Targeting Cholesterol

10/18/2006 09:18 AM |

Good article today in the NY Times by Ron Rabin about NIH recommendations regarding lowering LDL levels....Rabin comments on an article in the Annals of Internal Medicine which recommends trying to hit low levels but warns against a one size fits all approach to doing so.... One of the author is concerned about no one really knows what the "right"combination of drugs will be to achieve that optimal target.

The Times articles quotes another article (hey, someone actually did some research) from Dr. Vincenza Snow that concluded:"
Patients respond differently to statins, with some achieving more success in cholesterol reduction than others, Dr. Snow said. But, she said, “our goal is not necessarily to get to a certain level of cholesterol, but to decrease heart attacks and strokes, and you can reduce that risk with a certain dose of statin.”

Personalized medicine. And for that you need a variety of medications, genetic tests and diagnostics. Simply shoving everyone onto the cheapest or oldest therapy at the lowest dose possible is not likely to be the most effective way to reduce risk. Which is what medicine should be all about.  Read More & Comment...

Lead Balloon

10/18/2006 08:35 AM |

CMS Floats Trial Balloon for Part D Data Sharing Initiative

Drug Industry Daily
By: Stephen Langel


The Centers for Medicare & Medicaid Services (CMS) is using a proposed rule issued today to test the legal waters for its plan to collect and share prescription drug plan data to base Medicare reimbursements on product comparisons, sources say.

The proposed rule would require any entities offering prescription drug coverage under the Medicare Rx law to provide the CMS with data about the products they offer, including drugs, biologics and medical devices, as part of their contracts with the government. "Through the appropriate use of the new prescription drug claims data, we have an unprecedented resource to help us learn more about prescription drug usage by seniors and how we can help seniors get the most benefit from prescription drugs," former CMS Administrator Mark McClellan said.

The CMS would then use the data, which includes various measures of the products' cost, to improve the workings of the Medicare program, according to the rule. The agency would also share this data with the FDA to "provide protection against adverse drug events" and with HHS' Agency for Healthcare Research and Quality's (AHRQ) to do comparative drug studies.

This development comes weeks after the initiative seemed dead because of questions regarding CMS' statutory authority (DID, Oct. 2). The agency is using the proposed rule to make legal arguments supporting the policy. "We are engaging in this rulemaking in order to resolve the statutory ambiguity," the rule said.

The agency believes that it has "broad authority" under the Medicare Rx law to share such data. Section 1860D-12(b)(3)(D) of the law provides the HHS secretary with the authority to "collect a broad array of data in order to properly carry out his responsibilities," the rule said. But the section also limits use of the data to work necessary to carry out the act.

However, the agency believes the law gives it some leeway, saying that if the secretary believes it is necessary and appropriate to carry out responsibilities even outside the scope of the section, he has the authority to do so.

The proposed rule prompted a strong response by both supporters and opponents of comparative trials. Peter Pitts, director of the Center for Medicine in the Public Interest and a former FDA associate commissioner for external relations, told DID the rule is the foundation for cost-based medical coverage that shortchanges the public and "sets an extremely dangerous precedent." The CMS is "trying to take authority away from the doctors and give it to the accountants."

While McClellan had proposed comparative trials as a way to ensure the best medicines were covered, without him leading the agency this decision will devolve into a purely cost-based decision, Pitts added. "Once he's out the door, there's no guarantee" that this program will be run correctly. McClellan left the CMS last week for the American Enterprise Institute-Brookings Joint Center for Regulatory Studies.

PhRMA is cautiously optimistic about the rule. Comparative data "can offer a valuable source of information," a spokesman said. But research based on that data has a number of limitations, he added.

However, public interest groups such as Consumers Union have long supported this strategy and lauded the rule. "The CMS initiative is very exciting, and holds out the promise for major advances in understanding what works and doesn't work in the world of pharmaceuticals, and where short-term adverse reactions and long-term dangers may be lurking," Bill Vaughan, the group's senior health analyst, told DID.

The key to the program's success is not the rule itself, but the FDA obtaining sufficient funding to use the data, he added. The agency needs money from the Prescription Drug User Fee Act to "mine the CMS data for the gold nuggets of knowledge that it can offer. With adequate support, the FDA can use the CMS database to make the adverse event reporting system and
other postmarket approval monitoring work the way that consumers hope and expect."  Read More & Comment...

