Washington (AP) - New drugs cleared by the Food and Drug Administration last year kept pace with 2008, suggesting a much-touted push for drug safety has not slowed down approvals.
The FDA's new leaders did step up early warnings about potential drug safety issues and citations to companies that violate safety regulations.
Drug approvals inched higher to 26 first-of-a-kind prescription medicines last year, from 25 in 2008, according to figures from Washington Analysis, an investment research group. New drugs cleared in 2009 included Novartis' kidney cancer drug Afinitor and Bausch and Lomb's pink eye medicine Besivance.
The FDA hasn't yet tallied its year-end drug approvals but will have the number by Friday. As of Dec. 1 the agency reported 25 new drugs approved.
During 2009, the agency added 31 new or updated "black box" warning labels to drugs already on the market. That was down from 56 boxed warnings in the previous year, when the agency issued several broad warnings that resulted in boxed labels for entire groups of drugs.
The 2009 totals suggest a moderate approach to regulation from FDA, despite drug industry concerns that recently-appointed Obama administration officials would result in fewer drug approvals.
President Barack Obama tapped Commissioner Margaret Hamburg and Deputy Commissioner Joshua Sharfstein last year to restore the agency's credibility, following a string of safety problems involving everything from blood thinners to peppers to peanut butter.
In August, Hamburg announced the agency would speed up and expand its issuance of warning letters to companies that don't follow FDA regulations.
"The agency must show industry and consumers that we are on the job," Hamburg said. "Companies must have a realistic expectation that if they are crossing the line, they will be caught."
Analysts say the take-charge attitude has energized the staff and empowered them to make decisions.
"Sharfstein and Hamburg bring confidence and certainty to an agency that was badly in need of it," said Ira Loss, an analyst with Washington Analysis who has covered the agency for three decades. "The rank-and-file staffers are now able to move with confidence that the agency has their back."
In the past year, the FDA also increased its use of so-called early communications, a sign the agency is acting more quickly to address safety concerns. Under the policy, the FDA issues warnings to the public when it first begins looking at potential side effects with a drug, even if no direct link has been established.
The agency issued five early communications last year, including reports of liver damage with GlaxoSmithKline PLC's over-the-counter weight loss pill alli and heart problems with Roche's asthma drug Xolair. Both issues are still under investigation. In 2008 the agency issued two early communications.
FDA also stepped up actions against bogus or dangerous consumer products.
Since last spring, FDA regulators moved to shut down makers of phony swine flu remedies, defective nasal sprays and dietary supplements that contain steroids.
Drug industry executives have criticized the FDA in recent years for approving fewer new drugs. Drug approvals peaked at 53 in 1996 and have bounced around in the twenties and teens in recent years. Many critics suggest the agency has become too cautious in response to the safety scandal surrounding Vioxx, the Merck painkiller which FDA approved in 1999 but then pulled from the market in 2004 due to heart risks.
FDA officials have countered that new drug submissions have been declining for a decade as companies struggle to come up with new medications. The FDA can't approve drugs that aren't submitted.
The agency says it has addressed staffing issues that slowed reviews in recent years, and is operating within its goal of taking 10 months to review regular drug applications and six months for priority applications.
DrugWonks on Twitter
Tweets by @PeterPittsDrugWonks on Facebook
CMPI Videos
Video Montage of Third Annual Odyssey Awards Gala Featuring Governor Mitch Daniels, Montel Williams, Dr. Paul Offit and CMPI president Peter Pitts
Indiana Governor Mitch Daniels
Montel Williams, Emmy Award-Winning Talk Show Host
Paul Offit, M.D., Chief of the Division of Infectious Diseases and the Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, for Leadership in Transformational Medicine
CMPI president Peter J. Pitts
CMPI Web Video: "Science or Celebrity"
Tabloid Medicine
Check Out CMPI's Book
A Transatlantic Malaise
Edited By: Peter J. Pitts
Download the E-Book Version Here
CMPI Events
Donate
CMPI Reports
Blog Roll
AHRP
Better Health
BigGovHealth
Biotech Blog
BrandweekNRX
CA Medicine man
Cafe Pharma
Campaign for Modern Medicines
Carlat Psychiatry Blog
Clinical Psychology and Psychiatry: A Closer Look
