Latest Drugwonks' Blog
Sid Taurel, Lilly CEO has an editorial in the Boston Herald about the mission of drug companies, of all things. More CEOs should talk about the science they are investing in and do it often.
Taurel writes:
"We are now beginning to understand biology as a set of information processes, and we’re developing realistic models of how disease and aging progress. And, we are developing the tools to reprogram them.
I believe that this represents the most exciting and important story in any technology field in this new century.
It might take decades for biologists to map all of this territory . . . and fully solve these new puzzles. But the good news is that patients will not have to wait decades to see the medical benefits of this massive effort. "
Unless military juntas, backed by certain members of Congress, make a hash of IP globally.
http://news.bostonherald.com/editorial/view.bg?articleid=187903&format=&page=1
Taurel writes:
"We are now beginning to understand biology as a set of information processes, and we’re developing realistic models of how disease and aging progress. And, we are developing the tools to reprogram them.
I believe that this represents the most exciting and important story in any technology field in this new century.
It might take decades for biologists to map all of this territory . . . and fully solve these new puzzles. But the good news is that patients will not have to wait decades to see the medical benefits of this massive effort. "
Unless military juntas, backed by certain members of Congress, make a hash of IP globally.
http://news.bostonherald.com/editorial/view.bg?articleid=187903&format=&page=1
This from fark.com...
FDA and drug makers claim that patients who eat and drive while under the influence of sleeping pills are actually asleep, rather than awake, intoxicated, and making bad decisions.
FDA and drug makers claim that patients who eat and drive while under the influence of sleeping pills are actually asleep, rather than awake, intoxicated, and making bad decisions.
What's the cost of playing politics with health care? Well, in this case, it seems to be $10 billion -- charged to the American tax payer by Representatives Waxman, Barton, and McCrery.
Lawmaker Inquiry May Bump Medicare Costs
By KEVIN FREKING, Associated Press Writer
WASHINGTON -- A lawmaker's inquiry could slightly increase the cost of the Medicare drug benefit if its results are publicized, congressional auditors said Tuesday.
Rep. Henry Waxman, D-Calif., has asked several insurers sponsoring Medicare drug plans to submit information about price concessions they wring from drug manufacturers. That pricing information is given to the Centers for Medicare and Medicaid Services, but cannot be disclosed.
Waxman's request has pharmaceutical companies worried, though he has not said what he would do with the information once he gets it.
The Congressional Budget Office estimates that disclosing the discounts means the cost of the drug benefit would likely increase by less than $10 billion over a 10-year period, and possibly much less.
The program is expected to cost about $45 billion this year alone.
Under the drug program, manufacturers typically give insurers a discount if they agree to cover a particular drug for their customers. The manufacturers would be less likely to offer the large rebates if they had to provide it to other types of insurance plans in the private sector, which would increase costs for the government and for enrollees, auditors said.
The publication of the prices also could encourage "tacit collusion" among the manufacturers of comparable medicines, they said. Such collusion occurs if drug makers offer similar discounts rather than trying to outdo each other in their pricing.
The CBO had originally projected in 2003 that disclosing discounts would increase the cost of the program by $40 billion over 10 years. The CBO lowered its estimate, in part, because Medicare plans are not getting substantially different discounts than what commercial plans get. The CBO had originally projected that Medicare plans would get substantially larger discounts, but the difference has been narrower than expected.
Two Republicans, Reps. Joe Barton of Texas and Jim McCrery of Louisiana, requested the CBO analysis.
Lawmaker Inquiry May Bump Medicare Costs
By KEVIN FREKING, Associated Press Writer
WASHINGTON -- A lawmaker's inquiry could slightly increase the cost of the Medicare drug benefit if its results are publicized, congressional auditors said Tuesday.
Rep. Henry Waxman, D-Calif., has asked several insurers sponsoring Medicare drug plans to submit information about price concessions they wring from drug manufacturers. That pricing information is given to the Centers for Medicare and Medicaid Services, but cannot be disclosed.
Waxman's request has pharmaceutical companies worried, though he has not said what he would do with the information once he gets it.
The Congressional Budget Office estimates that disclosing the discounts means the cost of the drug benefit would likely increase by less than $10 billion over a 10-year period, and possibly much less.
The program is expected to cost about $45 billion this year alone.
Under the drug program, manufacturers typically give insurers a discount if they agree to cover a particular drug for their customers. The manufacturers would be less likely to offer the large rebates if they had to provide it to other types of insurance plans in the private sector, which would increase costs for the government and for enrollees, auditors said.
The publication of the prices also could encourage "tacit collusion" among the manufacturers of comparable medicines, they said. Such collusion occurs if drug makers offer similar discounts rather than trying to outdo each other in their pricing.
