Scott Gottlieb doesn’t just talk the talk..this is a guy who cares about patients and knows that physician discretion is still a primary source of medical innovation. And he knows that real risk management comes with integrating advanced technologies early in the drug development process, not burdening doctors and patients with paperwork as with the Tysabri risk management program…Read the article below as a great example of how Scott and FDA staffers are making a difference and why they deserve more time, money and resources to innovate:

FDA Official Questions Key Drug Safety Policy - 16 June 2006 Drug Industry Daily - By Stephen Langel

The FDA is growing increasingly concerned about its own practice of requiring companies to provide risk management plans (RMPs) as a condition of drug approvals, a high-ranking agency official said.

The FDA believes that RMPs, while important in some instances, may be too prevalent, Scott Gottlieb, the agency’s deputy commissioner for medical and scientific affairs, said in a speech before the American Medical Association. As the requirement for RMPs becomes more pervasive, the burdens could become too much for physicians and their patients, he said during the June 12 speech. “I worry about the future,” he said.

An RMP is a method the agency uses to assess the risks and benefits of a drug and minimize the risks while maximizing the benefits. But Gottlieb believes these plans — which many times include physician training programs for proper use of the drug, public notices about its dangers and drug registration programs could become too much of a burden and restrict doctors’ discretion.

“The more we promulgate plans that attempt to guide or even control [medical] decisions, the more we encroach on professional autonomy,” he said. This is especially problematic when busy clinics do not have the time to go through the various steps these plans require, he added.

Industry groups such as PhRMA have also expressed concerns with the burden RMPs can represent. The group has argued that while it supported the idea of RMPs, the agency needs to ensure that they do not impose overwhelming burdens on the medical community. “Care must be taken not to overburden the healthcare system by using too many resource-intensive tools in RMPs,” the group said in a risk management presentation.

Both the FDA and the medical community are to blame for this trend, Gottlieb told DID in a follow-up interview. While doctors have not always done everything possible to police themselves, the agency has not always created opportunities for physicians to be involved in ensuring safe drug use, he said.

The agency believes that greater cooperation between the FDA and the medical community is the solution. “I believe some of the same safety goals embodied in the RMPs could be achieved if we had more ability to collaborate more closely and effectively with physician organizations,” he added.

To reach this goal the agency is working to establish an office that will ensure more regular collaboration and communication about clinical issues with medical organizations, Gottlieb said. Terry Toigo, the agency’s acting associate commissioner for external relations is heading the team that is developing this new office, he added.

Gottlieb raised his concerns at a time when the agency has made RMPs a common requirement in granting drug approvals. For example, the FDA recently allowed multiple sclerosis drug Tysabri to be sold after the product was pulled from the market, but only if the company provided an RMP (DID, June 6).

Not really. When’s the last time you saw any pol manufacture or expend any political capital to advocate for faster cures.

By the way, on the Ketek matter. How many articles have mentioned that nearly ten million prescriptions have been written for Ketek worldwide since it was approved in Europe in 2001 and about 5 million have been written in the US since it was approved here in 2004. Over that time there have been 11 cases of acute liver failure, including the four deaths, in patients treated with Ketek, according to an FDA memo. FDA safety evaluators also uncovered 23 other cases where patients suffered serious liver injuries after receiving the antibiotic. Which means the incidence for liver problems (we can assume a part of those were the result of genetic mutations and poor prescribing, neither of which can be anticipated under our current regulatory system) is about .00066 percent and a death rate of 0.0000008

Meanwhile, “Acetaminophen poisoning has become the most common cause of acute liver failure in the United States,” report the authors of a new study in the December 2005 issue of Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD). While attempted suicides still account for many cases, almost half are the result of unintentional overdose.
Now about 100 million people use acetaminophen each year. And each year about there about 56,000 ER visits and 100 deaths (liver failure) attributed to the drug. That’s an injury rate of .000056 if my math is right and a death rate of 0.0000001. This drug has the same genetic problems with metabolism as Ketek.

Meanwhile the community acquired pneumonia for which Ketek was developed and is used for — since other antibiotics are failed to beat back resistant bacter — leads to 500,000 hospitalizations and 50,000 deaths a year.

Somehow Grassley and the media has misplaced these facts, along with the incontrovertible evidence that the drug works.

