Latest Drugwonks' Blog
In his recent Wall Street Journal op-ed, Scott Gottlieb reveals how government-run comparative studies reflect a desire to focus on cost rather than care – and not (as often claimed) to usher in an era of science-based efficiency in medicine.
The Center for Medicine in the Public Interest recently held a conference on large scale comparative effectiveness studies. (Report can be found at http://cmpi.org/archives/2007/08/new_cmpi_report.php) As Gottlieb mentioned, one government study (ALLHAT) didn’t prove its hypothesis that older drugs are more effective in controlling blood pressure.
At the CMPI conference Dr. Michael Weber (an original member of the ALLHAT team) revealed that “ALLHAT exposed African-American patients for several years to treatments investigators knew would not be effective in controlling their blood pressure -- something so unethical that if a pharmaceutical company had done it or any of us as individual academics had done it, we would not only be thrown out of our jobs, we would be pilloried and maybe even be facing criminal charges. The study was driven entirely by a 40% excess stroke rate in black patients that was predictable before the study began. And they used that as their reason to claim superiority of the diuretic.â€
The government ran a study denying African Americans needed care to make a political point: cheaper drugs are better. Because ALLHAT is perceived as anti-industry no one cares if the regimen harms people. Is this the kind of comparative effectiveness we want – or that patient’s need?
The Center for Medicine in the Public Interest recently held a conference on large scale comparative effectiveness studies. (Report can be found at http://cmpi.org/archives/2007/08/new_cmpi_report.php) As Gottlieb mentioned, one government study (ALLHAT) didn’t prove its hypothesis that older drugs are more effective in controlling blood pressure.
At the CMPI conference Dr. Michael Weber (an original member of the ALLHAT team) revealed that “ALLHAT exposed African-American patients for several years to treatments investigators knew would not be effective in controlling their blood pressure -- something so unethical that if a pharmaceutical company had done it or any of us as individual academics had done it, we would not only be thrown out of our jobs, we would be pilloried and maybe even be facing criminal charges. The study was driven entirely by a 40% excess stroke rate in black patients that was predictable before the study began. And they used that as their reason to claim superiority of the diuretic.â€
The government ran a study denying African Americans needed care to make a political point: cheaper drugs are better. Because ALLHAT is perceived as anti-industry no one cares if the regimen harms people. Is this the kind of comparative effectiveness we want – or that patient’s need?
I am sure the black helicopter types who believe drug companies are actually colluding in ways to medicate children for mental illness...but is there any self-respecting psychiatrist who would actually fit this statement from an AP article on the increase in diagnoses for pediatric manic depression.
"Some doctors believe bipolar disorder doesn't occur in children, and until last month there was only one drug approved to treat the illness in kids."
The reporter never identifies those scholars. And then to link this statement with the fact that most pediatric drugs are used off-label. (Better to treat and observe than use kids as lab rats)
Yeah, and there are no drugs approved to treat stomach cancer in kids but they use them anyways.
Here's the entire article:
http://news.yahoo.com/s/ap/20070903/ap_on_he_me/bipolar_kids_3
"Some doctors believe bipolar disorder doesn't occur in children, and until last month there was only one drug approved to treat the illness in kids."
The reporter never identifies those scholars. And then to link this statement with the fact that most pediatric drugs are used off-label. (Better to treat and observe than use kids as lab rats)
Yeah, and there are no drugs approved to treat stomach cancer in kids but they use them anyways.
Here's the entire article:
http://news.yahoo.com/s/ap/20070903/ap_on_he_me/bipolar_kids_3
If you decided to use MapQuest for directions to better drug safety ideas, it might very well direct you to the intersection of Information and Engagement.
Nowhere is this made more clear than with a new program called iGuard. According to their website (http://www.iguard.org):
"iGuard is the fastest and easiest way for you to get personalized alerts and updates on the safety of your medicines.
We are the catalyst for the new conversation among patients, physicians, pharmacists, drug researchers and the government. Launched in 2007 as a startup venture funded by Quintiles Transnational, "iGuard puts the power of drug safety in the hands of each American, right where it should be," states Dr. Hugo Stephenson, founder and president of iGuard.
We facilitate the virtual flow of communication among patients, physicians, and researchers according to two guiding principles:
With iGuard, patients can feel safer because they will be sent the drug safety information they need, when they need it.
The more people that join iGuard, the faster we can help researchers identify safety problems - and communicate this information back to patients, caregivers, and their providers."
