The Conflict of Interest Priesthood is Defrocked

09/19/2008 02:22 AM |

Danny Carlat, the self-annointed, holier than the rest of , high priest of what passes for bias and conflict of interest in medicine doesn't like it when someone suggests that the assertion that pharmaceutical support for CME is corrupting is simply an biased assertion that survives only in an evidence free zone.... This exchange, which shows the practicing psychiatrist becoming unhinged by my fairly mild post, shows what happens when a self-righteous gasbag is punctured:

Getting Slimed by the Slime Specialists

"I must be doing something right. Yesterday, after I provided some free publicity for an upcoming "evidence-based" evaluation of industry funding of CME, I received the following comment from the Vice President of CMPI, Robert Goldberg:

Apparently you are the only pure one left on the planet. You have no biases or opinions that color your judgment or clinical practice. And of course your opinion about the negative pharmaceutical industry's impact on research -- none of which can be demonstrated through the traditional scientific methods but only appeals to emotion -- are right and everyone else is wrong. But that's not bias. Apart from the fact that the Sourcewatch material is three years old and outdated (which means you didn't even bother to check the facts since our 990 is readily available) you don't even have the intellectual or moral courage to engage on the merits of the issue CME or more generally the relationship between industry and academia. Rather, you resort to the oldest rhetorical trick in the book: attacking the character or motives of a person who has stated an idea, rather than the idea itself. That's the sign of a bully and a coward. If you had any integrity or guts at all you would show up at our session (the very thought of it must give be keeping you up nights!!) engage in reasoned discussion. But I doubt you will.

In this response, Mr. Goldberg demonstrates exactly why his organization and his blog have become notorious for perfecting the art of personal-attack-as-policy-discussion. Those who want to find example after example of Mr. Goldberg's and Mr. Pitt's inimitable rhetorical style should read this expose recently published in opednews.com.    Here Danny links to the ravings of Evelyn Pringle....a most reliable and objective source of information...

Some of their pit bull (sans lipstick) pronouncements:

--"Sidney Wolfe, Public Citizen’s General Secretary of Junk Science..."

--"Not the real FDA - a Grahamatization" (referring the David Graham, the FDA analyst who revealed the extent of the Vioxx health risks)

--"That's the sign of a bully and a coward," describing me. We've descended to that level of name-calling now?

If Mr. Goldberg would like to engage in the merits of the CME discussion, he merely has to read dozens of my prior postings, in which I comment ad nauseum on the innumerable developments, debates, and policy pronouncements in the world of CME. If he would like concrete examples of commercially biased CME, I have provided them in spades.

Unlike the speakers at his conference, I don't have Fortune 500 companies standing in line ready to pony up for a trip to Washington D.C. at a moment's notice. If CMPI really wanted to engage in an "evidence-based" discussion, they would have invited speakers with alternative points of view, but they didn't, and because of that, the conference is a charade and is merely an opportunity for networking among those who profit mightily from industry-sponsored CME. "


And here's the psychiatrist's temperate posting of the previous day....

Wednesday, September 17, 2008

Jurassic CME Park comes to Capitol Hill

Look out, congressmen and senators. The dinosaurs are stampeding the Hill.

That reactionary unthink tank, Center for Medicine in the Public Interest (CMPI), is sponsoring what they are calling an "Evidence-Based Evaluation" of industry support of continuing medical eduation. You can view their invitation here.

For those who have not yet learned about CMPI, go to Sourcewatch for as much information about them as you can stomach. Essentially, they are a front group for the pharmaceutical industry, the CME industry, and whatever other stakeholding company is willing to fund them according to this menu of donating options. For example, $10,000 buys you a "corporate sponsorship" and up to four meals with "CMPI research scholars," $25,000 nets you a seat in the "Chairman's Circle" and an invitation to a "summit," and big spenders can go whole hog with a $100,000 membership in the "President's Club," and a "personal briefing."

Joining with this den of integrity will be none other than George Lundberg, M.D., editor-in-chief of Medscape. Dr. Lundberg embarrassed Medscape and the entire medical community recently with this video editorial in which he responded to the CME concerns of the nation's top medical organizations by saying: "We are just going to keep doing what we are doing. It is good. We are clean. Our work is transparent.”

Other participants, all of whom will examine the issue from a balanced and "evidence-based" perspective, are:

 

  Read More & Comment...