The U.S. Food and Drug Administration has approved a combination of Hycamtin (topotecan hydrochloride) and cisplatin for use as the first drug treatment for women with late-stage cancer of the cervix when a physician determines that surgery or radiation therapy are unlikely to be effective. The approval includes a new indication for Hycamtin, which was approved in 1996 for treating ovarian cancer and in 1998 for small cell lung cancer.

In the United States there are an estimated 10,000 new cases of cervical cancer and about 3,700 related deaths each year.

“We are making great strides in the fight against cervical cancer, a disease that, world wide, is the second most common cancer in women,” said Dr. Andrew von Eschenbach, Acting FDA Commissioner. “This course of drug therapy is a potentially life-prolonging option for thousands of women.”

No doubt a Congressional hearing will be called to investigate.

Has Charles Grassley finally jumped the shark in his attempt to generate media attention with his fearmongering over drug safety? His marching over to the HHS to demand a meeting with the official who is “covering up” the coverup of the coverup of Ketek fizzled when the sober-minded folks there simply told him to get lost.

Here is the breathless account from the Washington Post:

“After months of trying to get firsthand information from a government official familiar with a controversial new antibiotic, Sen. Charles Grassley, R-Iowa, marched into the Department of Health and Human Services headquarters Wednesday asserting his congressional right to receive the data.

After a brief meeting with senior HHS and Food and Drug Administration officials, Grassley departed empty-handed and angry.

“This is extraordinary for me,” the senior Republican said outside the headquarters. “I haven’t had to go to an agency like this since 1983 to get information I requested.”

“I smell a coverup,” he said.

Even Post reporters have to put some fact outs…..turns out Grassley does have his hands full….

“FDA officials denied any impropriety, saying they were cooperating with Grassley龝 staff and had sent 400 boxes of documents related to the approval and safety of the drug, Ketek. Some information had to be withheld, the agency said, because of continuing investigations.”

So much for Grassley’s effort to turn the Ketek incident, which in no way affected the safety or the importance of the drug, into the DaVinci Code.

What’s more the FDA is planning to go head and submit the data to an FDA advisory committee for an application to use Ketek for another infection…. I think Grassley’s act is wearing thin and prancing over to HHS to exercise his congressional right (does that include the right to yank FDA staffers away from their job and have them work in your office to dig up dirt on the agency they are supposed to work for, Senator?) only to be told to keep his pants on is pretty damn funny. Hey Chuck, any limos driven by guys wearing black following you as well?

We need more of this resolve on the part of the FDA and companies. That’s how you treat blowhards and bullies who think they are Jack Bauer but instead wind up looking like Inspector Clousseau.

One of the most difficult meetings I ever held at the FDA was with a group of parents (mostly moms) of teenagers who had committed suicide while taking SSRI antidepressants. In the wake of a very emotional advisory committee meeting, heavily covered by the media, these well-meaning and understandably devastated parents believed that these medicines were the cause of their horrible losses. I listened. Afterwards I wept. A parent of two children, I cannot even begin to understand their agony.

But as much as they needed to believe that the medications were at fault, the science was never clear. Anecdotal events, even terrible ones, are not science. Now a major new study, the first of its kind, finds that rather than boosting suicide rates, SSRIs have actually saved thousands of lives by preventing suicides since they were introduced in 1988.

And before you ask, no, the study was not funded by a pharmaceutical company. The funding came from the NIH and the Dana Foundation. The full study appears in the June issue of the journal PLos Medicine.

For this study, the authors analyzed federal data on suicide rates since 1960, along with sales of fluoxetine (Prozac) since it became available in 1988. Analysis was continued through 2002. Prozac was used as a benchmark for the broader class of drugs.

Between the early 1960s and 1988, suicide rates held relatively steady, fluctuating between 12.2 per 100,000 and 13.7 per 100,000.

Since 1988, however, suicide rates have been on a gradual decline, with the lowest point being 10.4 per 100,000 in 2000. During the same time frame, Prozac prescriptions rose, from 2,469,000 in 1988 to 33,320,000 in 2002.

Using mathematical modeling, the investigators estimated the rates of suicide if the pre-1988 trends had continued, estimating that there would have been an additional 33,600 suicides if the pre-1988 trends had been maintained.

With that in mind, moves to restrict the use of SSRI antidepressantscould have a harmful effect, the authors stated.

“I don’t think these claims that antidepressants increase suicide have a solid base,” said Dr. Julio Licinio, lead author of the study and Chairman of the Department of Psychiatry and Behavioral Sciences at the University of Miami.

