Latest Drugwonks' Blog

An incredibly clueless article on drug spending today in the AP typical of MSM coverage of Rx issues..all about prices and costs and nothing about value:

Spending on specialty drugs soar
By THERESA AGOVINO, AP Business Writer
Wed Jun 7, 12:48 AM ET

Spending on high cost specialty drugs soared 17.5 percent last year and is expected to more than double by 2009, according to a report released Wednesday.

She goes on to write:”The explosive growth is spending on specialty drugs is especially problematic because there is no pathway for generic competitors to enter the market.”

Why is this problematic? These medicines often replace halfway measures for which there are no effective treatment and are most always more cost effective than the endless surgery, hospitalization, lab tests, nursing support, home care that is required. That includes care for people with breast cancer, cystic fibrosis, Gaucher’s disease, HIV, and RA where the cost-effectiveness is well demonstrated. You did not care to cite any of this literature or experts.

Woud she be willing to hold the line on drug costs and suffer in order to make drug spending less “problematic.” Perhaps the addition of the new cervial cancer vaccine should be restricted because it to will add to “explosive growth” in drug spending.

Are reporters just that biased against drug companies or just too lazy to do more than merely regurgitate press releases or both?

The scaremongers at the NY Times are at it again with a biased piece about the use of medicines for manic depression in children:

June 6, 2006
Use of Antipsychotics by the Young Rose Fivefold
The use of potent antipsychotic drugs to treat children and adolescents for problems like aggression and mood swings increased more than fivefold from 1993 to 2002, researchers reported yesterday.

The researchers, who analyzed data from a national survey of doctors’ office visits, found that antipsychotic medications were prescribed to 1,438 per 100,000 children and adolescents in 2002, up from 275 per 100,000 in the two-year period from 1993 to 1995.

The findings augment earlier studies that have documented a sharp rise over the last decade in the prescription of psychiatric drugs for children, including antipsychotics, stimulants like Ritalin and antidepressants, whose sales have slipped only recently. But the new study is the most comprehensive to examine the increase in prescriptions for antipsychotics…

I am the father of a child who is bi-polar so my immediate response is thank goodness more parents are getting the right medication for their kids sooner then me and my ex-wife did. The years with which we and my daughter struggled with behavioral issues, depression, destructive outbursts, and other problems which I do not care to go into at this time were a direct result of misdiagnosis, mis-medication and failure to arrive at the proper combination of drugs. There is a reason the medication rates have increased: better diagnosis, earlier treatment, all of which have led to better outcomes. There is some mismanagement to be sure but with at least 1 million children with bipolar illness there is much more undertreatment. The failure of the NY Times article and Benedict Carey to even discuss the benefits of these medications and to suggest that an increase is questionable and without scientific support is reprehensible and irresponsible. This is so typical of the media who in lieu of a real story or controversy seeks to stir one up.

For real information instead of the garbage the NY Times passes off as medical reporting you can go to the website of The Juvenile Bipolar Research Foundation at

Tysabri's Back

  • 06.06.2006

The FDA said it would make Tysabri available by early June and it has done so…The risk management plan is tough but was developed in concert with patients. No thanks to the traditional MS advocacy groups some of whom had even opposed returning Tsyabri to the market. The advisory committee and the FDA officials were moved by the efforts of patients who demanded the drug’s return and by how well informed they were about risks and benefits…

Health Affairs dedicates a bunch of articles about the Oregon effort to compare drug effectiveness. We all know just how reliable and up to date literature reviews of old classes of medicines are, particularly in an era where genomics will help select medicines for patients and targeted therapies and diagnostics will shape clinical care. But let is not be said that Health Affairs is nothing by on the cutting edge of 20th century medicine. In any event, as part of it’s effort to give the underachieving access to peer review publications, it allows one Alan Heaton, head of pharmacy at the the Minn blues to weight in as follows: Give us the hard evidence for open formularies,” he demands in his Perspective. Heaton cautions that using evidence-based principles to pick superior products within drug classes risks giving the manufacturers of anointed products unwarranted pricing leverage. âIronically, pharmaceutical companies spend hundreds of millions of dollars to market product differentiation,â he observes, but âthe reality is that 80-90 percent of the population can use one drug, leaving only a small group who cannot tolerate that particular drug and need one or two other choices in a given class.”