Conservative's Forum
Club For Growth
CNEhealth.org
Diabetes Mine
Disruptive Women
Doctors For Patient Care
Dr. Gov
Drug Channels
DTC Perspectives
eDrugSearch
Envisioning 2.0
EyeOnFDA
FDA Law Blog
Fierce Pharma
fightingdiseases.org
Fresh Air Fund
Furious Seasons
Gooznews
Gel Health News
Hands Off My Health
Health Business Blog
Health Care BS
Health Care for All
Healthy Skepticism
Hooked: Ethics, Medicine, and Pharma
Hugh Hewitt
IgniteBlog
In the Pipeline
In Vivo
Instapundit
Internet Drug News
Jaz'd Healthcare
Jaz'd Pharmaceutical Industry
Jim Edwards' NRx
Kaus Files
KevinMD
Laffer Health Care Report
Little Green Footballs
Med Buzz
Media Research Center
Medrants
More than Medicine
National Review
Neuroethics & Law
Newsbusters
Nurses For Reform
Nurses For Reform Blog
Opinion Journal
Orange Book
PAL
Peter Rost
Pharm Aid
Pharma Blog Review
Pharma Blogsphere
Pharma Marketing Blog
Pharmablogger
Pharmacology Corner
Pharmagossip
Pharmamotion
Pharmalot
Pharmaceutical Business Review
Piper Report
Polipundit
Powerline
Prescription for a Cure
Public Plan Facts
Quackwatch
Real Clear Politics
Remedyhealthcare
Shark Report
Shearlings Got Plowed
StateHouseCall.org
Taking Back America
Terra Sigillata
The Cycle
The Catalyst
The Lonely Conservative
TortsProf
Town Hall
Washington Monthly
World of DTC Marketing
WSJ Health Blog
DrugWonks Blog
Push for Drug Safety Did Not Slow FDA Drug Approvals Last Year
Wednesday, January 06, 2010
By Matthew Perrone, Associated Press
Read More & Comment...
Personalized medicine means the “Four Rights” – the right medicine for the right patient, in the right dose at the right time. We’ve made some significant strides forward via (among other things) molecular diagnostics – but we’ve only scratched the surface.
Consider two recent studies on how we’re diagnosing and treating depression.
According to the Wall Street Journal, “More Americans are being prescribed multiple psychiatric medications for use at the same time, but most people diagnosed with recent depression don't get adequate treatment, according to two independent studies published Monday.”
Advancing the tools and techniques of personalized medicine is real healthcare reform. And there’s no better place to start than with the FDA’s Critical Path Program and its Reagan Udall Foundation.
To paraphrase – we have promises to keep. And miles to go before we sleep.
Read More & Comment... Drugs May Aid Only Severe Depression
Some widely prescribed drugs for depression provide relief in extreme cases but are no more effective than placebo pills for most patients, according to a new analysis released Tuesday.
The findings could help settle a longstanding debate about antidepressants.
NOW WATCH AS CAREY DUMPS ON MEDS IN A BACKHAND WAY..
While the study does not imply that the drugs are worthless for anyone with moderate to serious depression — many such people do seem to benefit — it does provide one likely explanation for the sharp disagreement among experts about the drugs’ overall effectiveness.
Taken together, previous studies have painted a confusing picture. On one hand, industry-supported trials have generally found that the drugs sharply reduce symptoms. On the other, many studies that were not initially published, or were buried, showed no significant benefits compared with placebos.
THE LAST GRAF IS NONSENSE. NO TRIALS -- INDUSTRY OR OTHERWISE HAVE EVER SHOWN THAT ANTIDEPRESSANTS SHARPLY REDUCE SYMPTOMS. THEY ARE HARD TO DESIGN AND ENDPOINTS HARD TO MEASURE. MANY ARE TO0 SMALL. WHICH IS WHY MANY ANTIDEPRESSANT STUDIES ARE NOT PUBLISHED. RATHER IT HAS BEEN THE CUMULATIVE CLINICAL EXPERIENCE THAT HAS DEMONSTRATED BENEFIT IN LARGE PART BECAUSE TESTING AGAINST PLACEBO DO NOT TAKE INTO ACCOUNT THAT 60 PERCENT OF ALL PEOPLE WHO START ON ONE ANTIDEPRESSANT SWITCH. THUS THE STAR-D TRIAL, A GOVERNMENT FUNDING STUDY THAT USE A CROSSOVER DESIGN MIMICING CLINICAL PRACTICE FOUND SIGNIFICANT BENEFITS THROUGH THE INDIVIDUALIZATION OF TREATMENT. WHEREAS...
The new report, appearing in The Journal of the American Medical Association, reviews data from previous trials on two types of drugs and finds that their effectiveness varies according to the severity of the depression being treated.
Previous analyses had found a similar pattern. But the new study is the first to analyze responses from hundreds of people being treated for more moderate symptoms, as are most people who seek care.
AGAIN, UNTRUE.. SEE THE STAR-D TRIAL
“I think the study could dampen enthusiasm for antidepressant medications a bit, and that may be a good thing,” said Dr. Erick H. Turner, a psychiatrist at Oregon Health and Science University. “People’s expectations for the drugs won’t be so high, and doctors won’t be surprised if they’re not curing every patient they see with medications.”