Passing of a Health Insurance Pioneer

09/17/2008 10:39 PM |

I had the pleasure of talking with and meeting J. Patrick Rooney. He was the man who launched the HSA movement and saw the approach expand from an idea to a fixture in the health care firmament. He died two days ago and his energy and intellect -- as well as his impatience -- will be missed. This article from the Indianapolis Business Journal captures much of Mr. Rooney's unique charm, character and vision. It mentions that he once wrote: “When I die, I would like God to welcome me."

Mission accomplished.


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Oh Brother, Where Art Thou?

09/17/2008 09:44 PM |

A question I get asked a lot these days is – Who should be on the short-list for FDA Commissioner?

Henry Waxman isn’t on my list – but he sure sounds like he wants the job.

According to Alicia Mundy at the Wall Street Journal, “In a letter sent today, Waxman, a California Dem who chairs the House oversight committee, demanded that the agency explain its priorities and accused it of carrying water for the drug and device industry."

His specific accusations surround the issues of pre-emption and the dissemination of medical journal articles that discuss off-label use. (For more on pre-emption, see here and here. And on the issue of off-label, see here and here.)

This most recent episode of the Waxman Inquisition really goes beyond the pale. In his letter, America’s Oversighter-in-Chief comments that Deputy HHS Secretary Tevi Troy isn’t to be trusted because:

(1) He once worked at, among other places, Hudson Institute and (2) Because his brother is Dan Troy.

Well, I worked with Tevi at Hudson – and during our joint tenure there we received exactly zero funding from the pharmaceutical industry. But, hey, why let the facts get in the way when the rhetoric of personal attack provides such florid opportunity? Did Mr. Waxman’s office even bother to check the facts? Facts? Facts? Who needs facts when you’ve got friction.

As to Dan Troy, I can personally attest from confidential knowledge that they are, in truth and in fact, brothers. So what? What is Mr. Waxman implying?

Shameful. Cowardly.

It’s also disappointing (but not surprising) that Mr. Waxman chose to release the letter to the media before it arrived at the FDA.

Maybe next time Mr. Waxman should ask one of his interns to hand-deliver the letter – since it’s so urgent.

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Out of the "Ordinary"

09/17/2008 12:07 PM |

From the Financial Times:

“A legal battle between GlaxoSmithKline and Greek wholesalers over parallel trade in drugs – which could have implications for the price of medicine - ended with a mixed result on Tuesday morning at Europe’s top court.

The European Court of Justice ruled that if a dominant company refused to meet “ordinary” orders for medicinal products, because it wanted to put a stop to parallel exports, it was breaching EU competition law.

But the judges said that it was up to individual countries’ courts to decide whether orders were “ordinary”. They would need to look at both the previous business relations between the drug company and the wholesalers concerned, and the size of the orders in relation to market needs in the country concerned.

Drug prices in Greece are among the lowest in Europe. GSK’s lawyers had argued that wholesalers there were placing ever-larger orders for certain drugs, mainly so that they could export the products and enjoy the benefit of higher prices in other EU states.

As a result, in 2000, GSK changed its Greek distribution system, and supplies to wholesalers were interrupted. The wholesalers complained that this amounted to anti-competitive conduct and an abuse of a dominant position.

In April, a senior legal adviser at the ECJ largely ruled against the company. Tuesday’s full court decision significantly qualifies that position.”

And via Bloomberg, this add:

“The court ``has confirmed that companies must be able to take reasonable and proportionate steps to protect their own commercial interests, even if they hold a dominant position and such steps must be assessed in the light of the ordinary requirements of the markets,'' London-based Glaxo said in a e-mailed statement.”

Is this the beginning of the end of pharmaceutical parallel trade in the EU?  It depends.  But one thing is certain, if nations such as the US decide to start draining the European medicines supply through some sort of importation scheme, many EU nations may see this as, well, out of the “ordinary.”

No matter -- if the EU decides to act in its own best interests perhaps the next Congress can design a plan where we import cheaper drugs from ... India.

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Caste of Characters

09/16/2008 09:40 PM |

The House Energy & Commerce Committee needs to help fix the problem, not the blame.