The CBO had originally projected in 2003 that disclosing discounts would increase the cost of the program by $40 billion over 10 years. The CBO lowered its estimate, in part, because Medicare plans are not getting substantially different discounts than what commercial plans get. The CBO had originally projected that Medicare plans would get substantially larger discounts, but the difference has been narrower than expected.
Two Republicans, Reps. Joe Barton of Texas and Jim McCrery of Louisiana, requested the CBO analysis.
And what did the military junta expect, a big wet kiss?
Abbott Won't Launch New Drugs
In Thailand After Patent Revocation
By NICHOLAS ZAMISKA
Abbott Laboratories has decided against launching any new medicines in Thailand in response to the military-installed government's decision to revoke the company's patent for its blockbuster AIDS drug, according to people familiar with the matter.
The U.S. drug maker has also withdrawn its current drug applications from the government review process, these people said, adding that Abbott has no plans to stop selling drugs that are currently on the market.
Abbott's move, which could leave patients in Thailand with fewer options for treatment of certain conditions, raises the stakes in a battle between multinational pharmaceutical companies and the Thai government that took power following a military coup last year.
In January, the government said it would suspend patent protections for two drugs to make them more widely available to patients who need them. These included the HIV treatment Kaletra, made by Abbott, of Abbott Park, Ill., and Plavix, a blood-thinning drug originally developed by Sanofi-Aventis SA of Paris and co-marketed in several countries by New York-based Bristol-Myers Squibb Co.
In certain situations, including national emergencies, World Trade Organization rules allow a government to unilaterally make or sell patented drugs without the permission of the drug companies. However, pharmaceutical companies have criticized Thailand for stretching the scope of those rules beyond widely accepted boundaries.
Abbott has withdrawn its application for seven medicines, according to a person familiar with the matter, including a new formulation of Kaletra, the AIDS treatment. Abbott notified the Thai government a few weeks ago, after talks between the two sides broke down, the person familiar with the matter said.
A decision that may keep critical, life-saving drugs away of patients who need them could prove controversial for Abbott. "It's not good for anyone, even the American company because they will lose the market," says Thawat Suntrajarn, director general of the Ministry of Health's department of disease control, who says that he was unaware of Abbott's decision.
Abbott Won't Launch New Drugs
In Thailand After Patent Revocation
By NICHOLAS ZAMISKA
Abbott Laboratories has decided against launching any new medicines in Thailand in response to the military-installed government's decision to revoke the company's patent for its blockbuster AIDS drug, according to people familiar with the matter.
The U.S. drug maker has also withdrawn its current drug applications from the government review process, these people said, adding that Abbott has no plans to stop selling drugs that are currently on the market.
Abbott's move, which could leave patients in Thailand with fewer options for treatment of certain conditions, raises the stakes in a battle between multinational pharmaceutical companies and the Thai government that took power following a military coup last year.
In January, the government said it would suspend patent protections for two drugs to make them more widely available to patients who need them. These included the HIV treatment Kaletra, made by Abbott, of Abbott Park, Ill., and Plavix, a blood-thinning drug originally developed by Sanofi-Aventis SA of Paris and co-marketed in several countries by New York-based Bristol-Myers Squibb Co.
In certain situations, including national emergencies, World Trade Organization rules allow a government to unilaterally make or sell patented drugs without the permission of the drug companies. However, pharmaceutical companies have criticized Thailand for stretching the scope of those rules beyond widely accepted boundaries.
Abbott has withdrawn its application for seven medicines, according to a person familiar with the matter, including a new formulation of Kaletra, the AIDS treatment. Abbott notified the Thai government a few weeks ago, after talks between the two sides broke down, the person familiar with the matter said.
A decision that may keep critical, life-saving drugs away of patients who need them could prove controversial for Abbott. "It's not good for anyone, even the American company because they will lose the market," says Thawat Suntrajarn, director general of the Ministry of Health's department of disease control, who says that he was unaware of Abbott's decision.
Mark McClellan remains the hardest working man in American health care -- and one of the most astute.
Consider his recent remarks at the IOM symposium on the drug safety challenges faced by the FDA. Mark makes a very strong case that the agency should make more use of the pooled information contained in large health-care databases, like those run by private insurers that include information about 100 million Americans.
According to McClellan, surveillance, for problems like the increased risk of heart attack and stroke that led to the withdrawal of the popular painkiller Vioxx in 2004, could broaden the FDA’s view of drug safety problems as they emerge while respecting patient confidentiality.
Here's a link to the media report on Mark's comments:
http://www.msnbc.msn.com/id/17583122/
That's FDA reform for all -- not just REMS for Dems.
Consider his recent remarks at the IOM symposium on the drug safety challenges faced by the FDA. Mark makes a very strong case that the agency should make more use of the pooled information contained in large health-care databases, like those run by private insurers that include information about 100 million Americans.
