Not only do doctors face incessant promotion from perky pharmaceutical sales representatives, they now face an unprecedented level of “counter-detailing” initiatives. Counter-detailing has been around for a long time and doctors used to receive calls from managed care companies and hospitals if their prescribing fell outside the actuarial levels of profitability. However, Diedtra Henderson at the Boston Globe is reporting that the counter-detailing movement is being taken to a new level (a short except is included below). In Pennsylvania, the Independent Drug Information Service is in the midst of a $1 million campaign to get doctors to prescribe older/generic/cheaper drugs, and thereby save the State money.
I’m all for older, cheaper drugs when they are appropriate. And sometimes they aren’t. These drugs often have more safety and adverse event problems than newer drugs (even though efficacy may be equal). These drugs are usually dosed more frequently and therefore patient compliance becomes a factor. So the older drugs may be “as effective” as prescribed, but are they “as effective” in the clinical setting when patients start missing doses? Even more interesting, the Independent Drug Information Service is only counter-detailing in the Upper GI (H2 vs. PPI), Pain/Arthritis (NSAID vs. Cox-2) and anti-platelet (Plavix vs. asprin) categories. From these three limited conditions, pundits have been willing to universally declare that older/cheaper/generic drugs are better.
The brain behind the operation, Dr. Jerry Avorn, admits that he has failed to quantify the cost savings behind these counter-detailing interactions. Since Avorn has been advocating this since 1983, I’m not sure when he will get around to doing some outcomes research. I wonder if the Independent Drug Information Service and Jerry Avorn will also quantify the health outcomes associated with their efforts. Or do they merely care about the cost savings? The big question will be are patients better (or worse) off because of these interventions?
This initiative is just another example of the paternalism I discussed yesterday. These initiatives and its backers are saying to physicians, “if you only knew, you’d behave differently.”
That being said, I fully support counter-detailing efforts and providing doctors with more information, rather than less. Unlike pharmaceutical industry opponents, I don’t believe restricting access to information serves the greater good and I have faith that physicians can make independent, appropriate decisions on behalf of their patients.
Excerpts from the Boston Globe article:
BOSTON GLOBE
Independent lens Counter-detailers help doctors wade through drug company marketing
By Diedtra Henderson, February 26, 2007
EMMAUS, Pa. -- Drug companies flood doctors' offices with attractive salespeople whose mission is to boost the number of prescriptions written for their products. But some say that the tactics used by the representatives, known as detailers, wrongly hype expensive new drugs when older, cheaper treatments work just as well.
To combat the sales pitches, critics are now employing the same marketing methods that drug companies use to sell doctors on new products.
Avorn has not analyzed the cost savings that result from the one-on-one sessions with doctors. But he has looked at how the prescribing patterns of doctors who wrote Celebrex prescriptions changed after the counter-detailers compared the heart risks and stomach-sparing benefits of such new-generation drugs with other painkillers.
© Copyright 2007 Globe Newspaper Company.
Wednesday, February 28, 2007
Tuesday, February 27, 2007
A Question of Influence – Are Doctors Morally Bankrupt?
I’ve been struggling with this question recently. There’s a paternalistic movement in the U.S. today to shield America’s doctors. For some reason, doctors need to be protected—from drug companies, from insurance companies, from patients and even from even each other. And it is this notion that doctors are morally bankrupt that the paternalists are selling.
This argument has boiled over in the last six months with respect to pharmaceutical companies (and insurance companies, I might add) providing free lunches and pens to physicians and their office staffs. The argument that has been chronicled in dozens of media stories (including two New York Times pieces; the first, and the second) and quasi-journal articles is that lunches, pens, notepads, etc. unduly influence physicians.
There is even a “grassroots” movement called No Free Lunch organized by the Corporation for Non-Promotion-Based Medicine (which, according to its website, accepts donations, although does not disclose its sources of funding or its IRS 990; the group is not registered with the GuideStar non-profit clearing house). This organization urges physicians to avoid any interaction with pharmaceutical companies, including pens, lunches, etc. However, their disdain of drug companies doesn’t seem to apply to anyone else (including insurance companies) trying to influence their physician’s prescribing patterns, the diagnostic tests they order and the medical procedures they perform.
This whole paternalistic attitude stinks to me. Evidently, physicians are different than the rest of us. Evidently, the same physicians who spend years in school learning professional medical judgment throw out their knowledge the minute they graduate and latch onto the first pretty female drug rep from AstraZeneca or Pfizer. Evidently, physicians are willing to sell their souls for a $7.00 Quizno’s sandwich and a Snapple.
Does this sound ridiculous? Well, this is exactly what some physicians and the paternalists are claiming. The paternalists would have us believe that doctors are morally bankrupt and their judgment is not to be trusted.
