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Drugwonks
Latest News!Written By Comment Count Comment Last Three February 28, 2009
Dr. Robert Goldberg
Winston Churchill once noted: "This is no time for ease and comfort. It is the time to dare and endure."
Last night Peter and I were surrounded by people who celebrated Dr. Sol Barer, CEO of Celgene for his leadership and vision in transformational medicine. They and we were graced by the warmth and wit of John Stossel, Rich Bagger, Mike Ferguson, myleoma survivor Elijah Alexander, and Dr. Jules Hirsch -- individuals who are leaders in their respective fields of journalism, the pharmaceutical industry, politics, professional football and academic research. Their charge to us, at the First Annual CMPI Odyssey Dinner, was to dare and endure as they have, on behalf of medical innovation. We were called upon to speak out, to make biomedical innovation a personal and passionate cause -- and to battle against those who vilify its capitalist origins. I can't thank enough those who gathered with us to begin this new movement -- friends old and new -- for their support, generosity, warmth and participation. Above all, I am left with a memory of your kindness, the appreciation of which I look forward to repaying in the months and years ahead! Thank you. -
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February 27, 2009
Peter Pitts
OMB Budget Document:
"The Budget supports the Food and Drug Administration’s (FDA’s) new efforts to allow Americans to buy safe and effective drugs from other countries ..." Don't kid yourself by thinking this has anything to do with lowering costs for seniors (because even the AARP says Part D is a better deal) or "broadening access" for the uninsured (which is what pharmaceutical patient assistance programs are for). Importation is yet another stealth strategy towards a straight up price control regime for medicines. If importation goes forward, you don't need to revoke the Non-Interferene Clause. This has been Rahm Emanuel's strategy for the past few years and now he's an agent in place. If you like "universal care" provided by Uncle Sam, MD -- you're going to love importation. Here we go again. -
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February 27, 2009
Peter Pitts
Sing in me, Muse, and through me tell the story -
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February 26, 2009
Dr. Robert Goldberg
Here's my take on the Obama healthcare "downpayment"
1. I don't like tax increases. However capping the deductibility of health care expenses at some point does make sense. So does taxing benefits beyond a certain dollar value or income level (inflation adjusted). Obama got that half right. 2. Requiring HMOs to bid using the Medicare actuary's estimate was something President Bush proposed in 2003. Most people don't remember that. Now Obama is proposing the same thing in lieu of the bonus. Will seniors pay more or less? Will they be better off? Hard to predict. 3. No price controls on part D which rewards use of market forces and preventive technologies. Cuts to medical imaging and home health which will likely not stand or will be adjusted. 4. The administration proposes a bundled hospital payment that includes 30 days for post discharge care. Can we say DRG-based capitation? Nothing new here...just another reimbursement code to exploit. The Obama team did as little as prescriptively possible to come up with $700 billion for universal health care. More -- about a trillion more (at least) will be needed and even then not everyone will be enrolled. And of course enrollment does not equal better health or outcomes. Where will the rest of the money come from? A tax on employers in lieu of providing coverage. So for the most part the health care reforms are nothing new and the cost is very high. Still, the down payment does little to move us towards "government run" health care. If free market types want to come up with a way to provide people with a choice of health plans that eliminates penalties for pre-existing conditions and a range of insurance products that are affordable that does not involve government control over medical decisions, now is the time. It can't be HSAs alone, which are still a confusing and difficult benefit to provide. It has to protect people from financial catastrophe, reward healthy behavior, reward better outcomes, encourage more personal responsibility. And the proposal has to be bold and big. Nothing else will compete or do. -
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February 26, 2009
Peter Pitts
According to a story in today’s Washington Post, “President Obama is proposing to begin a vast expansion of the
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February 25, 2009
Peter Pitts
Good speech. Liked the overall tone. Pleased to report that the Vice President's hair is holding up nicely (which is more than I can say for my own).
