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A follow up to the noxious fearmongering and the failure of the media to look at the implications of Congressman Markey, Waxman and the esteemed expert in clinical trial design Charles Grassley to scuttle non-inferiority studies and demand randomized clinical trials to determine safety and effectiveness for all medicines: There is no other way to say it than to state that such an approach would harm the sickest and most vulnerable among us and cripple efforts to accelerate treatments for Alzheimer’s, cancer and AIDS. Perhaps that it why even the NIH regards this politically motivated and doctrinaire approach to be unethical
Consider the following study:
“Enrolling children with asthma in the placebo arm of a clinical trial is common, harmful and ethically unjustified argue researchers from the University of Chicago and the National Institutes of Health (NIH) in the January 2004 issue of Pediatrics. After a systematic review of all clinical asthma trials involving children in the United States published between 1998 and 2001, the researchers found that children with asthma were more than twice as likely to be harmed — defined as forced to withdraw from the trial due to asthma exacerbation — if they did not receive standard asthma therapy compared to children who received standard treatment.”
Or here’s another way to look at it. If, as Markey (who has also pushed for a federal G force standard for rollercoasters) had his way, Ketek would be taken off the market. t’s “lethal” says he. Try telling that to the hundreds of thousands of children who would have died from community acquired pneumonia without it.
To my mind, the real killer in all this is not Ketek, but the politically motivated decisions of pols like Markey who ignore science and mislead the media for their own self serving agenda.
Read More & Comment...Thanks to the spreading outrage — unreported by the MSM — of the sanctioned anti-Jewish postings on the Moveon.org Actionforum (yes Osama, there was a moderator who saw and knew EVERYTHING) the blog itself has been shut down… Here is how the Moveon folks try to explain it away:
ActionForum Temporarily Offline
The MoveOn Great Goals ActionForum will be down until after the election. So much is happening with the MoveOn PAC Leave No Voter Behind campaign and other projects that our systems are at their limits. Suspending the Forum gives us a margin of safety and is a prudent thing to do. We will bring the forum back up after the election.
Well actually, Moveon changed course and is now imposing a 24 hour delay button its Forum monitors. So much for the margin of safety and prudence…
Wisely. Boldly. Timely.
Who Says What’s Best?
US News & Wold Report
By Bernadine Healy M.D.
Evidence-based medicine has the ring of scientific authority. But it’s not as self-evident as it sounds. EBM is a movement born in the 1990s as an alternative way of practicing medicine, in which “best” evidence, gleaned mostly from randomized clinical trials and cost-benefit studies, is the basis for what docs should or shouldn’t do. Touted as a way to improve patient care and restrain unnecessary treatment, EBM sees itself as a major shift away from traditional medicine that emphasizes the expertise of the medical profession. That includes knowledge of the underlying nature of disease, mechanisms of therapy, basic and clinical research, and physician experience. The autonomy and authority of the doctor, and the subsequent variability in care, are the problems that EBM wants to cure.
It’s no surprise that EBM draws strong support from governments that seek uniform standards to assess performance and cost effectiveness. According to Marc Rodwin, professor of law at Suffolk University Law School in Boston, EBM puts experts trained in social science, public health, epidemiology, and economic analysis on par with physicians and “breaks the lock hold” the profession has over how medicine is practiced and compensated. Depending on where you sit, that may be good or bad. But you still have to recognize that EBM carries its own ideological and political agenda separate from its clinical purpose.
Remember the mammogram wars over whether women should get them during their 40s? The protagonists were the EBM-ers who said no and the radiologists and oncologists who said yes. For the naysayers, randomized clinical trials were inadequate to show that the test saved lives, even though it did detect cancers sooner. Such a mammogram program would be costly, and unnecessary biopsies for false positive readings even costlier. But based on their interpretation of clinical evidence, cancer experts maintained that the test saved lives. What’s more, they factored in the nature of the disease: more aggressive in younger women and best cured if picked up early. But in 1997 the Department of Health and Human Services gave a thumbs down to recommending that women start having mammograms in their 40s. Women promptly exercised their political clout, which led to an HHS reversal. (In fact, the trend has been for more screening in this age group, not less.)