But Dr. Turner added, “The findings shouldn’t dampen expectations so much that people refuse to even try medication.”
A team of researchers, including psychologists who favor talk therapy and doctors who consult widely with drug makers, performed the new analysis, using government grants. The group evaluated six large drug trials, including 728 men and women, about half of them with severe depression and half with more moderate symptoms.
Three of the trials were of Paxil, from GlaxoSmithKline, a so-called S.S.R.I., and the other three were of imipramine, an older generic drug from the class known as tricyclics. The team, led by Jay C. Fournier and Robert J. DeRubeis of the University of Pennsylvania, found that compared with placebos, the drugs caused a much steeper reduction in symptoms of severe depression (cases scoring 25 or higher on a standard scale of severity, putting them in the top quarter of the sample). Patients with scores of less than 25 got little or no added benefit from the medications.
“We were able to give an overall estimate of effectiveness for the first time in this more moderate severity range, from 14 to 20 on the scale, in which there’s no question that doctors would likely consider prescribing medication,” Dr. DeRubeis said.
His co-authors included Steven D. Hollon and Dr. Richard C. Shelton of Vanderbilt University, Sona Dimidjian of the University of Colorado, Dr. Jan Fawcett of the University of New Mexico and Dr. Jay D. Amsterdam of Penn.
The effects of other popular S.S.R.I.’s like Lexapro and Prozac are not likely to be much different than those of Paxil, experts said.
Dr. DeRubeis and others said antidepressants’ inability to outperform placebos against moderate symptoms stemmed partly from the sustained attention that patients in drug trials received from top doctors — which itself can help relieve symptoms, drug or no drug. For some people, too, the drugs’ side effects may cancel any benefit.
HOW ABOUT THE USE OF GENETIC TESTS TO INDIVIDUALIZE AND OPTIMIZE DRUG SELECTION TO REDUCE SIDE EFFECTS?
THIS IS A POOR STUDY RECAST AS A SLAM AGAINST MEDICATIONS BY THE NYTIMES
FOR THOSE INTERESTED IN THE STAR-D RESULTS AND IMPORT.
Read More & Comment...
Bloomberg reports that “Democrats will likely drop the idea of setting up a new government-run insurance program as they try to quickly resolve differences between House and Senate health-care bills, party members in both chambers said.”
Illinois Senator Dick Durbin, the No. 2 Senate Democrat said, “The Senate has pushed this to the limit of 60 votes. We have to be careful that whatever we change doesn’t jeopardize that 60-vote margin.”
“We’ll never have another chance like this in my political lifetime,” Durbin said. “This is it.”
Healthcare reform is too important to tie it to Senator Durbin’s political lifetime. The American public is not concerned about Senator Durbin’s political lifetime.
The goal, according to Bloomberg, is to have a bills signed by the State of the Union.
Shouldn’t the goal be to pass healthcare reform legislation that advances the public health in smart and progressive ways? Why the artificial deadline?
Should we accept legislation that compromises the public health?
Read More & Comment...Read More & Comment...
This is an abomination, especially if a super-majority is needed to kill it.
Read More & Comment...
Article published Jun 28, 2009
Doctor shortage proves painful to state
By BRENT CURTIS Staff Writer
Much of the state is short on primary care providers at a time when the nation as a whole is searching the same pool of doctors.
Since the start of the year, Rutland County, for example, has lost three primary care doctors and three more are over age 60 and planning to retire within the next few years, said Rutland Regional Medical Center President Thomas Huebner.
"We have the biggest shortage of primary care doctors in the state," Huebner said, pointing to a 2008 state Department of Health report that indicated that all but a tiny portion of the county faced a "severe need" for primary care physicians.
And that study was conducted before the departure of three primary care doctors earlier this year.
The loss of those doctors is more than just an inconvenience for their patients. With the demand for primary care in Rutland County exceeding the supply – which Huebner said is short by about four doctors – patients are forced to wait longer to see doctors who are overburdened. Also, many doctors in the region aren't accepting new Medicare or Medicaid patients – most physicians can only accept so many state-insured patients due to low government reimbursement rates – which compels many patients to put off doctor visits until their needs are acute and they end up in the hospital.
It's a fallback practice for those who can't find primary care doctors that Huebner and other health care professionals say ends up costing hospitals, insurance companies and ultimately those paying for insurance more.
And the primary care problem hardly is unique to Rutland or to Vermont for that matter.
Elsewhere in the state and nation, primary care physicians are in short supply.
Dr. Ted Epperly, president of the American Academy of Family physicians, said the United States is about 15,000 primary care doctors short of demand — a 30 percent shortfall across the board for all 50 states.