According to McClellan, surveillance, for problems like the increased risk of heart attack and stroke that led to the withdrawal of the popular painkiller Vioxx in 2004, could broaden the FDA’s view of drug safety problems as they emerge while respecting patient confidentiality.
Here's a link to the media report on Mark's comments:
http://www.msnbc.msn.com/id/17583122/
That's FDA reform for all -- not just REMS for Dems.
Scott Gottlieb, in this Forbes.com piece, weighs in on the latest lunacy from Mr. Waxman, Congress' new Oversighter-and-Chief.
Medicine & Markets
Democrats Opt For Socialism Over Success
Scott Gottlieb, M.D.
A series of sharply worded letters fired off by a California congressman to health insurance companies, demanding that they disclose proprietary price data on what they pay for drugs they dispense to Medicare members, could undermine the government’s new drug benefit--a program that by all measures is working.
Medicare’s new program relies on networks of private drug plans, all competing to offer attractive benefits and discounted drugs in order to sign up new members. Most of the health plans have enrolled millions of members, and they have used this purchasing clout to extract deep discounts from the drug makers, translating into cheaper health coverage for Medicare members.
But even a successful program, so long as it relies on elements of the private market, is anathema to politicians if the political aim is health care run solely by Washington.
Enter Rep. Henry Waxman, D-Calif., the new head of the House Committee on Oversight and Government Reform. Under the guise of "oversight," Waxman sent letters to the 12 largest prescription drug plans, including Aetna, Humana and Wellpoint.
He demanded that they divulge data on the prices that they are paying for the drugs they offer beneficiaries, along with their administrative costs, negotiated price discounts and other price concessions obtained from drug makers. Waxman said he wants to determine how profitable they are and how much of the savings they negotiate is passed on to Medicare beneficiaries.
Rest assured, the Waxman dispatches wont push the plans off the cliff, so do not expect near-term impacts. But disclosing this commercial and confidential data could slowly erode the competitive activities that enable the Part D plans to save consumers' money and the new benefit program to lower drug costs.
Competition between the plans to lower costs turns on the negotiations that take place between the health plans and drug makers, and the ability of a drug maker to offer a preferred health plan more favorable pricing, often bundling together different drugs in one negotiation, without having to offer the same price to everyone else. This kind of price discrimination enables health plans use leverage and dealmaking to extract the lowest price for the panels of drugs that are most suitable to their members.
Disclosing the price breaks would probably quash the ability to work these bundling deals, which are at the heart of many discounts. With all the prices made public, every plan will get the same deal regardless of what they are willing to offer. You can bet the public price they are offered will be higher than the private deal they might have been able to cut.
The irony is, by all measures, this competition is working for consumers. Why would Washington want to abate it?
The average monthly premium that seniors pay is $24, far lower than the $37 originally estimated by government actuaries. While Democrats have hammered away at the idea that having seniors choose among competing drug plans is too "confusing," recent polls show satisfaction with the benefit at about 80 percent.
In 2007, insurers are marketing more than 50 different drug plans in every state except Alaska and Hawaii--up from an average of about 40 in 2006. Seventeen insurers are selling nationwide plans, up from nine last year. That compares with the one or two that critics of including private plans predicted would be available in many markets.
The Medicare program agrees that disclosing the price breaks would undermine the ability of health insurers and pharmacy benefit managers like Caremark Rx and Medco Health Solutions, who also administer drug plans, from obtaining discounts.
The program cites an FTC analysis concluding that whenever competitors know the actual prices charged by other firms, tacit collusion and thus higher prices may be more likely. Separately, the Congressional Budget Office said a proposal to disclose the price data would add $40 billion over 10 years to the cost of the Medicare drug benefit.
Right now, Medicare has held firm and is not disclosing the data. The Medicare law prevents public disclosure of the prices that Medicare drug plans pay drug makers for their medicines. Waxman’s letters to the private plans are a clever attempt at end-running this law. These plans are harder pressed to hold out, since the Waxman request carries the threat of a subpoena.
But they too would be wise to hold firm and let the courts decide just what Congress has a right to access. At least one company has sent a box of files with a nice note attached, but has not yet sent what the congressman asked for. Worst case, a judge rules the raw data must be turned over and empowers a monitor with explicit restrictions on how Congress uses the information.
The only prices that really matter, the ones that beneficiaries pay, are all publicly disclosed on Medicare’s Web site so that consumers can be smart shoppers. The broader lesson that bears reminding is that the government makes a bad business partner, especially when it comes to health care. Just ask the HMOs, who signed on a decade ago to treat Medicaid and Medicare beneficiaries only to see reimbursement rates slashed when the plans turned profitable. Now drug companies are seeing the consequence of their own Faustian bargain.