EBM also questions the prostate-specific antigen test, or PSA, for prostate cancer. The evidence-based method concludes that the test brings more harm than benefit, as it leads to unneeded biopsies and surgeries on often slow-growing cancers. This is at odds with the American Cancer Society, which says that men should have annual PSAs starting at age 50, and African-Americans, who have a higher prostate cancer rate, at age 45. This does not help that young primary-care doctor who published a mournful essay in the Journal of the American Medical Association in 2004. He did not get a PSA on his 53-year-old patient, based on his dutiful practice of evidence-based medicine. When found to have advanced prostate cancer, the patient sued and won. The jury put its faith in the medical experts who testified that PSAs are the best way to pick up tumors when they are most treatable.
Sift and sliver. Were these tests not so well known, the selective rules of evidence-based medicine might have prevailed. Patients would have been none the wiser. This concern underlies a scathing commentary on the EBM movement in the International Journal of Evidence-Based Healthcare by Dave Holmes, a professor of nursing at the University of Ottawa. He and his colleagues argue that EBM is “outrageously exclusionary” and even “microfascism” in the way it sifts knowledge. Though harsh, he makes a point: By anointing only a small sliver of research as best evidence and discarding or devaluing physician judgment and more than 90 percent of the medical literature, patients are forced into a one-size-fits-all straitjacket. Ironically, this comes at a time when both human genomics and informed patients are demanding more tailored and personal prescriptions for care.
EBM has its merits, but let’s make it just what it claims to be: a system to gather and synthesize evidence and disseminate it widely in order to enhance medical decision making. Do so using the full range of relevant medical knowledge and science and the foremost thinking of its experts, without political or ideological bias. This “best” EBM should be integrated into medicine, not be at odds with it.
Read More & Comment...The Froward Five of FDA Reform — U.S. Reps. Edward Markey (D-MA), John Dingell (D-MI), Henry Waxman (D-CA), Bart Stupak (D-MI) of the House Energy and Commerce Committee, and Senate Finance Committee Chairman Charles Grassley (R-IA) — desperately looking for a way to reinvigorate their FDA jihad, have requested that the Government Accountability Office (GAO) investigate the agency’s “reliance” on non-inferiority studies.
(FYI: Mr. Markey’s website refers to the FDA as the “Federal Drug Administration.” Glad he’s on top of these issues.)
Markey remarked, “The Bush Administration’s FDA has been working hand in glove with the drug industry for six years, leaving Americans vulnerable to dangerous drugs and insufficient information about the side effects of those drugs.”
Yes Virginia, before President Bush took office all drugs were 100% safe and label information was clearly commuicated
Also, last time I looked, the GAO wasn’t staffed with clinical trial design experts — they’re at the FDA.
(FYI — Mr. Markey — that’s the Food & Drug Administration.)
Remember the National Institute for Health Care Management (NIHCM) study? Remember NIHCM, the “nonprofit, nonpartisan organization dedicated to improving the effectiveness, efficiency, and quality of America’s health care system that just happened to be brainchild of one CEO of one major HMO who wanted to launch an attack on drug costs to get the press off his back onto the Rx industry? But never mind that. The study, written by one Mick Hunt said that the increase in drug spending between 1995 and 2000 was largely due to spending on medications that the FDA did not categorize as providing significantly improved efficacy or safety even as it ignored the number of new medicines receiving priority review increased and ignored vaccines and biologics. It also ignored research by Lichtenberg (which it was forced to include in a second version of a report) demonstrating that the consumption of the medicines the study derided actually reduced treatment costs and increased life expectancy.
