Latest Drugwonks' Blog
You need to show a decline in rates of death in a randomized clinical trial conducted over ten years in mostly white Europeans
The decline in death rates has to be from all causes, not the disease you were screening for
The determination of what a sufficient decline in death rates is at the sole discretion of USPSTF.
In otherwords, no new screenings such as this new breast cancer detection tool being developed in Israel.
A game-changer in breast cancer detection
Early detection is the key to improving breast cancer survival rates, but mammography is not the ideal method to accomplish this goal. On this point, medical experts across the globe agree.
Not as clear is what could do the job without the disadvantages of mammography — which often causes pain or discomfort; emits radiation; cannot properly image dense breast tissue; relies on a radiologist’s interpretation of the image; and is not recommended for routine screening of women under age 40 or 50.
Of several approaches being developed worldwide, an Israeli solution pioneered by electro-optical engineer Boaz Arnon holds particular promise in providing a game-changing device for early detection of breast cancer.
Arnon’s mother, Ruth, succumbed to the disease in 2004. Through Real Imaging, the company he founded in 2006, he was determined to offer an accurate alternative that would address all issues of concern and still be cost-effective.
Appropriately named RUTH, the device he invented uses a new trademarked platform he calls MIRA (functional Multidimensional Infra-Red Analysis). Built on principles from existing technologies and mathematics, MIRA enables functional quantitative analysis of 3D and infrared signals emitted from cancerous and benign breast tissue.
“Our solution is not sensitive to age or breast density, and works without radiation,” Arnon tells ISRAEL21c. “We image the patient from a distance of 70 centimeters (25.5 inches), with no physical contact or radiation, and we have developed an automatic method that aims to detect breast cancer early, easily and as cheaply as possible.”
No more guesswork
“Physicians should be highly praised for their success rate in diagnosing breast cancer with the tools available today,” says Arnon, “but still, the death rate from breast cancer is unacceptable.”
Breast cancer is by far the most frequent cancer among women, with an estimated 1.38 million new cancer cases diagnosed in 2008 (accounting for 23 percent of all cancers), and is now the most common cancer both in developed and developing regions.
Though a medical doctor will oversee screenings with RUTH, “automatic” is one of its most key features. Results will not have to be interpreted by human eyes, thanks to the device’s unique process of calibration using mathematical algorithms formulated from three-dimensional models of hundreds of women with and without malignancies. The algorithms provide unprecedented accuracy, as Real Imaging has demonstrated in blind studies.
Op-Ed: Comparisons are odious
Agency sets an unhealthy precedent for ‘effectiveness’ research
By Trevor Butterworth Tuesday, May 29, 2012Imagine that all the pharmaceutical companies united to create an institute for quality research, and gave it $1 billion to study “comparative effectiveness” — whether drugs still under patent worked better for people than cheaper generics. Imagine that the pharma companies dug farther into their pockets and came up with another $11 million to train physicians, pharmacists and nurses to be ambassadors for this institute, and that these ambassadors would travel the country offering $4 million worth of further education credits to any doctors or nurses who would agree to listen to their spiel.
If you’re thinking that this is, in fact, what Big Pharma already does, remember, this is still a hypothetical exercise. In reality, such a plan would never get by the Food and Drug Administration, which is to drug marketing what the Spanish Inquisition was to heresy. But if, somehow, such a project were ever to happen, you’d seriously doubt whether it would be unbiased, wouldn’t you? It strains credibility to think that the pharmaceutical industry would go to such expense to say that the cheaper drugs were just as good as the expensive ones.
So guess what the U.S. government has gone and done? It’s given $1 billion to the Agency for Healthcare Research and Quality (AHRQ) to study “comparative effectiveness.” And the agency, in turn, is paying a company — Total Therapeutic Management — $11.6 million to recruit and train doctors, pharmacists and nurses to shill the findings of these comparative-effectiveness studies at high-volume medical practices. As a reward for listening to the government’s spiel, you get a continuing education credit from a $4 million fund.
It’s not clear why the government is using taxpayer money to pay people to sit in a doctor’s office and explain the wonders to be found by going to AHRQ’s website (at present, not many). But in case these busy physicians miss out on this wonderful opportunity for no-cost, taxpayer-funded education, the government is spending another $26 million for a national and regional PR campaign to raise awareness about the program.