In Washington, the only health care businesses that continue to get honest funding by Congress are the ones that do not work. As soon as something turns a profit, Congress looks to take it away. The fear about Part D was always that the drug program would devolve into price controls, thus destroying incentives for research and development as European governments have done.
Ironically, the politicians working the hardest to hobble the successful Part D plans are those like Waxman who are also advocating a universal health care system. Given the political track record they are laying, what health care venture is going to ever trust them? If Waxman succeeds, Part D will be added to a long list of cautionary tales for health companies contemplating work with Washington.
Medicine & Markets
Democrats Opt For Socialism Over Success
Scott Gottlieb, M.D.
A series of sharply worded letters fired off by a California congressman to health insurance companies, demanding that they disclose proprietary price data on what they pay for drugs they dispense to Medicare members, could undermine the government’s new drug benefit--a program that by all measures is working.
Medicare’s new program relies on networks of private drug plans, all competing to offer attractive benefits and discounted drugs in order to sign up new members. Most of the health plans have enrolled millions of members, and they have used this purchasing clout to extract deep discounts from the drug makers, translating into cheaper health coverage for Medicare members.
But even a successful program, so long as it relies on elements of the private market, is anathema to politicians if the political aim is health care run solely by Washington.
Enter Rep. Henry Waxman, D-Calif., the new head of the House Committee on Oversight and Government Reform. Under the guise of "oversight," Waxman sent letters to the 12 largest prescription drug plans, including Aetna, Humana and Wellpoint.
He demanded that they divulge data on the prices that they are paying for the drugs they offer beneficiaries, along with their administrative costs, negotiated price discounts and other price concessions obtained from drug makers. Waxman said he wants to determine how profitable they are and how much of the savings they negotiate is passed on to Medicare beneficiaries.
Rest assured, the Waxman dispatches wont push the plans off the cliff, so do not expect near-term impacts. But disclosing this commercial and confidential data could slowly erode the competitive activities that enable the Part D plans to save consumers' money and the new benefit program to lower drug costs.
Competition between the plans to lower costs turns on the negotiations that take place between the health plans and drug makers, and the ability of a drug maker to offer a preferred health plan more favorable pricing, often bundling together different drugs in one negotiation, without having to offer the same price to everyone else. This kind of price discrimination enables health plans use leverage and dealmaking to extract the lowest price for the panels of drugs that are most suitable to their members.
Disclosing the price breaks would probably quash the ability to work these bundling deals, which are at the heart of many discounts. With all the prices made public, every plan will get the same deal regardless of what they are willing to offer. You can bet the public price they are offered will be higher than the private deal they might have been able to cut.
The irony is, by all measures, this competition is working for consumers. Why would Washington want to abate it?
The average monthly premium that seniors pay is $24, far lower than the $37 originally estimated by government actuaries. While Democrats have hammered away at the idea that having seniors choose among competing drug plans is too "confusing," recent polls show satisfaction with the benefit at about 80 percent.
In 2007, insurers are marketing more than 50 different drug plans in every state except Alaska and Hawaii--up from an average of about 40 in 2006. Seventeen insurers are selling nationwide plans, up from nine last year. That compares with the one or two that critics of including private plans predicted would be available in many markets.
The Medicare program agrees that disclosing the price breaks would undermine the ability of health insurers and pharmacy benefit managers like Caremark Rx and Medco Health Solutions, who also administer drug plans, from obtaining discounts.
The program cites an FTC analysis concluding that whenever competitors know the actual prices charged by other firms, tacit collusion and thus higher prices may be more likely. Separately, the Congressional Budget Office said a proposal to disclose the price data would add $40 billion over 10 years to the cost of the Medicare drug benefit.
Right now, Medicare has held firm and is not disclosing the data. The Medicare law prevents public disclosure of the prices that Medicare drug plans pay drug makers for their medicines. Waxman’s letters to the private plans are a clever attempt at end-running this law. These plans are harder pressed to hold out, since the Waxman request carries the threat of a subpoena.
But they too would be wise to hold firm and let the courts decide just what Congress has a right to access. At least one company has sent a box of files with a nice note attached, but has not yet sent what the congressman asked for. Worst case, a judge rules the raw data must be turned over and empowers a monitor with explicit restrictions on how Congress uses the information.
The only prices that really matter, the ones that beneficiaries pay, are all publicly disclosed on Medicare’s Web site so that consumers can be smart shoppers. The broader lesson that bears reminding is that the government makes a bad business partner, especially when it comes to health care. Just ask the HMOs, who signed on a decade ago to treat Medicaid and Medicare beneficiaries only to see reimbursement rates slashed when the plans turned profitable. Now drug companies are seeing the consequence of their own Faustian bargain.
