Tag: Pharma

PHARMA/PHYSICIANS: Yet more on Rx data sales

The NEJM has a perspective about the sale of Rx data of physicians prescribing patterns, which caused a lot of fuss on THCB a while back. In my view this is problem about number 728 on the docket of what’s wrong in American health care, and those physicians complaining about it should look to solve the first several hundred before they set their sites on changing the law, or just kick the drug reps out of their offices. There’s nothing particularly good about the current situation but it’s just not that big a problem and banning the sale of data won’t change it too much. the perspective from Robert Steinbrook largely agrees.

Prohibiting the release of prescribing data to sales representatives will not put an end to another practice to which some physicians object: the use of such data by managed care or pharmacy benefit managers. These entities have sources of information that are independent of the AMA Masterfile. It also will not stop visits from sales agents, which doctors have always had the right to refuse, nor will it curtail the marketing of drugs. According to the AMA, the potential effects of restricted release may include a reduction in the number of “offers physicians currently receive from the pharmaceutical industry, such as drug samples, CME programs and speaking engagements.”

PHARMA: The Macular Degeneration Rip Off, By PAT AWASH

Occassionally I get actual patients writing into me at THCB and sometimes it’s worth letting their experience with the system tell a story about how the opaque world of drug and health services pricing comes home to ground level. This is a verbatim email from a 70 year old patient Pat Awash:

Friday, June 9, 2006 I was facing imminent blindness in  one eye and poor vision in the other. Beginning Saturday a miracle began to unfold after an initial injection in my eye of Avastin. Avastin is used to treat mestasticized colon cancer and someone deduced that it might, just might be effective for Age-Related Macular Degeneration, the leading cause of blindness and vision impairment among the elderly.

Due to an undetermined cause, leaking fluid had formed a large blister behind my retina causing four changes in my eye-glass
  prescription between February 24, 1906 and late May, 2006, the last of which
  did not hold for four days. I was frightened to say the least. Only one day after the injection I  experienced a 70% vision improvement. This improvement continues each day and I am using a three-year-old prescription.

I am writing in objection to the current policy of the FDA in regard to Avastin. It is an off-label use but the cost is minimal, only $60.00 when provided at cost as my physician does. The same drug company that
  makes Avastin has developed Lucentis which has a slightly different molecular
  structure than Avastin but is basically an analog. Only thing is, Lucentis will cost an expected $1,500.00 per dose. They claim a reported $400 million research cost but I’m wondering what is included in that amount. 

I hope you get the picture. The manufacturer of Lucentis has changed the drug to the degree that it can be classified as a new drug. Whereas Avastin is expensive when used as a cancer drug it is very  inexpensive for eye treatments because the dose is so small, and some would say Lucentis is not as effective. Once approved, Lucentis will be covered by
  Medicare, a windfall for the manufacturer and huge cost to the public considering a rapidly aging population. Gentech could have done the trial on Avastin.
  Everything would be ok except Genentech will no longer make Avastin available except to those who exclusively treat cancer patients.
  No off-label applications and no choice for patients. Thankfully, my physician bought a substantial (several month’s) supply prior to the June 1, 2006 cut-off date.
  I find this insane and I think you will too. I am sick and tired of experts saying how much trouble Medicare is in when this kind of shenanigan is going on.


Pat Ahwash (a 70-year-old senior citizen)

PHARMA: Can There Be Too Many Cures for Cancer? by Maggie Mahar

Last week, an upbeat story
  in the New York Times
described how big pharmaceutical companies have discovered
  cancer. A few years ago, the article points out, companies like Pfizer, Glaxo
  and Wyeth had relatively little interest in what they saw as a "niche market."

While a great many people die of cancer, the disease takes so many different
  forms that each market is relatively small. Big Pharma generally would rather
  focus its research on diseases with a broad base-allergy medications, for example,
  are a big favorite (even if, according to the National
  Institute for Health Care Management
, most people taking allergy medications
  don’t actually suffer from allergies.)

Drugmakers also prefer drugs that customers can be counted on to take for many
  years. (There is a saying in the pharmaceutical industry: "A pill that
  cures is good. A pill that you take every day is better.") Cancer patients
  tend to "die within months," the Times pointed out, curtailing profits.

