The Born Identity

• 01.15.2008

My book review of Embryo: A Defense of Human Life...

http://www.nypost.com/seven/01132008/postopinion/postopbooks/the_born_identity_433669.htm

Contempt for Pharmaceutical Companies: The Right Stuff for Being President?

• 01.15.2008

Here are two of the qualities Leon Wieseltier in The New Republic like about about John McCain that make him a nearly ideal presidential candidate. "anxiety over the environment and contempt for pharmaceutical companies."

Contempt for pharmaceutical companies? And how does that translate into good public policy? Pushing for drug reimportation? Patent seizures?

I think there is a bit of projection on Leon's part but what prompts this hatred? What did drug company's do wrong that deserves contempt? I know this will tick off the whack jobs that equate anything that is sponsored by drug companies as a pollutant or a criminal activity, but I really would like to know.

Dear Abby: No Comment

• 01.15.2008

The U.S. Supreme Court has, without comment, opted not to accept an appeal of Abigail Alliance v. von Eschenbach. This means the federal appeals court ruling that patients do not have a constitutional right to experimental drugs stands.

This is a tough, emotional issue and, with such heated rhetoric on both sides, it's easy to lose sight of the fact that everyone wants the same thing -- expanded access to drugs under clinical investigation.

That's precisely why, when I was at the FDA, we stopped calling clinical trials "compassionate use." It sounded too paternalistic. Allowing desperately ill patients into clinical trial programs shouldn't be an act of noblesse oblige it should be an act of civil society.

The question is, how to do so with greater alacrity and responsible, robust oversight.

When it comes to pharmaceutical safety, pure libertarianism isn't in the best interests of the public health. Expanded access to experimental drugs simply can't and shouldn't morph into total, unfettered access.

That doesn't mean the status quo is working. What it means is that the FDA needs to figure out a way to dramatically broaden and facilitate expanded access to experimental drugs under its review. And the Abigail Alliance and its supporters need to keep up the pressure to reform the current system.

We believe this is best done in a spirit of collegiality rather than a confrontational courtroom or in Congress.

And we believe the time for all parties to sit down for serious discussions is immediately. Lives hang in the balance.

Fibromyalgia? What would Hillary say?

• 01.14.2008

Page One story in today's New York Times continues the debate over whether or not fibromyalgia is a "real" disease. After all -- it's just a "women's problem," right?

Why is this on Page One? Surprise! Because one of the storylines is about how evil drug companies (in cahoots with the FDA) are spending money creating and promoting drugs for this faux syndrome.

But there is one paragraph worth sharing. The focus is on why the FDA chose to approve Lyrica (pregabalin) -- with an indication for treating fibromyalgia -- over the objection of some (unnamed) junior reviewers.

“While pregabalin does present a number of concerns related to its potential for toxicity, the overall risk-to-benefit ratio supports the approval of this product,” Dr. Bob Rappaport, the director of the F.D.A. division reviewing the drug, wrote in June 2004.

Risk. Benefit. Fibromyalgia. Millions of women. Millions of dollars. After all, if Pharma can help -- then there must be a hidden agenda. Ergo, pitch it for Page One, baby.

Nonsense. What would Hillary say? Someone should ask her about this during the next debate?

At the end of the day, it's a balanced article and an interesting issue. Alex Berenson does a nice job. But there's nothing new. Isn't there any real news that can be reported on the wood of our nation's newspaper of record?

Insta-Americans: The Television Show

• 01.14.2008

Click here:

http://www.kvue.com/video/index.html?vid=207443

Then look under "HealthVue Video: Experts: Know where your health info comes from."

And we do.

Jonathan Swift, meet Werner van den Gobbledygook

• 01.11.2008

For those of you watching EU policy on information to patients (“ITP” in EU parlance), there are two documents worth discussing.

The first is “Communication from the Commission to the European Parliament and the Council Concerning the Report on Current Practice with Regard to Provisions of Information to Patients on Medicinal Products’

(I know, it sounds like the title of a Jonathan Swift essay)

I quote directly:

“The provision of information on medicinal products requires taking into consideration the needs of patients in the context of healthcare provision.”

