Latest Drugwonks' Blog

Springfield, MA — the small town that started a big problem finally threw in the towel yesterday and said it would stop treating it’s municipal employees like second class citizens by making them get their drugs from so-called “Canadian” pharmacies.

And then they lied.

According to a story in the Boston Globe, Springfield officials claim that on $5 million spend, they saved $3 million annually by doing business with profiteers masquerading as pharmacists.

Not even real Canadian drugs are that inexpensive. That’s wrong by a wide margin — and the Globe didn’t press for evidence to support such an absurd claim.

Typical? Unfortunately yes.

Another misleading comment in the story (written by the usually on-target Chris Rowland) repeats the canard that prescription medicines are “typically less expensive in Canada and elsewhere because government controls limit profits.”

Not accurate. What governments in Canada and elsewhere control are prices. Big difference in practice and in theory. (Not to mention that it also makes the practice sound a lot better for grandstanding politicians.)

Adieu Springfield.

Here’s a new way to think about whether or not FDA’s Critical Path initiative is important …

… Ask yourself, “What if it was my child?”

And then read this article from today’s edition of the New York Times.

A Conversation With Mary V. Relling
Saving Lives With Tailor-Made Medication

By CLAUDIA DREIFUS

MEMPHIS — In Mary V. Relling龝 office in St. Jude Children’s Research Hospital sits a small ceramic statue of St. Jude Thaddeus, the patron saint of impossible causes.

Dr. Relling, the head of the department of pharmaceutical sciences at St. Jude, has a fondness for impossible causes.

Her own is pharmacogenetics, a clinical discipline in which doctors use high-tech genetic testing to custom-make drugs to patients’ individual needs.

Though pharmacogenetics is controversial and not yet widely done, Dr. Relling, 46, travels the country advocating its use. At St. Jude, patients with leukemia are now routinely given genetic tests to determine their individual response to a medication. “We’ve seen it save lives here,” she said. “That’s made me a believer.”

When hundreds of patients are given a drug, she continued, “some will get no benefit, others will have terrible side effects, and still others will get benefits with tolerable side effects.”

Gene variants may be the cause.

Q. How is this tailoring of drugs different from the way they’re currently ordered?

A. Till now, there’s been a one-size-fits-all approach. In most cases, an average dose of a medication is ordered, and then, if the patient suffers side effects, the dosage is adjusted. With gene testing, we can customize the prescription.

Here at St. Jude, we’ve been gene-testing every child who comes to us with leukemia. I study acute lymphoblastic leukemia — A.L.L., the most common childhood cancer. When a youngster comes in with A.L.L., we get a sample of their DNA. We put it on a special computer chip that scans a half-million different places on the genome. Mostly, we’re looking for unusual variations of the genes and misspellings of the genetic code.

We have a database from earlier patients that helps us predict a patient’s risk of relapse and which misspellings are likely to result in drug sensitivities.

Q. Are there other diseases where the process might be useful?

A. The same medicine we use to treat leukemia is also prescribed for Crohn’s disease and ulcerative colitis. So that same genetic test could be employed to reduce side effects with those conditions.

At the moment, there seems to be a lot of promise for pharmacogenetics in the treatment of arthritis, heart disease, colon cancer and even psychiatric diseases like depression and schizophrenia.

Q. One can almost hear economists everywhere groaning, “Oh, no! Not another test to add to health care costs!”

A. The basic research behind pharmacogenetics — figuring out which genes are important with the various drugs and diseases — is costly. But on the clinical level, you can save money. With leukemia, we’ve seen that testing costs are minor compared to the savings gained by avoiding drug reactions, blood transfusions and additional hospitalizations.

Q. How widespread is genetic testing for prescriptions?

A. It’s very rarely used. Most probably, you can find it at some academic centers in big cities. And, of course, for many medications, the research isn’t in yet about which genes are important and why. But even where tests have been approved, insurers don’t cover all the costs, and that’s hindered this from growing.

Most prescribers don’t understand genetics very well. The fruits of the Human Genome Project have only been out for about five years, and a lot of doctors and pharmacists did their training before that.