Part of the goal of the study was to demonstrate how out of control drug costs were and are in terms of explaining huge increases in HMO premiums (at least at the Blues) A recent study by Americ’s Health Insurance Plans finds that non-drug medical costs accounted for 70 percent of average health premium increase in 2005.
Increased spending on physician services was the largest single contributor to the 8.8 percent average health premium increase in 2005. Outpatient hospital services such as diagnostic testing accounted for 22 percent of the increase followed by inpatient hospital services which accounted for 18 percent. Prescription drugs? The subject of the NICHM study and a Peter Jennings report based on the report and a slew of mainstrem media attacks? 16 percent? Other medical services were at 6 percent.
Why didn’t the media write stories about this fact? Why didn’t Ms. MickHunt include that in her dissembling and slanderous piece of propaganda? As Mark Twain noted, a lie can travel halfway round the world before the truth even gets its boots on….
Read More & Comment...
Recently I wrote about a research paper in nature describing a procedure that supposedly produced stem cells without harming an embryo. Turns out that the paper had a lot of hot air and spin to it. It was written and published to appeal to those yearning to tip the balance in favor of embryonic stem cell research. But it claimed more than the procedure actually produced. In essence, the authors used science and shading of language to dupe us… Shame on them and on us for not reading more carefully…
http://www.nature.com/news/2006/060904/full/443012a.html
Read More & Comment...What’s the trade-off between quality and speed? Can’t we have both? While this is a regular debate in the world of pharmaceutical development — it’s not so familiar in the realm of diagnostics. Until now — and it’s about time.
The issue at hand is FDA’s new draft guidance on a new category of complex diagnostic tests that are expected to play a growing role in tailoring medical treatments to specific patients.
Here’s a link to the FDA announcement:
I also suggest, as recommended reading, an article in today’s edition of the New York Times by the always thoughtful Andrew Pollack. (Sorry — I am not able to provide a hot link, but the title is “F.D.A. Seeks to Regulate New Types of Diagnostic Tests.”)
Please note that this is a draft guidance — the agency is accepting comments. Now is the time to help the FDA design a final guidance that will allow for both speedier approval and higher quality.
It can be done. It must be done.
Read More & Comment...Arguably the most hardworking and innovative health care administrator in US history announced that he is leaving his position as administrator of the Center for Medicare and Medicaid Services. Mark McClellan has done more to change thinking and the culture of healthcare away from command and control, government run systems to a consumer driven approach that dovetails with the technological trend towards personalized medicine. Mark oversaw and helped engineer both transformations first as FDA commissioner through the Critical Path initiative and then as administrator of CMS with the implementation of MMA which apart from giving seniors drug coverage for the first time via Medicare has also caused millions of seniors to take charge of their health care dollars.
Mark’s tenure was not without controversy. He took on those who wanted to import unsafe drugs as a political stunt and threatened to demoralize and scare seniors into not signing up for the new benefit. But as Ronald Reagan said: “A leader, once convinced a particular course of action is the right one, must have the determination to stick with it and be undaunted when the going gets rough.”
That was the essence of McClellan as a health care policy leader.
Read More & Comment...On August 15 I had an op-ed in the Baltimore Sun on the growing dangers of counterfeit drugs (“Pharmaceutical Fakery is Health Care Terrorism”). I pointed out that one of the weakest links in the chain is the European practice of parallel trade.
I believed it then. I believe it now. Here’s a link to my original article:
But I clearly ruffled some feathers Over There. Richard Freudenberg, the Secretary General of the British Association of European Pharmaceutical Distributors, dashed off a very defensive letter that appeared in The Sun on August 25.
(Here’s a link to the letter: http://www.baltimoresun.com/news/opinion/letters/bal-ed.le.25aaug25,0,2130712.story?coll=bal-oped-headlines.)
Among other things, he rants that my “allegations are, at best, unfounded, at worst blatently false.”
But not only does he think I am completely wrong, he proposes that he is completely right. He continues, “In fact, to date, there has not been a single case of counterfeit drugs in Europe which have entered the legitimate supply chain via parallel trade.”