If current trends persist, the AAFP predicts the deficit will grow to 40,000 over the next 10 years.
That estimate is no surprise given that only 17 percent of U.S. medical school graduates in 2008 expressed a preference for family medicine. The AAFP said the small percentage of primary care-minded graduates represented an "all-time low" among emerging students.
Even in Vermont, where the University of Vermont prides itself on ranking in the top 5 percent of all medical schools for primary care, access to family medicine is spotty.
In addition to Rutland County, large swaths of the Northeast Kingdom along with large portions of Grand Isle, Franklin, Lamoille, Addison, Orange, Washington and Windham counties were labeled "severe need" areas by the Department of Health. Many other areas of the state were listed as "limited need" areas.
In fact, the only sizeable areas with adequate supplies of primary care, according to the most recent state study that compares full-time equivalent hours with regional populations, were portions of Chittenden, northernmost Orleans, southern Addison, much of Windsor, central Windham and most of Bennington counties.
The reasons for the doctor shortage, which has been gradually worsening over the years, are well documented. Much of the problem boils down to money. Medical students who opt to specialize rather than enter primary care practices stand to make significantly more because specific procedures earn higher reimbursements than generalized care and diagnoses. For medical students leaving school with debt loads often topping $150,000, the decision to enter primary care practice often means a degree of financial hardship, according to survey-based research conducted in Vermont and nationwide.
Those same surveys show that primary care physicians tend to work longer hours than specialized doctors and must juggle larger caseloads with the reams of paperwork that accompany most procedures in modern medicine.
In Rutland, Huebner said those symptoms are particularly acute due to high ratios of Medicaid and Medicare patients in the community. Reimbursements from the two government programs are well below the cost of medical procedures.
Vermont can be a tough place to recruit new doctors who can often find higher wages in other states, according to the Vermont Medical Society.
"What Vermont has going for it is quality of life," said Paul Harrington, executive vice president of VMS. "Nothing trumps a desire to be here because there are other places where doctors do earn more."
On top of that, Harrington said Vermont has a higher ratio of Medicaid patients and an ever increasing number of Medicare patients due to a graying population.
The pay scale puts Vermont at a disadvantage when it comes to recruiting new doctors – and it makes keeping them here a challenge, as well.
Since the primary care shortage is a national problem, other states constantly are trying to lure doctors away from Vermont.
To keep physicians here, hospitals around the state utilize their own recruiters who not only try to bring doctors to their facilities but work toward a balance of doctors in private practice in the surrounding communities as well.
Hospitals have an interest in the medical community beyond their own walls because a shortage of primary care doctors means more patients arriving in the emergency room suffering from ailments that a family physician could have detected and dealt with at a less acute and less expensive stage.
"We're all in this together," said Donna Izor, vice president of physician services at Central Vermont Medical Center.
Izor, and other recruiters around the state, offer incentives such as electronic medical records, startup loans and hospitallist services – hospital employed doctors who oversee a primary care physician's patients during hospital stays – to ease the financial, paperwork and time burden that family physicians shoulder.
But all acknowledge that the real answer to the problem lies at the state and federal level, where Medicaid and Medicare reimbursement levels are set – and all too often are cut.
During the last legislative session, budget realities prompted legislators to cut Medicaid reimbursements by 2 percent.
In the Legislature's defense, Rep. Steve Maier, D-Middlebury, said legislators exempted a number of procedures common to primary care physicians from those cuts and he said the Legislature increased Medicaid reimbursements for some primary care procedures.
"We know there's a shortage and we know that quality primary care saves money for the system in the long term," said Maier, who is chairman of the House Health Care Committee.
The Vermont medical community is also looking at changing the way that primary care is delivered. Through a blueprint model originally developed to handle chronic care for patients, three pilot programs are underway in Burlington, Bennington and St. Albans that will provide a small supplemental sum for each primary care provider in the pilot. More importantly, the blueprint pilot establishes a team approach that would surround primary care doctors with physician assistants and specialists, who the pilot's drafters hope will assist family physicians and relieve some of their time and caseload burden.
Huebner said he is seeking to make Rutland the fourth pilot site for the blueprint.
In the meantime, the RRMC president said he's looking ahead to the opening of a federally qualified health care center at 69 Allen St. later this summer.
The center, which will serve as a satellite for the main FQHC center in Castleton, is starting small with just a single doctor, but Huebner said he has applied for funding to expand the practice by building a center on land owned by the hospital.
There are eight other FQHC centers in the state – the one in Springfield is the newest – and 34 satellite offices. The centers' greatest asset is something of a commentary on the underlying problem confronting other primary care doctors – they are paid a much higher reimbursement for Medicaid and Medicare patients.
The FQHC facilities operating in the state cover a majority of the state's 14 counties.
