Latest Drugwonks' Blog

This essay on how to improve R&D productivity rightly focuses on the need to be more targeted and value driven. But it begs the question of what to do about an FDA unwilling to adjust regulatory requirements that reward value driven development? http://www.oliverwyman.com/media/OW_EN_HLS_Publ_2011_Beyond_the_Shadow_of_a_Drought(2).pdf
Whether or not you feel that Plan B (aka -- "The Morning After Pill") should be available OTC to adolescents, the bigger issue (MUCH bigger) is the dangerous precedent of politicizing the FDA process.
 
The morning after Secretary Sebelius' unprecedented overruling of the FDA's decision one thing is clear -- the door is now wide open to anyone who has a beef over any decision rendered by Peggy & Co.
 
The line forms to the left.
 
When asked directly if the White House had weighed in on this matter, the HHS press office refused to comment. In other words, yes.  Can you imagine the hue and cry if this had taken place during the previous administration?
 
Having served as Associate Commissioner at the FDA during the first round of Plan B hysteria, I can personally attest to the heat and scrutiny it generated.  And appropriately so. The significant difference is that debate was internal to the agency. There were differences of opinion -- but the decisions (whether you agree with them or not) were FDA decisions.
 
Leaving aside the peculiar politics of reproductive health, this action by the Secrerary must be reversed. Left standing it will severely undermine the authority of the FDA and embolden those who think that political arm twisting should be used to influence agency decisions.
 
Katy -- bar that door!
The "word" is that FDA wants to  delay progressive approval by defining clinical benefit on a case by case basis and by front loading Phase I with all sorts of endpoints and metrics that it would be tantamount to going through all the hoops.   The point of the Critical Path initiative was to increase certainty and reduce the need for extensive human experimentation.  Instead, patients and doctors would tell innovators and the FDA how treatments are working in the real world.

The FDA would have a hand in writing regulations and guidances for accelerated approval.  But it seems to me that the agency should not be the one to determine clinical benefit especially when the scientific community and patients can do that.  It should just verify that products are doing what they were designed to do.  The pushback on progressive approval suggests that legislative action may be required to truly bring the FDA into the 21st century.

Yesterday I was pleased to chair Day 1 of the Social Media for Pharma event in New York City.

First off, this and similar events can no longer (and should no longer) be identified as “pharma” events. Witnessing today’s attendance by and active participation of members of the medical technology (née “device”) community along with a full table of dietary supplement marketers, makes it pretty clear this and similar symposia are healthcare events. 

And that’s a good thing.

A few memorable moments:

Greg Kueterman and Amy O’Connor of Eli Lilly & Company gave a splendid presentation on their health policy blog Lillypad (www.lillypad.lilly.com).  One of their most important points (not rocket science, but rarely discussed) is that, when it comes to healthcare in the social media space – it can be about things other than product marketing and that metrics are more than about volume.  It’s not about the top ten, but rather the right ten. Amen.

Greg asserted that he's “the Justin Bieber of healthcare social media.”  Not sure what that means, but it does seem to be an off-label claim.

William Martino (Saatchi & Saatchi Wellness) and Shermon McMillan (Chattem) – henceforth forever known as Shermon/William – painted an interesting portrait of social media and the OTC launch (and subsequent marketing) of Allegra. 

Ned Russell (Saatchi & Saatchi Wellness) pointed out that the oft-quoted FaceBook development maxim of “move fast and break things,” couldn’t be more antithetical to regulated healthcare communicators (note – not marketers, but communicators).  My comment was that this might explain the tone deafness of the world’s largest social media platform has to issues such as moderated user-generated commentaries.  (Also note that the FCC didn’t find FaceBook’s swiftness to cast aside privacy issues so kosher either.)

And, while we’re on the subject, why does FaceBook allow “drugs from Canada” pages.  Did they not get the memo from Google and the DOJ?

Tai Spargo of NORD discussed their new social media efforts in creating a plentitude of orphan disease sites minus any participation of the biopharmaceutical industry.  She also noted (and rightfully so) that there is no rare disease too small for social media.  To illustrate her point she displayed the FaceBook page “Cats in Sweaters.” Meow.

Check it out if you are so inclined at http://www.facebook.com/pages/Cats-in-sweaters/183921988289175. Idle hands indeed do the devil’s work.

Sharon Landa (Johnson & Johnson) and Erica Wittes Schlack (Communispace) discussed the design and utility of private (read, “closed”) social media communities.  Fascinating.  Two comments to pass along, “Feedback is about the brand, but discovery is about the consumer” (utility) and “Diversity is for conversation but similarity is for cohesion (design).