Lester Crawford

10/18/2006 07:56 AM |

George Orwell said, “Saints should always be judged guilty until they are proved innocent.” Les Crawford is no saint. He is just an American who served his country and the public health well over many years.

Hang in there Lester.  Read More & Comment...

The China Syndrome

10/17/2006 07:00 AM |

How is the spread of counterfeit prescription drugs being addressed in China?

Interesting new article in "Insight" (the official publication of the American Chamber of Commerce in Shanghai) that, indeed, offers insight into the views of PRC officials -- and the actions they are taking (or say they are taking) to combat the issue of prescription drug counterfeiting (aka: international health care terrorism).

See for yourself:

COVER STORY: Counterfeit Cures  Read More & Comment...

The Cost of Cancer Drugs (Continued)

10/16/2006 12:10 PM |

The announcement that Genentech is going to cap the cost of Avastin was met with derision and skepticism -- if you read the accounts in MSM. Critics assert that drugs like Avastin and Revlimid are not worth their price. But a complaint is not a statement supported by analysis. The Lenny Saltz school of public policy is to use the price of 25 year old cancer drugs as a benchmark and then loudly bleat that new drugs don't add anything in terms of survival.

A more thoughtful and scholarly approach is taken by Richard Gralla of the NY Lung Cancer Alliance. Dr. Gralla was quoted by Andrew Pollack of the NY Times as say that Avastin is not "cost effective to society." But that is not what Dr. Gralla said exactly. I called Dr. Gralla up because in light of his research with other drugs to treat lung cancer -- which focused on improving quality of life -- the statement seemed cold and too dispassionate. What Gralla told me -- and I am paraphrasing here -- is that most new cancer drugs that are based on new pathways and novel mechanisms while only improving survival by a couple of months in the sickest patients are by definition advances. Are they cost-effective? By virtue of the fact that they add -- on average -- little to life expectancy most new targeted therapies are NOT cost effective to society if you use the old measure of a quality adjusted life year being worth $50000 or less.

But University of Chicago economists Kevin Murphy and Robert Topel have found that: "eliminating deaths from cancer would be worth $47 trillion to Americans. In other words, Americans would be willing to pay this amount to achieve such an increase in the length and quality of their lives."

Hence, the potential benefits of increased spending on medical innovation are so huge, especially compared with the cost or illnes, that much higher expenditures on medicines, diagnostics, etc are justified, along with the prices that are required to sustain investment "even if they only yield small declines in death rates." See the article "The Cost of Living" in Chicago Business School magazine.

http://chicagogsb.edu/magazine/S00/research1.html

One other point: the Avastin cost cap reflects an acknowledgement that different groups of people, with different diseases at different stages, genetic and clinical characteristics will require variations in doses. Drugs are going to have be part of solution and not sold as a stand alone product. "More" will be replaced with "optimal" and the standard will be "value" not "cost-effective."  Read More & Comment...

In medicine, evidence can be confusing

10/16/2006 07:47 AM |

That's the headline of an article in today's USA Today. Yes, USA Today. Welcome to the mainstream debate over whether "evidence-based medicine" means cost-based reimbursement or patient-centric treatment.

Have a look:

http://www.usatoday.com/news/health/2006-10-15-medical-evidence-cover_x.htm  Read More & Comment...

Drug Companies Obviously Engaging in Diabetes Disease Mongering

10/13/2006 04:27 PM |

The word is that drug companies are now seeking to determine whether diabetes drugs can be used to prevent diabetes in those people who are on the cusp of the condition. I am waiting for the Seattle Times or another media outlet to run a story claiming that this effort to treat diabetes before it progresses is disease mongering designed to "get rich" just as it slimed effort to treat "pre-hypertension" as disease mongering a while ago. But of course, rolling out high priced products to treat people who are very sick is gouging those who have no choice. And since the data comes from drug companies or researchers who receive drug company money, the results can't be trusted in any event.

So we should simply ignore the evidence and medicine until truly pure research conducted on people at death's door is generated and results in medicines that are given away for free or at a generic price are made available.

But maybe I am being too idealistic....  Read More & Comment...