But independent U.S. Sen. Bernard Sanders, who has advocated for additional centers for years, said he won't be satisfied until two more centers are added in Addison and Bennington counties.
Sanders said this week that he has had recent success expanding the FQHC program, which will create 126 new health centers nationwide this year.
"We have 60 million people out there with no doctor of their own," he said. "What we need to do and work on is making sure that every person in the nation has access to a doctor."
Read More & Comment...
Harvard Teaching Hospitals Cap Outside Pay
The owner of two research hospitals affiliated with the Harvard Medical School has imposed restrictions on outside pay for two dozen senior officials who also sit on the boards of pharmaceutical or biotechnology companies. The limits come in the wake of growing criticism of the ties between industry and academia.
Medical experts say they believe the conflict-of-interest rules at the institution, Partners HealthCare, go further than those of any other academic medical center in restricting outside pay from drug companies. The rules, which became effective on Friday, impose limits specifically on outside directors who guide some of the nation’s biggest companies.
http://www.nytimes.com/2010/01/03/health/research/03hospital.html?pagewanted=printWill someone please explain to me what the downside of such ties are as long as all relationships are transparent and the research conducted is done so at arms length? Should academia receive no industry support of any kind?
However, it's okay for business professors who criticize pharma ties to academia to disgorge huge consulting fees from said corporations...
"Thomas Donaldson, a professor of business ethics at the Wharton School of the University of Pennsylvania, said: “It strikes me as a breath of fresh air in a room that’s getting progressively more stale. I hope this will set a standard for others — hospitals, medical schools.”
Professor Donaldson, who advises large companies on corporate governance, said dual roles in a hospital and at a drug maker were “dicey at best” because a director’s duty is to look out for the corporation’s financial interests.
The irony or hypocrisy is not even noted because, well, only pharma dough is evil. Meanwhile, I have obtained a photo of the new Partners RNAi antibodies facility... paid for from medical students actvitivy feesRead More & Comment...
As we flip the calendar to a new year, it’s time again for our drugwonks.com annual Golden Clipboard Awards.
Why a golden clipboard? Well, commenting on the current state of 21st century bioinformatics, CDER chief Dr. Janet Woodcock quipped that, "Today the major tool of modern medicine seems to the clipboard."
In the past, we’ve given out awards to those who impede (unwittingly or otherwise) the advance of medical progress. For 2009, in the spirit of non-partisanship, we hand out honors based on those who helped move the needle towards real healthcare reform in a more positive direction.
Herewith our 2009 honorees …
Honorable Mention: The FDA for telling Senator Dorgan et al. to park their idea for drug importation in a tamper proof location.
Honorable Mention: Richard "Buzz" Cooper of the Leonard David School of Public Health at University of Pennsylvania and Gary Puckrein of the National Minority Quality Forum for respectfully challenging the outdated Dartmouth methodology and forcing policymakers to examine the impact of poverty,
behavior and severity of illness on differences in health expenditures. Equally dead is not a
Honorable Mention: Representatives Mike Rogers (R) and Anna Eshoo (D) for working together to promote a safe and savvy pathway for follow-on biologics.
Honorable Mention: Billy Tauzin for cutting “the deal” that protects the Non-Interference Clause, thus preventing a slippery slide towards broader government price controls for pharmaceuticals. Price controls = choice controls.
The Bronze Clipboard: We are pleased to award the 2009 Bronze Clipboard to Paul Offit for bravely and publicly standing up to those (including CBS News) who slandered him and threatened the lives of his children for simply saying vaccines have benefits far outweighing the risks.
The Silver Clipboard: And the winner is NIH Director Francis Collins for telling it like it is about comparative effectiveness when he points out that it ignores individual differences that we know exist at the clinical and genetic level.
And the 2009 Golden Clipboard winner is … DRUMROLL PLEASE …
The Golden Clipboard Winner for 2009 is FDA Commissioner Peggy Hamburg for saying “yes” to science and personalized medicine and “no” to political interference at the Food & Drug Administration. She calls it like she sees it and that’s just the attitude required to help the FDA advance the public health by being both regulator and colleague to the industries the agency oversees. It’s a tightrope to be sure – but Dr. Hamburg has the requisite smarts and finesse.
And so, Golden Clipboards awarded, let us march forward together into 2010 with high hopes and in a spirit of cooperation to advance the public health.
(But we’re keeping our athletic supporters on just in case.)
Happy New Year.
This end-of-year revelation comes after my wife’s emergency appendectomy. Here’s the briefest chronology:
2AM: Horrible stomach pain and other relevant symptoms.