Not surprisingly (in advance of the budget) light on details. No surprises. Per healthcare reform, two words that may serve as tea leaves -- "down payment" and "affordable." "Down Payment" = incremental. "Affordable" = insurance reform. Relative to "affordable," here's are a few paragraphs from the recent Robert Pear story in the New York Times: Since last fall, many of the leading figures in the nation’s long-running health care debate have been meeting secretly in a Senate hearing room. Now, with the blessing of the Senate’s leading proponent of universal health insurance, Edward M. Kennedy, they appear to be inching toward a consensus that could reshape the debate. Many of the parties, from big insurance companies to lobbyists for consumers, doctors, hospitals and pharmaceutical companies, are embracing the idea that comprehensive health care legislation should include a requirement that every American carry insurance. While not all industry groups are in complete agreement, there is enough of a consensus, according to people who have attended the meetings, that they have begun to tackle the next steps: how to enforce the requirement for everyone to have health insurance; how to make insurance affordable to the uninsured; and whether to require employers to help buy coverage for their employees. The ideas discussed include a proposal to penalize people who fail to comply with the “individual obligation” to have insurance. “There seems to be a sense of the room that some form of tax penalty is an effective means to enforce such an obligation, though only on those for whom affordable coverage is available,” said the memorandum, prepared by David C. Bowen, a neurobiologist who is director of the health staff at the Senate Committee on Health, Education, Labor and Pensions. The full New York Times story can be found here. Another question worth pondering is wither Medicare Advantage? -
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February 24, 2009
Peter Pitts
Court verdict could give generic drug makers an unfair advantageGeneric drug companies are pressuring Congress to pass a bill that would profoundly alter how drugs are developed and sold. Supporters claim the measure will expand choice and lower prices for consumers. The truth, however, is that it will limit competition and drive up prices.In recent years, the generic drug industry has been growing by leaps and bounds. Once seen as fringe players, generics now account for 65 percent of all U.S. prescriptions and post $59 billion in annual sales. In fact, the generic market has been growing faster than the brand name drug market. This explosive growth has brought with it increased stature and influence. And the generic drug industry is not shy about flexing its newfound muscle in legal and legislative arenas. Drug innovators can spend 15 years and more than $1 billion discovering, developing, testing, and bringing a successful drug to market. In return for this tremendous investment, pharmaceutical companies are given a patent, generally for 20 years, during which they alone can sell the drug. This exclusivity period often includes the years spent in research and development, so drug companies don’t have very long to recoup their investment. And once a patent expires, generic drug makers are able to offer their version of popular drugs. Not saddled with massive R&D expenses, generic companies can offer the drug at a fraction of the cost of the original, allowing them to quickly gobble up the market share. Currently, the first generic manufacturer to win government approval can market their version of the drug without competition for six months. Often, the original drug innovator creates its own generic, called an “authorized generic,” and wins this brief exclusive marketing period. The bill currently before Congress will outlaw authorized generics, paving the way for generic-only companies to move their version to market more quickly. Proponents say this will lower prices for the generics, but the evidence suggests otherwise. Historical data demonstrate that authorized generics are usually introduced to the market at a 50 percent discount. Straight generics, on the other hand, are introduced at a 30 percent discount. In addition, once the six-month exclusivity period is up, the market is open to all generics, and the more there are, the lower the prices for consumers. Arbitrarily banning one of those generics is not only unfair to consumers, it also creates a disincentive for drug innovators to invent new cures. The development of new drugs is a risky and expensive process, so anything the government does to obstruct companies from recouping their investment tends to have a chilling effect on drug innovation. Which is why a recent decision by the California Supreme Court in the case of Conte v. Wyeth is so troubling. The plaintiff, Ms. Conte, became quite ill after taking a generic heartburn medication prescribed by her physician. Conte not only sued the generic manufacturer, but also Wyeth, the company that made the original brand name drug, even though she never ingested any medicine made by Wyeth. Because her physician admitted he had not read the warning labels for the generic drug he prescribed, but rather relied on the Wyeth warnings he had been exposed to decades earlier, Wyeth was found liable for Conte’s injuries. Pushing the bounds of common sense even further, the generic manufacturer has been excused from the case entirely. Why? Because even though they made the actual product that harmed Conte, the physician hadn’t read their warning label. This case sets a potentially disastrous precedent. In addition to doing all the research, development, testing, trials, and advertising for new drugs, innovators must also assume the legal liability for their competitors when they someday market a generic version of the drug. In our already-litigious society, it is difficult to imagine a greater deterrent to developing new medications. Generic drugs are widely trusted by Americans, as they should be. But however safe their products are, the policies the generic industry is pushing are anything but. They threaten to eliminate competition, drive up prices, and stifle innovation -- all prescriptions for catastrophe. Peter Pitts is president of the Center for Medicine in the Public Interest and a former FDA associate commissioner. -
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February 24, 2009
Dr. Robert Goldberg
In yet another example of how when you seek a "seat at the table" in Washington politicians take it as a sign that you can't stand on your own two feet or you would be willing to lie under the next bus they throw you under ...
