In a story titled somewhat cryptically Medicare chief stands by anemia move (do they mean he’s trying to become anemic?) Reuters reports that CMS is not backing down from its decision to radically cut payments for anti-anemia drugs for chemotherapy patients. In English this means that Amgen’s Arenesp (& Epogen, though that’s not officially for cancer patients) and J&J’s Procit (which is Epogen re-marketed by J&J) are not going to recover their lost sales from last year.  Those sales began to be lost when studies revealed that the fairly rampant use of those drugs was overuse, and also that they were causing some severe side-effects.

Of course for reasons that we all know (e.g. they have little to do with clinical endpoints and more to do with financial ones), community oncologists have flipped out. I do like the response from Dr. Barry Straube, the chief medical officer at CMS. He said:

Our staff looked at over 800 evidenced-based articles published in the literature," he said. "I doubt seriously whether most clinicians read all 800."

Of course the real impact of this was not on patients per se, but on Amgen’s stock price, which has not had the best of years. The little rally late last year was on hopes that CMS would change its mind. I’m afraid that that gravy train looks like it’s over.

I’m sure (well I’m not sure but I’ll cheerfully and casually postulate) to keep you all amused on a Friday) that there are many possible overlooked problems with Lipitor and the statins. I’ve heard of severe muscle pain, even amnesia. But then again most cardiologists and the medical establishment recommend statins very widely and the general medical opinion is that they’re under-used.

I’m reading an interesting book The Last Well Person by Nortin Hadler whom I had the pleasure of meeting at the FIDMD meeting a few weeks back. Nortin is not exactly modest(!) but he’s very amusing and has firm firm opinions. In the book he systematically goes through the randomized clinical trial evidence of the value of much heart treatment including angioplasty, heart bypass, and statins. And his analysis from the West of Scotland trial (which admittedly was using Pravachol not Lipitor) is that statin use made only marginal absolute improvements in heart attacks and essentially no difference in overall mortality.

But is Congress investigating whether the medical establishment has been lead astray or is leading us astray? No.

Apparently the most important question is whether Robert Jarvik actually rowed his own boat in a Lipitor commercial….