But here’s the really amazing thing about the government doing what pharmaceutical companies would be hung, drawn and quartered for doing: Because the government is doing this, it doesn’t need government oversight! Yes, the FDA, which normally polices what can and cannot be said in the promotion of health care, will have no jurisdiction at all over what this sales force will tell health care providers about how medicine should be practiced.
The immediate problem with this is simply the reverse of the problem dogging Big Pharma: If you’ve spent a billion dollars on a new drug, you have an interest in touting it as vastly better than the drug that preceded it. But if you have an interest in saving a billion dollars — and the U.S. government, as the world’s largest payer for health care, most certainly has such an interest — then surely you have a corresponding incentive to recommend cheaper treatments.
All of which leads to the multimillion-dollar, devil-in-the-details question: What does “comparative effectiveness” actually mean?
In theory, it means finding the best treatment for any given medical problem. But how are decisions made about what’s best? What if drug A cures 50 percent of people and costs $1 a pill and drug B cures 52 percent of people with the same problem but costs $10 a pill? The cost savings of, say, treating a million people each year on Medicare by using drug A are huge — but what if you happen to be in the 2 percent for whom only drug B works, and there’s no surefire way to figure that out before treatment?
The problem with comparative effectiveness (according to Peter Pitts, president of the Center for Medicine in the Public Interest and a former FDA associate commissioner) is that it’s very different from clinical effectiveness. The former aggregates health care outcomes for a given treatment, while the latter addresses variation within those outcomes — what works best and why, for the individual.
In a recent commentary in Drug Information Journal, Pitts warns that comparative effectiveness, as presently conceived, not only risks derailing the development of personalized medicine, it could end up pushing health care toward the slippery slope of rationing. There is always a trade-off between care and cost, but that trade-off keeps changing as medicine advances. What’s crazy expensive today could be far cheaper in five years’ time, and it could trigger further incremental breakthroughs in treatment.
A glance at the AHRQ’s link-heavy website shows that a lot of its reports are already old, while the billion dollars it got from Congress has yet to deliver any major new findings. This isn’t particularly surprising: Comparative effectiveness research takes time. But what if the eventual results end up being out of date — or get challenged as critically flawed? What will a government “comparative effectiveness” health rep say in such cases?
Again, we don’t know, because the government doesn’t think it needs to regulate itself as a provider of health care research and purchaser of health care. Even if you are an opponent of so-called socialized medicine, you, me and everyone else needs socialized regulation for promoting medicine and treatment. Government should play by the same rules it sets for others. In this case, our future depends on its doing so.
Get ready for many more such outrages: This is the agency that will determine which preventive services ObamaCare will require health plans to cover free of charge.
The task force claims that screening all adult men with the PSA (protein-specific antigen) test doesn’t prevent death from the disease. It argues that “the number of men who avoid dying of prostate cancer because of screening after 10 to 14 years is, at best, very small.”
Adding to the “costs” of the test are “false positives” — they tell people they have cancer when they don’t about 10 percent of the time. The task force thinks this problem makes the cost of screening higher than the tiny benefit screening generates for society.
First, the task force measures the effect of testing on the death rate from anydisease (all-cause mortality). That’s a bogus benchmark, because, as John Maynard Keynes famously noted, in the long run we all die. In fact, death rates from prostate cancer have dropped 57 percent among men ages 49 to 64 and80 percent among adult men over 75. National Cancer Institute data show that prostate cancers are being detected and treated earlier and that life expectancy is rising as a result.
The task force claims there is no evidence that screening directly reduces prostate cancer. But how, then, did death rates decline, if screening doesn’t work?
It does, of course. As prostate-cancer expert William Catalano notes, PSA screening is why the horror of not diagnosing this cancer until it has metastasized (advanced and spread) has all but disappeared.
The task force states that because the PSA test is imprecise, it will always lead to overdiagnosis. But false positives are a risk of all screening, and the error rate for prostate-cancer screening is no higher than screening for other illnesses or cancers.
Catalano also points out that it’s regular testing — not the test being used — that has likely contributed to raising the odds against the disease.
The task force also claims that the PSA test can’t tell us which tumors to treat. Yet it gives the patient and his doctorstime to figure that out.