http://www.ama-assn.org/amednews/2009/02/23/prsa0223.htm "Sunshine" bill sets $100 trigger for disclosing drug industry pay to doctors The proposal would let states regulate such income even further. Reflecting a growing trend, two universities and a specialist group announce new conflict-of-interest policies."Physicians who receive $100 or more from drugmakers or device manufacturers over the course of a year would have those payments posted to the Web under bipartisan Senate legislation introduced in January.The new bill is stricter than a version of the measure circulated last year that received support from industry and organized medicine groups, including the Pharmaceutical Research and Manufacturers of America and the American Medical Association. The reintroduced legislation, known as the Physician Payments Sunshine Act, came amid another round of disclosure and conflict-of-interest policies announced by doctors and academic health systems."Note that none of these disclosure or conflict of interest policies or limits on marketing announced by academic health systems restrict the ability of academic health systems to uh..market to the public, pay doctors out of central funds, receive and transfer money from insurance companies, hospitals, the for-profit arms of the health systems themselves, the lobbying or law firms that might retain the physicians from the academic health systems for expert legal work. Oh no. That exemption is about a wide as the part on Senator Grassley's scalp. And since we have no regard for the civil liberties of physicians and their family members...."The bill also would require drug companies or device makers that are not publicly traded to disclose any ownership interest held by physicians or their immediate family members. " Does that mean if Dr. Berkowitz invests his son's Bar Mitzvah money in a hedge fund that also holds a position in a start up seeking to cure cancer that it is the responsibility of the start up to track down that investment? Some university health systems have gone to idiotic lengths to prove to Grassley how pure they are..."University of Iowa Health Care, a 1,420-physician health system, also announced a stricter financial-conflict plan in January. Among other things, the new policy bars faculty, staff and trainees from seeking, accepting or giving patients product samples under the theory that the free drugs improperly influence prescribing habits." Nice theory. But is it true? And what if samples allow doctors to monitor if patients actually respond well to drugs without burdening patients with out of pocket costs? Doesn't that improperly influence prescribing habits? Since co-pays seem to drive down compliance in many cases isn't this policy harmful to patient health in order to appease Grassley? And meanwhile it hasn't stopped UI from boosting the amount of dough it spends marketing itself to the various insurance providers in the area. In any event, I agree with Senator Grassley tha "Shedding light on industry payments to physicians would be good for the system. Transparency fosters accountability, and the public has a right to know about financial relationships." So with that, the Sunshine Act should be amended to include any payment to physicians and any financial relationships in the health care industry. That includes when foundations and law firms pay physicians to travel to cushy locations to pontificate about drug and devicemaker influence in Bermuda and when the same pay doctors to conduct studies, publish reports and hold conferences. That includes when doctors are paid as expert witnesses and or receive any sort of gift, food, compensation of any value over $100 to advise, consult on policy or legal matter. That includes when academic health centers and hospitals pay for CME curriculum, as well as travel, food and lodging. That includes any time a physician is paid to conduct research, participate on a panel or advice a government agency, insurance company, benefit manager, HMO, etc that can influence a cilnical decision, guideline development, etc. And why stop at $100. Why not $50 or $25? Why stop at doctors? Why not nurse practitioners, pharmacists, home health workers, infusion specialist, lab technicians? -
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February 20, 2009
Peter Pitts
Very important editorial by Janet Woodcock and Larry Lesko in the current NEJM. The title, "Pharmacogenetics -- Tailoring Treatments for Outliers."