Trawling for Tragedy: The Montel Williams Show Hunts Down Ambien Accidents

10/13/2006 10:25 AM |

Another example of how and why drug safety is divorced from personal responsibility...talk shows seeking to depict those who abuse them as victims. This is post from an Ambien addiction website:

Hi Everyone,

I've been reading everyone's posts and I can truly say that Ambien seems to be affecting more and more people in this regard than many might think. I'm an associate producer for the Montel Williams Show and we're currently doing research on Ambien addiction and sleep disorders in conjunction with a sleep clinic here in NY. If you're interested in trying to beat this addiction or if you would like to share your story regarding sleep disorders, you're not alone and maybe we can help.

Feel free to contact me any time for more information

mike@montelshow.com


Now in fairness Montel Williams usually plays this kind of thing straight but to suggest that "Ambien affects more and more people..." is the sort of claim that one hopes is placed in context.  Read More & Comment...

Only in Waxman's World

10/13/2006 09:40 AM |

do prices never increase...as in the average premiums of Medicare part D plans. In the first phase of the program some plans had some incredibly low monthly premiums...about $4 a month for a standard plan with $250 deductible. Now these plans are raising the deductible to about $11 a month -- the outrage! -- with some plans that have no deductible actually lowering their premiums. That's what Aetna and Humana have done with some plans that fill the coverage gap. And some managed care plans are lowering premiums for programs that include drugs and all other care -- integrating coverage in order to insure that drugs are used to reduce the total cost of care if possible. But that never enters into Waxman's calculations.  Read More & Comment...

Is Hezbollah Filling Your Prescription

10/13/2006 07:49 AM |

I've penned a new op-ed running in today's edition of the San Diego Union-Tribune on the issue that won't go away -- drug importation. Even though it says it's authored by Leonard Pitts, it's actually written by yours truly (note citation at the end of the article). We rarely get confused in person.

Click on this link and then go to "Today's Paper" and then to "Opinion."

http://www.signonsandiego.com

Have a look and spread the word that we must transcend the soundbites about drug importation.  Read More & Comment...

FDA -- Maybe not so bad after all?

10/13/2006 07:40 AM |

From today's edition of the Wall Street Journal ...

Faster FDA Cures

Whoever controls Congress next year, the Food and Drug Administration is sure to be a political battleground. The controversial Prescription Drug User Fee Act of 1992 is scheduled for reauthorization, and the conventional political wisdom holds that the FDA is too "cozy" with Big Pharma and thus overeager to rubber-stamp dangerous new drugs.

So allow us to draw attention to an important and undernoticed study, "Assessing the Safety and Efficacy of the FDA," published by the National Bureau of Economic Research. Its surprising conclusion is that the FDA does a pretty good job managing "the central speed-safety trade-off" involved in drug approvals -- and might even do well to move faster.

The authors looked at 662 drugs approved between 1979 and 2002, a period that included the passage of the Prescription Drug User Fee Act that allowed drug companies to help fund the FDA budget in exchange for faster reviews. They found that the resulting modest gains in drug review times have produced unambiguous public benefits.

In monetary terms, the authors estimate that the law improved consumer welfare by as much as $19 billion. But more importantly, they found that more rapid access to beneficial drugs saved between 180,000 and 310,000 "life-years." By contrast, assuming that every risky drug withdrawn in that period was the fault of the Prescription Drug User Fee Act produces an upper-bound estimate of only 56,000 life-years lost.

This study deserves a lot more attention than it's been getting, since the Washington debate is dominated by bad ideas about how to make FDA regulation much more onerous. In particular, a recent report from the National Academy of Science's Institute of Medicine (IOM) is being spun as evidence that the FDA is somehow "broken" and in need of fundamental reform.

We've looked at the IOM report in detail, and it's hardly as damning of the FDA as media reports suggest. For example, the report explicitly rejects the idea that high-profile drug withdrawals -- such as Vioxx -- "represent de facto failures of the drug safety regulatory system. . . This is not so." The IOM also rejects the basic idea behind legislation sponsored by Senators Chuck Grassley and Chris Dodd that the FDA should have a drug safety office separate from the office that approves drugs in the first place: "Risk and benefit cannot be considered in isolation from one another."

But despite these sensible observations, the IOM still wants more regulation. Among its recommendations are vastly increased levels of post-approval safety monitoring. That might make sense if the goal is making regulators comfortable with the idea of approving drugs more quickly. But that doesn't appear to be what the IOM and its cheering section want.