In Washington, the only health care businesses that continue to get honest funding by Congress are the ones that do not work. As soon as something turns a profit, Congress looks to take it away. The fear about Part D was always that the drug program would devolve into price controls, thus destroying incentives for research and development as European governments have done.
Ironically, the politicians working the hardest to hobble the successful Part D plans are those like Waxman who are also advocating a universal health care system. Given the political track record they are laying, what health care venture is going to ever trust them? If Waxman succeeds, Part D will be added to a long list of cautionary tales for health companies contemplating work with Washington.
The Washington Times
www.washingtontimes.com
The VA 'model'
By Robert Goldberg
THE WASHINGTON TIMES
Published March 12, 2007
Recently, John Stossel of ABC had lunch with Sen. Hillary Clinton. Mr. Stossel writes that when he launched into one of his usual libertarian rants about free markets, Mrs. Clinton cited the VA as an example of government success. Indeed, under her husband's administration, the Veterans Health Administration came to provide the "best care anywhere," according to the Washington Monthly. It was clear in the Monthly piece and in Mrs. Clinton's other remarks about the glories of the VA health-care system that it was a model for expanding coverage to all Americans. Similarly, Democrats and the media could not contain their enthusiasm for the way the VA doled out drugs at bargain-basement prices as an alternative to the current Medicare drug benefit.
Democrats beat a strategic retreat from imposing restrictions on access to medicines that veterans deal with when it became clear that seniors valued freedom of choice. Mrs. Clinton might want to reconsider her recent depiction of the VA as a medical paradise she created in light of growing dissatisfaction and poor treatment of the mental-health needs of the members of the armed forces returning from Iraq. We know accepting responsibility is too much to ask.
The VA is having a hard time handling all the most common battle-related injuries: traumatic brain injury and post-traumatic-stress disorder. It is not a matter of lack of funding or staffing or compassion. It is a matter of trying to do what a single-payer government system does anywhere in the world: force as much of the treatment of specialized care of complex and chronic illnesses down to the primary care doctor in order to hold down costs.
The VA system has made much of the fact that some of its outpatient centers outperformed commercial managed-care organizations on certain process measures (screening for diabetes and diabetes-related illnesses, checking cholesterol levels) more than seven years ago. And no one should dispute that the VA has made strides to improve the ability to follow patients through the system, something that makes it easier to reduce errors and improve care.
But there are simple measures for judging the quality of care. If you need care, you get it when you need it. If you're sick, when you get treatment you get better. Finally, what is done is based on total well-being and for the long haul, not to meet a short-term budget goal. And the way to guarantee quality is simpler still. If you don't get care that meets those standards, you should be free to seek it out and get it somewhere else.
And when it comes to treating traumatic brain injury and post-traumatic-stress disorder, we have very good evidence about that earlier admission that newer medications and more aggressive treatments are essential to better outcomes. Both illnesses are also associated with other psychiatric disorders and substance-abuse problems. Meanwhile, on average, it takes six months for the VA to process a new claim for coverage. And once enrolled, it takes nearly a month to even get a primary care doctor, let alone to see a specialist for complex conditions. The VA is often in the forefront of research in such areas, but efforts to translate findings into clinical practice are stymied by the one-size-fits-all approach to doling out care.
And no amount of funding will change this approach fast enough to provide veterans the kind of care they deserve. More choice and the freedom to go outside the VA system rather than die waiting could make the difference. But don't hold your breath. Under the visionary leadership of Rep. Pete Stark, California Democrat, Congress is already seeking to reduce the amount of money spent on Medicare managed health plans to pay for other social programs. Since the so-called savings go to plans with the sickest seniors, siphoning that cash will not only hurt the elderly but would also deny veterans another choice of health care.
Congress is eager to give airplane passengers the right to a refund if they wait longer than three hours on the tarmac before takeoff. Why can't it give returning veterans the same right if they have to wait longer than what is medically prudent for care?
The failure of the VA system to meet the mental-health needs of returning soldiers is a direct result of the fact that they are not consumers but captives. If we are asking them to fight for our freedoms, the least we can do is give them the freedom to seek care when they return wounded from the battlefield. They truly deserve to receive the best care, anywhere they can get it.
Robert Goldberg is vice president of the Center for Medicine in the Public Interest.
www.washingtontimes.com
The VA 'model'
By Robert Goldberg
THE WASHINGTON TIMES
Published March 12, 2007
Recently, John Stossel of ABC had lunch with Sen. Hillary Clinton. Mr. Stossel writes that when he launched into one of his usual libertarian rants about free markets, Mrs. Clinton cited the VA as an example of government success. Indeed, under her husband's administration, the Veterans Health Administration came to provide the "best care anywhere," according to the Washington Monthly. It was clear in the Monthly piece and in Mrs. Clinton's other remarks about the glories of the VA health-care system that it was a model for expanding coverage to all Americans. Similarly, Democrats and the media could not contain their enthusiasm for the way the VA doled out drugs at bargain-basement prices as an alternative to the current Medicare drug benefit.
