Latest Drugwonks' Blog

Dumb and Dumber

  • 05.14.2006

Here’s a question: In the case where a life is on the line and you need a doctor who would you choose: someone who is world reknown, an expert in saving lives and treating the disease that threatens it but is under scrutiny by the mainstream media and the Left for consutling with drug companies or an untested doctor with no track record by who has done no consulting for biotech or drug firms? Only a dumb person — or a pure ideologue (an oxymoron) — would choose the latter.

Now apply this logic to banning people — regardless of their insight, clinical gifts or peer recognition — from advising the FDA because they consulted for the NIH or private companies. Merrill Goozner argues that there are plenty of oncologists for example that have not consulted for private firms that could serve the FDA. The question is: would excluding those that have consulted advance the public health. Applying the Goozner rule would exlude:
one of the world’s experts in prostrate cancer, one of the pioneers in using biomarkers to measure angiogenesis, a leader in the design of clinical trials for stomach cancer, one of the nation’s leading researchers dedicated to finding drugs that actually stop the progression of bladder cancer., and a Nobel Prize winner to boot…

This is dumber.

Peter and I have a better way that will increase the number of smart people helping the FDA as opposed to proposals that make them feel like criminals.


  • 05.12.2006

I am suffering from hypocrisy and stupidy overload….apart from the patently biased reporting on Pfizer’s clinical trials and cancer drug pricing in the WP and WSJ respectively we now have the double standard on the coverage of RU-486 safety. According to recent research, 1 in every 80,000 women who have a medical abortion die. 1 in every 1,000,000 women who have a surgical abortion die. I am not a math whiz but that means that RU-486 increases your risk of death 10 times. If Vioxx had done that, it would have been the subject of a Charles Grassley media orgy. And lost in the reporting is the fact that many of the deathrs attributed to RU-486 recently are linked to off-label use (vaginal vs. oral use). Or was this fact conveniently buried even as the press beats up on other forms of off-label use?

Meanwhile, the AP had this misleading headline : Paxil May Increase Suicide in Teens, FDA and GlaxoSmithKline Warn

Actually, the FDA said that nearly 15,000 patients treated with both Paxil and dummy pills revealed a higher frequency of suicidal behavior in young adults treated with the drug, according to the letter.

The FDA reported that there were 11 suicide attempts — none resulting in death — among the patients given Paxil in the trials. Just one of the dummy pill patients attempted suicide.

Given that small number, the results “should be interpreted with caution,” the FDA said. Eight of the 11 attempts were made by patients between the ages of 18 and 30. All trial patients suffered from psychiatric disorders, including major depression.”

Left unsaid of course is that people suffering from major depession are likely to exihbit suicidal behavior and that all medications are associated with an elevation of suicidadility and that use of antidepressants is associated with a decrease in the incidence of suicide among teens.

Meanwhile, USA today ran a story discussing whether Oprah is a modern day Billy Graham.

All of this reminds me of what Thomas Jefferson said: “The man who reads nothing at all is better educated than the man who reads nothing, but newspapers. “

The insanity of not permitting conflict-of-interest (COI) waivers for certain highly qualified members of FDA advisory committees is not only, well, insane, but also quite contrary to the best interests of the public health.

During my tenure at the FDA I was the senior official in charge of advisory committees and the final decision-maker on who got a COI waiver and who did not. Many did not — but those who did received their waivers because FDA professional career staff made a strong case that these people weren’t just important to the advisory committee — but critical.

Are we really going to pass legislation that bans the best and the brightest from serving the public health because their preeminent expertise has also been viewed as valuable by the pharmaceutical industry?

It looks like we just might. God help us.

Researchers have developed a screening tool for discovering unexpected effects that drugs may have on living cells. It could provide a better way of identifying both potential side effects of and applications for new drugs — and take the serendipity out of the drug discovery process. Published in the current issue of the journal Nature Chemical Biology, the new tool combines modern chemical screening techniques with computer analysis. Using it, pharmaceutical companies could get an early snapshot of the potential uses and possible side effects of particular drugs. Most drugs work by interacting with target proteins to influence their effect on biochemical pathways within cells. But because these pathways and their interactions are complex, a drug can often have side effects — beneficial or toxic. To ferret out these effects, drugs nowadays are usually screened one target protein at a time, says Graeme Milligan, a molecular pharmacologist at the Institute of Biomedical and Life Sciences, University of Glasgow. Although it works, this approach can be costly for the pharmaceutical industry. “Potentially toxic and off-target effects are generally not discovered until a later stage,” he says, after a lot of time, money, and effort have been spent.

Here’s a link to the entire article:

Godfather Ron Pollack is angry: 37 million seniors have signed up for Medicare Part D, including 10 million of the 14 million seniors without coverage. Best of all 90 percent of low income seniors are enrolled which makes Godfather Ron’s claim that most seniors have better coverage then Part D offers look stupid and silly. On another front, groups of Americans will be able to form their own health insurance associations, using Costco and others to compete with traditional insurers. The Godfather opposes this nationally though he supported such association health plans in Massachusetts.

When good things happen to good people and people in need, count on Families USA and its capo to scowl and pout. For Families USA and Ron Pollack, worse is always better and better is always bad (at least for their agenda).

Something to think hard about …

WASHINGTON — The Food and Drug Administration could compel drug makers to conduct additional clinical trials after it approves their products under an amendment passed by a US House committee.

To speed drug approvals, the FDA frequently defers some clinical trials until after a product is introduced on the market. But companies have failed to complete two-thirds of the post-marketing studies they pledged to conduct for drugs now sold to millions of Americans. Currently, the FDA does not have the authority to force drug makers to finish the trials.