For most patients, PSA screening gives a 5-to-10-year lead time — a vital window in which other new techniques (needle biopsies plus improvements in surgery and radiotherapy) can work.
Finally, the task force argues that PSA testing causes men to suffer from painful treatments and endure anxiety about false-positive results. It doesn’t measure this cost or have any data to support it. Worse, it disregards the scientific evidence that treatments reduce suffering and improve quality of life, even if they don’t always increase survival.
In reality, this ban is based on politics, not science. The task force — and similar ObamaCare agencies — applies standards that aren’t achievable. Going forward, new technologies would require decades of data and would have to demonstrate they’re nearly 100 perfect before ObamaCare would cover them.
Unless, of course, the procedure is politically popular: ObamaCare will treat contraception as cost-effective, although there’s no hard data to support that claim.
The value of health-care services, in other words, will be measured by political criteria, not by their ability to reduce suffering and death.
That’s an ugly future, indeed.
Counterfeit medicines are growing at such an alarming rate that it finally made it onto the recent Camp David G8 agenda. Counterfeit Avastin has found its way into America’s legitimate supply chain. It’s not just a theoretical problem any more. Now’s the time to close a major loophole that allows the purveyors of false profits to prey on an unsuspecting American public.
Now’s the time for a national standard for pharmaceutical track-and-trace that would enable manufacturers, wholesalers and distributors to provide documentation or a “pedigree” on the chain of custody of drug products, including identification of each prior sale, purchase or trade of a drug, along with the associated dates and parties involved
Earlier this month, 11 people were charged with the March 2010 record-breaking $75 million drug heist from the Eli Lilly warehouse in Enfield, Connecticut back in March of 2010. Fortunately, all of the stolen drugs from the Lilly warehouse were recovered before they could be re-introduced into the legitimate supply chain. But we won’t always be so lucky.
Criminals are going to continue to attack our drug supply because they are always going to be attracted by the high value of drugs in the U.S. market. You can’t prevent criminals from making attempts, but you can make it whole lot more difficult.
Now, while the iron is hot, is the perfect time to strike a blow for drug safety. There’s a general placeholder in the Senate version of PDUFA bill that requires more specifics. Now’s the time for the FDA to roll up its sleeves and work with Congress to come up with a national standard instead of leaving it up to each state to come up with it’s own standard (as in California). In many respects, the only thing worse than no standard is to have 50 different standards that would create 50 different ways for counterfeiters to game the system.
This isn’t a new problem. The Prescription Drug Marketing Act of 1987 (PDMA) was signed into law by the President in 1988. PDMA was enacted to (1) ensure that drug products purchased by consumers are safe and effective, and (2) avoid the unacceptable risk to American consumers from counterfeit, adulterated, misbranded, subpotent, or expired drugs. Both Congress and the FDA recognized that such legislation was necessary to increase safeguards in the drug distribution system to prevent the introduction and retail sale of substandard, ineffective, or counterfeit drugs.
In 2004 (during my service as an FDA Associate Commissioner), I served on the agency’s first Counterfeit Drug Taskforce. Our report outlined a framework for public and private sector actions that could further protect Americans from counterfeit drugs, including implementation of new track and trace technologies to meet and surpass goals of the Prescription Drug Marketing Act (PDMA). Our framework called for a multi-layer approach to address the problem and included the following measures:
- Secure the product and packaging
- Secure the movement of drugs through the supply chain
- Secure business transactions
- Ensure appropriate regulatory oversight and enforcement
- Increase penalties
- Heighten vigilance and awareness
- International cooperation
But the devil is in the details and there’s always the danger of allowing the perfect to get in the way of the (public) good. Implementing PDMA has been a nightmare for 1000 reasons – not the least of which is a single, FDA-mandated track-and-trace technology. But time marches on. Technological advances since 1988 provide a plethora of possibilities. It’s time for the FDA to work with all stakeholders and put a national standard in place.
And the FDA won’t be acting alone. In a May 22nd colloquy, Senators Enzi and Harkin support moving forward with a more permanent and robust solution. Senator Enzi: “The language in the Manager’s Amendment is a placeholder to show our intent to continue working on this critical, but complex, policy.” Senator Harkin: “The logical next step in this policy is to work to improve the safety of the drug distribution system that gets drugs from manufacturers to the pharmacists and other providers who dispense them to patients. The FDA currently lacks the authority to establish a uniform, comprehensive national system to secure the pharmaceutical distribution supply chain.”