So much brilliance here it is hard to know where to start …

Last time I checked, evidence based principles were being used to exclude drugs and select just one to drive down prices…or maybe Heaton is just a lousy businessman — as for the claim that one drug fits all — it is so scientifically without merit — SSRIs, atypicals, anticonvulsants, lipid lowering drugs, beta blockers and combination therapies thereof — that it hard to know where to begin except to extend my sympathy to the million of people who as suscribers of Minn BCBS have to suffer under Heaton’s harebrained decisions.

The other day a senior FDA official asked what the agency should do to combat all the negative media coverage. My response, “Do something because nothing isn’t working.” In retrospect that was a bit harsh. FDA has been doing things, mostly from rule-making to infrastructure, that are making a difference — albeit not any that the MSM or many elected officials seem to notice.

Two examples of moving forward towards better risk communications are the long-awaited and hugely significant new physician labeling rule and the savvy personnel choice of Paul Seligman as CDER’s new Associate Center Director for Safety Policy and Communication in the Center for Drug Evaluation and Research. Two superb examples of forward motion.

Not sexy, but crucial.

Can more be done to aggressively battle a blood-thirsty media and bandwagon pols? Don’t get me started.

Actually — do get me started.

Lots of stories today about this being the 25th anniversary of the discovery of the AIDS virus and many stories noting how many people are alive today because of protease inhibitors which the last time I checked were developed not by NIH or the Cubans or global health collaborative funded by a global R&D tax but by drug companies. The death rate in the Western world has been slashed by these drugs and the gains to society in terms of increased productvity and deferred health care costs has been substantial. Much of the recent progress has come as a result of efforts to target and personalize therapy. There are now over 60 drugs and vaccines in development. Companies have by and large come around to offer their drugs for free or at cost in those parts of the world where AIDS has hit hardest. And yet the media and activist organiizations have largely ignored this contribution. Case in point was a recent article that started out by claiming that biotech company Gilead was a war profiteer in the battle against AIDS. The last time I checked the Gilead drug was being “sold” if that term can apply for about 27 bucks a bottle ini about 100 countries compared to $800 a bottle in the US. And Doctors without Morals and other HIV activitst groups have the gall to attack Gilead for denying access. And the MSM makes THIS the lead story? Gilead has done more for those dying of HIV with its one drug that than French based group of clinical nomads has done in its decade or so of withdrawing from war torn areas and getting media coverage from Paris for its sanctimony…

Per Dr. Bob’s thoughtful blog (see below), complicated is indeed good for patients. However, “complicated” is bad for two other important constituencies — the media and policy makers. For these folks (with important exceptions) “complicated” is bad because it’s not “simple.” (Sorry, I know that sounds solipsistic, but it’s important to make the point.)

That’s why we (and that’s a collective “we” fellow drugwonks) have to work even harder to make sure those who report and those who decide report and decide based on the facts — as hard as that may be and as naive as it may sound.

The alternative is unacceptable. That’s why it’s called the Critical Path.

The media is abuzz with the news that big drug companies are rolling out drugs that will compete with cancer drugs like Herceptin that target certain pathways or genetic mutations that cause cancer instead of killing the cancer cells themselves. Not exactly. By definition, a targeted medicine does not compete since it hones in on a specific approach or response. Case in point the BMS drug dasatinib which was developed after researchers noticed that a certain subset of patients on Gleevec developed resistance to the drug after a while. Other targeted cancer drugs have the same narrow application at first but then can expand to other uses as the same pathways are implicated in other disease mechanisms…And finally, genetic and protein analysis will determine who are high responders and who are not.

It is getting quite complicated. Better for patients. Which is what matters most. The challenge will be to translate all this into solutions that reduce death and suffering and extending the model to other diseases…

DateLine NBC ran a segment tonight on counterfeit drugs. While this story is nothing new to you drugwonks out there, it’s serving as an overdue wake-up call to tens of millions of Americans. This summer, in collaboration with the Stockholm Network and the Centre for the New Europe, the Center for Medicine in the Public Interest (the home of will publish a new book called “Coincidence or Crisis: Prescription Drug Counterfeiting.” It features articles by many leading policy experts, an introduction by Congressman Mark Souder, and is edited by your’s truly.

If you would like additional information on how to order this important new book, please e-mail me at

Not coincidentally, on June 7th I will be testifying in front of the US-China Economic & Security Review Commission on the topic of prescription drug counterfeiting in China. My testimony will begin at 3:30 in room 385, Russell Senate Office Building. Transcripts of the entire hearing will be available at

Rumor de Jour

  • 06.03.2006

Recess appointment for an important public health official.


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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