To rebut Mr. Freudenberg, I asked Graham Satchwell, one of the world’s undisputed experts on counterfeit prescription medicines, to address the issue. Here is what Mr. Satchwell had to say — unexpurgated — and he pulls no punches.
RESPONSE BY GRAHAM SATCHWELL TO RICHARD FREUDENBERG:
Over two years ago I published a book on counterfeit medicines and organized crime. Since that time the matter has gained greater attention and one could reasonably believe that the Pharmaceutical Industry, the middle-men and the American public were becoming more aware — as indeed they must if they are to be adequately protected. It was heartening for instance to see the British regulatory authority, the FDA and World Health Organisation and others beef up there anti-counterfeiting efforts.
As part of the global campaign to raise awareness Mr. Peter Pitts wrote an article published in the Baltimore Sun on August 15 (“Pharmaceutical Fakery is Health Care Terrorism”).
So much to the good.
How disappointing then that the leader of the British Association of European Pharmaceutical Distributors has apparently had his head up his harness for the last two years.
In his response to the cautionary article by Peter Pitts, Richard Freudenburg commented, “Peter Pitts incorrectly links the worrisome issue of counterfeit medicines with the perfectly safe and legal practice of parallel distribution of medicines in Europe.”
Mr. F is of course wrong to glue the words perfectly safe to legal in the way he does, for they are certainly not inseparable. After all, prostitution, pot-holing, drunkenness, bungee jumping, and suicide are amongst the many types of behavior that are often legal but dangerous they also certainly are — similarly parallel trade in medicine — legal but not always safe.
Mr. F goes on to contend that, “parallel distributors source and sell products exclusively from EU countries and therefore do not facilitate the entry of products from non-EU countries such as Russia.” If only Mr. Fraudenberg could guarantee that that were always the case. However, if were to do so he would he would be naive, stupid or dishonest.
It seems to be a matter of overwhelming logic that in any given population you will have those who comply with the rules and who usually behave ethically and those who will break the rules because of perceived self interest or negligence. Were it not so then our planet would surely witness a race, tribe or occupation where crime and punishment were unknown.
Nevertheless, unprepared to leave his criticism there, Mr. F continues, and it seemed to me by this stage of reading Mr. F’s critique that he was developing a style, for he again links to distinct notions as if one, “Associating counterfeiting with Europe’s parallel distributors, who have operated successfully and safely for decades, is unjustified and irresponsible.”
“Successfully and safely?” The former means that they have made a lot of money, the latter is provably untrue for there have indeed been occasions on which counterfeit medicines have been found in the distribution chain and in the hands, or from the hands of those holding parallel traders licenses.
Perhaps Mr. F is unaware? Perhaps he shouldn’t be. Perhaps he should do a little research. Perhaps he would do a greater public service to the American public if he were to highlight the extreme weaknesses in the systems within Europe for the movement of pharmaceutical products and the dangers — real and potential — which that threat poses. But hang on, who does he represent? Well he is paid to represent the interests of those very European traders who benefit from parallel trade — strange coincidence you might think.
Mr. F’s slip is really showing when he offers the following, ‘In fact, to date there has not been a single case of counterfeit drugs in Europe which have entered the legitimate supply chain via parallel trade.” How very wrong you are Mr. F, please do some research.
Of course it might be that in Mr. F is only talking about the performance of his membership, which comprises, across Europe, only about 70 companies. Let me remind Mr.F. lest it slipped his memory, there are literally thousands of parallel traders licenses in existence in Europe.
The erstwhile Mr. F assures us “member companies across the EU, adherence to strict Good Distribution Practice guidelines is mandatory.” Yes Mr. F, like speeding restrictions on our roads, politicians declaring all their expenses properly, and little boys washing behind their ears.