There was also much chatter about how to make social media programs work along side of “traditional communications initiatives.”

Rather than calling them “traditional,” perhaps we should label them as “legacy” programs.

And we all know what happens to those.

AHIP on HSAs

  • 12.06.2011
Politico notes that AHIP’s new report on health-savings accounts contain some interesting findings:
 
America's Health Insurance Plans is out with a new report on the state of health savings accounts. Among the findings: Lower-income individuals open HSAs at a greater rate than do higher income groups - with an average income in the mid-$50,000 range - and the amount of money that individuals have accumulated in their accounts has grown over time, and the amount of money being rolled over from one year to the next also has increased.
 
Click here to read the report.
FDA Approved Hangover Medication Hits Market.

The New York Daily News (12/3, Pesce) reported, "A new FDA-approved hangover cure has hit the market." The over-the-counter medication, dubbed Blowfish, "combines 1,000 milligrams of aspirin, 120 milligrams of caffeine and a stomach-soothing agent into two effervescent tablets taken the morning after a night of heavy drinking." Blowfish "costs $2.99 for a single dose, or $11.99 for a six-pack" and "is currently available in Ricky's NYC stores or online at ForHangovers.com."

        The website of WCBS-TV New York (12/5) reports, "Just in time for the holidays, the FDA approves a purported hangover remedy. Blowfish, created in the West Village, is promised to get rid of all your hangover symptoms within 15 to 30 minutes." FOX News Radio (12/4, Rappoport) added that that the drug "combines aspirin, caffeine and a stomach soother into two effervescent pills to be taken the morning after a night of partying." The remedy's creator Brenna Haysom "says the pill is only intended for people who had one too many, not binge drinkers."


At CMPI’s “PDUFA without the Politics” Capital Hill Briefing, Dr. Tim Franson (President, USP Convention, former Vice President, Global Regulatory Affairs, Eli Lilly & Co., and one of the “father’s of PDUFA”) mentioned the Hawthorne Effect – “that which is measured gets accomplished.”

Which begs the question – should more things in PDUFA V be measured or measured with more robust deliverables?

Are “meetings” sufficient promises – or are actions more desirable?  Specifically – are meetings about a benefit/risk grid enough or should there be a date-certain for a regulatory instrument to be operational?

Should PDUFA V be exclusively about process? What about provision?

Speech is conveniently located midway between thought and action, where it often substitutes for both.  – John Andrew Holmes

Always listen to the experts. They’ll tell you what can’t be done and why. Then they do it.  – Robert Heinlein

On Tuesday the Center for Medicine in the Public Interest (www.cmpi.org ) hosted a Capitol Hill panel entitled, “PDUFA without the Politics.” I was the moderator and was honored to be joined by a panel of peerless nonpareils that included Vincent J. Ventimiglia, Jr (Former Assistant Secretary for Legislation at the US Department of Health and Human Services), Paul T. Kim (Former Deputy Staff Director for health policy for Senator Edward M. Kennedy), Michele J. Orza (Former Assistant Director of the Health Care Team at the Government Accountability Office), and Tim Franson (Former Vice President, Global Regulatory Affairs, Eli Lilly & Co., President, USP Convention). The Honorable Michael C. Burgess, M.D. (Vice-Chairman, Subcommittee on Health, U.S. House of Representatives) offered remarks as well.

The participants were pithy, poetic, and pragmatic.

We will shortly post videos of all the aforementioned presenters.  In the meantime, here’s a short news story from Drug Information Daily:

Lawmakers Plan to Use PDUFA V Bill to Ease Conflict Rules for Advisory

Panels

Lawmakers plan to attach a bill easing financial conflict rules for FDA advisory panel members to legislation reauthorizing the Prescription Drug User Fee Act (PDUFA), a congressional leader says.

Rep. Michael Burgess (R-Texas) introduced H.R. 3206 last month and said Tuesday it would be attached to the measure authorizing PDUFA V, yet to be introduced to Congress. H.R. 3206 would eliminate the existing financial conflict rules for panelists, opening the door for committee members with greater expertise on the products they discuss.

Burgess, vice chair of the House Energy and Commerce Health Subcommittee, offered similar legislation during consideration of PDUFA IV in 2007, but it was voted down along party lines. With his Republican party now in control of the House, he may have an easier time gaining approval of the bill.

Speaking at a PDUFA V briefing for Capitol Hill staffers hosted by the Center for Medicine in the Public Interest (CMPI), Burgess said there are about 10 strong candidates for legislation to tack on to PDUFA V. One possibility is a bill addressing the issue of drug shortages, he said.