I’ve heard people say that medicine won’t change until there are major lawsuits against prescribers who fail to use tests to individualize therapy.

Q. How have the drug companies responded to the promise of pharmacogenetics?

A. Unfortunately, they are not set up for it. The big pharmaceutical companies have a different business model. They make their money from blockbuster drugs that reach millions of people with standardized doses. They don’t want their markets to fragment, which is the obvious effect of pharmacogenetics.

Genomic testing is going to mean that we define smaller and smaller markets for every drug. Instead of one medication for high blood pressure, a manufacturer will have to produce dozens of variants and combinations.

It’s already difficult to get drugs that benefit smaller numbers of patients. “Orphan” drugs are often not manufactured because they help only a small group.

In pediatric cancer, we see what happens to orphan drugs because children’s cancers are rare and, thus, orphan diseases. Of the nine drugs we regularly use for leukemia, seven have been unavailable for varying periods of time during the last decade.

Q. What can you do in that situation?

A. We’re trying to start making it here at St. Jude. We’re not a drug manufacturer, and it isn’t easy for us to do. We’re also working with pharmaceutical companies to see if we can’t help them make it available. But we can’t depend on market forces for our supply.

We’ve seen that the pharmaceutical companies, if they are interested in cancer drugs at all, are mostly concerned with adult cancers — the larger market.

Q. How did you become a pharmacist?

A. I attended the University of Arizona in the late 1970’s, as a French major. In my freshman year, I took the required chemistry course with a brilliant teacher, William Lippincott. He made chemistry come alive. Becoming a pharmacist seemed like a practical route to a chemistry career, with good job possibilities after graduation.

Even today, it’s a great profession for a young person to consider. There is a tremendous demand.


Quiz/lings

  • 08.28.2006

Q: According to the MSM, what is the opposite of “pro-industry?”

A: “Objective.”

KooksRUs

  • 08.28.2006

Now that the confirmation of Andy von Eschenbach is on a fast track, expect the crazies to come out of the woodwork for the 15 nanoseconds of fame. We are expecting any day now for David Vitter — who has lent a helping hand to Hezbollah’s efforts to ship counterfeit drugs from Canada to the US by banning US Customs from inspecting packages of medicines (80 percent of which were fake and came from reliable sources such as Pakistan and Iran) — to put a hold on his nomination until there is a final vote on his proposal to weaken the defense of the homeland.

In the meantime for your reading pleasure…here is a an oped from a complete kook..someone who insinuates that Andy is a Nazi (he’s German you know, born during the war). http://www.newstarget.com/020118.html

The author (and I use that term loosely) is Byron J. Richards who purports to be an expert on the role of leptin in obesity. A quick search of Richards BJ on medline comes up with a big fat zero in publications. That’s not surprising since BJ got his certification by taking an exam and paying $400. This kookery is being pushed by a group called the Alliance for Human Research Protection which was formed by Loren Mosher who believed that schizophrenia and other mental illnesses could be treated without any medication. The group is lavished with mainstream media attention and coverage because it froths at the mouth about suicidality and SSRIs. That is supposed be the result of some sort conspiracy between the drug companies and the FDA. The Alliance is dangerous to the extent that the media fails to investigate its history and underlying faith that mental illness can be treated without any medication. Now that Tom Cruise has been cut loose from Paramount, maybe he can join the anti-Andy kook campaign….

For Love and Money

  • 08.25.2006

This is not a joke.

It is very scary.

Please pay attention.

The John D. and Catherine T. MacArthur Foundation , known for its $500,000 “Genius Grants,” has created a similar prize for nonprofit organizations.

Terrific right? Not so fast.

The prizes for nonprofits were given today to nine groups, including a reconstituted D.C. organization now known as Knowledge Ecology International — formerly the Ralph Nader-affiliated Consumer Project on Technology. That’s the group led by our pal, the patent-hating Jamie Love.

What “genius” thought up this one?

Love says his group is going to use this new infusion of cash to push for legislation in Congress next year to drive down the price of drugs by changing how research and development are financed. The goal would be for development to be based on drugs’ potential health benefits, not on their potential market value. If this “new paradigm” is successful with the U.S. pharmaceutical industry, Love says, the impact would be felt internationally as well.