Statements coming out of the committee like -- “The FDA has refused to take meaningful regulatory action despite the fact that, for the past three years, it possessed credible information that Ranbaxy had engaged in a pattern of fraudulent behavior regarding its generic drug applications and records pertaining to good manufacturing practices.” -- is not being fair to an agency that at the time under debate and yet today is under-funded and under-staffed.

But when the committee says -- “The FDA, for example, conducted preapproval inspections for only 17 percent of the Ranbaxy applications approved since January 2005. It also allowed Ranbaxy to perform the key bioequivalence studies for generic drug approvals in facilities owned by the firm and conducted by clinicians employed by the firm.” – they’re right.  The same rule that holds true for innovator companies must also applied to generic drug manufacturers – otherwise the public’s queasiness about the quality and character of generic drugs will continue.

But Representative John Dingell, who chairs the committee, goes to far when he says, “The heparin fiasco made it clear that the FDA had compromised the policies that were put in place during the last generic drug scandal to protect the public from fraud. This latest Ranbaxy announcement further confirms that those protective policies are in shambles. The FDA is not doing its best to protect the medicines that Americans depend on for their health.”

That’s not true.  It’s not fair.  And it’s not helpful.

  Read More & Comment...

Panic Over Plastics

09/16/2008 06:36 PM |

You gotta love the media ...

FDA backs BPA as study links it to heart disease, diabetes  Read More & Comment...

FDA Inks Penn

09/16/2008 12:42 PM |

FDA and the University of Pennsylvania have signed a five-year MOU to work on advancing (among other things) drug/device co-development, companion diagnostics, translational medicine and new clinical trial models.

All good things.

The issue of companion diagnostics is particularly crucial or, more appropriately, critical (yes -- like in Critical Path) -- and not just for existing medications (warfarin and Herceptin come to mind) -- but also for pipeline programs.  Are we approaching a time when the FDA might consider asking for companion diagnostics to be developed as part of the approval process for some products?  That would be a 21st century personalized partnership, adding a whole different dimension to both safety and efficacy.

The FDA/Penn agreement also will faciliate interaction between the FDA and Penn students -- an important next step in the agency's urgent need to expand its recruitment efforts.

Particular congrats go out  to Mary Poos, the FDA's Sultana of MOUs, for yet another job well done.
  Read More & Comment...

Safety vs. Safe Use: Why Not Both?

09/15/2008 04:44 PM |

With all the focus on drug safety, what’s gotten lost in the shuffle is the issue of safe use.

According to an April 2007 Harris Poll, more than one-third of Americans surveyed decided not to take a prescribed medicine because of safety concerns about risks and more than a quarter chose not to fill a prescription at all over safety concern.

And, according to Gretchen S. Dieck, Ph.D., senior vice president, Safety and Risk Management for Pfizer, “… surveys of practicing physicians, health policy experts and the general public have revealed a lack of understanding of the fundamental safety science, processes and terminology.  This can contribute to misinformed decisions by patients about treatment options, which can lead to sub-optimal health outcomes.”

To that end, Pfizer Inc announced today the launch of a new interactive online educational resource,

http://www.pfizer.com/responsibility/medicine_safety/medicine_safety_education.jsp

It’s worth a look – and it’s a good conversation starter on the important issue of sharing responsibility when it comes to both the safety and safe use of medicines.

  Read More & Comment...

Insuring Profits

09/15/2008 04:26 PM |

Talk about putting profits before patients!

According to a Medical Society of the State of New survey, the vast majority of physicians practicing in New York say they feel pressure from insurance companies to prescribe certain medical treatments, sometimes at the expense of what is best for patients.

Of the over 1200 physicians surveyed this month, 90% said they changed the way they treat patients based on restrictions from an insurance company, and 92% said incentives and disincentives offered by insurance companies regarding treatment options "may not be in the best interest of patients."

87% of physicians said they sometimes feel pressure to prescribe a treatment based on cost. About 93% of physicians said insurance companies have required them to change prescriptions in the past.

To see how that plays out when you extrapolate private greed to bureaucratic need, click here.

  Read More & Comment...

The Comrade Commissars of Government Health Care

09/15/2008 12:40 PM |

Representative Henry Waxman (D-CA), America’s very own Oversighter-in-Chief, wants to require drug companies to submit reprints of journal articles that discuss off-label use to the FDA before said companies can provide them to physicians.

A modest proposal.