For the record, I’m in favor of pharmaceutical companies trimming their marketing budgets, including the chochkeys and free lunches. The money could be better spent on R&D. But doctors don’t need to be coddled and I don't believe physicians can be bought for a salad.
This argument has boiled over in the last six months with respect to pharmaceutical companies (and insurance companies, I might add) providing free lunches and pens to physicians and their office staffs. The argument that has been chronicled in dozens of media stories (including two New York Times pieces; the first, and the second) and quasi-journal articles is that lunches, pens, notepads, etc. unduly influence physicians.
There is even a “grassroots” movement called No Free Lunch organized by the Corporation for Non-Promotion-Based Medicine (which, according to its website, accepts donations, although does not disclose its sources of funding or its IRS 990; the group is not registered with the GuideStar non-profit clearing house). This organization urges physicians to avoid any interaction with pharmaceutical companies, including pens, lunches, etc. However, their disdain of drug companies doesn’t seem to apply to anyone else (including insurance companies) trying to influence their physician’s prescribing patterns, the diagnostic tests they order and the medical procedures they perform.
This whole paternalistic attitude stinks to me. Evidently, physicians are different than the rest of us. Evidently, the same physicians who spend years in school learning professional medical judgment throw out their knowledge the minute they graduate and latch onto the first pretty female drug rep from AstraZeneca or Pfizer. Evidently, physicians are willing to sell their souls for a $7.00 Quizno’s sandwich and a Snapple.
Does this sound ridiculous? Well, this is exactly what some physicians and the paternalists are claiming. The paternalists would have us believe that doctors are morally bankrupt and their judgment is not to be trusted.
For the record, I’m in favor of pharmaceutical companies trimming their marketing budgets, including the chochkeys and free lunches. The money could be better spent on R&D. But doctors don’t need to be coddled and I don't believe physicians can be bought for a salad.
Monday, February 26, 2007
The Truth About Drug Safety
Prescription drugs are powerful medications with the potential risk for adverse events. However, yesterday’s New York Times article pointed out the truth behind these adverse events.
A study in the Journal of the American Medication Association last October by Dr. Daniel Budnitz at the Centers for Disease Control and Prevention found that prescription drug errors are a “major cause of serious illness in the country, especially among the eldery.” Senior citizens are more than twice as likely as younger people to be treated in the emergency room for adverse drug events. But the truth is that more than half of these incidents happened on a doctor’s watch—patients were just following doctor’s orders. In other words, over half of medication errors could be prevented if physicians were effectively monitoring their patients.
This was corroborated by the August 2006 report by the Institute of Medicine found that adverse drug events harm more than 1.5 million people each year, kill several thousand and costs the country over $3.5 billion annually.
The lesson is clear—the only person looking out for your health is you.
A study in the Journal of the American Medication Association last October by Dr. Daniel Budnitz at the Centers for Disease Control and Prevention found that prescription drug errors are a “major cause of serious illness in the country, especially among the eldery.” Senior citizens are more than twice as likely as younger people to be treated in the emergency room for adverse drug events. But the truth is that more than half of these incidents happened on a doctor’s watch—patients were just following doctor’s orders. In other words, over half of medication errors could be prevented if physicians were effectively monitoring their patients.
This was corroborated by the August 2006 report by the Institute of Medicine found that adverse drug events harm more than 1.5 million people each year, kill several thousand and costs the country over $3.5 billion annually.
The lesson is clear—the only person looking out for your health is you.
Sunday, February 25, 2007
Pharmaceutical Industry Spends $55.2 billion on R&D in 2006
This month, PhRMA released its annual report on R&D spending in the biopharmaceutical industry. In 2006, the industry spent over $55.2 billion on research and development efforts.
This is probably accurate. Unfortunately, the report is released by the Pharmaceutical Research and Manufacturers of America and is considered suspect by many.
Unfortunately, the draught of new product innovation is likely to continue for several years. And the investment projects of today are not likely to pay off for at least another decade.
This is probably accurate. Unfortunately, the report is released by the Pharmaceutical Research and Manufacturers of America and is considered suspect by many.
Unfortunately, the draught of new product innovation is likely to continue for several years. And the investment projects of today are not likely to pay off for at least another decade.
Friday, February 23, 2007
Counterfeit Drugs
In the last week, there have been several media stories questioning the safety of drugs oversees and the potential risk they pose to U.S. citizens.
On February 20, The New York Times reported that there is explosive growth of fake drugs in many parts of the world. There is currently a worldwide outbreak of fake malaria drugs and an epidemic of counterfeit drugs in China. In the story, Dr. Ilisa Bernstein of the FDA indicated that counterfeit drugs in U.S. pharmacies are extremely rare but Internet pharmacies have opened the door of fake drugs into the U.S.
