Facebook's Dr. Feelgood & His Magical Sleep Potions

Hey, all of you drug-addled insomniacs out there. Haven't you had enough of the addictive poisons that big pharma has hooked you on? You know, the ones like Ambien, where CVS makes you provide a driver's license and passport, your 4th-grade report card, AAA card, and a stool sample to get a bottle of 30 stinkin' pills.

Well, it's a damn good thing that Facebook, the universal arbiter of health matters, "somehow" figured out that I too can use a hand getting my ZZZs, a problem that is faced by about one-quarter of the US.  And there it was, right in my face:  LifeMD, a telehealth company. Thanks, Zuckerberg!

Here's some more...

Observations: 1) Doesn't that couple look like brother and sister? No wonder they can't sleep. 2) These guys want your money fast! But does anyone truly believe that whatever they're selling is gonna be 50% more tomorrow? 3) How can they be offering a free consultation, a free prescription, and free rush delivery? Don't they want money? 

LifeMD hates Ambien and they're in a BIG rush to sell you something else. What is it?

Thanks to the power-mad psychopaths fine public servants at the DEA, just about any drug that is deemed to have any abuse potential (notably absent - alcohol and nicotine) gets slapped with a Schedule designation. Scheduled drugs cannot be sold by mail, but unscheduled drugs can be provided that the vendor meets certain requirements (like a stamp). This would seem to be the business plan of LifeMD.

So, it cannot be a coincidence that the sleep aids that the company is pushing are not scheduled. Nor is it likely to be a coincidence that they portray Ambien (scheduled) as a brief stop on the way to the coroner's officer while their sleep drugs are SO much better. More on this later.

What does LifeMD sell for insomnia?

For insomnia, LifeMD sells three prescription drugs, none of them controlled and only one of which was initially approved as a sleep aid.

• Doxepin (off-label antidepressant)
• Trazodone (off-label antidepressant)
• Rozerem/Ramelteon (sleep aid)

Are they any good? A qualitative, but helpful way to evaluate the "popularity" of a drug is to look at how patients rate it and (even better) some of the quotes they offer. A useful site for getting this information is Drugs.com. Let's look at how the LifeMD drugs fare and also Ambien on the site. 

Drugs.com ratings

Patients rate drugs on a scale of 1-10 where 1 means "I wouldn't give it to Hitler" and 10 means "Wonderful." How well are these drugs (and Ambien) received by insomniacs?

Figure 1. Drugs.com patient ratings of four sleep meds.

Upon first glance, it appears that Doxepin, Trazodone , and Ambien are roughly equal while Rozerem is horrible. But taking a closer look at why the drugs were used is rather revealing. Both Doxepin and Trazodone were initially approved for other conditions (depression) and are used off-label for insomnia. Drugs.com sorts the ratings by condition; when you look at the ratings for insomnia alone things change a bit.

Here's an example.

The average score for Doxepin, 6.1, is inflated by the scores of the drug for other conditions. For insomnia, it received a 5.7 rating.

Repeating this exercise, we get:

Figure 2. Drugs.com patient ratings (adjusted) of four sleep meds. 

** Rozerem and Ambien were not adjusted because they are solely for insomnia. 

From adjusted patient ratings, we can conclude that all three LifeMD sleep drugs are inferior to Ambien, at least according to a small sample of people who rated them, with differences ranging from significant to modest.

But LifeMD paints a different picture: [MY EMPHASIS]

Ambien is a controlled substance that can be abused and potentially cause dependency. [OR NOT] Additionally, these drugs can cause the dreaded daytime “hangover effect”, leaving you feeling tired and groggy. [OR NOT]

In contrast, LifeMD offers FDA-approved prescription medications regulated for safety, quality, and potency [EXACTLY LIKE AMBIEN]. Prescribed by licensed healthcare providers through LifeMD, these medications have fewer side effects and are significantly more powerful. [THEN WHY ARE THEY RATED INFERIOR BY PATIENTS?]

Fact: Ramelteon, the #1 recommended sleep aid available through LifeMD, is 10X more stronger/potent than melatonin. [WHICH IS USELESS]

Why is LifeMD selling these three drugs for insomnia?

Because they can. None of the three sleep aids sold by LifeMD are controlled substances; the company cannot legally provide these. Therefore, it's unsurprising that LifeMD criticizes Ambien, a product it cannot sell, while also making exaggerated statements about its own products

Does this meet the criteria for false information? Probably not, but Facebook has its own method of policing information. Let them figure it out:

What the hell is wrong with Rozerem? My

Of the four sleep drugs discussed the ratings for Rozerem are noticeably different from the other three and not in a good way. A few patient quotes from people who gave it a low rating (1) may explain this.

"Rozerem is the worst medication I have taken. No wonder why it's not prescribed often. To people who have anxiety, stay away from this useless drug. Spare yourself from panic attack and laryngoedema. Very dangerous medication."

"Expensive and totally worthless"

"It's very expensive for it NOT to be effective. My insurance paid $400 & my copay was $100." 

"Rozerem did absolutely nothing for me. You might as well take a TicTac."

 "It gradually increased depression to such a degree that I almost admitted myself to the ER for depression watch."

"Made my insomnia worse. Took it for a week then threw it out after I was up for 36 hours."

Bottom line

LifeMD is, at the very least disingenuous. The company makes its sleep aids sound like a panacea when, in fact, they are two old antidepressants used off-label and one new sleep aid that people hate. Ambien outperforms all three drugs but LifeMD makes it sound like a death sentence in the waiting. If the US didn't have such stupid laws about controlled substances and Ambien was available by telemedicine would LifeMD change its tune? 

Don't lose sleep thinking about it.

NOTE:

(1) To be fair, there was a group of people who gave Rozerem high ratings and good reviews. But a 4.2/10 rating is pretty awful. After a brief search, I could find only one drug with a worse rating – Fosamax, a true abomination that is (mis)used for osteoporosis. That managed to get a ghastly 2.6 rating.