Here's the beginning to whet your appetite: If it were not for the great variability among individuals, medicine might as well be a science and not an art. — Sir William Osler (1892) Over the past half century, biomedical science has developed randomized, controlled clinical-trial methods that can distinguish treatment effects from the noise of human variability. Positive results from tests of a treatment in a randomized, controlled trial provide great confidence that an intervention improves a prespecified outcome in a population defined by explicit entry criteria. These methods are rightly venerated because they have helped move medicine from anecdote to science and have largely brought about the therapeutic advances of the past 50 years. However, although population-based, randomized, controlled trials of drugs control for disease variability, they generally do not reveal why some people do not have a response to treatment, others have excessive pharmacologic responses, and still others have side effects that occur in a distinctive pattern for a given drug. Addressing this question is our next challenge. Currently, medicine is addressing this challenge through the lens of genomic technologies. There is considerable debate about the quality, quantity, and type of evidence that would be needed to change clinical practice by introducing pharmacogenetic testing for a given drug. What methods should be used to understand individual responses once an overall population benefit has been shown in randomized, controlled trials? -
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February 19, 2009
Dr. Robert Goldberg
What will $1.1 billion buy in terms of medical evidence? A lot more work for consultants who do nothing but review other reviews of clinical trials and practice guidelines to produce what else, an easily digestible guideline that everyone can follow -- particularly the HMOs and the research organizations set up by the HMOs that will do the reviews for AHRQ that will dictate to doctors what to do:
"As a result of this increase in the quantity of relevant information, synthesized information such as systematic reviews, clinical guidelines, and resources (e.g., The Cochrane Library), have become essential tools for the users of the evidence (Druss and Marcus, 2005). However, the number of these products has also grown substantially. For example, as of September 2007, the Agency for Healthcare Research and Quality’s (AHRQ’s) National Guideline Clearinghouse (2007b) listed 54 clinical practice guidelines under the heading “antihypertensives.” In this situation, end users need a mechanism to determine which summaries are the most relevant, valid, and reliable." This is according to an Institute of Medicine study: Knowing What Works in Health Care: A Roadmap for the Nation (2008) Board on Health Care Services (HCS)So the key to improving the practice of medicine is to rely on the summaries which are -- according to the HMO-run and beholden institutes that do most of the work for AHRQ and their HMO heavy stakeholder group -- the most relevant, valid and reliable....Or is it about cost? Jean Slutsky, who will essentially be in charge of the billion or so that AHRQ spends compares her agency favorably to NICE in the UIK among others: "Health care expenditures are growing faster than incomes for most developed countries, jeopardizing the stability of health care systems globally.1 This trend has led to interest in knowledge about the most effective use of health care worldwide. To increase the value of health care services, many countries have established programs or independent agencies that inform health care decisionmaking through systematic reviews of technologies, pharmaceuticals, and other health care interventions. A few examples include the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom, the Institute for Quality and Efficiency in Health Care (IQWiG) in Germany, the Haute Autorité de Santé (HAS) in France, and the Canadian Agency for Drugs and Technologies in Health (CADTH)" As I have mentioned here and here AHRQ has a cozy relationship with NICE analogues established by HMOs: "We have something that looks somewhat analogous in many of the domains in which NICE is working," says Joseph Newhouse, Ph.D., professor of health care policy at Harvard Medical School and a former member and vice-chair of the Medicare Payment Advisory Commission (MedPAC). It's just not "pulled together in one agency with a crisp mandate." Starting with the private sector, there are a number of technology assessment groups that analyze drugs, devices, and procedures—the most well known of which is the Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). "It has been around for about 10 years and is definitely considered the most rigorous of the groups," says Barbara J. McNeil, M.D., Ph.D., a professor and head of the Department of Health Care Policy at Harvard Medical School who is a member of TEC Medical Advisory Panel. TEC completes 20 to 25 assessments of drugs, devices, and procedures each year, usually for treatments with increasing requests for coverage but unclear value. A recent example is the use of electron beam CT (computed tomography) for the evaluation of patients with suspected cardiac disease. The TEC staff completes a detailed review and the Medical Advisory Panel uses this information to make a judgment about its clinical effectiveness. Kaiser Permanente and the Centers for Medicare and Medicaid Services (CMS) are among TEC's clients. Similar groups include ECRI (formerly the Emergency Care Research Institute) and Hayes Inc. Many health plans, including CIGNA HealthCare, have their own internal medical technology assessment groups. -
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February 18, 2009
Peter Pitts
Timely and honest editorial (penned by Richard Horton) in the February 7 (Volume 373) edition of The Lancet. He points out that the battle lines being drawn and between clinician, medical research and the pharmaceutical industry are artificial at best -- and dangerous at worst. Dangerous, because all three constituencies are working towards the same goal -- improved patient outcomes.