That’s for sure. If by “impact” you mean the global destruction of pharmaceutical R&D.

The legislation, are you sitting down, is to be sponsored by none other than the Honorable Member from Ben & Jerry’s — Rep. Bernard Sanders (I-Vt.).

“We’re going to make a run [in Congress] on this new idea,” said Sanders. The lobbying focus, he said, will probably be on trying to develop a citizens movement similar to the one that supported importing “Canadian” drugs.

And we all know how well that worked.

BTW, isn’t it against the law for a not-for-profit to support and lobby for legislation? Or is that only if they’re, say, conservative or free-market?

KEI received $500,000 from the MacArthur Foundation to help with start-up costs associated with becoming an independent nonprofit.

“Start-up costs?” What are they starting up? A hedge fund?

CMPI (the public policy institute parent of drugwonks.com) will be submitting its MacArthur Foundation grant shortly.

Merrill Goozner criticized us (or me) for being pro-industry enroute to explaining why I did not post anything on the stem cell legislation vote last month. That logic is convoluted. Goozner is assuming that the drug industry is conservative, and therefore opposes stem cell research and that I am conservative and oppose stem cell research and that therefore as a tool of industry I did not write something that my minders would not like….. Actually, considering that industry supported the California bond initiative and would stand to benefit from stem cell research, that I wrote an oped in the Washington Times in favor of stem cell research Goozner’s logic is shall we say, about as good as his reporting? PS Merrill, CMPI is NOT part of the Manhattan Institute…or do facts not matter in your left wing world?

In any event, heres a post on stem cell research. The latest experiment coming from Advanced Cell Technology — a followup to it’s research with mice embryo’s demonstrate that it is possible to produce stem cells without harming or destroying embryos. According to an article on WebMD:

“ACT researchers Irina Klimanskaya, PhD; Robert Lanza, MD; and colleagues used a technique called preimplantation genetic diagnosis, or PGD; it is used during in vitro fertilization techniques. This basically means plucking out one of the eight cells from a blastomere, a very early stage of embryo development.

Such “biopsied” embryos are perfectly healthy and, after implantation in a woman’s womb, develop into normal fetuses. More than 1,500 PGD children have been born.

The researchers cultured 19 stem-cell-like “outgrowths” derived from these harvested stem cells. From these, they were able to get two stable lines of human embryonic stem cells. Under proper conditions, these cells showed the potential to become any cell type of the human body.

Klimanskaya and colleagues predict that the technique will become more efficient in the future.

“Blastomere-derived human embryonic stem cells could be of great potential benefit for medical research, as well as for children and siblings born from transferred PGD embryos,” they conclude.

The findings appear in an advance online issue of the journal Nature.”

For some, even this will be a bridge too far. But for the vast majority of Americans, this approach, if reproducible and usable will settle the debate since such biopsies are already done. Opponents will find themselves increasingly isolated because their position will have shifted to fit the shift in science. The NIH should at the very least provide federal funding to replicate the ACT research.

A Hero for Our Time

  • 08.23.2006

CMPI Board Member, friend and inspiration Suzanne Pattee is the July 2006 recipient of the Heroes of Hope Award. The award is given by The Heroes of Hope⢠Living with CF Program Advisory Panel. It is given to recognize people with CF who give hope and serve as role models to others. Chosen from a nationwide pool of candidates, Suzanne received the honor for her ability to inspire others with CF through her positive attitude, strong community outreach, and her outstanding commitment to proactively manage her health. Suzanne, a Virginia resident, will be joined by family, friends, and her CF care center team to receive her award today, on August 23,during a ceremony given in her honor at the Johns Hopkins Hospital Adult CF Program.

I have known Suzanne for over ten years. We have rarely talked about her illness. But she is a living example of what the combination of determination and medical innovation can do to provide people with longer and fruitful lives. We both remember the time that the Clinton folks — when they were planning to reinvent health care — told companies working on CF drugs that it would be more cost-effective to focus on diseases with larger populations. (That’s right people, it takes a village to ration care.) And even now, people with CF find their access to new medicines in Canada and Europe rationed and limited and delayed. Thankfully, Suzanne has fought against that dark movement here in America. Her accomplishments are many and I wish everyone that purports to care about medical progress had half her courage and passion!