5:45AM: 911 call
5:50AM: EMTs arrive
6:00AM: Arrive at emergency room
6:07AM: Wife in emergency room bed
6:15AM: Nurse takes blood
6:20AM: Initial physician consultation
6:25AM: Wife on saline and anti-nausea drip
7:00AM: Wife gets some morphine
7:00AM – 11:00: Wife rests comfortably waiting for CT scan
11:00AM: CT scan (One machine was out of service, hence the long wait.)
11:10AM: Resident confirms diagnosis of appendicitis
11:15: Initial consultation with surgery resident
1:00PM: Surgery prep
2:00PM: Surgery
3:30PM: Recovery Room
5:00PM: Admitted to empty room
9:30AM (the following day): Released
To use a pain intensity scale analogy – the entire experience was only “moderately painful.”
Which brings me back to the plural of anecdote being reality. As a good resident of the 21st century, I used Facebook to let my friends and family know about my wife’s condition. The Americans were all appropriately sympathetic. The Europeans were mostly amazed. Amazed that we didn’t wait hours for an emergency room bed. Amazed that we saw a doctor in fewer than 5-8 hours. Amazed that we weren’t told to go home and come back at a later date (since her white blood cell count was only slightly elevated and the appendix wasn’t in danger of bursting) and not amazed but astounded that the surgery was done immediately. That there was actually a room available and that it was vacant – at a large urban hospital – they couldn’t even fathom.
Here is one verbatim comment from one continental comrade:
“I waited three days in London to see a GP and 20 hours at ER for an "exploratory op." It burst and I nearly died (to say nothing of the two life-threatening incidents whilst I was being "cared" for). But hey! The public option is better than letting people choose, right?”
So, while the plural of anecdote isn’t data – it is reality. And, in the immortal words of George Santayana, “Those who do not learn from history are doomed to repeat it.”
Speaking of General Santayana, here’s one of his less famous observations – keenly apropos of the current debate on American healthcare reform, “Fanaticism consists in redoubling your efforts when you have forgotten your aim.”
And the occasional anecdote goes a long way to reminding us of that, um, reality.
Read More & Comment...
“The Food and Drug Administration is developing guidelines that will set tougher scientific standards for data from tests on humans that makers of medical devices submit when seeking approval of their products, a top agency official said.
Dr. Jeffrey Shuren, the acting director of the Center for Devices and Radiological Health, said in a telephone interview on Monday that the F.D.A. most likely will soon urge device makers to take steps like using more sharply defined targets to measure the success of clinical trials. The agency may also urge producers to more closely follow patients enrolled in such trials to determine whether the targets are met, he added.
The F.D.A.-sponsored study found that more than 40 percent of the studies used to approve cardiovascular devices had lacked high-quality data about either the treatment or safety goals of the study. In addition, that study also found that about 25 percent of trials had failed to adequately follow the outcomes of a sufficient number of patients, a level the review defined as 90 percent or more of patients initially enrolled in a trial.”
The full New York Times story can be found here.
Read More & Comment...
According to a new report just issued by the Center for Technology and Aging, medical optimization (“med-ops”) via information technology is an important element to improving medication-related errors and improving medication adherence among older adults.
The report says "widespread use" of technology aimed at this population could save thousands of lives and billions of dollars.
"More widespread use of technologies that reduce the cost and burden of medication-related illness among older adults is urgently needed," said David Lindeman, the center's director.
The Institute of Medicine reports that more than 2 million serious adverse drug events and about 100,000 deaths occur annually due to medication use problems. The New England Healthcare Institute estimates that $290 billion in healthcare expenditures could be avoided if medication adherence were improved.
"Medication non-adherence is responsible for up to 33 percent to 69 percent of medication-related hospital admissions and 23 percent of all nursing home admissions," said Lindeman. "As Congress debates ways to improve our healthcare system and lower costs, it will be critical to put in place incentives that encourage providers to accelerate the use of available 'med-op' technologies."
The report addresses three areas of opportunity for medication optimization: reconciliation, adherence and monitoring. It describes the technologies being used or under development within the three areas along with an assessment of their pros, cons, market stage and economics.
Some of the technologies described include:
* Medication kiosks, such as those piloted at the Veterans Health Administration;
* Walgreen's online medication history tool for consumers;
* Cognitive assessment tests like the Mini-Mental State Exam (MMSE);
* "Rex," a talking pill bottle designed by Pittsbugh-based MedivoxRx that assists visually or cognitively impaired patients;
* The Med-eMonitor System, a portable electronic medication-dispensing device from Rockville, Md.-based InforMedix;
* Mobile phone apps with medication management, reporting and trending features; and
* Wireless point-of-care testing devices to monitor medication use.
According to the report, of the 3 billion medication prescriptions issued each year in the United States, 12 percent are never picked up by the patient and 40 percent are not taken correctly.