You know what would be even better – what about this – all medical journals have to submit their manuscripts to Mr. Waxman's office before they’re even published in the first place. After all, shouldn’t we address the problem in its most nascent stage?

(Yes, of course, after peer review.)

Better yet, maybe congressionally-appointed health care commissars should sit in on the peer review process of every medical publication? Why not? And, while we're at it, these new comrade commissars should also attend all pre-NDA agency meetings that discuss clinical trial designs.  Needless to say, a statutory voting seat (with veto authority!) on all advisory committies should be de rigueur.

Better still, perhaps PDUFA fees should cover the hiring of FDA political commissars who would have veto power over agency decisions?

These ideas are perfectly consistent with so many other congressional efforts at improving our health care system – just like “academic detailers” – health care commissars of another sort.

Welcome to the Comrade Commissars of Government Heath Care.

And caveat emptor.

  Read More & Comment...

Autism's False Prophets

09/15/2008 04:04 AM |

My review of Paul Offit, MD's new book about the savage war against science being waged by the anti-vaccine movement...

http://www.nypost.com/seven/09142008/postopinion/postopbooks/autisms_false_prophets_128960.htm

Meanwhile the NEJM/media's war against Gardasil's approval for use in women up the age of 26 failed...

Gardasil Approved to Target More Cancers

Sept. 12, 2008 -- The FDA today announced that the vaccine Gardasil may be used to prevent some cancers of the vulva and vagina in girls and women ages 9-26.

Gardasil is already approved to help prevent a leading cause of cervical cancer in women of that same age range.

Gardasil targets four strains of the human papillomavirus (HPV) that cause most cases of cervical cancer. Two of those HPV strains can also cause some vulvar and vaginal cancers.

"There is now strong evidence showing that this vaccine can help prevent vulvar and vaginal cancers due to the same viruses for which it also helps protect against cervical cancer," Jesse L. Goodman, MD, MPH, director of the FDA's Center for Biologics Evaluation and Research, says in a news release.

"While vulvar and vaginal cancers are rare, the opportunity to help prevent them is potentially an important additional benefit from immunization against HPV," Goodman says.
http://children.webmd.com/vaccines/news/20080912/gardasil-approved-to-treat-more-cancers

Yeah, well to the media it's all just "hype". 

http://well.blogs.nytimes.com/2008/08/29/blaming-the-media-for-gardasil-hype/

  Read More & Comment...

One Good Pitts Deserves Another

09/12/2008 02:33 PM |

If I do say so myself.

Have a look at our latest newsmaker interview with Representative Joe Pitts (R,PA).
  Read More & Comment...

From Parklawn to Parking on the Lawn

09/12/2008 12:35 PM |

AP reports that Food and Drug Administration has recently hired more than 1,300 professional staffers in a move that “officials hope will help it better protect the public health amid rapid technological and scientific change.”

40% or so of the total positions are paid for via PDUFA fees; ergo the new hires will mainly be evaluating new drugs or medical devices and, in some cases, monitoring safety issues.

That’s great news.  But where are they all going to park? White Oak isn’t even finished yet and already it’s looking like the seating charts will have to be rearranged – particularly since CDER is getting 663 new staffers.

It's a good problem to have.

CFSAN is slotted to get 104 -- a 10% increase (a good start – but not enough). And ORA will grow by 245. Good news.

1,000 of the new hires have already started, with another 158 due to report later this month. An additional 160 have accepted offers. Of those on the job already, more than 850 are professionals, including chemists, biologists, pharmacologists, statisticians, medical officers, microbiologists and field inspectors.

Of the total 1,317 positions, 770 are new jobs and 547 are posts that were left vacant by people leaving the agency for other jobs or due to retirement.

But it’s not all rosy and it’s not as easy as reporting numbers.

The FDA hired nine cancer specialists, but another 20 rejected offers. "They could not make the money they would be making on the outside if they came into public service," said Kimberly Holden, the FDA’s senior manager directing the recruitment initiative. The agency could offer as much as $275,000 a year, she said, but oncologists can make $400,000 annually outside of government service.

All-in-all, it’s a good start. But it’s just the end of the beginning -- and just barely.

  Read More & Comment...

