most medical drug discoveries are molecules made by nature. (however currently synthesized) Its been a while since a new pain reliever with less side effects became available and surely big Pharma has tried.
It would not be surprising to hear that the continual new drugs that pharmaceutical companies are stuck with today are not as effective as their effective advertisement campaigns claim they are. It rings true in respect to common high power ruthless marketing techniques; Crush the competitors and dilute the knowledge base of the masses with mush.
Will the fact that some consumers/doctors made less effective and more costly choices make them liable for possible health issues related to an inferior product? Did this study identify them specifically and compare side effects also?
'Independent' medical research has been corrupted by corporations before (remember what the Tobacco industry did to invent the term “cigarette lie/argument”) and although its nice that an Independent Research Institute is currently functional with some critical review process... how long will they last? They will likely need public support to survive.
There have been a lot of new cancer drug/treatments that seem to be promising we still have the extremely draconian chemotherapy in use. Its hard to keep in mind that there is no profit in a total cure. Treatment is profitable and there is a huge, really huge, industry that depends on that alone.
Given that the pharmaceutical industry depends on Hollywood Accounting Principles to survive it a good bet that we have smoke... and a fire probably not far away. It takes time to devise a sales marketing solution to maximize profits. And. Once they make it to the market; What price will be levied?
A very cynical opinion for sure but the only thing that American/world industry can be trusted with is to be ruthless beyond life, health and liberty. (certainly the US Constitution was no big deal to get rid of)
Big pharma is a effective monopoly of a few large companies dominating the market. This monopoly is enforced by the DEA and the FDA with their almost totally imaginary international trade quality fears. What we need instead of some large cold heartless corporation owned drug stores is a good local apothecary.
High prices kill people in the same way as no treatment at all. Witch doctors and blood letting might be better than the current system.
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All molecules are made by nature, even ones that come out of a test tube. All molecules are made of elements, all elements are 'natural'.
just as natural, as Einstein's E=MC2 equation, it's the product of nature, it's also the natural property of someone's intellect !!!
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Re: Re:
Are you trying to be deliberate stupid or something?
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Not rocket science.
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Bad Pharma
The fundamental question is not only are drugs getting worse compared to placebo, but why we test against a placebo at all. For most new drugs there is already a medically accepted alternative in place. For example, if you have a new headache pill the real world choice is not should I take this new pill or do nothing. The choice should be should I take this new pill or take an aspirin.
-Matt
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Yes new drugs have come along way
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Magnesium Chloride and/or Citrate can help ameliorate just about anything
Magnesium supplementation helps the body absorb protein and b complex vitamins better, which also helps the body work better.
Doctors don't mention this to people because knowing this about well absorbed magnesium (like magnesium chloride or magnesium citrate) does not make money for the pharmaceutical companies.
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