Mr. F assures us all, “The idea that the EU’s latest enlargement round has compromised the safety of the European pharmaceutical supply chain also belies reality.” At this stage one might wonder about whose reality we are discussing here, Mr.F’s or the rest of the civilized world? For anyone with any doubt about the increased risk of all sorts of criminality which faces Western Europe from the newest members of the Union, please (a) do a Google search on such criteria as fraud+Eastern Europe, or (b) read what the EU officials or WHO or Interpol have said on the subject, or (c) read the rather detailed report of Dr. Jonathan Harper, or (d) simply ask any reasonably informed law officer.
There can be little doubt that few parallel traders would want to deal in counterfeit medicines, but as Mr. F knows, or should, it is the very act of removing original packaging with anti-counterfeiting features and repackaging those goods in translated items before shuffling them from country to country and dealer to dealer that affords the opportunity for the unscrupulous few to do real harm.
Two years ago I took the opportunity to publicly debate some of these issues, yet Mr. F. seems unaware of the evidence that so clearly undermines his position, surely he cannot have forgotten? If he has, then let me invite Mr. F to publicly debate these issues with me at any venue of his choice. This is a real and specific opportunity for Mr. F to set the record straight and once again here some hard facts.
Want to do it Mr.F?
There was a time when there were many voices in Europe and the USA echoing the sentiments of the bold Mr. F. Most have been embarrassed into silence, it is time for Mr. F to stop insulting the intelligence of consumers.
If any US reader wants to know more about the real situation in Europe then visit my website (PocoSolutions.com) go to articles and see the full text of A Sick Business and other articles.
Thank you, Graham. Well said.
Ringside seats for this debate between Mr. F and Mr. S (when scheduled) will be available at www.drugwonks.com.
Read More & Comment...Doctors in Botswana, already battling one of the highest levels of HIV per capita in the world, are being overwhelmed by a dramatic rise in cancer cases as a result of the epidemic….
The cost of treating Kaposi’s Sarcoma was an additional burden on the public service health budget.
“The cost per patient is 350 pula (58 US dollars) per course which is repeated four to six times. There is also the cost of radiotherapy which is between 5,000 and 7,000 pula. With other types of cancer, these amounts increase to 2,000 pula per course,” he said….”
Meanwhile at the Tenth International Obesity Conference experts noted that” the cost of treating health problems related to being overweight was immeasurable on a global scale, but was estimated at billions of dollars a year in countries such as Australia, Britain and the United States.
“We are not dealing with a scientific or medical problem, we’re dealing with an enormous economic problem that, it is already accepted, is going to overwhelm every medical system in the world,” said Prof. Philip James, the chairman of a global task force set up by medical organizations that deal with weight-related problems.
He said governments had been forced to confront rising obesity rates because of the expense of treating related health issues.”
Health care costs are rising, exploding like ballon…speading like a cancer…
The reason is not drug costs or greedy drug companies or useless medical technology.
The reason is disease. Disease — or our inability to prevent it or stop it early — is expensive. Things that killed us quickly and sooner have been replaced with illnesses that use a combination of genes and environment to trigger chronic and long term patterns of illness that cripple and kill. And there are some who believe that those who make profit out of finding ways to pre-empt these pathways are bigger evils than the diseases they fight.
So who is the bigger enemy of the human race?
David Cutler, Harvard University health care economist extraordinaire, was lead author of study look at the value of medical care. After estimating that half of gains in life expectancy are attributable to medical care (the rest due to lifestyle changes and fewer murders, accidents) Cutler and company found:
:…although medical spending has increased substantially during the past 40 years, the money spent has provided good value. However, temporal trends suggest that the value of health care spending is decreasing over time, particularly for older age groups. “
Cutler adds two important qualifications: “Studies suggest that there were substantial improvements in the quality of life during this period, especially among the elderly. Thus, our estimates are likely to have understated the value of medical spending. Finally, although we excluded gains in life expectancy that were due to nonmedical interventions, we did not exclude their associated costs, owing to the difficulty of disaggregating them from the overall costs of health care. This resulted in the overstatement of cost increases and thus the understatement of the value of medical advances. ” In otherwords, medical spending is probably more valuable than reflected in the study..