Under the amendment, which was attached to a must-pass appropriations bill, the agency could begin proceedings to stop the sale of specific drugs if promised clinical trials for those products are not done.

Some attack the FDA with malice and ignorance. That’s not helpful. Others attack people at the FDA. And that’s just plain wrong.

Bob and I share our feelings today on NRO. Here’s the link. The title of our remarks is “Miller’s Crossing.”

Remember all those whiners who said seniors were too old and stupid to choose a drug plan? Now they’re attacking consumer-directed plans and the effort to give people more information on choices — like price and quality. The reason: too much information will overwhelm most of us because we — unlike the health care gods at the Kaiser and Commonwealth Foundation — are too slow and stupid to make intelligent choices. Here’s one of the leaders of the Too Stupid to Choose Coalition, Drew Altman, on the subject of consumer choice:

“It’s not about whether consumers should shop for health care like plasma TVs,” says Drew Altman of the Kaiser Family Foundation. “It’s about two fundamentally different approaches to health care: comprehensive and less comprehensive with high-deductible plans. Which does America want?”

Gee Drew, I guess all health plans are the same with no difference in outcomes, service, cost, etc? Maybe health care isn’t like plasma TVs but it’s obvious you think it should be more like the current black box you want us to shut up and accept. As for the canard that people scared about dying not being able to make a rational decision…where does that happen in real life? In the extreme, hospitals are being judged by how well they treat acute stroke and cardiac arrest and the data is being made available to insurers and consumers. Iin the main, treatment of chronic illness or surgery, people do have the time to make a choice. That goes - heaven forbid — even in the treatment of cancer or other life threatening illnesses. The people I know who struggle with such illnesses are searching for more information to make the best choice possible. But Mr. Altman and his coalition think people are too incompetent to make these choices or that they don’t matter.

And as for seniors, they certainly know how to make a good choice. Just ask them on Election Day.

Tech Support

  • 05.09.2006

Study: Number of Drugs Entering Testing Up

The number of drugs that entered clinical testing surged 52 percent in the three years ended in 2005, signaling the pharmaceutical industry may be emerging from its research and development drought, according to a new study by the Tufts Center for the Study of Drug Development.

The increase represents a jump from the 21 percent decline in medicines entering testing in the five years ended in 2002 from the five-year period ended in 1997, according to a study of 10 pharmaceutical makers

According to the Center the improvement seen in the recent study is a result of new technologies that enable scientists to better judge a drug candidate’s likelihood of success and an increase in products licensed from other companies.

If you’ve heard that one, try this —

The Washington Post story on Trovan in Nigeria conveniently fails to include several pertinent facts, underscoring the victory of headlines over facts.

For example, the article claims that “… the panel said an oral form of Trovan, the Pfizer drug used in the test, had apparently never been given to children with meningitis.”

In fact,while Trovan had never been used in children with meningitis, other antbiotics of the flouroquinolones class had been tested in children with that disease with success.

Here is a summary of one such study ( Ciprofloxacin in preterm neonates: case report and review of the literature. van den Oever HL, Versteegh FG, Thewessen EA, van den Anker JN, Mouton JW, Neijens HJ. Eur J Pediatr. 1998 Oct;157(10):843-5.)

The article also implies that the Trovan trial did nothing to help address the epidemic of meningitis in Nigeria.

Despite optimal therapy, meningococcal meningitis has a 10% fatality rate and at least 15% central nervous system damage. The Post continues to ignore the fact that Pfizer’s treatment resulted in the best survival rate of any treatment then being administered in Kano. While Doctors Without Borders (DWB) treated patients with epidemic meningitis in Kano with a different medication, oily chloramphenicol, which was not approved for use in Nigeria, and succeeded in lowering the death rate to approximately 9.1 percent, Pfizer lowered the mortality rate even further to 6 percent. The rate was the same for the group who were administered Trovan and the group who received the other antibiotic that Pfizer supplied. Pfizer’s rate was also lower than the overall rate for the epidemic which ranged from 10-30 percent.

Nearly 50-100 percent reduction in mortality and Pfizer was ignoring the problem?

Finally, the head of the Nigerian “commission” who did the study has his own problems …

Dr Abdulsalami Nasidi, who chaired the commision looking at the Pfizer conduct is also head of an umbrella body for anti-AIDS groups and government agencies in Nigeria. It turns out that the his group was asking AIDS patients to pay for their drugs, which it got free. Medicins Sans Frontieres’ found nearly half of people on drug treatment in Nigeria did not receive sufficient doses due to lack of funds.

The Post fails to note that Nasidi had opposed the Pfizer trial from the outset. Moreover, the Post failed to discuss the fact that two factions in Nigeria were at war over the trial and that many observers claimed (it’s in the report the Post had) that Pfizer knew it was not wanted in Nigeria…. Indeed it is clear from the report that Pfizer was caught in the crossfire of a political feud and that much of the “testimony” regarding the handling of the study is of the “he-said, she-said” variety with one group saying the trial was conducted properly (those supporting use of Trovan) and those saying it was not (those who opposed the trial from the outset). Yet the Post story reads as if the report consistently slams Pfizer and the researchers.

It doesn’t.

And just last week The Global Fund against AIDS, Tuberculosis and Malaria at the weekend halted US $50 million in grants to Nigeria, citing the country’s failure to meet performance targets.

Fund spokesman Jon Liden said the governing board voted to suspend payment on two five-year grants after just two years because Nigeria had missed targets on anti-AIDS treatment access and other goals.

So let’s see, Nasidi is both the chair of this commission and of the AIDs group criticized for selling drugs it got for free and for missing performance targets.

Nothing like attacking a big, bad pharma company to divert attention from your own incompetence.

The Washington Post got played.


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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