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Much hand wringing and speculation over the FDA’s recent Vanda decision. And the big question being asked is:
Is this the end of the dynamic duo of safety/efficacy and the beginning of a new Holy Trinity that includes comparative effectiveness?
Most reporting went something like this (courtesy of the Washington Post):
“Vanda Pharmaceuticals' stock tumbled 73 percent Monday after federal regulators rejected the
In fairness, the FDA didn’t actually say anything. This is how Vanda chose to represent the communications it received from the agency.
But rather than looking at this through the lens of comparative effectiveness – perhaps a better way to think about it is via comparative safety. Should inferior performance in some settings (for example if you won't know about it for weeks) be a molecule killer? The debate isn’t only (or primarily) whether it's bad to be worse – but also whether it can be easily monitored.
A tough situation for the FDA and a potential opportunity for those who would exploit this situation to call for a NICE-like system in the U.S. – such as Senators Baucus and Conrad and their “Comparative Effectiveness Research Act of 2008”
But it’s really just the latest example of why dogmatic approaches to drug regulation don’t work -- and why the Critical Path program is so essential.
Nobody said the FDA’s job was an easy one.
"The government could start paying impartial experts to visit doctors to talk about the safety, effectiveness and cost of prescription drugs and other treatments.
The idea would be to give presentations along the lines of those given by company drug reps. But the federally funded presentations would provide a counterweight to the industry messages on specific drugs.
A bill to that end is likely to be introduced today in both houses of Congress, according to the Prescription Project, a nonprofit that backs this sort of thing."
Impartial? Hardly. Right off the bat bias is built in...the government subsidized detailing will reduce drug costs..or else? Already a conflict of interest is introduced..the federal drug reps will be beholden to Senators Kohl, Grassley who have one objective...using detaiing to restrict the use of brand drugs.
And who will benefit? I noticed the Prescription Project supports the measure. No coincidence that Jerry Avorn who runs his own academic detailing company and contracts with state Medicaid agencies is an advisor to the Prescription Project, which in turn benefits from suing drug companies. And Avorn using ALLHAT as an example of conflict free prescribing. Problem is, ALLHAT undertreats most African Americans who have stroke.
This is beyond academic medicine rent seeking behavior as the previous post pointed out...this is a power grab that punishes patients. Worse, can you imagine have federal drug reps reporting on the who, what and where or what doctors are doing... Talk about a pharmaceutical police state..Don't like what docs are prescribing, call in DEA 2.0
A new study in the Journal of Public Health shows that German physicians have "a feeling" when evidence-based medicie is being used as a cost containment tool rather than a clinical tool to improve patient outcomes. The study also indicates that for certain disease states (i.e., diabetes) EBM may play a greater role than in others (i.e., CNS ).
Here’s the abstract:
The MHRA started investigating Mr Essadki in January 2006 after receiving information from Pfizer that customers had complained about two websites advertising Viagra and Cialis for sale. On March 2006 MHRA enforcement officers, accompanied by representatives from Pfizer and Eli Lilly together with the Metropolitan Police, went to Mr Essadki’s home address and found a quantity of Viagra and Cialis tablets. These were seized along with computers, mobile phones and a laptop.
Mick Deats, Group Manager of Enforcement at the MHRA said, “The MHRA will not hesitate to take action against those who undermine public health. There is considerable risk to the public from obtaining medicines through unregulated websites. A medicine bought in this way has no guarantee of safety, quality or effectiveness. It could be counterfeit. It may not contain the right amount of medicine. At worst it may cause a severe side effect."
First – the operation began in March 2006 – over two years ago.
According to the Wall Street Journal, “Powerful members of Congress want to remake the Food and Drug Administration by giving it broad powers to levy fines, order drug recalls and restrict drug-industry advertising. Leading the drive are Rep. John Dingell (D., Mich.) and his longtime friend in Congress, Sen. Chuck Grassley (R., Iowa).”
“The lawmakers say an FDA restructuring should build a much taller wall between the agency and the industry it regulates. The FDA would gain authority to recall drugs, which it can't do today, and to impose significant fines on drug companies for safety violations. The lawmakers also want the FDA to inspect generic-drug makers before approving a new product. Perhaps most importantly, they want the next president to appoint a tough FDA commissioner completely independent from the industry.”
Can anyone out there think of even one drug that the FDA wanted recalled that was not “voluntarily” recalled?
No – I didn’t think so.
(Also, isn't the FDA already an entirely independent government agency?)FDA officials "are too cozy with the companies they regulate," Mr. Grassley said, adding that new leadership must "fix the culture."
What does “too cozy” mean? Really, what does it mean?
Senator Grassley believes the FDA Office of New Drugs, which he said has been compromised by its relations with industry lobbyists, among them former top FDA officials.”
And what does that mean? Any evidence to back up such blowhard accusations?
Too boot, here’s some really shoddy reporting by the Journal’s Alicia Mundy,
“Some current and former FDA safety reviewers have opened a whistleblower Web site to air their concerns that FDA leaders are pushing them to approve some drugs”
She is referring to www.thoreau-fda.com/index.php.
Oops.
But who needs facts when you have red-hot rhetoric and a gullible reporter who's willing to take a leak anywhere?
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.