But recently, big drug-makers have begun to recognize that cancer drugs can
  be profitable-if the price is high enough:

". . . companies have discovered that some patients will tolerate prices
  of tens of thousands of dollars a year, " the Times observed, "making
  drugs for even rare cancers into big moneymakers. Gleevec, which is used primarily
  for two obscure cancers – chronic myelogenous leukemia and gastrointestinal
  stromal tumor – had sales last year of $2.2 billion."

The race to get on the cancer bandwagon could lead to a flood of "me too"
  drugs that duplicate each other, the article acknowledged. But from the standpoint
  of the patients there [are] never too many, cancer drugs, the article asserted,
  quoting Dr. Robert J. Motzer, a kidney cancer specialist at Memorial Sloan-Kettering
  Cancer Center in New York City.  After all, the more drugs there are in the
  pipeline, the better chance a patient has of finding one, or a combination,
  that will work for them. Besides "competition could . . . bring down prices,"
  the Times suggested.

Really? If so, that would be a first.

When it comes to healthcare, competition almost never leads to lower prices.
  In most markets, comparison shoppers reward quality at a lower price. But when
  you’re dying of cancer, you’re probably not hunting for a bargain-even if you’re
  paying 20% of the cost out of your own pocket.

More importantly, even if you wanted to compare cost and quality, how would
  you go about doing it? As anyone who has ever been seriously ill knows, the
  more you learn about the pros and cons of various treatments, the less certain
  you are likely to be as to which might be the best for you.

Ambiguity haunts medical care. In my newest book, (Money-Driven
  Medicine: The Real Reason Health Care Costs So Much
Harper/Collins, May
  2006 )," I quote Dr. Atul Gawande, who describes "uncertainty"
  as "the core predicament of medicine . . . the thing that makes being a
  patient so wrenching, being a doctor so difficult and being part of a society
  that pays the bills so wrenching."

A Boston surgeon and author of Complications: A Surgeon’s Notes On An Imperfect
  Science, Gawande is quick to admit that even the physician is often not at all
  sure as to the "best" treatment for a given condition. Little wonder
  that patients are not able to bring down prices by shrewdly picking the product
  that offers the best value.

As for the idea that when there are more drugs in the marketplace, patients
  stand a better chance of finding one that works, some physicians warn that too
  many new drugs only adds to the confusion in a marketplace where free market
  competition has turned into a free-for-all.

According to the Pharmaceutical Research and Manufacturers Association, some
  400 cancer drugs from 178 companies are now in clinical trials-and many oncologists
  complain that this is more cures than they can hope to keep track of.

A sign of the times: in 2004 the
  Times reported
that one session of the American Society of Clinical Oncology’s
  conference was titled "Therapy of Metastatic Colorectcal Cancer: What Do
  We Do with So Many Options?"

As each drug company races to fill its own pipeline, a fragmented industry
  spawns a dizzying array of half-way cures. Too many drugs shrink tumors-but
  don’t bring any mortality benefit. Meanwhile, too much competition and too little
  collaboration makes it difficult for oncologists to sort out which drugs are
  most effective alone, which should be used together-and in what sequence.

When I was writing Money-Driven Medicine Dr. Genie Kleinerman, chief of pediatrics
  at Houston’s M. D. Anderson Cancer Center, recalled how two companies refused
  to work together to help her prove that two of their drugs might do a better
  job of targeting malignant cells of osteosarcoma ( a bone cancer that occurs
  in children), if they were used in combination. In the lab, Kleinerman had shown
  that you could mix the two agents. Now, she needed the company to do clinical
  trials in order to win approval from the FDA.

"But the lawyers for the two companies couldn’t come up with an agreement
  on who would own the rights to the combination and who would pay for what,"
  Kleinerman recalled, still frustrated. "Today it would be the same situation
  -or probably worse. The pharmaceutical industry has become so protective of
  who owns the intellectual property. You probably couldn’t even get them to sit
  down at the same table."

Instead, companies pursuing parallel research squander millions producing tumor-shrinking
  drugs that, too often, offer "no
  improved survival, no better quality of life, no added safety
" according
  to one study in the British Medical Journal–though they almost always cost

And as the pharmaceutical industry’s big guns elbow their way into the cancer
  marketplace, peddling pills that cost tens of thousands for a course of treatment,
  they are gobbling up much-needed health care dollars. Paying for these drugs
  is straining the system. Two years ago, Bains & Company, a management consulting
  firm estimated
  that paying for all of the drugs in development would require $60 billion a
  year-up from $10 billion at the time.