Here’s more about this remarkable woman from the press release issued about her award:

“Suzanne has grown to be an extraordinary leader in the CF community,” said Robert J. Beall, Ph.D., president and CEO of the Cystic Fibrosis Foundation who has been a colleague of Suzanneâs for more than 20 years. “The depth and richness of her experience, including her law degree and previous work with the biotechnology industry, has contributed to her skills to benefit the CF community at large. Never have I known a more intelligent, quick-witted and above all, determined individual â Suzanne is clearly an inspiration to us all.”
Suzanne has faced CF head-on since she was diagnosed at 6 months of age after experiencing common symptoms including pneumonia and failure to thrive. At that time, the median age of survival for someone with CF was five years. According to the CF Foundation’s National Patient Registry, the predicted median age of survival is now 36.8 years. Today, at the age of 43, Suzanne realizes that her experience with CF is not typical and feels extremely lucky in her life. She views having CF as a surmountable hurdle and, at times, a blessing in disguise as it allows her to interact with and be inspired by others with CF whom she might never have had the chance to meet.
Not one to take a back seat approach to issues she is passionate about, Suzanne first began educating others about CF as a CF Foundation poster child at age six. She has worked with the CF Foundation for 14 of the past 20 years, and leverages her insight as an attorney in her current position as the CF Foundationâs Vice President of Public Policy and Patient Affairs. In this role, she advocates for people with CF with the U.S. Congress and the Administration, and spearheads the CF Foundationâs focus on adults with CF.
“The Heroes of Hope Living with CF program is proud to recognize Suzanne for her tireless dedication to providing legal and emotional support to those with CF who desperately need it,â said Lisa Yourman, Heroes of Hope Living with CF Advisory Panel member and CF advocate. âBy promoting the rights of CF patients nationwide and selflessly dedicating her life to help others overcome and persevere through CF and other challenges, Suzanne is an ideal recipient of the Heroes of Hope award.â
Through her steadfast work with the CF Foundation, Suzanne is faced daily with the trials CF brings to children, adults and families. She uses this as her inspiration to help lessen the burden of CF on others by fighting for federal and state policies to ensure access to life-saving CF medication and specialized CF care. Suzanne has been a leader in bringing adult-related CF issues to the forefront of the CF communityâs agenda, and was an initiator of the CF Foundationâs infection control policy guidelines that seek to reduce the risks to people with CF from potential cross infection.
Suzanne strives to live every day with meaning and passion. Suzanne recognizes the critical importance of consistently following her daily medical regimen, which consists of inhaled medications, antibiotics, digestive enzymes, nasal irrigation and chest physical therapy. Suzanne makes regular physical exercise a part of her routine, including activities like dancing and swimming, and is careful to monitor and care for her CF-related diabetes.
She also enjoys spending time with her friends and family, including her 11 nieces and nephews, playing with her dog, Daisy and singing along with Broadway musicals.

.

When Arnold Schwarzenegger returns to the silver screen, his first movie should be called Total Lack of Recall.

Last November, citing his support for the free market, the Governor campaigned against Proposition 79, a plan that would have placed price controls on prescription medicines. Prior to that, in his State of the State speech and in a widely discussed letter to Congress, Schwarzenegger pointed out that it is unfair and inappropriate that American consumers bear a disproportionate share of the cost of developing new medicines that benefit the whole world. He encouraged the Congress to demand an end to price controls in foreign countries and vigorously support those pharmaceutical and biotech companies who refuse to sell their products to countries imposing price controls.

Today he supports a plan almost identical in its folly to Proposition 79. Yep, in a strange rhetorical twist, he was against it before he was for it.

Total Lack of Recall. But that was then and this is, well — closer to the Governor’s battle for reelection.

“This (the Governor’s initiative) is a huge victory for the needy,” said Assembly Speaker Fabian Nunez (D-Los Angeles). “This goes a long way toward correcting the wrong that was done at the ballot box in November.”