Another likely candidate is a bill to increase incentives for antibiotic makers, according to Foley Hoag lobbyist Paul Kim.

Proactive Lawmakers

Also at the briefing, Peter Pitts, former FDA associate commissioner and president of CMPI, urged Congress to be more proactive in changing the technical letter the FDA and drugmakers agreed to during PDUFA negotiations earlier this year. Specifically, Pitts called for more programs and agency action to address transparency and striking a better risk-benefit balance in product reviews.

Following these recommendations might mean altering the package the FDA and industry ratified, which has only happened once in the previous four PDUFA bills.

Recently, David Wheadon, PhRMA's senior vice president for scientific and regulatory affairs, said the package includes a "robust set of programs" to provide an objective measure of risk-benefit analysis at the agency.

I found it very hard to watch this 60 Minutes piece on kids whose parents were forced by extended joblessness and sudden, sustained cuts in pay to live out of their cars.   Having been unemployed and down to my last dollar many years ago (with the added burden of finding out a month before my son was born that my previous employer had not paid my health insurance premiums and was not going to give me my last paycheck) the segment not only resonated and brought back some sad and unpleasant memories, it reminded me that for millions of people the difference between a decent life and having to depend on government is very slim indeed.  A robust economy will go far to restore opportunity.  In the meantime, we all must do what we can to stop more people from winding up in the same situation share by those interviewed by 60 Minutes.

http://www.cbsnews.com/8301-18560_162-57330802/hard-times-generation-families-living-in-cars/



Event Horizon

  • 11.30.2011
BioCentury Reports:

EC proposes new research program

The European Commission proposed a new EU research and innovation program for 2014-20 called Horizon 2020, which would have a budget of EUR 80 billion ($107 billion). The proposal includes allocations of EUR 24.6 billion ($32.8 billion) for science research in Europe, including an increase in funding of 77% to EUR 13.2 billion ($17.6 billion) for the European Research Council (ERC); EUR $13.7 billion ($18.2 billion) for industrial technology development and small and medium-sized enterprises; and EUR 31.8 billion ($42.4 billion) to address societal concerns in areas such as climate change, energy and resource scarcity, and health and aging.

The EC said Horizon 2020 will have a simpler set of rules and procedures for obtaining funding than those of previous research programs, with the goal of reducing time to funding following a grant application by about 100 days. The European Parliament and EU Council will now review the proposal, with the goal of adopting it by year end 2013. The current research program, Framework Programme 7 (FP7), has a budget of EUR 54 billion and runs from 2007-13.
CMPI

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.

Blog Roll

Alliance for Patient Access Alternative Health Practice
AHRP
Better Health
BigGovHealth
Biotech Blog
BrandweekNRX
CA Medicine man
Cafe Pharma
Campaign for Modern Medicines
Carlat Psychiatry Blog
Clinical Psychology and Psychiatry: A Closer Look
Conservative's Forum
Club For Growth
CNEhealth.org
Diabetes Mine
Disruptive Women
Doctors For Patient Care
Dr. Gov
Drug Channels
DTC Perspectives
eDrugSearch
Envisioning 2.0
EyeOnFDA
FDA Law Blog
Fierce Pharma
fightingdiseases.org
Fresh Air Fund
Furious Seasons
Gooznews
Gel Health News
Hands Off My Health
Health Business Blog
Health Care BS
Health Care for All
Healthy Skepticism
Hooked: Ethics, Medicine, and Pharma
Hugh Hewitt
IgniteBlog
In the Pipeline
In Vivo
Instapundit
Internet Drug News
Jaz'd Healthcare
Jaz'd Pharmaceutical Industry
Jim Edwards' NRx
Kaus Files
KevinMD
Laffer Health Care Report
Little Green Footballs
Med Buzz
Media Research Center
Medrants
More than Medicine
National Review
Neuroethics & Law
Newsbusters
Nurses For Reform
Nurses For Reform Blog
Opinion Journal
Orange Book
PAL
Peter Rost
Pharm Aid
Pharma Blog Review
Pharma Blogsphere
Pharma Marketing Blog
Pharmablogger
Pharmacology Corner
Pharmagossip
Pharmamotion
Pharmalot
Pharmaceutical Business Review
Piper Report
Polipundit
Powerline
Prescription for a Cure
Public Plan Facts
Quackwatch
Real Clear Politics
Remedyhealthcare
Shark Report
Shearlings Got Plowed
StateHouseCall.org
Taking Back America
Terra Sigillata
The Cycle
The Catalyst
The Lonely Conservative
TortsProf
Town Hall
Washington Monthly
World of DTC Marketing
WSJ Health Blog