Once you get past all the banal bureaucratic gobbledygook, there’s some pretty interesting bureaucratic gobbledygook.

(Is there someone somewhere in a secret, secure location in Brussels named Werner van den Gobbledygook who edits all these EU documents?)

“Most sources available point to the increasingly active role of patients in this regard; patients have a right to be informed and in this context they should be able to access information about their health, medical conditions and the availability of treatments.”

A crucial point – but if the delivery of information is placed in the hands of governments (aka "payors") – will “availability of treatments” be defined as “what will be reimbursed” or will the full panoply of options be presented to newly empowered European patients? This is not just a finesse question, but rather hits at the heart of the matter. He who controls the access to knowledge controls the knowledge.

“Patients are no longer simply taking what is prescribed for them, but are increasingly involved as manager of their health. They become intensely involved with their illness, show great interest in health issues and have a constantly growing need for information.”

This is an elliptical way of saying that, when patients learn that they are being denied treatment because of cost-based vs. patient-centric government care schemes, they get upset – very upset.

And finally, “Recent evidence indicates that patients are however often unsuccessful in playing a larger role in their health decisions.”

Even though government health care limits, by definition, many health care options, the lack of information adds to that dilemma. According to the report, “Although there is insufficient evidence published, an increase in the quality and appropriateness of information available to patients would be expected to contribute to achieve better health conditions and also to contribute to a more efficient use of resources. Better informed patients are expected to adhere better to treatments and to better understand clinical decisions. This should lead in the long term to social and economic benefits.”

That’s right. And, once you plod your way through all the conditional phrasing, the report is saying that more information results in better outcomes which reduces costs. Amen. But when they say there is “insufficient evidence,” what they’re really saying is that there’s actually a lot of solid research – except that it pertains to the positive benefits of direct to consumer advertising. But at least they’ve embraced the concept that more information is better.

Unfortunately the report also calls for the EU to “keep the ban on direct to consumer advertising on prescription-only medicines.” (For more on this point, please see “Will Brussels DTC the Light?" at http://drugwonks.com/2006/10/will_brussels_dtc_the_light.html.) But that's another issue for another time.

Towards the end of the report, this refreshingly honest statement:

“Member States authorities may not be in a position to fully address patients’ needs in terms of the substance of information and the access via different means. In turn, the pharmaceutical industry possesses the key information on their medicines but this information can currently not be made available to patients and healthcare professionals throughout the EU.”

So much for Health Action International (HAI) who claims, “There is no health information gap in Europe.”

And then there’s the companion document, “Commission Staff Working Document: Background information supportive to the Communication from the Commission to the European Parliament and the Council concerning the Report on Current Practice with Regard to Provision of Information to Patients on Medicinal Products, in the form of different annexes”

(Indeed, the titles just keep getting sexier, pithier, and more lyrical).

Again, I quote directly:

“Pharmaceutical companies possess key information about their products which only in part (through leaflets and labels) is made available to the public. Consequently, the pharmaceutical industry has the potential to be an important source of information to respond to the growing demand for more and better information by patients and to help reduce the current information gap, provided that there will be adequate rules to ensure reliability, objectivity, and quality of information.”

And, “Like many patient organizations most pharmaceutical companies argue that information should be of high quality and not be judged by its source. These companies want to be able to produce non-promotional information for patients about their own medicines and diseases and make it public.”

EU Commission recognition that the pharmaceutical industry can be a valuable partner in the broader dissemination of timely and accurate health care information is an important step in the right direction.

And it’s about time because, as Julian Morris of the London-based International Policy Network quipped, “Europe is running out of failed alternatives.”

When You Have Nothing Nice To Say

• 01.10.2008

We are used to the usual beside the point rejoinders when people disagree with us. I'm linking to this particular one because, well, it's so feisty and original. At least Dr. Poses actually read what I wrote and responded substantively. Like calling me a tool of Big Pharma. And we had a meeting of the minds on comparative effectiveness. Oh well.