Democrats beat a strategic retreat from imposing restrictions on access to medicines that veterans deal with when it became clear that seniors valued freedom of choice. Mrs. Clinton might want to reconsider her recent depiction of the VA as a medical paradise she created in light of growing dissatisfaction and poor treatment of the mental-health needs of the members of the armed forces returning from Iraq. We know accepting responsibility is too much to ask.
The VA is having a hard time handling all the most common battle-related injuries: traumatic brain injury and post-traumatic-stress disorder. It is not a matter of lack of funding or staffing or compassion. It is a matter of trying to do what a single-payer government system does anywhere in the world: force as much of the treatment of specialized care of complex and chronic illnesses down to the primary care doctor in order to hold down costs.
The VA system has made much of the fact that some of its outpatient centers outperformed commercial managed-care organizations on certain process measures (screening for diabetes and diabetes-related illnesses, checking cholesterol levels) more than seven years ago. And no one should dispute that the VA has made strides to improve the ability to follow patients through the system, something that makes it easier to reduce errors and improve care.
But there are simple measures for judging the quality of care. If you need care, you get it when you need it. If you're sick, when you get treatment you get better. Finally, what is done is based on total well-being and for the long haul, not to meet a short-term budget goal. And the way to guarantee quality is simpler still. If you don't get care that meets those standards, you should be free to seek it out and get it somewhere else.
And when it comes to treating traumatic brain injury and post-traumatic-stress disorder, we have very good evidence about that earlier admission that newer medications and more aggressive treatments are essential to better outcomes. Both illnesses are also associated with other psychiatric disorders and substance-abuse problems. Meanwhile, on average, it takes six months for the VA to process a new claim for coverage. And once enrolled, it takes nearly a month to even get a primary care doctor, let alone to see a specialist for complex conditions. The VA is often in the forefront of research in such areas, but efforts to translate findings into clinical practice are stymied by the one-size-fits-all approach to doling out care.
And no amount of funding will change this approach fast enough to provide veterans the kind of care they deserve. More choice and the freedom to go outside the VA system rather than die waiting could make the difference. But don't hold your breath. Under the visionary leadership of Rep. Pete Stark, California Democrat, Congress is already seeking to reduce the amount of money spent on Medicare managed health plans to pay for other social programs. Since the so-called savings go to plans with the sickest seniors, siphoning that cash will not only hurt the elderly but would also deny veterans another choice of health care.
Congress is eager to give airplane passengers the right to a refund if they wait longer than three hours on the tarmac before takeoff. Why can't it give returning veterans the same right if they have to wait longer than what is medically prudent for care?
The failure of the VA system to meet the mental-health needs of returning soldiers is a direct result of the fact that they are not consumers but captives. If we are asking them to fight for our freedoms, the least we can do is give them the freedom to seek care when they return wounded from the battlefield. They truly deserve to receive the best care, anywhere they can get it.
Robert Goldberg is vice president of the Center for Medicine in the Public Interest.
Mark McClellan's spoke to the generic trade group about follow on biologics. In a word, focus on working with the FDA to develop the science for FOBs instead of just ramming through the current legislation which could, because it is devoid of science, could set FOBs back a decade. In this regard, Hillary Clinton appears to have moved into the science-based camp and has called for more clinical testing and post marketing monitoring of FOBs. Good for her. It shows she is serious about the subject.
Here's what the FDA has said about the benefits and risks of various EPOs:
"FDA and the manufacturer of these products have agreed on revised product labeling that includes updated warnings, a new boxed warning, and modifications to the dosing instructions. The new boxed warning advises physicians to monitor red blood cell levels (hemoglobin) and to adjust the ESA dose to maintain the lowest hemoglobin level needed to avoid the need for blood transfusions. Physicians and patients should carefully weigh the risks of ESAs against transfusion risks.
Recently completed studies describe an increased risk of death, blood clots, strokes, and heart attacks in patients with chronic kidney failure when ESAs were given at higher than recommended doses. In other studies, more rapid tumor growth occurred in patients with head and neck cancer who received these higher doses.
In studies where ESAs were given at recommended doses, an increased risk of death was reported in patients with cancer who were not receiving chemotherapy and an increased risk of blood clots was observed in patients following orthopedic surgery."
Now here is how the BMJ -- what an appropriate acronym -- covers it:
"Concerns about the safety of a class of drugs used to treat anaemia have triggered a federal alert in the United States. The alert comes after recent studies reported a higher incidence of fatal cancers and cardiovascular events among patients who were treated with drugs known as erythropoiesis stimulating agents when the drugs were used to raise haemoglobin concentrations to more than 120 g/l.