It's worth a look -- because it provides a hopeful glimpse into the future of drug safety.
I have seen the future -- and it is collaborative.
Nowhere is this made more clear than with a new program called iGuard. According to their website (http://www.iguard.org):
"iGuard is the fastest and easiest way for you to get personalized alerts and updates on the safety of your medicines.
We are the catalyst for the new conversation among patients, physicians, pharmacists, drug researchers and the government. Launched in 2007 as a startup venture funded by Quintiles Transnational, "iGuard puts the power of drug safety in the hands of each American, right where it should be," states Dr. Hugo Stephenson, founder and president of iGuard.
We facilitate the virtual flow of communication among patients, physicians, and researchers according to two guiding principles:
With iGuard, patients can feel safer because they will be sent the drug safety information they need, when they need it.
The more people that join iGuard, the faster we can help researchers identify safety problems - and communicate this information back to patients, caregivers, and their providers."
It's worth a look -- because it provides a hopeful glimpse into the future of drug safety.
I have seen the future -- and it is collaborative.
And ALLHAT Jazz too.
Important op-ed by Scott Gottlieb in today's Wall Street Journal on the continuing jihad against incremental innovation via poorly designed studies and slanted reporting thereof.
As Scott writes:
"The difficult nature of these "comparative" drug studies, the sort contemplated in Schip, requires more care, not less. These studies are hard to execute by their nature, a fact given short shrift by policy makers who believe the conclusions gleaned from the research will provide immediate cost savings.
For one thing, as the Allhat study proved, detecting small clinical differences between two active drugs, such as whether one pill lowers blood pressure more than another, requires very large studies that often fail to capture all of the patient preferences and characteristics that go into real world medical decisions. And once the study is completed, determining whether small differences are clinically meaningful can take years of follow up.
When the trials are under-funded and too small, or are poorly designed or conducted, important differences are not detected, which supports the theory that older drugs are as good as newer ones even if that is not true. This flawed science seems just fine with those who support these trials largely for cost purposes."
And many top clinical experts agree. Click on the link below and see what Hebert Meltzer, MD who helped to design CATIE, Michael Weber, MD, similarly involved with ALLHAT, Dr. Susan Horn of the Institute for Clinical Outcomes Research, Dr. David Shern, President and CEO of the National Mental Health Association, Ralph Snyderman, MD of Duke University have to say on the topic.
Download file
No matter how you cut it, evidence-based medicine based on bad evidence is bad medicine. This language disintermediates physicians, hurts patients and helps nobody other than payors (both public and private).
And that's not public health -- it's politics
Important op-ed by Scott Gottlieb in today's Wall Street Journal on the continuing jihad against incremental innovation via poorly designed studies and slanted reporting thereof.
As Scott writes:
"The difficult nature of these "comparative" drug studies, the sort contemplated in Schip, requires more care, not less. These studies are hard to execute by their nature, a fact given short shrift by policy makers who believe the conclusions gleaned from the research will provide immediate cost savings.
For one thing, as the Allhat study proved, detecting small clinical differences between two active drugs, such as whether one pill lowers blood pressure more than another, requires very large studies that often fail to capture all of the patient preferences and characteristics that go into real world medical decisions. And once the study is completed, determining whether small differences are clinically meaningful can take years of follow up.
When the trials are under-funded and too small, or are poorly designed or conducted, important differences are not detected, which supports the theory that older drugs are as good as newer ones even if that is not true. This flawed science seems just fine with those who support these trials largely for cost purposes."
And many top clinical experts agree. Click on the link below and see what Hebert Meltzer, MD who helped to design CATIE, Michael Weber, MD, similarly involved with ALLHAT, Dr. Susan Horn of the Institute for Clinical Outcomes Research, Dr. David Shern, President and CEO of the National Mental Health Association, Ralph Snyderman, MD of Duke University have to say on the topic.
Download file
No matter how you cut it, evidence-based medicine based on bad evidence is bad medicine. This language disintermediates physicians, hurts patients and helps nobody other than payors (both public and private).
And that's not public health -- it's politics
Here's a really superb example of health care grass roots "social marketing" -- made all the more exciting since it bubbled up all by itself ...
http://nocnews.blogspot.com/2007/08/healthcare-prescriptions-and-insurance.html
And in case you cannot link to the Pharmaceutical Executive article mentioned there, here's a better link ...
http://cmpi.org/archives/2007/08/opinion_fewer_cents_more_sense.php
(And, yes, it's the same Nazareth that's in The Band song "The Weight.")