Here's the post below...

http://hcrenewal.blogspot.com/2008/01/sceptical-look-at-dire-warning-is.html#links

That health care in the US is now in a crisis is now a cliche. Finding our way out of this crisis requires logical discussion based on evidence, not half-truths and irrelevancies promulgated by people with hidden financial ties.

What does promulgated mean? Is that how you get MRSA?

ATLA Shrugged

• 01.10.2008

The organization formerly known as the Association of Trial Lawyers of America (ATLA) -- the NewSpeak-named American Association for Justice -- doesn’t like our study on the dangers of Internet health care information.

We must be doing something right.

According to the president of the association, Kathleen Flynn Peterson, “How can anyone take these groups seriously when they release studies based on a methodology of Google searches?”

Kathy -- it was a study about Internet searches. Google -- get it?

Since we're asking questions, here's one for Ms. Peterson -- Why are tort lawyers masquerading as health care advocates on Google in the first place?

Autism is a Genetic Disorder

• 01.10.2008

The recent article in the NEJM has the results of a carefully researched genomic analysis that included scientists from several institutes. The study was elegant -- comparing families and children with autism spectrum disorder (all independently adjudicated) with controls that did not along with those that had a bipolar diagnosis and therefore shared a genetic duplication and deletion on Chromosome 16p11.2 The analysis was run a three platforms and cross referenced to assure inter-reliabiity of results The consortium found that "a region of chromosome 16p11.2 influences susceptibility to autism when it is either deleted or duplicated" in about 1 percent of all cases. This adds to the growing body of knowledge that autism has multiple genetic sources

But that won't stop the fanatics and their propagandists like David Kirby who claim that it is something else, even if it isn't thimerasol, just as long as it is something that corporations are pushing in a dark conspiracy with the government:

"All that said, thimerosal may well not be a factor in a single case of autism. But what if one day, we discovered it had caused, say, one percent of all cases? With estimates of autism as high as 1.5 million in the country, that would mean 15,000 Americans who were ravaged by thimerosal (not to mention everyone overseas).

But if thimerosal is vindicated, or shown to be a very minor player, then what about other vaccine ingredients? And what about the rather crowded vaccine schedule we now impose upon families of young children? And what about reports of unvaccinated children in Illinois, California and Oregon who appear to have significantly lower rates of autism? Shouldn't we throw some research dollars into studying them?

You can answer that, no, we shouldn't, because the vaccine-autism debate is over.

But I am willing to wager that it has only just begun."

I hear the black choppers whirling overhead.

http://content.nejm.org/cgi/content/full/NEJMoa075974

How do you make a hormone?

• 01.10.2008

The FDA sent letters warning seven pharmacy operations that the claims they make about the safety and effectiveness of their so-called "bio-identical hormone replacement therapy," or "BHRT" products are unsupported by medical evidence, and are considered false and misleading by the agency. FDA is concerned that unfounded claims like these mislead women and health care professionals.

The pharmacy operations improperly claim that their drugs, which contain hormones such as estrogen, progesterone, and estriol (which is not a component of an FDA-approved drug and has not been proven safe and effective for any use) are superior to FDA-approved menopausal hormone therapy drugs and prevent or treat serious diseases, including Alzheimer's disease, stroke, and various forms of cancer.

FDA is concerned that the claims for safety, effectiveness, and superiority that these pharmacy operations are making mislead patients, as well as doctors and other health care professionals. Compounded drugs are not reviewed by the FDA for safety and effectiveness, and FDA encourages patients to use FDA-approved drugs whenever possible. The warning letters state that the pharmacy operations violate federal law by making false and misleading claims about their hormone therapy drugs.

The complete FDA announcement can be found here:

http://www.fda.gov/bbs/topics/NEWS/2008/NEW01772.html

The FDA also responded today to a citizen petition from Wyeth, Madison, NJ, asking FDA to take regulatory action against compounding pharmacy operations that produce compounded "BHRT" drugs. Other stakeholders, including health care providers and consumer groups, have also raised concerns about "BHRT" drugs.