"Who’s going to pay for that? It’s just going to become unaffordable,"
  said Elgar Peerschke, head of the North American health care practice at Bain.

Oncologists like Genie Kleinerman believe that if government gave drugmakers
  incentives to pool their research, they might be able to develop fewer, more
  effective and more affordable remedies at a lower cost. But that’s not how free
  market competition normally works-at least not according to the conventional
  wisdom of a market-driven health care system.

PHARMA/POLICY/POLITICS: McKinnell’s friends turn and bitch-slap him, by The Industry Veteran

The Industry Veteran is back. He notes a piece I’d missed in which the oh-so-rational editorial board of the Wall Street Journal declared Part D to be a future political liability for their desire to drown the government in a bath-tub. And it’s all or mostly the fault of poor Hank McKinnell. The Veteran’s not too impressed with their analysis:

In its May 19 editorial, the Wall Street Journal bitch slapped Pfizer’s CEO, Hank McKinnell, for strongly advocating the 2003 Medicare Modernization Act (i.e., Part D) before the legislation passed and since.  In the week preceding the May 19 cuffing, McKinnell apparently did a panegyric for Medicare Part D in front of the Journal’s editorial board that the Goebbels Gang considered less than persuasive.  Before writing their Night of the Long Knives editorial, the Journal’s editors knew that McKinnell’s partisanship for Part D was more than mere flack work, sycophancy or a simple affirmation of sound, eighteenth century economics.  In his role as president of Big Pharma’s trade group, the Pharmaceutical Research and Manufacturers Association (PhRMA), McKinnell was a driving force behind the Medicare Modernization Act.  Never more than six months behind the news, the Journal is finally reflecting some of the sotto voce criticism that McKinnell is receiving from within Pfizer itself.The Journal’s criticism of Medicare Part D and its advocates combines boilerplate, right wing economics with Monday morning political quarterbacking and crypto-fascist scare threats about single-payer health systems.  The patellar reflex economics faults Part D for contributing to the federal deficit.  In this respect the Journal aligns with Reaganite and other conservatives who label Bush a fraud for posing as a conservative when he is actually a big deficit spender who obtains Congressional acquiescence for his military Keynesianism by declining to veto porkbarrel legislation.  The Wall Street Journal’s reproval of Bush’s spending, however, is less credible than Claude Rains’s declaration of shock at learning that there is gambling at Rick’s Cafe.  Bush is only opposed to federal spending if it benefits the middle class and the poor.  He doesn’t have the slightest problem with a fiscal deficit policy as long as the spending benefits his cronies and benefactors who run multi-billion dollar corporations.  It is for this reason, rather than some fixation on 1960’s vocabulary, that I call George Bush a fascist.  In siding with the stopped-clock conservatives who favor a balanced budget, the Wall Street Journal’s editors merely seek a cloak of principle for their Hjalmar Schacht economics.The Journal’s Monday morning quarterbacking faults Republicans for thinking that the Medicare Modernization Act would turn Medicare from a Democratic into a Republican issue.  Instead the MMA gives Democrats a reason to call for constant improvements to the program that will require more federal spending.  In the Journal’s horror scenario, the out of control spending will lead to calls for Medicare to act as a single purchaser that can constrain costs.  The Journal holds some smelly socks and underwear between its thumb and forefinger to admonish thoughts of price constraint by claiming that the pharmaceutical industry will fail to discover new remedies if it can no longer gouge a cancer patient $300,000 a year for his medication.  (I mean, is this a great country or what?)  If a rejoinder to the Journal’s herring-stained fright-wig is necessary, it is the fact that the development of new molecular entities constitutes the sole reason for the existence and capital investment of branded pharma companies and biotechs.  The aging demographics of the developed world, and our commitment to health and longevity, virtually guarantee a fair return on this investment for a biopharmaceutical industry.  Not content with a fair rate of return, the Wall Street Journal, Hank McKinnell and George Bush take a unconscionable rate as their entitlement and that is where I want to see them bent, broken and humiliated.  Is Medicare Part D turning out badly?  If so, that’s good.  When it comes to George Bush and all his constituencies, worse is better.