The complete colloquy can be found here.
It’s time to give the FDA the authority it needs to put 21st century track and trace into commission on behalf of the public health.
Compulsory what?
Drug regulation in India-the time is ripe for change
The Lancet
To say that India's drug regulatory authority, the Central Drugs Standard Control Organisation (CDSCO)-whose remit includes new drug approval, licensing of manufacturing facilities, and regulation of drug trials-is not fit for purpose seems a gross understatement.
A damning 118-page report from the Indian Parliamentary Standing Committee on Health and Family Welfare documents its successive failings. It describes a vast, geographically disseminated organisation that is dangerously understaffed: nine officers at headquarters deal with 20 000 applications, more than 200 meetings, 700 parliamentary questions, and 150 court cases per year. There is also a dearth of medically qualified staff, poor support infrastructure, a seeming lack of coordination between departments, and a scarcity of decent computer systems.
It is therefore not surprising that, of 42 approved drugs randomly chosen for investigation by the Committee, some had not passed through the correct regulatory channels. But the fact that 11 had no phase 3 studies done, 13 "did not have permission for sale in any of the major developed countries", and there was "no scientific evidence to show that...33 drugs are really effective and safe in Indian patients" points to problems at the very foundations of CDSCO. Its mission of meeting the aspirations ... demands and requirements of the pharmaceutical industry", rather than the protection of patients, is a very shaky foundation indeed.
The Committee's report has several suggestions for improvement. However, rather than trying to overhaul an organisation that is failing so catastrophically, India should seize this opportunity to wipe the slate clean and form a new drug regulatory body.
A smoothly running, professional drug regulatory body is essential to ensure, first, that high-quality, adequately assessed drugs are available to India's population and, second, that India's drug industry is regulated well enough to contribute successfully to India's domestic and export sectors. It should go without saying that whatever action India takes, the philosophy of the drug regulatory body should be the protection of patients, wherever they are.
This week the CDC recommended that baby boomers be screened for Hepatitis C. The motivation behind this recommendation is the development of a new class of Hepatitis C treatments that are in pill form and not injected.
Simplicity of treatment makes screening more successful. Yet people who are identified with the disease may have to pay more out of pocket for more effective and convenient care than they do for less effective and time consuming infusions.
That's because most health plans, following Medicare Part D, pay 100 percent of the cost of injectble drugs while paying only 70-80 percent of new oral medications. Since these drugs are expensive -- though relative to dying, permanent disability or the cost of repeated hospitalizations, organ transplants -- they are bargain patients wind up forking over tens of thousands of dollars for treatments do less. Moreover, because you can take a pill at home the cost of infusion goes away.
Our system of health care reimbursement is out of whack with the value of new, simpler treatments. It covers what is cheapest and then only covers in part technologies that work and are less instrusive if the cheap approach fails. That, not over use of tests ot treatments, is the biggest source of waste in health care, a source that could be eliminated if we did things right the first time,
Similarly, all new cancer drugs are in pill form. They make staying alive and healthier, simpler to do. They generate value for consumers who can go back to work, eliminate costly procedures such as blood transfusions, stem cell replacements and help avoid the side effects of chemo, which are tantamount to being shoved into a microwave while seasick.
Maybe Medicare and health plans think they are saving money by forcing people to pay a penalty for better treatments that are more convenient. They are wrong. There is mounds of data demonstrating that every dollar spent on new cancer and HIV drugs offset $7 spent other services. And the combination of longer life, improved health and increased productivity is not even accounted. My colleague John Vernon and I have shown that social value of increased health and longevity runs into the trillions. Advances in cancer alone have allowed people to live longer with fewer disabilities. If I were in control of my premium dollars, that's where I would want my money to go.
Instead, people -- particularly those with life threatening illnesses that are not caused by poor health habits -- have to pay more for these advances than any other health care service. Does it make sense to subsidize massage therapy or birthing pools at a higher level than pills that prevent cancer .
We don't need lots of legislation to change the paradigm. All the employers investing millions in 'wellness programs' could tell insurance plans the game has to change. States can introduce legislation making parity a requirement. Some will say this will add to the cost of premiums. So what? Studies have shown people are willing to pay more to be protected from catastrophic costs or give up the frills that are covered but never used. I bet a health plan that covered pills to treat hepatitis C and cancer could keep premiums where they are if they stopped covering the extras like acupuncture, chiropractors, massage therapy, gym memberships.