"And yet, effective tools and technologies already exist to greatly reduce these problems," said Lindeman. "Ultimately, medication optimization technologies can lead to significant improvements in the cost and quality of care for older adults."
Number of words devoted to such concepts in both the House and Senate health reform bills? Zero.
Read More & Comment...
The best that can be said about this cynical exploitation of people and families in hospice settings is that at least there is no Death Panel making coverage decisions. The cut is across the board, one size fits all and designed not to save lives or save Medicare as Senator Reid claims, but to win the support of specific Senators and special interests. Connecticut’s Chris Dodd gets a hospital, New York and Florida get to keep Medicare Advantage, a program that allows poor seniors to get additional services (like hospice) without paying more premiums while millions of other seniors will be tossed from the program. (They will be able, once again, to buy expensive supplemental insurance from AARP, which coincidentally supported the health care bill.) There are very special Medicaid payments for Ben Nelson’s Nebraska, which already gets more dollars per person and a higher federal share of payments than the programs average.
Liberals excuse this behavior by claiming it is the one-time cost of getting a deal done that benefits the nation as a whole. However, such horsetrading – cutting benefits to free up cash for universal healthcare is a central feature of both the House and Senate bills and of government run systems in general.
Healthcare policy and deal making is already a big business.
It is easier to get cuts by force than through regulatory “reform.”
And, when it comes to health care, there seems to be nothing but wild cards. From “the deal” that Billy Tauzin cut with the White House to the future of follow-on biologics, from the “doc fix” to clinical effectiveness, from closing the doughnut hole to paving a pathway for follow-on biologics, there are enough issues in play to offer at least a dozen plausible scenarios. They’re all interesting and important. But some (in a very Orwellian sense) are more important than others.
The most important is the future of innovation.
For the rest of the story, see here.
Read More & Comment...
Late one recent wintry night in the midst of congressional deliberations over healthcare reform, having worked hard on trying to reconcile the many swirling eddies of the current debate, I retired to bed for a few hours of fitful respite. That is until I was awoken from my solemn slumbers by a billowy translucent apparition who identified himself as the Ghost of Healthcares Yet-to-Come.
“Away ye spirit,” I intoned, “for I need my sleep and indeed I see you for what you really are – a detail rep for prescription sleep aids.” “Nay,” replied the apparition. “I am here to reveal to you alternate realities for American healthcares yet-to-come.” And with a wave of his spectral hand appeared a magical black bag. “Look within,” he intoned. “And see how the future of American healthcare can unfold.” “Did you bring a pizza by any chance,” I queried? “Sorry, can’t do that any more,” the ghost replied. “Let our journey begin.”
And so from inside his ebony satchel he ceremoniously withdrew a heavy, leather-bound tome with a caduceus embossed on the cover. “What alchemist’s manual is this?” asked I. “It is,” whispered the spirit, “from the cabinet of doctors Pelosi and Reid. It is the final version of healthcare reform legislation.”
“Oh splendid visitor,” I pleaded. “May I gaze upon these pages and take notes for my blog? “NO!” the ghost sternly admonished. “You may look at the book but may never read what is inside – just like members of Congress before the final vote.”
“Not fair,” said I. “Alas,” the specter replied. “Such is the future when healthcare legislation is focused primarily on politics rather than on advancing the public health.”
“But it need not be that way,” my navigator continued. “Let us move on to an alternate future.” And with that he once again reached down into his black bag, revealing not a book but a Kindle. “Power it up,” he directed. “And see another future for American healthcare.
And it was wondrous. A future of enhanced access, innovation and accelerated approvals. A future where, with appropriate FDA guidance, pharmaceutical companies actively engage in social media. A future where insurance companies reward their customers for medication compliance, weight loss, smoking cessation, and disease prevention. A future with a national standard for electronic medical records and e-prescribing. A future where the insurance industry offers high quality health policies across state lines to the many millions of previously uncovered Americans at significantly lower costs. A future where reimbursement decisions are based on patient-centric concerns rather than 20th century cost-centered models. A future where physicians are compensated fairly by Medicare and Medicaid. A future where, through enhanced transatlantic regulatory harmonization, there is no “approval gap” for drugs, devices, or diagnostics. A future where the only doughnut hole question we consider is cream-filled or regular. A future where drug importation is a side show panel not in the US Senate, but at Ripley’s Believe-it-or-Not.
“Can we peer into the future of the FDA,” I wondered.
“You’re such a wonk,” said my ethereal companion. “If you insist.”
And insist I did. As I browsed further into the magic Kindle I saw an FDA that’s both regulator in protecting the public health and colleague in helping to advance it via the Reagan Udall Foundation. I saw an FDA with a cutting-edge information management system. I saw an FDA that embraces predictability over ambiguity. I saw an FDA that understands the unintended consequences of early risk communications.