“If you have a drug that’s supposed to be causing something, the more of the drug that’s used, the more of the bad outcome you would have. What we show is the converse.”

Whille this new science will provide little solice to the parents I met, it will help mental health professionals, their patients — and their patients’ loved ones — better understand the value of available therapies.

And that’s important. Very.

There was no — none, zero talk of denial. Rather there was talk of trying to get straight what the enforcement procedures would be,” Crawford testified, according to a transcript of the May 24 deposition that was released late Monday by the Center for Reproductive Rights â which has sued to force the FDA to allow over-the-counter sales of Plan B for all ages.

So, there was no conspiracy to deny young women access to OTC sales of Plan B? What this depostion reveals is that Dr. Crawford was willing to make a tough decision and exercise leadership. He knew the political consequences of the perception of his actions and didn’t care. He is more of a mensch than the those who attacked him ever will be. Maybe all the media speculation and second -guessing about Dr. Crawford’s integrity and motivation will stop. Maybe all the hit and run attacks on the FDA fed to reporters by Sid Wolfe and his ilk will stop and we can actually have a rational discussion of how to make drug development faster and safer. Too much to hope for perhaps.

We can’t all have our own personal FDA. Not you. Not me. Not Senator Charles “I’m not a doctor but I play one on C-SPAN” Grassley, not Consumer Reports.

Consider Consumer Reports. Based on its “own” analysis of FDA data, it reached a significantly different conclusion than all of the scientists and food experts at the FDA’s Center for Food Safety and Applied Nutrition (CFSAN). Despite the fact that both the FDA and the EPA said that pregnant women should eat more fish — including tuna fish — Consumer Reports says the opposite. All the best science supports the FDA. All the lawyers support Consumer Reports. And who do you think gets the media coverage?

And as Senator Grassley moseys over to the Department of Health and Human Services today for another session of media-savvy grandstanding, we would all do well to remember the words of Dr. Mark Goldberger, director of FDA’s office of antimicrobial products:

“It’s more complex than it seems at first glance.”

Indeed.

This just in off the AP wire …

An experimental vaccine is showing promise against Alzheimer’s disease, reducing brain deposits that are blamed for the disorder.

The deposits have been cut by between 15.5 percent and 38.5 percent in mice, with no major side effects, researchers said Monday in the online edition of Proceedings of the National Academy of Sciences.

Tests of the DNA-based vaccine are under way in monkeys, and if those are successful, testing in people could begin, perhaps within three years, said lead researcher Yoh Matsumoto of the Tokyo Metropolitan Institute for Neuroscience in Japan.

If all goes well, this type of treatment might be available for people in six or seven years, he said.

Scientists estimate that as many as 4.5 million Americans suffer from Alzheimer’s, the most common form of dementia. The illness, named after Dr. Alois Alzheimer, a German doctor who studied it in 1906, involves the parts of the brain that control thought, memory and language.

Its cause remains unknown, and while there is no cure some drugs can slow progress of the illness in people in the early and middle stages.

Other efforts to develop an Alzheimer’s therapy also are under way.

Two years ago, trials of a potential vaccine that seemed to help slow the memory decline caused by the disease were halted after several participants developed brain swelling.

Matsumoto said that problem did not occur in the tests of his vaccine.

The brains of people suffering from Alzheimer’s disease are cluttered with a plaque made up of a small protein called amyloid beta, or Ab.

In the mouse tests, the Ab deposits were reduced overall, and in certain parts of the brain the reduction was as much as 50 percent, the researchers said.

Dr. Sid Gilman, a professor of neurology at the University of Michigan who has done research in vaccines for Alzheimer’s, said the new research showed the vaccine was efficient and safe in the mice.

He cautioned, however, that it’s very difficult to compare the level of efficiency from one trial to another, “so how effective this may be compared to other approaches is debatable.”

The reasons for the brain swelling in the earlier tests have been determined, Gilman said, and new forms of that therapy are now being tested.

A variety of clinical trials are under way looking at other potential treatments for Alzheimer’s including a hormone that might prevent brain cell death, several drugs, antioxidants, cholesterol-lowering medications and antibodies.

The Japanese research was funded by the ministry of education of Japan and the Novartis Institute of Biomedical Research.

I received a few media calls yesterday asking me if I thought there would be an outcry from “the religious right” about Gardasil potentially “causing” sexual promiscuity in teenage girls. My response: I have heard nil (the same amount as the number of goals scored by Team USA yesterday in the World Cup). Seems to me that in the light of such a really important public health advance that the media would be reporting on, well, a really important public health advance. The only thing I have heard (and I’m hearing it a lot) is that this new vaccine should become mandatory. And, indeed, I agree that it should.