In discussing detailing and CME Horton writes, "Still, industry has an important voice in medicine, one that under the right arrangements doctors should be aware of and hear at all stages of their career." His main point is that we must dismantle the battlements and embrace of philosophy of "symbiosis not schism." It's what's in the best interest of the patient. Horton's editorial can be found here. It's worth a read. -
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February 18, 2009
Peter Pitts
Today, the Center for Medicine in the Public Interest the public policy home of drugwonks.com) is proud to announce the appointment of former Congressman Mike Ferguson as a Senior Fellow and Director of its new Odyssey Initiative for Biomedical Innovation and Human Health.
Ferguson is chairman and CEO of Ferguson Strategies LLC, a government affairs and business consulting firm based in Washington, D.C. Ferguson served in the House for nearly a decade, representing New Jersey's 7th District. Peter Pitts, the Center's President and former Associate FDA Commissioner, said Ferguson's appointment demonstrates CMPI's commitment to broaden its scope and influence. “Congressman Ferguson was a strong advocate in Washington for key health care initiatives during the last decade, and he helped to shape the debate about the future of important reform proposals,” Pitts said. “Congressman Ferguson brings to CMPI his compassion for and commitment to those suffering from illnesses, as well as his wealth of experience on Capitol Hill, and that combines to represent a real value-added for CMPI.” Robert Goldberg, PhD, will help guide the Center's new initiative, and he said Ferguson will be helpful in advancing the deployment biomedical innovation. “Under Mike's leadership, the Center will show how medical innovations are the ‘green technologies' that can solve our country's most pressing health care problems and help point out when policies and positions are choking off the entrepreneurship and investment that sustain such progress,” Goldberg said. Ferguson completed four two-year terms in Congress in January, when he also started Ferguson Strategies. “I'm looking forward to continuing my efforts to accelerate the translation of medical knowledge into better and more effective ways to prevent and treat disease,” Ferguson said. “Medical innovation is the key to making health care more effective, efficient and affordable. We plan to make this case and develop policies that reward innovation in every part of the health care system.” In Congress, Ferguson served as vice chairman of the House Energy and Commerce Subcommittee on Health, and he was instrumental in securing passage of the Medicare Part D prescription drug benefit. He also led opposition to efforts that would have allowed drug importation and imposed government-mandated price controls for prescription drugs and rationing of health care services. Ferguson successfully led the congressional effort to secure House and Senate passage of the Lifespan Respite Care Act – legislation he authored – that authorizes $289 million for states to train volunteers to help an estimated 50 million families caring at home for adults and children with special needs. President Bush signed Congressman Ferguson's bill into law in 2006. Ferguson was the recipient of the 2006 Legislator of the Year Award from the National Visiting Nurses Association, and the 2007 Congressional Award from the Leukemia & Lymphoma Society. In addition to the Health Subcommittee, Congressman Ferguson also served on the Telecommunications and the Internet Subcommittee, and the Oversight and Investigations Subcommittee. A graduate of Delbarton School in Morristown, New Jersey, Ferguson attended the University of Notre Dame in South Bend, Indiana, where he received a bachelor's degree in government. He earned a master's degree in public policy from Georgetown University in Washington, D.C. -
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February 17, 2009
Peter Pitts
The words are nice -- now let's see if the actions lead to NICE. -
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February 17, 2009
Peter Pitts
Saw this article online (courtesy of Google and the Press Association), and thought it worthy to share: From a drop of saliva or cheek swab it can analyse DNA to tell if a patient has the right genetic fit for a particular drug. The Snip Doctor looks for known single nucleotide polymorphisms (SNPs) - single letter changes in the genetic code - that can affect an individual's response to medical treatment. Each year the NHS spends around £460 million dealing with the 250,000 patients who are admitted to hospital suffering adverse reactions to prescribed drugs. The unwanted side effects can vary in severity from dizziness and nausea to heart palpitations or loss of consciousness. The finished product will be an all-in-one device that can rapidly analyse a sample placed in its cartridge and flash the result up on a screen. Being able to predict bad responses to drugs such as antidepressants or cholesterol-lowering statins would allow doctors to tailor dosages and types of medication to individual patients. Scientists at Imperial College London and its spin-out company DNA Electronics are now carrying out trials of the Snip Doctor's effectiveness. -
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February 16, 2009
Peter Pitts
Front-page article in today’s New York Times on the $1.1 billion for comparative effectiveness.