COI Coyness

09/11/2008 02:53 PM |

Here’s the first paragraph from the story in today’s Wall Street Journal on the continuing controversy swirling around academic research and pharmaceutical industry funding:

“WASHINGTON -- Some major universities are reviewing the way they handle funding from drug companies in the wake of criticism from Sen. Chuck Grassley, who is pressing the federal agency that controls government health-research money to get tougher on universities that don't disclose ties to the industry.”

It seems that some academic researchers are being either sloppy or stupid about disclosing research grants they receive from industry.

Giving these folks the benefit of the doubt may be the right thing to do (you know –like “innocent until proven guilty”) but it ain’t gonna happen in today’s shoot-first-and-ask-qustions-later environment – and it could very lead to individual researchers (and their institutions) losing NIH funding.

Here’s what Senator Grassley has to say about the matter:
 
"Starting today, the NIH could send a signal that business as usual is over … The simple threat of losing prestigious and sizable NIH grants would force accurate financial disclosure."

The Senator is right.  But the issue is quickly morphing beyond mere issues of filling out the required forms in at timely manner.

Consider the comments of Jerome Kassirer, the purer-than-pure (despite mega-millions in pharmaceutical advertising revenue), former editor of the New England Journal, "Universities have been treading on dangerous ground with their increasingly complex financial ties to industry.  They are worried that these things could ultimately affect their tax-free status."

Get the picture?

(Note to Jerry – you may be next.)

For more on the COI controversy, please attend our September 22nd conference, "Industry Support for Continuing Education of Health Care Professionals:  An Evidence-Based Evaluation."  There's no cost -- and here's the complete invitation.

  Read More & Comment...

IQWiG Aims at the Stars

09/10/2008 09:58 AM |

“I Aim at the Stars,” was a 1960 B-movie biopic about Wernher von Braun. Many felt that it should have been subtitled, “But sometimes I hit London.”

In keeping with that metaphor, comes news that Germany’s IQWiG (the Institute for Quality and Efficiency in Healthcare) is preparing to test a new cost-benefit methodology towards the end of this month. The test will last for about four months.

To do this it has had to draft a cost-benefit methodology. A first version was put out for public consultation earlier this year and drew many comments (not all laudatory) from stakeholders. Some were critical of the proposed "efficiency frontier analysis" the institute plans to use as the basis of cost-benefit assessments. IQWiG claims that efficiency frontier analysis can be "used in a very flexible manner to compare the cost-benefit relation of any number of therapy alternatives.”

“Flexible” is in the eyes of the beholder.

IQWiG´s new methodology will help determine an “appropriate ceiling” price for drugs that are reimbursed by the statutory health insurers but cannot be included in a reference price group. IQWiG’s assessment will also include a budget impact analysis that can be used in estimating how a decision may affect expenditure in the health care system as a whole.

The cross-channel (and potential cross-Atlantic) implications are especially timely coming on the heels of the Baucus/Conrad bill and while experts are predicting a meltdown of Britain’s NHS.

The answer? According to Sir Michael Rawlins, chairman of the National Institute for Health and Clinical Excellence (NICE), draconian rationing. As he said earlier this week, "Rationing is a necessary evil. We have to do it. There will be losers and winners." That's "universal" health care in its true guise of cost-based "government" health care.

As Tom Lehrer sang, “Once the rocket goes up who cares where it comes down. That’s not my department says Wernher von Braun.”

  Read More & Comment...

The shot not heard 'round the world

09/09/2008 02:11 PM |

Today the NY Times, in a house editorial, tells the truth about vaccines and autism. 

But where are the front page stories?  Where's the outrage? 

Where's the justice?

Here's the complete editorial:

Debunking an Autism Theory

Ten years ago, a clinical research paper triggered widespread and persistent fears that a combined vaccine that prevents measles, mumps and rubella — the so-called MMR vaccine — causes autism in young children. That theory has been soundly refuted by a variety of other research over the years, and now a new study that tried to replicate the original study has provided further evidence that it was a false alarm.

The initial paper, published in The Lancet, the prestigious British medical journal, drew an inferential link between the vaccine, the gastrointestinal problems found in many autistic children and autism. In later papers, researchers theorized that the measles part of the vaccine caused inflammation in the gastrointestinal tract that allowed toxins to enter the body and damage the central nervous system, causing autism.

Now, a team of researchers from Columbia University, Massachusetts General Hospital and the Centers for Disease Control and Prevention has tried and failed to replicate the earlier findings.