The IOM also proposes draconian restrictions on new-drug advertising and tighter conflict-of-interest standards for FDA advisory panel members. This despite the fact that the most qualified scientists and doctors have substantial sources of private income, and despite a study by the Naderite Public Citizen group that failed to find one instance of a panel recommendation that would have changed if allegedly conflicted members had been excluded.

Most fundamentally, the IOM presents little evidence that there is even a problem to remedy. By contrast, the National Bureau authors at least attempt to put some real facts on the table. They note that the absence of other attempts at hard, quantitative analysis in the great FDA debate is "somewhat paradoxical, since despite the agency's strict adherence to evidence-based evaluation of products overseen, there is less evidence on its own safety and efficacy. Put differently, no product application would pass the FDA approval process with the quality and type of evidence that currently exists for evaluating the FDA policies themselves."

The upshot of the economists' report is that the 1992 Prescription Drug User Fee Act deserves reauthorization. But the evidence also suggests Congress should probably be looking for other ways to make FDA approvals still faster. Despite the high-profile Vioxx panic, the FDA is far more likely to kill by depriving you of a drug than allowing you to take a dangerous one.  Read More & Comment...

Ceasefire? I doubt it.

10/12/2006 02:47 PM |

Yesterday I was privileged to participate in the latest in a series of Senator John Breaux’s “Ceasefire” debates. (Ceasefire events bring together a variety of speakers with opposing viewpoints in an effort to find common ground. Past speakers include former Speaker of the House Newt Gingrich, Senator Hillary Rodham Clinton, Former Secretaries of HHS Donna Shalala and Tommy Thompson, Press Secretaries Ari Fleischer and Mike McCurry, and former Senators Tom Daschle and Ron Nickles. The Ceasefire on Healthcare series is made possible by a grant from Pfizer Inc.)

I was paired with David Kendall, Senior Fellow for Health Policy and Director of the Health Priorities Project at the Progressive Policy Institute.

We had, what’s the right word here, a robust conversation. The entire debate will shortly be posted (as a podcast) at http://www.ceasefireonhealthcare.org/podcast, but I wanted to share two things that seemed especially germane and interesting –

(1) We debated whether or not physician “pay-for-performance” is a good thing. (My position is that it all depends on what “performance” means.) Consider this – if we limit what medicines doctors can prescribe based on cost-centric rather than patient-centric models, how can we possibly measure “performance” outcomes?

(2) Senator Breaux asked if we thought health care would play a major role in the up coming Presidential election. David said, “yes.” I said “no.”

If the current debate over health care is any indication, what we’re in store for is too many months of sounds bites, finger pointing, and pharma bashing.

And that is not a debate over health care.   Read More & Comment...

No health care information please, we’re Canadian

10/12/2006 12:00 PM |

Maclean's, Mon 16 Oct 2006

Byline: DANYLO HAWALESHKA

In the pivotal courtroom scene from A Few Good Men, Tom Cruise shouts, "I want the truth!" at Jack Nicholson, whose truculent character is testifying. "You can't handle the truth!" Nicholson famously retorts. Today, in a real-life courtroom drama, CanWest MediaWorks Inc. has, in a manner, assumed Cruise's role, with a somewhat less altruistic goal in mind than simple verity.

In a civil lawsuit now before Ontario's Superior Court of Justice, CanWest contends Canadians are being denied important truths about prescription medications because of strict limits on drug advertising. Canada's largest media company claims the regulations thwart its constitutional right to freedom of expression.

CanWest's suit against the attorney general of Canada casts the country's Food and Drugs Act as the villain. The act forbids direct-to-consumer advertising (DTCA) that ties a prescription drug to a treatment, cure or disease. (It is illegal for CanWest to, for instance, run an ad to promote Viagra for impotence, but quite legal to separately publicize the brand, or the condition; there are no such restrictions on ads that target physicians exclusively in, say, trade journals.) In a sworn statement, Arturo Duran, a CanWest MediaWorks president, claims permitting DTCA in Canada would educate the public about drug risks and benefits. "There is no evidence to justify a ban on truthful advertising of prescription drugs," Duran says.  Read More & Comment...

Clement See!