Of course the Leftists countered that other countries had similar increases in life expectancy with less money. But you can make international comparisons…too much variation within the US, let alone between countries. The true comparision, comarping gains due to medical intervention only demonstrate the superiority of our system…cancer, stroke and heart by pass mortality rates…no contest…Sorry Gooz…Get your facts straight for once..
And leave it to Sid Wolfe to come up with the meanest and most pointless comment:âThe fact that someone is writing this paper shows how desperate the health care system is to justify these out-of-control increases in health spending,â So in otherwords, every time Sid Vicious writes a paper it is an act of desperation? Here’s the difference: David Cutler is a well respected economist who has published in peer reviewed economic journals and has advised presidential candidates on health care reform ranging including Bill Bradley. And Sid Wolfe is just a hack.
Read More & Comment...The article on PDUFA in today’s WSJ is headlined “Drug Firms Use Financial Clout To Push Industry Agenda at FDA” conjures up an image of drug companies conspiring to ram useless and dangerous drugs through the FDA. I mean, what else do you with financial clout except water down regulations governing safety and efficacy?
Turns out (and Anna either doesn’t know or doesn’t think it’s important) both biotech and pharma companies would like to devote some user fee money to fund Critical Path programs that would allow the FDA to hire and train scientists who can use new molecular tools and new clinical trial methods leading to more targeted and personalized medicines. Then there is an effort to help the FDA establish collaborations with large health systems to collect clinical data in cooperation with companies after a drug is marketed. Finally, there is talk of devoting some money to promote industry, academic, and agency initiatives like the one created with MIT Center for Biomedical Innovation to develop software for detecting adverse drug effects and reactions of new drugs after they hit the U.S. market or the one with the Critical Path Institute to develop a biomarker to do the same thing before a drug goes into development.
Only a professional scowl like Sid Wolfe (see post above) would complain this is a waste of additional industry funding. Why is it that Mathews couldn’t report on these possibilities?
Read More & Comment...Remember the nearly gleeful article Stephanie Saul wrote about Apotex had outfoxed Bristol and Sanofi just a couple of weeks ago? And the fawning piece that described Apotex CEO Bernard Sherman as both a wily businessman, consumer crusader and man of charity? Well, now that Apotex has had the law shoved down its throat, Stephanie seems a bit dazed and uncharacteristically plays it straight for once … almost like the news jarred her back to the default settings of objective reporting…
September 1, 2006
Generic of Plavix Is Blocked
By STEPHANIE SAUL
A federal judge in Manhattan ordered a Canadian company yesterday to stop distributing its generic version of the blockbuster anticlotting drug Plavix, granting a reprieve to Bristol-Myers Squibb and Sanofi-Aventis, which co-market the brand-name drug.
The Plavix marketers had seen a drastic erosion of their United States sales since the Canadian company, Apotex, introduced its generic version on Aug. 8 in a challenge to the patent held by the big companies. Analysts say that the large supplies of the generic drug already on the market could continue to impinge on sales of Plavix for several months …
Judge Stein did say that the patent was likely to be enforceable, based on the evidence and testimony so far. He also observed that Bristol-Myers and Sanofi had suffered “irreparable harm” as a result of the patent infringement.
He nonetheless required Bristol-Myers and Sanofi to post a $400 million bond to compensate Apotex in the event the generic company won in a trial on the validity of the patent, now set to begin in his court next January …”
Apparently the judge did not buy, as did Stephanie, Bernie’s claim that he never intended his wheeling and dealing (getting BMS and Sanofi to pay for only half of generic sales if it lost its patent suit) to really mean anything, citing as evidence letters he sent to Chuck Grassley in which he wrote that he hated all the wheeling and dealing. The judge saw it for what it was: a shakedown that was part of an effort to void the patent without exploring the validity of the patent itself …
“In his 57-page ruling, Judge Stein wrote, ‘The public interest in lower-priced drugs is balanced by a significant public interest in encouraging the massive investment in research and development that is required before a new drug can be developed and brought to market.’”