These researchers studied a group of 38 children with gastrointestinal problems, of whom 25 were autistic and 13 were not. All had received the vaccine for measles, mumps and rubella. The scientists found no evidence that it had caused harm. Only 5 of the 25 autistic children had been vaccinated before they developed gastrointestinal problems — and subsequently autism. Genetic tests found remnants of the measles virus in only two children, one of whom was autistic, the other not.

The new study adds weight to a growing body of epidemiological studies and reviews that have debunked the notion that childhood vaccines cause autism. The Institute of Medicine of the National Academy of Sciences, the C.D.C. and the World Health Organization have found no evidence of a causal link between vaccines and autism.

Meanwhile, the original paper’s publisher — The Lancet — complained in 2004 that the lead author had concealed a conflict of interest. Ten of his co-authors retracted the paper’s implication that the vaccine might be linked to autism. Three of the authors are now defending themselves before a fitness-to-practice panel in London on charges related to their autism research.

Sadly, even after all of this, many parents of autistic children still blame the vaccine. The big losers in this debate are the children who are not being vaccinated because of parental fears and are at risk of contracting serious — sometimes fatal — diseases.

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Needling while Healthcare Burns

09/09/2008 12:15 PM |

The headline of the AP story says it all, “Congress likely to delay health care overhaul.”

“As Congress returns from summer recess, lawmakers are expected to continue needling pharmaceutical makers and health insurers with investigations, while holding off on major health care reform until next year.”

That’s what this country needs – more needling!

But isn’t health care reform the driving domestic policy issue?  

“Health care has fallen in importance as an issue to voters and that would make one question how aggressive action is going to be next year," said Lehman Brothers analyst Tony Clapsis.

Guess not.

“… analysts are not holding their breath for universal health care coverage, despite some recent rhetoric from the campaign trail.”

"Some" rhetoric? That's generous.

How about less needling, less rhetoric – and more focus on dealing with the problem.  Which aspirant to the White House will have the courage to call for bringing all parties (drug companies, insurance companies, physicians, patients, hospitals, etc.) together to really begin addressing ways to provide access to excellence?

Reform by soundbite is insulting and dangerous.

  Read More & Comment...

Donut Hole Defined

09/08/2008 05:19 PM |

 A new Kaiser Foundation sponsored study uses an IMS data set to look at how many seniors hit the donut hole and what happens when they do.  It turns about about 14 percent go through the point where seniors have to spend up to $3850 of their own money on drugs.  That's about the same as in 2006 according an independent study conducted by IMS itself if you take away seniors who did not spend anyting on prescription.  Adding in seniors that spent nothing you get about 6 percent hitting the donut hole. 

The Kaiser folks wiped out the seniors who spent nothing to plump up the bottom line figure.   Why is one level of spending any less or more important than any other.  Indeed, when doing weighing of distributions you have to add those folks in so that decision was a political one to say the least, not a methodological imperative.  Six percent is still 3 million people.  And it doesn't take away from the fact that both studies found people who hit the hole -- up to one in 10 -- stopped taking their meds for diabetes, depression, Alzheimer's, hypertension and that more than half did not restart after getting catastrophic coverage.  

The biggest problem with the Kaiser study is that it does not compare the behavior of seniors with and without gap coverage indeed the authors admit:

"The IMS database does not provide sufficient information about Part D plans (in particular, it does not distinguish among the multiple plan offerings of a single sponsor) to allow for identification of the small share of enrollees in plans with gap coverage, which prevents us from excluding them from the analysis." 

http://www.forbes.com/forbeslife/health/feeds/hscout/2008/08/21/hscout618675.html

Small share?  Actually over 60 percent are enrolled in plans in gap coverage. 

The interesting policy question is what aren't more seniors choosing plans with gap coverage over the lowball premium plans? 

A further policy question is whether encouraging seniors to switch from an existing medicine in a class -- generic or not -- to another drug is wise.   Gail Shearer of Consumer Union sent a letter to the NY Times arguing that "taking the cholesterol-lowering drug simvastatin (the generic of Zocor) instead of Lipitor saves about $60 to $70 a month. Likewise, many people with acid reflux disease can save $150 to $200 a month by taking nonprescription omeprazole (the generic of former best-selling Prilosec) instead of the much-advertised Nexium. People should raise the issue of drug prices with their doctors to make sure they get prescriptions for medicines they can afford."

http://www.nytimes.com/2008/09/07/opinion/l07Medicare.html?scp=1&sq=gail%20shearer&st=cse

I am glad she urged people to raise the issue with doctors because switching drugs is something people should not do on their own.  Direct to consumer information -- from any source -- should start with patient VALUE in the long term and work from there.   Off the cuff money saving comments can be dangerously expensive otherwise. 