I have been stewing about this drive by reporting or smear for a couple of days….This from an article in the Boston Globe, a piece on Chuck Grassley entitled “Watching the Watchdog” which recounts the various safety molehills Grassley has made mountains out of. He is never asked, in reference to his grave concern about the FDA being too cozy with industry, why it is perfectly kosher for the chairman of the Finance committee to have an FDA employee in his office, on his staff doing his bidding for free free at taxpayer expense when the guy should be at his desk at Rockville or White Oak.

But that is not the only thing: Grassley implies that the drug industry tried to whack one his staffers because of his heroic work on drug safety. This is a serious charge and the way it is laid out makes it seem that drug safety was the reason she was attacked: “

Grassley also has reason to be concerned about his staff’s well-being. Last November, his chief investigator, Emilia DiSanto , was attacked outside of her suburban Virginia home. The assailant, dressed in black, clubbed her with what appeared to be a baseball bat. The FBI and Capitol Police are still investigating and no arrests have been made. Grassley suspects DiSanto was targeted because of her work on drug safety and other matters.

“Unless the guy was a psychopath, it doesn’t seem to me like it was random,” he said. “If they had knocked her out with the first hit, she’d be dead. She was able to just survive and fight back, and the guy got scared and ran off.”

“She’s OK,” he added, “but, obviously, we [will] live with this for a long, long, long time.”

For the record, over the last year the Senate Finance Committee has scrutinized healthcare fraud, organ-donation procedures used by hospitals, drug-safety matters and the use of nonprofit groups related to former lobbyist Jack Abramoff. That still doesn’t mean there is any connection but in the context of the article it seems that drug safety work was the trigger for the attempted hit when in fact there could have been any number of forces. Why was this subject even introduced? To make Grassley into some sort of crusader? To smear the drug industry by association. Shouldn’t such an allegation have some supporting evidence instead of just hanging out there like some spitball? Both Grassley and the Globe should keep their suspicions to themselves. Enough for now. I have to take a shower.

From the Kaiser Foundation’s daily dose of depressing news about how health care in America generally sucks, this time another piece about how horribly the Medicare drug benefit is mistreating seniors and — above all - the poor, poor pharmacists from the mind of Robert Pear: “The New York Times on Sunday examined the effects of the Medicare drug benefit on beneficiaries, pharmacists and doctors in McAllen, Texas, a town near the Mexican border in the Rio Grande Valley. According to the Times, beneficiaries in the town are “hav[ing] difficulty getting the drugs they need,” and pharmacists and doctors “are struggling to figure out which drugs are covered by which plans.” In addition, pharmacists are “swamped with questions and complaints from beneficiaries” and “have run into many practical problems as they try to navigate a complex program administered by dozens of prescription drug plans, each with its own policies and procedures,” the Times reports (Pear, New York Times, 6/11).

Yes Robert, and somehow 90 percent of all seniors have managed to navigate this “complex program” as easily as you have been able to navigate around their successes. Perhaps you could write an article about you go about avoiding writing about their stories for so damn long without including the words clueless or bias…

As the keynote speaker at our recent conference on the Critical Path (graciously sponsored by our think tank confreres at the Manhattan Institute) Dr. Andy von Eschenbach described 21st century medicine as having to be “personalized, predictive, and participatory.”

And the same can be said for the FDA.

The agency must become more personalized in the sense that it can no longer operate under a “one-size fits all” mentality to regulation — particularly (and for example) as relates to clinical trials.

The agency must, similarly, become more predictive. Consider here the three “Bs” — Bayesian Statistics, Biomarkers, and Bioinformatics.

As for participatory, the 21st century FDA must both engage and lead. The agency’s recent rope-a-dope communications strategy has resulted in falling public confidence, increased media strutiny, more intense and self-serving political posturing, and an internal crisis of confidence. Unfair and unearned? You bet. But reality.

Andy spoke about “FDA Evolution.” He reminded the audience that a caterpillar is going to morph into a butterfly — and there’s nothing it can do to prevent that change. So too will the FDA change into something. But, unlike the caterpillar, the FDA can decide what it wants to become and choose how it wants to evolve. But evolve it must. According to Andy, the process must (must!) be a collaborative effort. FDA can neither work nor change in a vacuum.