Meanwhile on February 17, the Associated Press ran a story, “FDA Warns of Wrong Drugs Being Sold Over the Internet.” Consumers who thought they were purchasing sleep medicines and antidepressants from "Canadian pharmacies," instead received the schizophrenia medication haloperidol from Greece. Many of these individuals needed to receive emergency medical treatment for adverse events.
Surprisingly, in the face of the worldwide counterfeit drug epidemic, AARP is actively pushing for legislation to allow for the legal importation of prescription medications (see the AARP statement). The law AARP supports would initially allow for importation from “Canada” (see above paragraph on how well that currently works) and then expand to other countries. Evidently, the folks at AARP believe that the government is going to be able to keep counterfeit products out of the country.
The question is, how long will it take until we get the first report of America’s seniors dying of fake drugs (and it’s only a matter of time)? Who will accept responsibility for allowing this to happen? AARP? It’s millionaire CEO, Bill Novelli? The politicians who passed the law enabling their deaths? Or will the pharmaceutical companies be vilified for it (something they had no control over and actively opposed)?
On February 20, The New York Times reported that there is explosive growth of fake drugs in many parts of the world. There is currently a worldwide outbreak of fake malaria drugs and an epidemic of counterfeit drugs in China. In the story, Dr. Ilisa Bernstein of the FDA indicated that counterfeit drugs in U.S. pharmacies are extremely rare but Internet pharmacies have opened the door of fake drugs into the U.S.
Meanwhile on February 17, the Associated Press ran a story, “FDA Warns of Wrong Drugs Being Sold Over the Internet.” Consumers who thought they were purchasing sleep medicines and antidepressants from "Canadian pharmacies," instead received the schizophrenia medication haloperidol from Greece. Many of these individuals needed to receive emergency medical treatment for adverse events.
Surprisingly, in the face of the worldwide counterfeit drug epidemic, AARP is actively pushing for legislation to allow for the legal importation of prescription medications (see the AARP statement). The law AARP supports would initially allow for importation from “Canada” (see above paragraph on how well that currently works) and then expand to other countries. Evidently, the folks at AARP believe that the government is going to be able to keep counterfeit products out of the country.
The question is, how long will it take until we get the first report of America’s seniors dying of fake drugs (and it’s only a matter of time)? Who will accept responsibility for allowing this to happen? AARP? It’s millionaire CEO, Bill Novelli? The politicians who passed the law enabling their deaths? Or will the pharmaceutical companies be vilified for it (something they had no control over and actively opposed)?
Thursday, February 22, 2007
Johnson and Johnson Makes Patient-Education Movie
Johnson and Jonson premiered a new feature-length documentary last night called INNERSTATE (view the press release). The film follows the lives of three patients with autoimmune diseases and explores the physical and emotional struggles of disease.
A pharmaceutical company making a movie? You have to wonder if this is a 60-minute infomercial destined for late night cable TV. However, according to press reports, the JnJ product (Remicade) is never mentioned in the film and the movie is entertaining and informative.
This hasn’t stopped industry critics from condemning the film. Dr. Jerry Avorn, the infamous Harvard researcher who is (still) out hyping his latest book, has even weighed in. He is quoted on CNN Money as saying, “You should know it's a commercial. I'm very troubled by the blurring of the lines between advertising and patient education.” Unfortunately, Dr. Jerry Avorn did not even see the movie (it wasn’t even out when the article was written). It is good to see that people like Dr. Avorn can have an opinion on something of which they have no knowledge.
What remains to be seen is whether this tactic will work for JnJ. Is this just a new take on the old DTC advertising? Will this initiative actually drive sales for JnJ’s product? Or is JnJ taking a different approach? Is this statement from JnJ that is beyond a mere promotional campaign?
A pharmaceutical company making a movie? You have to wonder if this is a 60-minute infomercial destined for late night cable TV. However, according to press reports, the JnJ product (Remicade) is never mentioned in the film and the movie is entertaining and informative.
This hasn’t stopped industry critics from condemning the film. Dr. Jerry Avorn, the infamous Harvard researcher who is (still) out hyping his latest book, has even weighed in. He is quoted on CNN Money as saying, “You should know it's a commercial. I'm very troubled by the blurring of the lines between advertising and patient education.” Unfortunately, Dr. Jerry Avorn did not even see the movie (it wasn’t even out when the article was written). It is good to see that people like Dr. Avorn can have an opinion on something of which they have no knowledge.
What remains to be seen is whether this tactic will work for JnJ. Is this just a new take on the old DTC advertising? Will this initiative actually drive sales for JnJ’s product? Or is JnJ taking a different approach? Is this statement from JnJ that is beyond a mere promotional campaign?
Pharmaceuticals Actually Save Money
You know something is true when even The New York Times, with its notorious anti-pharmaceutical bias, prints a story that is favorable to the industry.