Our way of paying for health insurance and covering benefits is still pre-industrial. As I had mentioned in a previous post, you have to bribe doctors to use health IT even as thousands of health professionals are paying for iPads and using them in practice. Simplicity empowers. Medications are a highly efficient way of treating disease. I don't mind paying a portion of the cost of these treatments out of pocket. But it makes neither clinical or economic sense to force consumers to pay a higher percentage of the cost relative to less transformational care.
If somone running for public office wants an issue to campaign on, the tax on access to innovation that these co-pays impose is a great one. In the meantime, companies have to do a better job of showing it's innovative products enhances value by increasing clinical utility for patients and reducing the complexity of care. No doubt certain interests will oppose paying for progress that could eliminate their jobs or income. But the last time I checked, the typewriter and bank teller lobbies didh't have much success. On a related matter, why are we using clincal trial methodologies from the 19th century? From recruitment to treatment to followup, we can use digital technologies, biomarkers, remote sensors to cut the time and cost of evaluating new products in more than half.
Digital and personalized health technologies will creatively destroy the existing approach to medicine. Only regulation and political inertia stand in the way.
Change can be accelerated by we the patients. As Eric Topol has written: "the change will come from the truly empowered, beyond informed, consumer who has access to all the relevant data and is now fully participatory. This transcends the era of internet access to health information that started in the late1990’s, since now each individual should be able to access all of their biologic, physiologic, and anatomical data that was largely unobtainable before. And the earlier in life the better, in order to foster the critically needed emphasis on prevention of diseases—which
has been essentially ignored until now."
It's time to stop sticking it to patients when there are more empowering and powerful pills out there.
PDUFA passes Senate 96-1. 1= Bernie Sanders, the Senator from Ben & Jerry's.
When money speaks – the truth is silent.
-- Russian Proverb
I’ve just returned from Moscow where I was proud to participate in the first ISPOR conference (co-sponsored by the Ministry of Health) on HTA ever held in the Rodina. And it was a very worthwhile experience.
The meeting featured a cast of international HTA all-stars. Some useful take-aways:
Luigi Migliorini (the WHO’s Special Representative to the Russian Federation) noted that the conference was taking place at the same time as the World Health Assembly – which he referred to as “the Duma of the WHO.” Whether he was making a somewhat forced local reference or trying to make some type of political statement is up for debate.
Hans Severens (Erasmus University) spoke about “the possibilities and the impossibilities of HTA.” His main point (which became a mantra of all of the day’s presentations) is that, when it comes to HTA, “all decision-making must be made in a local context.” He also firmly stated that economic concerns are only one of many petals on the HTA flower – another point reinforced throughout the course of the program. Countries “shouldn’t just adopt NICE findings” but should assemble all available information and put all data into a local context.
If all politics is local – so to must HTA designs and decisions.
Severens said that, “all HTA research is biased.” This reinforces the point made by NICE’s Sir Michael Rawlins that HTA “is not based on empirical research, there is no empirical research anywhere in the world, it is really based on the collective judgment of the health economists. There is no known piece of work which tells you what the threshold should be. It is elusive."
Elusive indeed.
Jérôme Boehm (Health and Consumer Directorate, European Commission) discussed the EC’s work towards developing protocols to share HTA data through a common database – but that “HTA must be a national decision.” He also added that there should be “no interference between market authorization and HTA.”
Wim Goettsch (Deputy Secretary, Medicinal Products Reimbursement Committee, the Netherlands) also affirmed that HTA decisions should be taken at the local level and that it needs to be as much about relative effectiveness (what we in the US refer to as comparative clinical effectiveness). He also pointed to an EU-wide database of HTA studies (www.eunethta.eu) that is becoming the “go-to” source for existing reports and information.
EUNETHTA, describes itself as “focusing on scientific cooperation in HTA in Europe, thirty four government appointed organisations from the EU Member States, Accession Countries and EEA work together to help developing reliable, timely, transparent and transferable information to contribute to HTAs in European countries.”
(Is PCORI aware of this? If not, they should spend some of their hundreds of millions of dollars doing so – rather than reinventing the wheel.)