And at the center of that evolution, said Dr. von Eschenbach, is the Critical Path initiative. This point was eloquently echoed by another conference speaker — Dr. Janet Woodcock.

To pursue Andy’s caterpillar/evolution theme, consider this — We are all crewmembers on board the FDA’s Voyage of the Beagle.

And we must all have a common mission — evolutionary change. It kind of puts “survival of the fittest” into a new context.

The FDA has announced that it “will fully implement regulations related to the Prescription Drug Marketing Act of 1987, which requires drug distributors to provide documentation of the chain of custody of drug products — the so-called “pedigree” — throughout the distribution system.”

Most recently, in early 2004, FDA delayed the effective date of certain regulatory provisions regarding pedigrees to allow the industry time to adopt electronic technology for tracking drugs through the supply chain. Based on information from drug supply stakeholders, the FDA had expected this technology to be in widespread use in the drug supply chain by 2007, but it now appears that these expectations will not be met.

Accordingly, the hold, which will expire in December, will not be continued.

A paper pedigree? In the 21st century? Will this really be an effective deterrent in the battle to combat counterfeiters so sophisticated they can produce both packages and pills imperceptively different from the real McCoy? Do we really think the bad guys can’t produce their own paper pedigree documents?

This is a big problem — but it’s not the point. This is a signal from the FDA that industry cannot drag its feet when it come to developing and implementing more potent e-pedigree systems such as RFID.

According to the FDA’s announcement:

“A potential new measure to safeguard the drug supply is the use of electronic track and trace technology, such as radio-frequency identification (RFID), which creates an electronic pedigree (e-pedigree) for tracking the movement of the drug through the supply chain. The FDA had expected this technology to be in widespread use in the drug supply chain by 2007. In early 2004 FDA delayed the effective date of the regulatory provisions regarding pedigrees to allow the industry time to adopt this technology. However, it now appears that FDA’s expectations for adoption of the technology by 2007 will not be met. FDA therefore has determined it can no longer justify delaying implementation of the pedigree regulations.”

Any questions?

As Peter pointed out (try saying that ten times fast) the FDA leadership is poised to move the agency into the 21st century and with it the ability of medicine to be predictive and preventive. More to the point, it is imperative that, we are able to accelerate and reduce the cost of bringing new cures to market. There is no reason why the fight against Alzheimer’s Disease should not get the same Part E approach as cancer and HIV and no reason why the Critical path can’t be used to make it happen at the reviewer level. And there is no reason why the FDA cannot help pave the way for faster, smarter scale up of vaccine facilities for products against neglected global diseses.

IT will need help — a consortium with money will do. But the enemies of medical progress are all around. They put their political careers and hatred for drug companies first and foremost. They blame everything, include the tragic physicial attacks on their staffers, on drug companies and those that support them. As the Tysabri case showed, they created an environment where a highly effective medicine for a debilitating disease was treated as more toxic than aspirin.. This was the result not of scientific concern but of political pressure. People suffered and their condtions worsened because of the grandstanding and moralizing of some inthe media and the halls of Congress. And they will perpetuate that suffering if they get their way.

We won’t let that happen..

Today Dr. Bob and I officially released the “Prescription for Progress” taskforce report on the Critical Path. More on this shortly, but here’s a taste …

Our keynoter, Dr. Andrew von Eschenbach, noted that the FDA was at a “strategic inflection point” in its history. All you hi-tech wonks out there will no doubt be familiar with that phrase and it’s coiner — another Andy, Andy Groves of Intel.

Great minds think alike — like revolutionairies.

The British government has posted a “help wanted” ad for the post of director of the National Health Service in the Times of London.

I am not making this up. Check it out at http://jobs.timesonline.co.uk.

Hello Alistair Wood!

The fact that the government is willing to consider non-British candidates is (IMHO) an important sign that they’re (at least potentially) ready to look at new ways to approach the myriad of critical issues facing health care in the 21st century UK. (That’s a polite way of saying that maybe, just maybe, the Brits are beginning to admit that their system is in DEFCON 4 — not that we should brag too loudly.)

If you choose to apply, please feel free to use drugwonks.com as a reference.

I nominate Scott Gottlieb. Look British. Think Yiddish.

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

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

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

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

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

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

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

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

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

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

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

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

For real information instead of the garbage the NY Times passes off as medical reporting you can go to the website of The Juvenile Bipolar Research Foundation at
http://www.bpchildresearch.org/

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

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

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

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