Those of you who want to see Judge Stein’s entire ruling can go to this link:
http://www.nysd.uscourts.gov/courtweb/public.htm
Read More & Comment...In August, drugwonks.com received over 100,000 visits. (And considering we’re not a “mass” blog, we think that’s pretty terrific.)
Thanks to all of you for helping make drugwonks.com such a success.
(Yes, you too Senator Grassley.)
Read More & Comment...
This just in from the WSJ.
And it’s astounding.
Scientists Use Gene Therapy
To Shrink Malignant Tumors
For the first time in the history of treating cancer, gene therapy has apparently succeeded in shrinking and even eradicating large, metastatic tumors.
The therapy worked in only two of 17 patients who were treated. But many researchers are hailing the study, which was published Thursday in the online edition of Science, as groundbreaking because it provides compelling evidence in human patients that gene therapy can be effective against one of the toughest challenges in medicine: terminal cancer.
Moreover, the technique used in this pilot study — genetically altering immune-system cells so that they target tumors — could eventually apply to many different kinds of cancers, not just the cancer that afflicted patients in this trial, which was melanoma.
Here’s a link to the entire article:
http://www.wsj.com/article/SB115704231287350662.html?mod=home_whats_news_us
We’re waiting to see what Senator Grassley has to say.
Read More & Comment...Per the FDA’s list of Canadian Internet pharmacies that are selling counterfeit drugs, Andrew Strempler, founder of Mediplan (considered the first Internet pharmacy), says the FDA allegations are false.
Strempler : “We test our products and stand behind our products.”
drugwonks.com: “Put up or shut up.”
Governor Schwarzenegger is supporting pharmaceutical price control legislation that the people of California have already rejected once — and recently. Unless cooler heads prevail it could very well be hasta la vista medical progress.
Here’s what I had to say about it in the Orange County Register:
http://www.ocregister.com/ocregister/opinion/abox/article_1258737.php
As California goes so goes the nation? We should all hope not.
Read More & Comment...Counterfeit drugs are a serious danger.
Senator Vitter, et al., who think “from Canada” always means “from Canada” need to pay attention to the facts, reconsider their position — and put the public health in front of political posturing.
A good place to start would be to read the lastest FDA news release. Here it is.
FDA Warns Consumers Not to Buy or Use Prescription Drugs
from Various Canadian Websites that Apparently Sell Counterfeit Products
The U.S. Food and Drug Administration (FDA) is advising consumers not to purchase prescription drugs from websites that have orders filled by Mediplan Prescription Plus Pharmacy or Mediplan Global Health in Manitoba, Canada following reports of counterfeit versions of prescription drug products being sold by these companies to U.S. consumers. FDA is investigating these reports and is coordinating with international law enforcement authorities on this matter.
FDA recommends that consumers who have purchased drugs from these websites not use the products because they may be unsafe. Laboratory analyses are underway for intercepted product that was destined for the U.S. market.
Preliminary laboratory results to date have found counterfeits of the following drug products from these websites: Lipitor, Diovan, Actonel, Nexium, Hyzaar, Ezetrol (known as Zetia in the United States), Crestor, Celebrex, Arimidex, and Propecia. All of these medications require a prescription from a licensed health care provider to be legally dispensed.