10/12/2006 11:33 AM |

Open Letter from the Ontario Pharmacists' Association

TORONTO, Oct. 11

Hon. Tony Clement
Minister of Health, Government of Canada
Minister's Office, Health Canada
Brooke Claxton Building, Tunney's Pasture
Ottawa, Canada K1A 0K9

Dear Minister,

Ontario pharmacists are gravely concerned about the imminent threat to Canada's prescription drug supply, and the corresponding public health and safety threat to Canadians, arising from legislative changes and relaxed enforcement measures in the United States that re-open America's border to the importation of prescription drugs by U.S. patients.

As you know, Congressional leaders struck a deal on September 29 to allow Americans to carry back from Canada a 90-day personal supply of prescription drugs through "foot traffic" importation. The Department of Homeland Security compounded this change by ceasing confiscation by Customs and Border Protection agents of drugs ordered over the Internet and mailed to Americans, effective October 9.

We appreciate that these developments represent political deal-making by American lawmakers to take high U.S. prescription drug costs off the table as an issue to protect incumbents in the U.S. mid-term elections. However, the impact on Canada is clear: we are back to a free-for-all for cross-border drug importation.

We are deeply disturbed that in spite of the serious implications for Canada's drug supply and the health and safety of Canadians, there is no evidence of consultation with the Government of Canada, or of any effort to ask how our pharmacists and drug experts view American patients raiding Canada's medicine cabinet.

Our pharmacists do not want to become America's drug store. Our job is to provide medications and expertise to Canadian patients, not provide solutions or the shortcomings of the U.S. health care system and its problem with high drug costs.

U.S. demand is more than ten times the size of Canadian supply. We do not have the capacity to feed America's need for lower-cost drugs, and unimpeded depletion of our supply poses a serious threat to public health and safety in Canada.

We are further concerned that the legitimizing of Internet drug purchases by Americans encourages fraud by offshore criminals posing as Canadian pharmacists and selling counterfeit drugs. This is a health and safety threat to both American and Canadian patients who rely on the reputation of Canadian pharmacists and buy drugs from what they believe are Canadian Internet pharmacies, believing them to be safe and genuine.

In fact, U.S. customs statistics on mail-order seizures show at least 10 per cent of packages purportedly from Canadian Internet pharmacies contain counterfeit drugs.

We believe it is prudent and reasonable to also call attention at this time to the renewed emergence with these U.S. legislative and enforcement changes of a national security vulnerability in both the U.S. and Canada arising from the re-opening of the door to the potential for drug terrorism, with drugs sent by mail used as a vehicle of attack on innocent members of the public.

In this respect, an April 2005 report to Congress warned "the nation's medicine supply is vulnerable to exploitation by organized criminals, drug traffickers and terrorists. We should not contemplate opening our borders to threats to our medicine supply when in all other aspects we are searching for ways to tighten the security of our borders."

While the legislative changes enacted to date do not support bulk importation, we note that proponents of the changes in Congress have indicated their interest and intent to bring forward "full-blown" importation legislation in the future. We must warn unequivocally that bulk importation would quickly deplete the Canadian drug supply and cause a crisis in drug
availability for Canadians - in one credible U.S. analysis, within 38 days.

We also have a more fundamental concern that these developments further encourage the use of Internet pharmacies by patients who bypass their own community pharmacists. Patients who do so jeopardize their health and risk dangerous drug interactions by relinquishing expert consultation and crucial pharmacist-patient interaction.

We are disappointed that the Government of Canada has stood idly by while the U.S. has made changes that threaten the Canadian prescription drug supply, pose a danger to the health and safety of Canadians, raise national security vulnerabilities and undermine the important, long-standing relationship between pharmacists and patients.

We respectfully call on the Government of Canada to take immediate action to protect Canada's prescription drug supply by banning prescription drug sales to U.S. patients by all means, including "foot traffic", Internet and mail order.

We look forward to your reply at your earliest convenience.

Marc Kealey
Chief Executive Officer
Ontario Pharmacists' Association

For further information: or to set up an interview, please contact: Mary-Anne Cedrone, Manager of Communications, Ontario Pharmacists' Association, (416) 441-0788 ext.4266, Cell: (416) 278-5582  Read More & Comment...