The complete article (by Robert Pear) can be found here. Pear writes, “Under the legislation, researchers will receive $1.1 billion to compare drugs, medical devices, surgery and other ways of treating specific conditions. The bill creates a council of up to 15 federal employees to coordinate the research and to advise President Obama and Congress on how to spend the money.” Let’s not kid ourselves. This is really about head-to-head drug trials. Is anyone even paying lip service to anything else? According to Pear, “The program responds to a growing concern that doctors have little or no solid evidence of the value of many treatments.” Really? No solid evidence? What about all those journal articles? What about professional guidelines? What about the growing availability of outcomes data? “Little or no solid evidence.” In other words, evidence generated by the pharmaceutical industry doesn’t count -- but government research (like CATIE and ALLHAT) does. Talk about politics trumping science! Pear reports that, “Women and members of minority groups expressed concern about that approach. Drugs and other treatments can affect different patients in different ways, they said, but researchers often overlook the differences because their studies do not include enough women, blacks or Hispanics … The final bill says that the research financed by the federal government shall include women and members of minority groups.” That’s nice. But when you use the same 20th century tools for clinical trial design – you get the same 20th century data. It’s important to note that not one cent of the stimulus bill went towards the development of 21st century drug development and regulatory tools – precisely what the FDA’s Critical Path program is designed to address. Here are a couple of other important issues that are rarely mentioned: (1) Pharmaceuticals represent about 11.5% of our national healthcare spend – about the same as the rest of the developed world. 7% of that expense is for on-patent drugs. (2) Generic drugs represent 56% of the volume and 4.5% of the spend. And both of those numbers are growing. (3) The way to “save lives” is to make sure that the right patient gets the right medicine in the right dose at the right time. Whether or not they save money depends on where you sit and who you ask. “The new research will eventually save money and lives,” said Representative Pete Stark (D, CA), chairman of the Ways and Means Subcommittee on Health. Really Congressman? In that order? Where you stand often depends on where you sit. If you’re a payer (either public or private), saving money can often mean denying expensive end-of-life care. If you’re a patient, well, you might have another view. Pear writes, “Britain, France and other countries have bodies that assess health technologies and compare the effectiveness, and sometimes the cost, of different treatments.” “Sometimes?” Come on. As Aldous Huxley wrote, “Facts do not cease to exist because they are ignored.” Pear repeats what drugwonks.com shared on February 12, that the House Appropriations Committee (in a report accompanying its version of the economic recovery bill) said that research comparing different treatments could “yield significant payoffs” because less effective, more expensive treatments “will no longer be prescribed.” For more on this see “The UnCERtainty Principle.”) If we want to provide excellent care and save money, there are two crucial public health issues that are being ignored by our elected representatives: (1) Early diagnosis/prevention. No monies for either of these two items in the stimulus package. (2) Compliance programs. According to a Harris survey, one in three (33%) U.S. adults who have been prescribed drugs to take on a regular basis report that they are often or very often noncompliant with their treatment regimens for any number of reasons. Early diagnosis, prevention programs, and compliance issues are huge pieces of the healthcare cost pie – but not, it seems, sexy enough from a political talking point perspective. No doubt members of Congress will say that such things will be addressed when we debate health care reform. But isn’t that what we’re doing now? -
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February 16, 2009
Dr. Robert Goldberg
You can't be against quality. And I'm not. Any more than I am against cost-effective medicine or comparative effectiveness. Peter and I have posted and written much on the the CMPI model for measuring quality and approach comparative effectiveness from the patient perspective and using tools that promote predictive, prospective care. And we will have a lot more to say and do in the months ahead. (Too bad John Mack couldn't get the wax and other debris out of his ears when I was talking about that in my opening remarks at the epharma conference. Then again, some people only hear what they want to hate instead of walking 5 feet and say "Hello, my name is John, what did you mean when you said ..." ) But I digress.
Having said all that, I applaud Janet Corrigan and Nancy Nielsen for trying to bring order to the quality chaos. But I wonder if the problem is not the orgy of objects to measure but the lack of focus on creating measures that are derived from clinical, as opposed to claims data, biomarkers instead of randomized clinical trials, meaningfully designed systems that help doctors in their daily practice instead of top down systems like the one being conceived by the billion dollar slush fund? www.ama-assn.org/amednews/2008/12/29/prsd1229.htm -
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February 16, 2009
Dr. Robert Goldberg
Dean Vernon Wormer: Mr. Kroger: two C's, two D's and an F. That's a 1.2. Congratulations, Kroger. You're at the top of the Delta pledge class. Mr. Dorfman?