I was checking out potential book titles when I cam across this site, Health Care for Dummies. Given that I’ve spent some of the week beating up on the AMA, and spent some of yesterday touching on why the health care system looks like it does today—mostly based on Paul Starr’s book. But the real conspiracy theory is much more fun (even if I can’t exactly vouch for the truth). Read on for an amusing Friday diversion.

I’ll see ya back here on Tuesday


POLICY/PHARMA: Cato calls the Republicans on the Part D deceipt

I approve of government programs done well. Michael Cannon doesn’t approve of them done much at all. We both disapprove of them being done expensively and then having so-called Conservatives in power lie bold face about their costs and enrollment rates. Yup, I’m sending you over to the Cato Institute blog. That might be a first for TPM Cafe, but it’s a great explanation of what’s wrong with Part D.

(Also posted at TPMcafe)

CODA: I haven’t made it thorugh Kling’s book yet, and I had a real problem with Cannon’s — as it missed the point so badly that I didn’t think it was worth reviewing. But with Radley Balko keeping up on the drug war stuff, Cato remains the thinking man’s right wing think-tank.

PHARMA/POLICY: Yet more revisionism in Part D

It’s incredible how a couple of bullshit surveys, dishonestly conducted have changed the rhetoric a little on Part D. Now there’s a very odd article about Part D in The LA Times, which has been speaking truth to one power (Kaiser Permanente) all last week. Apparently it’s all going swimmingly well.

By the May 15 deadline, federal officials expect to have more than 20 million seniors enrolled in plans under Medicare Part D, as the benefit program is called. That would include at least 7 million who previously lacked insurance for outpatient prescriptions. Of the millions who have signed up, many are enjoying significant savings, sometimes $1,000 a year or more. That’s a considerable achievement for a government that has not tried to roll out such an ambitious entitlement program since the days of Lyndon B. Johnson. It’s especially so for President Bush, who is no fan of big government.

And read on because it quotes lots of dinisterested parties like everyone’s favorite lobbyist and truth-teller Karen Ignagni, and the flack from the AEI, before it gets to the real triumph of Medicare Part D. It’s cheap, much cheaper than we were told!

Mike Leavitt, HHS secretary was happy to point that out:

As proof that privatization is already working, Leavitt points to estimates that the program’s net cost to the federal government will be $678 billion over 10 years, instead of the $737 billion projected last year.

Funny that because this is what the PBS Newshour reported in March 2004

When the Medicare law was passed last November, Congress’s scorekeeping arm, the Congressional Budget Office, pegged the cost at $395 billion over ten years. Contrast that with the $534 billion estimate from HHS’ Centers for Medicare and Medicaid Services, or CMS. The Bush administration released that estimate last month as part of its 2005 federal budget request.

So we’re not yet hitting some of the wilder estimates of the program cost, and we’re only going to be (maybe) $280 billion over the original budget promised, or a mere $140 billion over the real estimate that was deemed so explosive that it was forcibly hidden from Congress by Tom Scully, the Bush flack then running CMS. That must mean that the whole thing is cheap and shows that the market is working!  And of course we can trust everything that these guys say, as in every other aspect of their performance.

Pity that if we just paid the prices the VA gets we could cover all seniors with no donut hole for less money, but at least we’re helping out with private enterprise and promoting choice! Because that’s such a great thing.

Martha Straub, 86, a retired secretary from Woodland Hills, gives her new drug benefit an A and the signup ordeal a D. That averages out to a C+. "It’s very hard for an individual to dial in the plan that’s going to be most beneficial to you," said Straub’s daughter, Lorna Bashara, who helped her mother. "It was like looking for a needle in a haystack."

(Cross posted over at TPMCafe, who’s blog on the subject is somewhat quietening down)

POLICY/PHARMA: Tierney on Limbaugh–A Taste of His Own Medicine

Rush Limbaugh, idiotic conservative and drug-addict—who I hear in 1990 on his show saying that drug addicts should be “written off” and lately was attacking medical marijuana users, has according to Tierney been given A Taste of His Own Medicine . I’ve been waiting to comment, but Tierney has done so, even if he’s a little kind to him, but his article is well worth reading. I reproduced it below because it’s behind the NY Times firewall. It’s also worth remembering that while Richard Paey stood up and is doing 25 years while clearly innocent of the crime he’s accused of, Limbaugh was too cowardly to obtain his own drugs, and got his housekeeper to do it for him. But I guess that’s a minor point. Here’s Tierny:

Now that Rush Limbaugh has managed to keep himself out of prison, the punishment he once advocated for drug abusers, let me suggest a new cause for him: speaking out for people who can handle their OxyContin.