How the Media Mismanages the Drug Safety Issue: A Scientific Perspective

10/11/2006 01:03 PM |

If you want a concise explanation as to why the drug safety issue is spiraling out of control and how the media's reporting on such issues contributes to a sense of danger in every drug, read this excellent post from The Scientist.....





A few years ago Princeton health economist Uwe Reinhardt, Dartmouth geriatrician Joann Lynn, and I filmed a documentary on the effect of advancing biomedical technology on affordable healthcare in the United States. Five hours of interviews were reduced to 10-minute bookends for a set of short, emotional stories that obliterated the complexities of the issues. As Reinhardt quipped in our cab, repeating the oft-cited quote, the plural of anecdote is not data. Except on television.



We've all had this experience: You bring work home and talk about concepts central to biomedical research such as evidence-based medicine, controlled trials, equipoise, peer-review, or impact factor. Friends' eyes roll up into their skulls in boredom. Yet the same topics come up in everyday conversation all the time, just framed in a different way: "I know a person who lost his house to the cost of drugs," and "you know a guy who is alive because of Lipitor." Heated arguments ensue about real problems in science, but driven by someone's single story.



Stories are not the enemy of good science and evidence-based medicine. Physicians make crucial but subtle changes in their practices based on individual experiences. Scientists all use intuition and inductive reasoning in the nascent period of an investigation. But anecdotes cannot substitute for either ethnography or controlled study. When Terri Schiavo became the world's test case for diagnosing persistent vegetative state (PVS), the emotional intonations about Ms. Schiavo waking up began to sound like Intelligent Design.



A paradox of biomedical research is that huge controlled trials, meta-analyses, and reviews of the literature are ubiquitous, but the number of "case reports" - and journals comprised entirely of incidental "findings" - is growing.



The media has no idea how to deal with case reports. The worst example of this in recent times was a case study of Zolpidem, the nonbenzodiazepine-branded 'Ambien' and approved by the US Food & Drug Administration for the treatment of insomnia. Physicians Ralf Clauss and Wally Nel have published, a few cases at a time, their very different use of the medication. The Guardian carried a breathless report of Clauss et al's August report in the journal NeuroRehabilitation of three cases involving patients who have been in PVS, they report, for more than three years. Claus and Nel grabbed the front page with the Guardian's report that they used Ambien to wake up these patients.



The 'investigators' had administered Zolpidem for between three and six years and saw each of the three 'treated' patients wake up each day as a result of the medication; one even "caught a baseball." When the medication wore off, the patients dropped back into PVS each evening.



Stunning science? It seemed so, too, back in 2000, when Claus and a different set of South African colleagues published in the South African Medical Journal on a single case with essentially the same outcome. In 2001 they made the same claim in a letter to the same journal. At no point did the investigators conduct an actual study of the phenomenon, with an IRB-approved research protocol or informed consent. Again and again they "wrote up" their "cases," describing their work as innovative medical management rather than research. Journal editors, asleep at the switch, have been derelict in publishing bad research disguised as cases - in this instance a case with the impact of finding a life-extending potion or the presence of extraterrestrial life.



Investigators who jumpstart their programs with case reports are often in search of research support, as was Claus - who as a result of the case report is now funded. In this respect they, and the journals who publish nothing but these case reports, are like the television producers I worked with: They aim at using the power of stories to make the claims and reap the rewards that come from research, but without doing the research. The victims are journalists, readers, and in the Claus case the patients and their families, who are exposed to uncontrolled experiments framed as good medicine. It is time for editors, journalists, the FDA, and the US Health & Human Services Office for Human Research Protections (OHRP) to clamp down on the "case study."



Glenn McGee is the director of the Alden March Bioethics Institute at Albany Medical College, where he holds the John A. Balint Endowed Chair in Medical Ethics.

gmcgee@the-scientist.com  Read More & Comment...

Harold Ford Jr's Fuzzy Medicare Math

10/11/2006 12:44 PM |

Now that the Yankees were eliminated from the ALCS in humiliating fashion I have found myself channel surfing to fill the time....I stumbled upon a C-SPAN broadcast of the debate between Congressman Harold Ford, Jr. and Bob Corker, the Dem and GOP candidates for Bill Frist's Tennessee Senate seat. I might have been hallucinating but I think I heard Ford say 2-3 times that if the government negotiated with drug companies (price controls) it could save Medicare $1 trillion. Since the Part D program will spend about $500 billion over ten years, I am waiting for Ford to explain his math. Or does he have a plan to force drug companies to kick in twice what the government spends on medicines? Or maybe this is over 100 years...