The US Food and Drug Administration issued the alert on 16 February, urging doctors "not to [give doses] to exceed haemoglobin levels of 12 g/dl" when treating patients with anaemia resulting from chronic renal failure, cancer or cancer chemotherapy, or HIV or AIDS."
See how BMJ traverses from proceeding with caution to prescribing beyond a specific hemoglobin level? Notice how things have moved from an advisory to a triggering a federal alert, like some terrorist warning? And note the inconsistency in metrics. Can we stick with 120g/l or 12g/dl from one graf to the next please?
Oh and leave it BMJ to allege a plot of some sort: conflicted scientists stuffed with cash hiding results about how plying patients with EPO kills them...as if there were no independent drug safety monitoring board reviewing the study as it progresses and if there were no mechanistic reason to explore the use of EPO in other cases...
"Issues of financial conflicts of interest and unpublished data have led to considerable controversy around the drugs. The New England Journal of Medicine decided not to publish an opinion piece it commissioned from Robert Steinbrook, one of the journal's senior physician writers, who questioned whether guidelines issued by the National Kidney Foundation to achieve higher concentrations of haemoglobin may have been tainted by multimillion dollar contributions from the manufacturers of the drugs, says a report in the Wall Street Journal (26 Dec 2006, p B1)."
Ok. I'm back. Had to shower after reading THAT again.
Let me state that I have always thought that the nextgen approach to EPO dosing - or dosing of any kind -- should be of the personalized sort, finding which dose works best with what subpopulation of patients. This is the right approach for any number of reasons.
Having said that, I am so sick and tired of this allegation of bribery regarding guidelines. If anyone -- including -- the lazy author of the first WSJ article on this subject had taken the time to read the NKF involvement in guideline development with respect to dialysis (a distinction that BM-J does not make in it's J'accuse) and use of EPO type meds they would see it is as transparent as BMJ's hatred of the pharmaceutical industry.
http://www.kidney.org/PROFESSIONALS/kdoqi/nkfAdvisory.cfm
And moreover they would see that in the past Medicare reimbursement rates had kept EPO doses artificially low to the point that people were not getting sufficient hemocrit levels. Dosing is higher and so is survival. At least in anemia. We are finding that this is not always the case in other clinical situations. Absent biomarker driven or more aggressive use of observational studies, reliance on RCTs will cause us to stumble our way to better or more targeted care. That's the way science proceeds. It is not a function of malfeasance.
"FDA and the manufacturer of these products have agreed on revised product labeling that includes updated warnings, a new boxed warning, and modifications to the dosing instructions. The new boxed warning advises physicians to monitor red blood cell levels (hemoglobin) and to adjust the ESA dose to maintain the lowest hemoglobin level needed to avoid the need for blood transfusions. Physicians and patients should carefully weigh the risks of ESAs against transfusion risks.
Recently completed studies describe an increased risk of death, blood clots, strokes, and heart attacks in patients with chronic kidney failure when ESAs were given at higher than recommended doses. In other studies, more rapid tumor growth occurred in patients with head and neck cancer who received these higher doses.
In studies where ESAs were given at recommended doses, an increased risk of death was reported in patients with cancer who were not receiving chemotherapy and an increased risk of blood clots was observed in patients following orthopedic surgery."
Now here is how the BMJ -- what an appropriate acronym -- covers it:
"Concerns about the safety of a class of drugs used to treat anaemia have triggered a federal alert in the United States. The alert comes after recent studies reported a higher incidence of fatal cancers and cardiovascular events among patients who were treated with drugs known as erythropoiesis stimulating agents when the drugs were used to raise haemoglobin concentrations to more than 120 g/l.
The US Food and Drug Administration issued the alert on 16 February, urging doctors "not to [give doses] to exceed haemoglobin levels of 12 g/dl" when treating patients with anaemia resulting from chronic renal failure, cancer or cancer chemotherapy, or HIV or AIDS."
See how BMJ traverses from proceeding with caution to prescribing beyond a specific hemoglobin level? Notice how things have moved from an advisory to a triggering a federal alert, like some terrorist warning? And note the inconsistency in metrics. Can we stick with 120g/l or 12g/dl from one graf to the next please?
Oh and leave it BMJ to allege a plot of some sort: conflicted scientists stuffed with cash hiding results about how plying patients with EPO kills them...as if there were no independent drug safety monitoring board reviewing the study as it progresses and if there were no mechanistic reason to explore the use of EPO in other cases...