“Correcting the wrong?” What Speaker Nunez means is that it goes a long way to legislating something the citizens of California voted down only 10 months ago. So much for the will of the people.

Or, for that matter, the needs of the people — particularly the most needy.

Under the proposal, doctors who wanted to prescribe de-listed drugs would first have to obtain specific permission from Medi-Cal — a bureaucratic burden. Though they are supposed to receive such authorization within 24 hours under federal law, some doctors say the actual process is far more tortured.

“Docs in community mental health are besieged with clients. They’ll have hundreds of clients with severe psychiatric disabilities assigned to them,” said John Buck, chief executive of Turning Point Community Programs, a Sacramento-based mental health nonprofit. “There’s always somebody in a crisis, and you’re talking about filling out more paperwork?”

For that reason, according to an article in today’s LA Times, advocates for the poor object to the involvement of Medi-Cal.

Loretta Jones, executive director of Healthy African-American Families, a nonprofit group based in Los Angeles, called the plan “abominable.”

“We’re taking our poorest population — which are usually women and children — and you’re making decisions about their healthcare that you would not make for a Blue Shield or a Health Net” population, she said.

With California’s new program, the Governor’s new moniker could be “the Abominable No-Man.”

Actor Schwarzenegger’s Total Recall might have been a hit, but Governor Schwarzenegger’s Total Lack of Recall is a dangerous, shortsighted miss.

The President went to Miinnesota to sign an executive order that will require federal agencies to ” compile information about the quality and price of care they pay for and share that information with their customers and each other. ”

In a statement made before the signing, Health and Human Services Secretary Mike Leavitt said, “It’s just the American way. We clip coupons. We check for bargain flights on the Web. We carefully research major purchases. But when it comes to health care, we lack the tools to compare either quality or the costs.”

Some might think the comparision facile. And to be sure, comparing the price of hip replacements is a bit different than comparing the price of flights to Florida. But, as the part D experience shows, it’s a start. And the Bush administration knows that price is not everything. Which is why, the prices will include all services requires for treatment — doctor services, drugs, rehab, etc — for treatment. Efforts are being made to organize comparisons around INTEGRATED care for disease or condition as well as prevention of illness or recurrence. Quality standards would have to adjust accordingly. As Alez Azar, the HHS Assistant Sec who is the point person on this initiative has noted, the Center for Medicare and Medicaid Services has ongoing efforts to measure quality and data collection efforts that private plans can already tap into or emulate as a platform. CMS has already provided a lot of information on prices and process measures that people can use to make comparative decisions. It just posted price information for 61 procedures in outpatient centers. ( http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1948) And this in initiative bolstered by the Bush exec order will roll out transparency efforts in six regions around the country.

Of course, there are many private quality initiatives. Aetna just announced it would post price data on common services and procedures. CMPI’s own board member, Susan Horn is a pioneer in the effort to integrate the continual measurement of quality into integrated care management. Go to www.isisicor.com for more info.

But the first step is to get the data systems up and running, online and as convenient to use as cellphones or ATMS. (Which means the same information has to be available in real time in California as it does in Maine.)

Linking payment to value and then to price…that’s something the market can and must do.

The bad news — as Peter notes — is that Avastin and Erbitux will not be made available to colon cancer patients in the UK because it doesn’t really prolong life. That is also what NICE said about Taxol, Herceptin and Gleevec by the way, all of which have been shown to increase survival and prolong life. The good news is, since NICE will not cover Aricept or other drugs for Alzheimer’s people with AD and colon cancer won’t know they are being denied Avastin and Erbitux.

Meanwhile, Madonna has told the Blair government that it should use mystical waters to clean up radioactive pollution. According to the Times of London she and husband Guy Ritchie “have been lobbying the government and nuclear industry over a scheme to clean up radioactive waste with a supposedly magic Kabbalah fluid.” The plan, just recently revealed, hinged on a “mystical” liquid that she says neutralized the radiation in a Ukrainian lake. Madonna, who studies Kabbalah, insists that the stuff is for real. The better news? NICE has already approved it for reimbursement because it’s cheap.

CMPI

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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