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WSJ Goes Into the Gutter on Sarah Palin

09/08/2008 02:33 PM |

Here's the WSJ's June Kronholz looking into the soul of Sarah Palin and concluding that her newborn Trig is, well, just a cynical political prop:

"Little Trig Palin prompted more than delegate coos when he joined his mother on stage at the Republican convention. He also raised new questions among parents whose children have disabilities.

Was Alaska Gov. Sarah Palin simply including her 5-month-old son, who has Down syndrome, in a big family moment, or was she exploiting him in a tight presidential campaign? Would he help break down social barriers facing children with Down syndrome, or would those children now be drawn into the right-to-life debate?"

Wasn't it the media and the left wing blogosphere who raised all these questions and invaded her family's privacy?  Of course it was and that's where Krumholz went for her "sources."

"Among bloggers' top concerns is a Bush administration measure that would trim Medicaid funding for community services for people with disabilities. Democrats have so far stalled the cuts, which advocates for the disabled said would force the disabled back into institutions.

Blogs also were filled with questions about Gov. Palin's record on services to the disabled during her two years in state office. This spring, Alaska agreed to almost triple its spending on special-needs children, to $73,840 each beginning in 2011. But Gov. Palin didn't help draft the legislation."

She didn't help draft the legislation??  Obviously a sign of neglect!!

..http://online.wsj.com/article/SB122083992345509015.html

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Lies. Damn Lies. And Statistics (about cancer).

09/08/2008 02:17 PM |

A new article in NewsWeek is titled, “We Fought Cancer…And Cancer Won.”

According to the article, “In 2008, cancer will take the lives of about 230,000 more Americans—69 percent more—than it did in 1971.”

That’s true.

The article continues, “Of course, since the population is older and 50 percent larger, that raw number is misleading. A fairer way to examine progress is to look at age-adjusted rates. Those statistics are hardly more encouraging. In 1975, the first year for which the National Cancer Institute has solid age-adjusted data, 199 of every 100,000 Americans died of cancer. That rate, mercifully, topped out at 215 in 1991. In 2005 the mortality rate fell to 184 per 100,000, seemingly a real improvement over 1975."

Also accurate.

Further, “Perhaps the most sobering statistic has nothing to do with cancer, but with the nation's leading killer, cardiovascular disease. Thanks to a decline in smoking, better ways to control hypertension and cholesterol and better acute care, its age-adjusted mortality has fallen 70 percent in the same period when the overall mortality rate from cancer has fallen 7.5 percent.  No wonder cancer "is commonly viewed as, at best, minimally controlled by modern medicine, especially when compared with other major diseases," wrote Harold Varmus, former director of NCI and now president of MemorialSloan-KetteringCancerCenter in New York, in 2006."

Yep.  But what's implicit in what Dr. Varmus says is -- since we're not dying of heart attacks and strokes (thanks largely to pharmaceutical interventions) -- we're living long enough to get cancer.  (Also -- NewsWeek fact-checkers please note --  Varmus wasn't the "former director of NCI," he was the former director of the NIH.)

So, are more people getting cancer?  Yes.  Are more people dying of cancer?  Yes.  Does that mean that we are "losing" the war on cancer?  Not necessarily.

“The meager progress,” according to NewsWeek, “has not been for lack of trying. Since 1971, the federal government, private foundations and companies have spent roughly $200 billion on the quest for cures."

Meager?  Really?

The often ignored reality is that 5-year relative survival rates, for all cancer sites, have increased from 50.1% in 1975 to 65.9% in 2000.

Is cancer close to being “cured?”  No.  Is cancer close to becoming a chronic disease?  It depends.  Is there much work to be done?  Certainly.  Is there need for even more financial investment on the part of both public and private sectors?  Of course.

Is there cause for hope?  Absolutely. And no better reason to embrace and fund the Critical Path program.

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