Flounder: Hello! Dean Vernon Wormer: Zero point two... Fat, drunk and stupid is no way to go through life, son. Mr. Hoover, president of Delta house? One point six; four C's and an F. A fine example you set! Daniel Simpson Day... HAS no grade point average. All courses incomplete. Mr. Blu - MR. BLUTARSKY... ZERO POINT ZERO. Now let's go to the Stimulus Bill * Various health IT computer systems of unknown use and impact: $19 billion * Spending on basic biological research including vaccines, HIV, cancer, etc: $6 billion * Spending on ways to reduce access to new technologies and treatments chosen by a stakeholder group made up of people from the insurance industry and at the sole discretion of the Secretary of HHS unless there is demonstrable proof as established by a handful of "stakeholders" from those from the insurance industry and those trained at NICE (including Steve Pearson): $1.1 billion * New spending for the FDA's Critical Path institute, food safety research, collaborations with European, Asian or African partners to harmonize drug safety standards: Zero point zero. -
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February 13, 2009
Peter Pitts
As we continue to furrow our collective brows pondering the eternal quandary of risk/benefit, I thought you’d enjoy the comments below (which I received this afternoon via e-mail from a respected physician who shall remain nameless): TO ALL THE KIDS WHO SURVIVED THE 1930s, 40's, 50's, 60's & 70's -
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February 13, 2009
Mario Coluccio
Yesterday the courts dealt a blow to the anti-vaccine zealots who insist there is a link between vaccines and autism. In its ruling the court said: "It was abundantly clear that petitioners' theories of causation were speculative and unpersuasive.” Dr. Paul Offit, Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and author of the controversial book “Autism’s False Prophets,” said "It's a great day for science, it's a great day for America's children when the court rules in favor of science.” Of course this decision will not stop the anti-vaccine zealots in their undying quest to purge our society of all vaccines. But this court ruling certainly serves as vindication for Dr. Paul Offit and others like him in the medical community who have been on the receiving end of death threats and constant attacks from anti-vaccine groups. Read article here -
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February 13, 2009
Peter Pitts
FDA and International Serious Adverse Events Consortium Release First Data on Genetic Basis of Adverse Drug EventsThe first data offering health care professionals a better look into the genetic basis of certain types of adverse drug events was released today by the FDA and the International Serious Adverse Event Consortium (SAEC). The data are focused on the genetics associated with drug-induced serious skin rashes, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, and helps better predict an individual’s risk of developing these reactions. “The SAEC has fulfilled a key goal of the Critical Path Initiative by providing the research community with public access to new genomic data on adverse drug events,” said Janet Woodcock, M.D., director, the FDA’s Center for Drug Evaluation and Research. “This consortium has taken a significant step forward by promoting open sharing of drug safety data. This type of cooperation has the potential to lead to more personalized approaches to medicine that can reduce a patient’s risk for experiencing an adverse drug event.” The SAEC is a nonprofit partnership of pharmaceutical companies, the Wellcome Trust, and academic institutions focused on research relating to the genetics of drug-induced serious adverse events. The samples from the initial serious skin rash cases and matched controls were collected by GlaxoSmithKline plc, London, U.K., and donated to the consortium for this research. By pooling these samples, the SAEC has identified numerous genetic associations that may contribute to an individual’s risk of developing serious drug-induced skin reactions. The data was compiled and analyzed just 16 months after the consortium was launched. “We are pleased to be able to provide these invaluable data to the research community to both improve the productivity of drug development and to begin the critical process of developing validated biomarkers to forecast patients who may be at risk for drug-induced serious adverse events,” said Arthur Holden, founder and chairman of the SAEC. “We continue to believe the application of genomics to research the genetic basis of serious adverse events will prove to be one the most productive early applications of this technology.” The consortium will publish its initial research results later this year. Researchers who enter in to a data use agreement can obtain free access to the data to generate custom data inquiries and obtain immediate results on the genetic basis of adverse drug events. For more information on the International Serious Adverse Event Consortium see www.saeconsortium.org. For information on the FDA’s Critical Path Initiative see http://www.fda.gov/oc/initiatives/criticalpath/ -
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