And speaking of PCORI, Steve Pearson (Institute for Clinical and Economic Review), reinforced (and seemed to be bemoan) the fact that it cannot use any of its time or resources to address cost issues.
The US needs to learn from the successes as well as the failures of the European HTA experience. HTA isn’t easy. It isn’t foolproof. The science is in its early days and it is imprecise and cost containment is only one of many factors (and, according to all the speakers, not the most important). There isn’t a one-size-fits-all methodology. As Mark Twain quipped, “For every complex problem there is usually one simple answer – and it is usually wrong.” That’s an adage we should keep in mind. Alas – there is no universal Michael Moore-like “SiCKO” solution.
HTA cannot make political decisions – or make them any easier. A lesson we must learn as we debate the future of IPAB here at home.
Mira Pavlovic (Deputy Director, HAS) also spoke to the growing importance of EUNETHTA as well as the issues of HTA relative to choosing the best endpoints and comparators. She also addressed one of the 800 pound HTA gorillas – pharmacovigilance. She ended her talk by asking the big question – “Can we think prospectively.”
She also said that , since l’affaire Mediator, new conflict of interest rules have forced her agency to use physicians who have “sheep grazing around their offices.” Baa humbug.
Laura Sampietro-Colom (Hospital Clinic Barcelona and immediate Past-President of Healthcare Technology Assessment International – HTAi) discussed the importance of international cooperation and data sharing and the organizations own HTA database. She mentioned that AHRQ is a member of HTAi. (Hopefully Carolyn Clancy has shared her password with Joe Selby over at PCORI.)
According to conference organizer Vitaly Omelyanovskiy (Director, Research Center for Clinical and Economic Evaluation and Pharmacoeconomics, Russian National Research Medical University), HTA is the “near abroad” meaning that, while still a foreign concept – it’s not too foreign. Russia’s initial goal, accordingly, is to begin studying international (meaning European) HTA information and experiences so that a more “Russian-style” program can de developed.
The US has much to learn from this thoughtful Russian model because, as Leslie Levin (Head, Medical Advisory Secretariat, Health Quality Ontario) so elegantly put it, “Nobody can do it alone.”
Not enough – but it’s a start.
On Saturday, May 19th, the G8 issued the 40-point Camp David Declaration. Point 9 of the declaration includes:
"To protect public health and consumer safety, we also commit to exchange information on rogue internet pharmacy sites in accordance with national law and share best practices on combating counterfeit medical products."
Not enough – but it’s a start. Just having the issue of drug safety on the agenda is a victory (as is a reaffirmation of the importance of intellectual property).
It's worth noting that according to our national law, any internet pharmacy attempting to sell prescription medicines to US citizens without a state pharmacy license is an illegal internet pharmacy.
Someone should share the G8 statement with Senator McCain and the other ill-advised supporters of drug importation.
The entire Camp David Declaration can be found here.
"The challenge of ecologic data is that it is impossible to reliably separate out the relative effects of any changes in screening, diagnosis, or treatment practices (or fundamental changes in the underlying risk of developing or dying of the disease in the population due to a multiplicity of other causes) that may have been occurring simultaneously over a given time period. "
This is pure dissembling BS designed to justify rationing.
Here is a more measured -- and patient-centered -- approach by urologist William Catalona:
The past half decade has seen a striking reduction of prostate cancer mortality rates in the US and other countries. The decrease has been ascribed, at least in part, to early diagnosis combined with more effective treatment, although there is no proof of a causal relationship.
Nevertheless, to the extent that early detection and effective treatment do reduce prostate cancer mortality and morbidity rates, PSA screening is clearly beneficial to many patients.
Some argue that PSA screening is not beneficial for all men screened because not every prostate cancer patient benefits from early diagnosis and treatment. Some tumors might never be life threatening and rare ones are incurable by the time the PSA level becomes elevated.
However, all available evidence suggests that PSA screening largely detects cancers that have features of clinically important cancers that are destined to cause suffering and death if untreated while they are still curable.
Some also argue that PSA screening is not beneficial to men who are never affected with prostate cancer. PSA screening does provide a feeling of well being in men who have persistently normal results, and even though a normal value can be misleading, with serial screening, PSA eventually reveals the cancer.
Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.