In any event, Ford's koolaid drinking on price controls contrasts with the bill he co-sponsored with Cal Dooley in 2003 which itself sounds and adds up remarkably like the Part D program now in operation. In case Ford forgot or you didn't know about it, here it is:

Zero-Premium, High-Cost Protection, Part B Drug Benefit

Universal ... Progressive ... Affordable

• Zero Premium: This benefit would be incorporated into the existing Medicare Part B
program. No separate premium and no increase in Part B premium.

• Universal Eligibility: All Part B enrollees.

• Universal Protection Against High Drug Costs: Medicare will pay 80 percent of the
cost of drugs after beneficiary has total drug costs of $4,000. The individual will pay
based on a flat three-tiered co-payment: $4/$16/$24*

• Benefit Counts All Drug Spending: Negotiated drug costs Β not just the
beneficiaries= out-of-pocket spending Î’ counts toward the $4,000 deductible.

• Low-Income Benefits: Beneficiaries up to 200 percent of poverty will be eligible to
receive enhanced benefits via Medicare drug discount cards, Medicare+Choice,
Medicaid, Medigap, and other new coverage options.

Medicaid – 135% of fpl tiered co-payment: $4/$16/$24*
135% - 150% of fpl tiered co-payment: $6/$24/$36**
150% - 200% of fpl tiered co-payment: $10/$40/$60***
(State option with a federal/state match at the SCHIP rate)

• Universal Benefit Via Medicare Approved Drug Card Plans: A wide variety of
Medicare approved drug card plans including PBMs, State Assistance Plans, retiree
coverage, Medigap, Medicare + Choice, Medicaid and others that offer all seniors access
to the market-based discounts widely available to people with private insurance. These
discounts would apply to all drug purchases.

• Universal Benefit Via Current Coverage: Encourage the continuation of current
drug coverage through Employer/Retiree plans, Medigap plans, Medicaid, State
pharmaceutical assistance plans, or Medicare+Choice plans; all based on
reimbursement agreements with Medicare.

• CBO Cost Estimate: Under $400 billion

"Market-based discounts" "PBMs" "Under 400 billion" Sounds like a program we already know.

I am still waiting to see how the D's will 'negotiate' down drug prices without closing down formularies and restricting choices like the VA does. Can anyone say Third Rail?  Read More & Comment...

Seeing Red over Pink Ribbons

10/11/2006 12:05 PM |

It is hard not to miss the mass of pink products and pink ribbon promotions, this month being Breast Cancer Awareness Month. (Pink ribbons being the symbol of the quest to treat and cure breast cancer in case anyone has been sleeping the past decade.)

Several corporations are and have allocated a share of the sales of their products to specific breast cancer screening or research activities as part of this effort or as part of a particular company's effort to be socially responsible. No one seems to mind when company's past some sort of eco-friendly sign on their packaging but apparently the idea that capitalist concerns would link the marketing of their products to supporting better cancer care for women is driving a handful of angry, socialist women types crazy.

They argue that corporations are "getting rich" by promoting breast cancer awareness and research. The case rests on one or two isolated cases where the amount to be contributed to a particular organization was not made clear or by comparing marketing costs (for the product in general) to the actual contribution.

Now excuse me, but what is wrong about using a campaign to rid the world of disease or some problem a bad thing for a company to do? When the National Campaign to End Infantile Paralysis (polio) started the March of Dimes Campaign it used tie ins galore and even got then President Roosevelt to hawk products that we donating a share of its proceeds to the effort. And no one seems to give a rip when Ben and Jerry's donates a share of its profits to eliminating low self-esteem issues working in left wing NGOs or Paul Newman kicks in part of his pasta sauce proceeds to his camp for kids dyiing of cancer. And in both cases, people probably buy the products to support the cause. I bought a particular type of matzah for Passover because a share of the dough (unleavened) went to support the Jewish National Fund.