Pulled into Nazareth ...
http://nocnews.blogspot.com/2007/08/healthcare-prescriptions-and-insurance.html
And in case you cannot link to the Pharmaceutical Executive article mentioned there, here's a better link ...
http://cmpi.org/archives/2007/08/opinion_fewer_cents_more_sense.php
(And, yes, it's the same Nazareth that's in The Band song "The Weight.")
Pulled into Nazareth ...
Oh, and the percentage of poor kids without health care coverage, the ones already eligible for Medicaid or SCHIP increased.
So, of course, the solution is to expand government coverage to rich white families.
http://www.census.gov/Press-Release/www/releases/archives/news_conferences/010500.html
So, of course, the solution is to expand government coverage to rich white families.
http://www.census.gov/Press-Release/www/releases/archives/news_conferences/010500.html
Carol Crim is not a name you will read about in the newspapers, although perhaps now you will read her obituary. But no tribute, no matter how well written, could possibly capture the impact this elegant lady had on America's health -- and on me personally.
I knew Carol in her role as executive secretary to Mark McClellan when he was FDA Commissioner. But she had served other Commissioners before him. She represented the Commissioner, the Office of the Commissioner, and the FDA to a wide variety of people both inside and outside of government, regardless of political affiliation, nationality, or degree of scientific standing with something so crucial, yet so lacking in so much of Washington, DC today. Class.
Those who knew her and worked along side her know what I mean. She helped keep us focused, keep our perspective, keep us on schedule and, on many occasions, keep our sanity.
When she became ill her friends and colleagues hoped publicly and wept privately.
Today, we weep publicly.
Carol, thanks for all the small favors, for loyalty and honesty, for precision and professionalism. And thanks for your friendship.
I miss you.
I knew Carol in her role as executive secretary to Mark McClellan when he was FDA Commissioner. But she had served other Commissioners before him. She represented the Commissioner, the Office of the Commissioner, and the FDA to a wide variety of people both inside and outside of government, regardless of political affiliation, nationality, or degree of scientific standing with something so crucial, yet so lacking in so much of Washington, DC today. Class.
Those who knew her and worked along side her know what I mean. She helped keep us focused, keep our perspective, keep us on schedule and, on many occasions, keep our sanity.
When she became ill her friends and colleagues hoped publicly and wept privately.
Today, we weep publicly.
Carol, thanks for all the small favors, for loyalty and honesty, for precision and professionalism. And thanks for your friendship.
I miss you.
along with others in a concise National Review Online symposium..
http://article.nationalreview.com/?q=ZmQwZTIzODQxYWQ3ZDlkNmVlZjVjYzA3MTA3ZTBkNzU=
http://article.nationalreview.com/?q=ZmQwZTIzODQxYWQ3ZDlkNmVlZjVjYzA3MTA3ZTBkNzU=
Not really, but Drew Altman of the Kaiser Family Foundation inadvertently comes up with great idea in plugging KFF's latest waste of money.
On the heels of co-sponsoring the hard hitting survey showing that poor seniors without Medicare part D coverage paid more for drugs than those without, KFF spent part of it's billions ona poll examining just how many people were affected by "Sicko."
Turns out that less than 4 percent of Americans saw the movie, give or take a couple of percentage points (that includes folks who saw it on the Web for free). Needless to say that's not the story KFF wanted to tell. So it asked who had heard of Michael Moore and Sicko right after the both had been basted with a huge marketing blitz. (Ok to market Sicko but not drugs, right?)
"The new poll finds that almost half (46%) had seen the movie or heard or read something about it a little over a month after its national release. This is not much less than the share of adults (61%) who were aware of "An Inconvenient Truth," the documentary on climate change featuring former Vice President Al Gore released in May 2006."
Well, at least Gore can say he won that race.
So what's the precious dross we can take away from this KFF poll?
"Our poll shows how the combination of good timing, a controversial director, and lots of free media attention can generate real impact for a film that very few people have actually seen," said Kaiser President and CEO Drew E. Altman, Ph.D. "'Sicko' is not a commercial juggernaut like 'Transformers' or 'Harry Potter,' and we're not likely to find Michael Moore action figures at fast food restaurants any time soon. But we are starting to see how films about social issues that capitalize on free media rather than traditional marketing can become social phenomena too."
