The Big Zit Rip-off GREELEY, CO (KUNC) - Most agree that something needs to be done to overhaul America's healthcare system. But leave it to KUNC commentator Dr. Marc Ringel to illustrate the problem - through something as small and innocuous as a pimple.

The question is up for grabs whether it's worse to have acne as an adolescent or as an adult. Many will remember a lone pimple that about spoiled prom. On the other hand, to find, way past adolescence, that you've developed an inflamed mug, complete with a red, swollen nose you fear puts you at risk of a reputation as a drinking buddy of W.C. Fields, is no fun either.

The condition of youngsters is called acne vulgaris, not because pimples are vulgar but from the Latin word meaning "commonplace." Adults are more prone to developing acne rosacea, which derives from the same Latin root as "rose," referring to the ruddy color of the affliction. Extreme rosacea can lead to the sort of scarring that gave W.C. Fields his bulbous nose. Many of the characters who Fields portrayed on the silver screen were drunks.

To set the record straight, alcohol is a contributing factor to some people's rosacea. Booze dilates the blood vessels of the face, especially on the nose. But there are other contributing factors to the facial irritation of rosacea, including low-grade infection, which is why antibiotics, either topical or oral, can help to control the disease.

One of the mainstays of antibiotic therapy has been doxycycline, a member of the tetracycline class of drugs that has the benefit of infrequent oral dosing. The standard adult dosage of doxycycline for infections like sinusitis or Chlamydia of the cervix is 100 mg once or twice a day. For treating rosacea, once a day is enough. Actually more than enough. It's been found that 40 mg daily is plenty.

Doxycycline is most commonly dispensed as 50 or 100 mg capsules. You can buy, for about $4.00 at many pharmacies, a month's supply of these pills. The antibiotic has been available for decades in generic form.

Or you can buy Oracea, a brand-name doxycycline marketed by Galderma Laboratories. Oracea will set you back over $200 a month if you purchase it in this country or about $150 if you shop online and make your buy from a Canadian outfit. To be sure, the dosage of Oracea is 40mg, making it, like the baby bear's porridge, just right.

I cannot imagine, though, how the extra 10 mg in a 50 mg generic doxycycline capsule could cause close to the distress that too-hot or too-cold porridge did to Goldilocks. Nor do I see how Oracea would work better than the plain vanilla generic except, perhaps, for an enhanced placebo effect generated by spending so much money on a product marketed especially to this affliction. A person might figure that such an exorbitantly expensive brand name would just have to work better.

Oracea is being touted directly to the public. I haven't seen the ads myself. I heard of the brand from a colleague who described his shock when he realized that the drug his patient had asked for by name was just a 40 mg capsule of doxycycline that was being sold for over $7 a pill.

This whole scheme represents the worst of the worst in the American pharmaceutical industry. A cheap broad-spectrum antibiotic that has its place in treating a host of diseases is repackaged in a slightly different dosage form, given a high-tone brand name, marketed directly to the public as a specific treatment for one particular condition, and its price is inflated more than 5000%.

There's no way the curmudgeonly W.C. Fields we know from the movies would have purchased Oracea. His on-screen persona was a notorious skin-flint and chiseler. Nor would he have risked loss of his trademark schnozz. On the other hand, I'm sure Fields would have regretted not being the one to have cooked up and made a killing off the outrageous Oracea marketing strategy. He'd have certainly said, "Wish I'd thought of it. © Copyright 2010, KUNC