“Is such a future possible,” I asked.
“Indeed it is,” the eidolon answered. “It is possible if we believe.”
“If we believe in what,” I asked. “In Santa Claus?”
“No, intoned the wraith, “in the Non-Interference Clause. If we believe in free market competition and personal responsibility; in putting and keeping the patient in the center of every conversation; at long-term rather than short-term savings; in hard facts rather than political platitudes; in allies rather than enemies. If we believe that, in order to save lives, reduce costs, enhance quality, and deliver on the promise of robust health to all groups of Americans, all of the players in the health care debate - including government - must work together as a team, as a unit, as a public health defense force armed and ready to advance the public health.”
“How can we ensure this pathway,” I beseeched.
"Let me tell you,” said the phantasm, “what my friend Ebenezer Scrooge once said to a colleague of mine. He said that men's courses will foreshadow certain ends, to which, if persevered in, they must lead.”
"But,” I asked, “if the courses be departed from, the ends will change. Say it is thus with what you show me."
But, before he could answer, I saw an alteration in the Phantom's hood and dress. It shrunk, collapsed, and dwindled down into a bedpost.
I awoke. Yes! And the bedpost was my own.
"The Food and Drug Administration, the National Institutes of Health, and a new Cure Acceleration Network Board are supposed to work together to facilitate the discovery of such cures and to translate them from bench to bedside. Grants can be made under the project of up to $15 million a year to eligible entities such as academic medical schools, biotech companies, and drug companies, who need only meet a $1 to $3 matching requirement. $500 million is appropriated for this program for 2010. "
Now here's Jost's take:
"This is all well and good and a great idea. But nothing that I can see in the legislation gives the taxpayer any stake in this investment. A drug or biotech company that in fact discovers a blockbuster drug or biologic through the federal government’s investment (perhaps for an off-label use) owes nothing in return. Shouldn’t we the taxpayers get some return on our investment, or at least the promise of reasonable prices?"
So money losing biotech companies develop a cure for, say Alzheimer's, with the help of maybe a $3 million grant and Jost frets about the taxpayer return. Am I missing something? Meanwhile he has no problem with billions being scattered to various Senators and pet demonstration projects that perpetuate current halfway treatment patterns?
If you want to know why health care reform is so....frustrating, just look at Jost's parade of blogs on health policy.
Here's the OMB director to Harry Reid saying all bets are off when it comes to the human cost:
"Based on this extrapolation, CBO expects that Medicare spending under the legislation
would increase at an average annual rate of roughly 6 percent during the next two
decades—well below the roughly 8 percent annual growth rate of the past two decades
(excluding the effect of establishing the Medicare prescription drug benefit). Adjusting
for inflation, Medicare spending per beneficiary under the legislation would increase at
an average annual rate of roughly 2 percent during the next two decades—well below the
roughly 4 percent annual growth rate of the past two decades. It is unclear whether such a
reduction in the growth rate could be achieved, and if so, whether it would be
accomplished through greater efficiencies in the delivery of health care or would reduce
access to care or diminish the quality of care. "
And if so, will it even offset the explosion in costs triggered by tossing money to millions of middle class people for more generous health care or stem the exodus of doctors stuck with a 20-30 percent loss of income...
The impact of this legislation, if implemented, will reverberate through our culture and politics for decades.
Read More & Comment...
Senior White house adviser David Axelrod said the Obama Administration "will push forward on safe re-importation of pharmaceutical drugs after the healthcare reform bill is finished."
According to Axelrod, "Let me be clear: The president supports re-importation, as he said, safe re-importation of drugs into this country. There's no reason why Americans should pay a premium for the pharmaceuticals that other people in other countries pay less for. And we will move forward on it."
If, by using the term “re-importation,” Axelrod means drugs that have been approved for sale in the United States, put on a truck or a plane or a ship and sent overseas – then he’ll be disappointed to find that there are precious few -- if any. If, on the other hand, he means “importation” – then what he’s saying is that the President supports the importation of foreign price controls.
And if, by “safe re-importation,” he means that the FDA can somehow be the guarantor of global drug safety (or even guarantor of drug safety for a dozen or so foreign nations) – then he’d better seek out expert opinion on the matter.
A good place to start would be the FDA.
FDA Assistant Commissioner for Policy David Horowitz to become a deputy general counsel at the Department of Health and Human Service's Office of General Counsel.
He’ll be missed.
Another opportunity for Commissioner Peggy to remake the agency in her own image.
(And that's a good thing.)
Social Networks
Please Follow the Drugwonks Blog on Facebook, Twitter, LinkedIn, YouTube & RSS
Add This Blog to my Technorati Favorites