But when some corporations decide to sponsor and promote their sponsorship of breast cancer activities, that is getting rich. The alternative I guess, if you read the bitter and disjointed screeds of the critics, is to have companies do nothing or, more precisely, contribute to their pet projects. In the case of breast cancer, it would be to fund massive studies and lawsuits about the role every food additive and greenhouse gas plays in triggering cancer instead of the effort to support treatments which just enrich drug companies anyway.

The way to deal with fringe elements in all these cases is to take the extreme thinking to its logical conclusion: when you do, you are confronted with a group of people who would rather women be denied better care in order to have their worldview adopted. (Of course they would have the government do it all with higher taxes..just like in Canada where the screening and awareness levels are lower than here). Given the choice between no corporate involvement and corporate involvement along with the funding for a variety of programs that promote early detection, treatment and research, the fringe groups attacking the pink ribbon programs would take a victory over "getting rich" any time.  Read More & Comment...

Quaker State Snake Oil

10/11/2006 07:44 AM |

You’ve got a friend in Pennsylvania? Not if you’re a low-income patient who needs access to the best medical treatment for your condition.

First Health/Provider Synergies, the PBM used by the Quaker State to manage most of its Medicaid formulary decisions, has adopted a draconian new procedure that will make it almost impossible for Medicaid-eligible Pennsylvanians to get any new, cutting-edge medicines.

Astonishingly, FH/PS will give each pharmaceutical innovator one hour per year to make clinical presentations on all their products and one additional hour per year for "continuing education" on their products. This is not one hour per product; this is one hour per company!

This is a staggering demonstration of disinterest in clinical information, further demonstrating Medicaid’s broken process for choosing medicines -- more akin to a rug bazaar than proper science.

And it negatively impacts Pennsylvania’s neediest population. In a private plan, the consumer can make a choice to accept a higher co-pay for the medicines their doctor deem best for their condition. Medicaid recipients cannot. Typically, a prior authorization enforced by FH/PS makes it impossible for Medicaid recipients to get the medicine their doctors want them to have.

When cost-savings are put ahead of patient health, it’s not only bad process, it’s bad medicine.  Read More & Comment...

Star Ledger Article on Drug Safety and drugwonks

10/10/2006 05:49 PM |

On the heels of Steve Usdin's great piece on the outdated approach FDA critics are takig to drug safety comes an excellent piece by the Newark Star-Ledger's Kitta MacPherson.
Pretty inteilligible quote by yours truly on the failure of second-guessers to call for more funding for Critical Path and to accelerate use of biomarkers and other approaches to identify safety signals before drugs are on the market and to "tag" people before they are prescribed. For Bruce Psarty to say -- "yes, pharmacogenomics is an exciting tool but not ready for prime time so let's spend billions on even larger clinical trials and reviewers and risk management programs" is to simply make it even more difficult to create better tools. And since the IOM report does claim that the most important recommendation it makes is to INTEGRATE safety and efficacy evaluation, why is everyone suggesting steps that separate them instead of supporting science-based techniques that achieve that goal.

Here's the link to the Star-Ledger article

http://www.nj.com/search/index.ssf?/base/news-9/1160455110190710.xml?starledger?ntop&coll=1&thispage=2#continue

And one more thing: Curt Furberg's article on drug safety in the Archives of Internal Medicine.... Here's Furberg explaining his reasoning for putting a "black box" or additional risk warning on drugs for ADHD:

"On the surface, it is hard to believe( so many children really have ADHD)," said Curt Furberg, professor of public health sciences at North Carolina's Wake Forest University Medical School, who voted for the black-box warning. "What is also interesting is this condition is not really recognized in other countries -- you wonder what we are treating. I am sure there are patients who need these drugs, but it is not 10 percent of all 10-year-old boys."

In otherwords, Furberg decided to scare people away from using "these drugs" because he thinks most kids don't need them.... That follows the bogus cancer scare and Psaty ginned up regarding calcium channel blockers... And we are supposed to follow his lead on how to reform the FDA.  Read More & Comment...

IOM, PDUFA, and other Acronyms Examined

10/10/2006 07:42 AM |

The precise and prosaic Steve Usdin, Washington, DC editor of BioCentury, offers a prescient and penetrating perlustration on the impact and implications of the recent IOM report, the pending Enzi/Kennedy legislation, and their potential repercussions on the forthcoming battle over PDUFA reauthorization.

Must reading.

Here's a link to the article entitled, "Total Lifecycle Regulation" ...

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