Like Limbaugh, Richard Paey suffers from back pain, which in his case is so severe that he’s confined to a wheelchair. Also like Limbaugh, he was accused of illegally obtaining large quantities of painkillers. Although there was no evidence that either man sold drugs illegally, the authorities in Florida zealously pursued each of them for years.

Unlike Limbaugh, Paey went to prison. Now 47 years old, he’s serving the third year of a 25-year term. His wife told me that when he heard how Limbaugh settled his case last week — by agreeing to pay $30,000 and submit to drug tests — Paey offered a simple explanation: “The wealthy and influential go to rehab, while the poor and powerless go to prison.”

He has a point, although I don’t think that’s the crucial distinction between the cases. Paey stood up for his belief that patients in pain should be able to get the medicine they need. Limbaugh so far hasn’t stood up for any consistent principle except his right to stay out of jail.

He has portrayed himself as the victim of a politically opportunistic prosecutor determined to bag a high-profile trophy, which is probably true. But that’s standard operating procedure in the drug war supported by Limbaugh and his fellow conservatives.

Drug agents and prosecutors are desperate for headlines because they have so little else to show for their work. The drug war costs $35 billion per year and has yet to demonstrate any clear long-term benefits — precisely the kind of government boondoggle that conservatives like Limbaugh ought to view skeptically.

Yet conservatives go on giving more money and more power to the drug cops. When critics complained about threats to civil liberties in the Patriot Act, President Bush defended it by noting that the government was already using some of these powers against drug dealers. Why worry about snooping on foreign terrorists when we’ve already been doing it to Americans?

Limbaugh objected when prosecutors, unable to come up with enough evidence against him, demanded to be allowed to go through his medical records in the hope of finding something.

He managed to stop them in court, but other defendants can’t afford long legal battles to protect their privacy.

Drug agents and prosecutors go on fishing expeditions to seize doctors’ records and force pharmacists to divulge what they’re selling to whom. With the help of new federal funds, states are compiling databases of the prescriptions being filled at pharmacies. Once their trolling finds something they deem suspicious, the authorities can threaten doctors, pharmacists and patients with financially crippling investigations and long jail sentences unless they cooperate by testifying against others or copping a plea.

Paey was the rare patient who refused to turn on his doctor or plead guilty to a problem he didn’t have. He insisted that he’d been taking large quantities of painkillers because he needed them. He wanted to protect his own right to keep taking them, and others’ rights as well.

“They say I was stubborn,” he told me last year. “I consider it a matter of principle.”

Limbaugh got off partly because he could afford the legal bills (which he says ran into millions of dollars) and partly because he cooperated with prosecutors. He confessed to being an addict, went into rehab and swore to remain clean.

Perhaps he really was one of the small minority of pain patients who hurt themselves by compulsively using drugs like OxyContin for emotional, not physical, relief. But most pain patients can become physically dependent on large doses of opioids without being what doctors consider an addict. They take the drugs not to escape reality, but to function normally.

Even if Limbaugh believes that drugs like OxyContin are a menace to himself, he ought to recognize that most patients are in Richard Paey’s category. Their problem isn’t abusing painkillers, but finding doctors to prescribe enough of them. And that gets harder every year because of the drug war promoted by conservatives like Limbaugh.

It has been said that a liberal is a conservative who’s been arrested. I wouldn’t wish such a conversion on Limbaugh. But a two-year investigation by drug prosecutors should be enough to turn a conservative into a libertarian.

BLOGS/PHARMA: The sexy world of drug reps–Have the link now

The Daily Show interviews the totally hot Miss Florida who’s also a drug rep and criticizes Jeffrey Avorn for promoting generics using non-hot nurses and pharmacists. Best bit is when they berate a senior for using generics and taking bread out of Miss Florida’s mouth. Hysterical…

UPDATE: Here’s the link. (only seems to work with  Explorer, Firefox just hangs)

This is a must see. I bet Avorn just didn’t understand what the hell was going on…


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