A Michael Moore action figure at a fast food restaurant. Now THAT is funny. Maybe KFF would also be interested in my concept for a health care action movie. It would start Bruce Willis as a NYPD type in London who rescues Michael Moore when is taken hostage by a NHS doctor who is also a terrorist. It's called Fat Free or Die Hard.
PS Does a KFF poll promoting "Sicko" count as 'free media' or 'traditional marketing?'
On the heels of co-sponsoring the hard hitting survey showing that poor seniors without Medicare part D coverage paid more for drugs than those without, KFF spent part of it's billions ona poll examining just how many people were affected by "Sicko."
Turns out that less than 4 percent of Americans saw the movie, give or take a couple of percentage points (that includes folks who saw it on the Web for free). Needless to say that's not the story KFF wanted to tell. So it asked who had heard of Michael Moore and Sicko right after the both had been basted with a huge marketing blitz. (Ok to market Sicko but not drugs, right?)
"The new poll finds that almost half (46%) had seen the movie or heard or read something about it a little over a month after its national release. This is not much less than the share of adults (61%) who were aware of "An Inconvenient Truth," the documentary on climate change featuring former Vice President Al Gore released in May 2006."
Well, at least Gore can say he won that race.
So what's the precious dross we can take away from this KFF poll?
"Our poll shows how the combination of good timing, a controversial director, and lots of free media attention can generate real impact for a film that very few people have actually seen," said Kaiser President and CEO Drew E. Altman, Ph.D. "'Sicko' is not a commercial juggernaut like 'Transformers' or 'Harry Potter,' and we're not likely to find Michael Moore action figures at fast food restaurants any time soon. But we are starting to see how films about social issues that capitalize on free media rather than traditional marketing can become social phenomena too."
A Michael Moore action figure at a fast food restaurant. Now THAT is funny. Maybe KFF would also be interested in my concept for a health care action movie. It would start Bruce Willis as a NYPD type in London who rescues Michael Moore when is taken hostage by a NHS doctor who is also a terrorist. It's called Fat Free or Die Hard.
PS Does a KFF poll promoting "Sicko" count as 'free media' or 'traditional marketing?'
Guarantees are hard to come by. Even with medicine, doctors would be hard-pressed to tell patients that the drug they're prescribing is certain to work. After all, thanks to different medical histories, personal biochemistries, and physiologies, everyone is different. There's no such thing as a "me-too" patient.
That's why patients and their doctors often try a variety of different drugs before finding one that works - because there's no such thing as a "me-too" medicine. But in the interest of saving a few bucks, such personalized treatments may soon become a thing of the past.
This fundamental misunderstanding is being advanced by politicians grasping for answers to questions on health care. For an example, look no further than Reps. Tom Allen, D-ME, and Jo Ann Emerson, R-MO, whose Enhanced Health Care Value for All Act would increase spending on one-size-fits-all, top-down solutions.
The bill would authorize $3 billion of investment on new research "on the comparative effectiveness of health care services (including prescription drugs, medical devices, procedures, and other treatments) to inform health care providers' decisions." Senator Hillary Clinton also has advocated a similar program.
Here's the rest of the story, courtesy of the Tampa Tribune ...
http://www2.tbo.com/content/2007/aug/27/na-one-size-medicine-does-not-fit-all/?news-opinion-commentary
Comparative Effectiveness -- the Hanging Chad of Health Care
That's why patients and their doctors often try a variety of different drugs before finding one that works - because there's no such thing as a "me-too" medicine. But in the interest of saving a few bucks, such personalized treatments may soon become a thing of the past.
This fundamental misunderstanding is being advanced by politicians grasping for answers to questions on health care. For an example, look no further than Reps. Tom Allen, D-ME, and Jo Ann Emerson, R-MO, whose Enhanced Health Care Value for All Act would increase spending on one-size-fits-all, top-down solutions.
The bill would authorize $3 billion of investment on new research "on the comparative effectiveness of health care services (including prescription drugs, medical devices, procedures, and other treatments) to inform health care providers' decisions." Senator Hillary Clinton also has advocated a similar program.
Here's the rest of the story, courtesy of the Tampa Tribune ...
http://www2.tbo.com/content/2007/aug/27/na-one-size-medicine-does-not-fit-all/?news-opinion-commentary
Comparative Effectiveness -- the Hanging Chad of Health Care
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.