"Issues of financial conflicts of interest and unpublished data have led to considerable controversy around the drugs. The New England Journal of Medicine decided not to publish an opinion piece it commissioned from Robert Steinbrook, one of the journal's senior physician writers, who questioned whether guidelines issued by the National Kidney Foundation to achieve higher concentrations of haemoglobin may have been tainted by multimillion dollar contributions from the manufacturers of the drugs, says a report in the Wall Street Journal (26 Dec 2006, p B1)."
Ok. I'm back. Had to shower after reading THAT again.
Let me state that I have always thought that the nextgen approach to EPO dosing - or dosing of any kind -- should be of the personalized sort, finding which dose works best with what subpopulation of patients. This is the right approach for any number of reasons.
Having said that, I am so sick and tired of this allegation of bribery regarding guidelines. If anyone -- including -- the lazy author of the first WSJ article on this subject had taken the time to read the NKF involvement in guideline development with respect to dialysis (a distinction that BM-J does not make in it's J'accuse) and use of EPO type meds they would see it is as transparent as BMJ's hatred of the pharmaceutical industry.
http://www.kidney.org/PROFESSIONALS/kdoqi/nkfAdvisory.cfm
And moreover they would see that in the past Medicare reimbursement rates had kept EPO doses artificially low to the point that people were not getting sufficient hemocrit levels. Dosing is higher and so is survival. At least in anemia. We are finding that this is not always the case in other clinical situations. Absent biomarker driven or more aggressive use of observational studies, reliance on RCTs will cause us to stumble our way to better or more targeted care. That's the way science proceeds. It is not a function of malfeasance.
Is cigarette smoking deleterious to America's health. Absolutely. Should Americans who currently smoke quit? Absolutely. Should the FDA regulate tobacco products? Absolutely not.
Pending legislation (Kennedy-Cornyn and Waxman-Davis) aims to give the FDA broad authority over tobacco products, providing the agency with oversight over virtually every aspect of tobacco company operations. The knee-jerk reaction is "great!" But, when you ask ""Would such legislation result in fewer smokers and reduced death and debilitation from tobacco? the answer is very unclear -- with the weight of logic and evidence saying otherwise.
For example, proposed legislation would set a very high bar (both scientific and procedural) before the FDA could approve a claim of "modified risk." The impact here would be to reduce any tobacco company's ability (or, most probably, desire) to promote their brands that are lower in nicotine content or, indeed, to even develop such products.
Or consider this, adult smoking has been declining since 1997 -- due to a number of things including clean air laws, media campaigns, and youth access programs. Who did these things? Largely the states. If FDA became the nation's tobacco czar, it would become difficult if not impossible to convince state legislators to continue to allocate the funds required for robust state-level tobacco control programs.
And then, of course, there's the question of both FDA resources and expertise. Let's take the latter first. What is the current level of FDA expertise in tobacco regulation? Let me put it this way -- none. As far as resources are concerned, the FDA's tobacco program would be funded by user fees. And, considering the current PDUFA-IV negotiations, you have to ask yourself if this is really the way we want to be going.
So, when you consider all of these issues (and there are many others)the answer to "Will FDA regulation of tobacco help to reduce tobacco use in America?" is very much an open one.
So for now, thank you for not regulating.
FYI -- the Center for Medicine in the Public Interest (the sponsor of drugwonks.com) does not accept funding from the tobacco industry.
Pending legislation (Kennedy-Cornyn and Waxman-Davis) aims to give the FDA broad authority over tobacco products, providing the agency with oversight over virtually every aspect of tobacco company operations. The knee-jerk reaction is "great!" But, when you ask ""Would such legislation result in fewer smokers and reduced death and debilitation from tobacco? the answer is very unclear -- with the weight of logic and evidence saying otherwise.
For example, proposed legislation would set a very high bar (both scientific and procedural) before the FDA could approve a claim of "modified risk." The impact here would be to reduce any tobacco company's ability (or, most probably, desire) to promote their brands that are lower in nicotine content or, indeed, to even develop such products.
Or consider this, adult smoking has been declining since 1997 -- due to a number of things including clean air laws, media campaigns, and youth access programs. Who did these things? Largely the states. If FDA became the nation's tobacco czar, it would become difficult if not impossible to convince state legislators to continue to allocate the funds required for robust state-level tobacco control programs.
And then, of course, there's the question of both FDA resources and expertise. Let's take the latter first. What is the current level of FDA expertise in tobacco regulation? Let me put it this way -- none. As far as resources are concerned, the FDA's tobacco program would be funded by user fees. And, considering the current PDUFA-IV negotiations, you have to ask yourself if this is really the way we want to be going.
So, when you consider all of these issues (and there are many others)the answer to "Will FDA regulation of tobacco help to reduce tobacco use in America?" is very much an open one.
So for now, thank you for not regulating.
FYI -- the Center for Medicine in the Public Interest (the sponsor of drugwonks.com) does not accept funding from the tobacco industry.
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.