DRUG NAME
USE(S)
LIPITOR
Cholesterol disorders
CRESTOR
Cholesterol disorders
ZETIA (US name) / EZETROL (Canadian name)
Cholesterol disorders
DIOVAN
High blood pressure
HYZAAR
High blood pressure
ACTONEL
Osteoporosis in postmenopausal women
NEXIUM
Gastroesophageal reflux disease (GERD)
CELEBREX
Arthritis-related pain
ARIMIDEX
Breast cancer
PROPECIA
Male-pattern baldness
Some of the websites that are operated by Mediplan or that have order fulfillment through Mediplan are:
www.RxNorth.com;
www.Canadiandrugstore.com;
www.Rxbyfax.com;
www.Northcountryrx.com;
www.Canada-pharmacy.com;
www.My-canada-pharmacy.com;
www.NLRX.com;
www.Canampharmacy.com;
www.Canada-Meds-For-Less.net; and
www.Canadian-safe.com
As a general matter, FDA advises consumers to use caution when buying medical products online. Although a website may appear reputable and similar to legitimate retail pharmacy websites, many actually operate from outside the U.S. and provide unapproved drugs from unreliable sources.
For example, in August of 2005, FDA conducted an operation at New York, Miami, and Los Angeles airports which found that nearly half of the imported drugs FDA intercepted from four selected countries were shipped to fill orders that consumers believed they were placing with “Canadian pharmacies.” Of the drugs being promoted as “Canadian,” based on accompanying documentation, 85 percent actually came from 27 other countries around the globe. A number of these products also were found to be counterfeit. These results demonstrated that some Internet sites that claimed to be “Canadian” were, in fact, selling drugs of dubious origin, safety and efficacy.
Today’s announcement is consistent with FDA’s earlier message of the dangers posed by such websites and the need for caution on behalf of the public.
Drug counterfeiting is illegal for good reason. Drug counterfeiting defrauds consumers and can expose them to products containing unknown, ineffective, or harmful ingredients. Counterfeit drugs may be toxic or contain doses that are too small to treat a medical condition, or so large that they could endanger the health of the user. Because of the dangers posed by counterfeit drugs, the FDA aggressively investigates all instances of drug counterfeiting.
Headlines claim that CMS spent $275 million on a quality demonstration project to measure cancer care that proved nothing…
Here’s the lede of the story as reported by AP
Report questions millions spent on effort to measure patient care
Wednesday, August 30, 2006
Kevin Freking
Associated Press
Cancer doctors received about $275 million from the federal government and the elderly last year as part of a yearlong research project that many doctors believe won’t produce any useful findings.
Under the program, the federal government paid $130 each time a chemotherapy provider assessed a Medicare patient’s pain, fatigue and nausea. The payments were designed to encourage doctors to report information that might one day lead to improved care for cancer patients….
Iowa Republican Sen. Charles Grassley, chairman of the Senate Finance Committee, said taxpayers and beneficiaries were “bilked” because they paid for services that physicians are already supposed to provide. …”
Let the record show that ” Senator Chuck Grassley (R-Iowa) and Senator Max Baucus (D-Montana) have presented a bill that entitles providers that report quality data and satisfy particular quality standards to obtain full Medicare reimbursement along with bonuses. Providers who do not report data will only receive Medicare reimbursements at the full rate of inflation minus two percentage points…”
If someone can explain the difference between what Medicare is doing and what Grassley has proposed, please comment….
Meanwhile, as to the OIG claim that the data is useless, let the record show that CMS will reimburse physicians who report whether their treatment of patients adheres to recommendations in nationally recognized practice guidelines published by either the National Comprehensive Cancer Network (NCCN) or the American Society of Clinical Oncology. The demonstration will focus on thirteen cancer types that account for at least 80% of all patients with cancer in the United States. ” Now this might not be outcomes data but at least it is a start…a baseline for measuring the transition to products that don’t produce such side effects and don’t require hospitalizaton…get it? Such measures are important since you would be astounded how many people don’t complete cancer care because of pain, fatigue and nausea and therefore die as a result. So compliance with protocols to reduce such feelings matter a hell of a lot. And the payment for collecting such data is less this year, a little fact that both OIG and news accounts forgot to include.
Shame on Grassley for grandstanding and being so grossly hypocritical in the process.
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