For those who missed it, Milt Freudenheim wrote in his February 21, 2007 column “To Save Later, Some Employers Are Offering Free Drugs Now,” has articulated what those in the industry have been saying (and proving) for years—pharmaceutical products actually save the healthcare system money. The overly zealous approach of pinching pennies on prescription drugs is ultimately counter-productive to long-term cost savings (and patient’s health).
Congratulations to the New York Times for getting this one right!
For those who missed it, Milt Freudenheim wrote in his February 21, 2007 column “To Save Later, Some Employers Are Offering Free Drugs Now,” has articulated what those in the industry have been saying (and proving) for years—pharmaceutical products actually save the healthcare system money. The overly zealous approach of pinching pennies on prescription drugs is ultimately counter-productive to long-term cost savings (and patient’s health).
Congratulations to the New York Times for getting this one right!
Wednesday, February 21, 2007
Whatever Happened to Able Laboratories?
The new Democratic controlled Congress has begun hearing scores of bills sponsored by the pro-generics groups. This prompted me to ask the question, what ever happened to Able Laboratories?
Able Labs was a generics company in New Jersey that manufactured mostly generic products. On May 27, 2005, the FDA announced that it was shutting down Able Labs (FDA press release and official warning letter). Over 15 million prescriptions were filled in 2004 for products manufactured by Able Labs, exposing thousands, and perhaps millions, of patients to sub-standard medications. The generic company Sun Pharmaceutical Industries Ltd. has purchased Able’s assets in bankruptcy proceedings and has re-started Able’s operations under its name.
This single dramatic example highlights one of the major pitfalls with the generics industry in America. When a person gets a prescription filled for a medication and the pharmacy dispenses a generic, the consumer is given no choice which manufacturer they purchase from. A consumer could get a medication from one of the reputable generics firms…or they could end up with a product from the next Able Labs. Which would you rather have?
With billions of dollars in patented, branded products going off-patent in the coming years, many more generics manufacturers will be producing many more generic drugs. Many of these products are going to extremely profitable for generics firms. With this kind of money up for grabs, it remains to be seen how ethical these generics companies are going be.
If the generics industry wants to advance healthcare in America, they should cast out companies like Able Labs and others with questionable business/manufacturing practices and push for legislation requiring that consumers be given the choice of selecting the manufacturer of the products they are to receive. Consumers have that choice in the grocery store when they purchase generic products, why not have that choice when it comes to something more serious like their health?
Able Labs was a generics company in New Jersey that manufactured mostly generic products. On May 27, 2005, the FDA announced that it was shutting down Able Labs (FDA press release and official warning letter). Over 15 million prescriptions were filled in 2004 for products manufactured by Able Labs, exposing thousands, and perhaps millions, of patients to sub-standard medications. The generic company Sun Pharmaceutical Industries Ltd. has purchased Able’s assets in bankruptcy proceedings and has re-started Able’s operations under its name.
This single dramatic example highlights one of the major pitfalls with the generics industry in America. When a person gets a prescription filled for a medication and the pharmacy dispenses a generic, the consumer is given no choice which manufacturer they purchase from. A consumer could get a medication from one of the reputable generics firms…or they could end up with a product from the next Able Labs. Which would you rather have?
With billions of dollars in patented, branded products going off-patent in the coming years, many more generics manufacturers will be producing many more generic drugs. Many of these products are going to extremely profitable for generics firms. With this kind of money up for grabs, it remains to be seen how ethical these generics companies are going be.
If the generics industry wants to advance healthcare in America, they should cast out companies like Able Labs and others with questionable business/manufacturing practices and push for legislation requiring that consumers be given the choice of selecting the manufacturer of the products they are to receive. Consumers have that choice in the grocery store when they purchase generic products, why not have that choice when it comes to something more serious like their health?
Tuesday, February 20, 2007
Pharm Aid
The pharmaceutical industry is in trouble. This statement shouldn’t surprise anyone who isn’t in a coma.
Like farming there is a draught and this is one of new product innovation. Like farming, the pharmaceutical lacks an effective and credible trade association.
Unlike farming, the pharmaceutical industry faces a vast public relations crisis. Pharma is really a victim of its own success. The pharmaceutical industry is America’s last growth industry. In the 1970s and 1980s, the industry invested billions of dollars in R&D. In the 1990s they enjoyed the fruits of that investment—and it was an investment the companies expect to get that money back! And there’s nothing wrong with that.
Just like Farm Aid of the 1980s, this Pharm Aid blog aims to provide an outlet of awareness, information and opinions.
Like farming there is a draught and this is one of new product innovation. Like farming, the pharmaceutical lacks an effective and credible trade association.
Unlike farming, the pharmaceutical industry faces a vast public relations crisis. Pharma is really a victim of its own success. The pharmaceutical industry is America’s last growth industry. In the 1970s and 1980s, the industry invested billions of dollars in R&D. In the 1990s they enjoyed the fruits of that investment—and it was an investment the companies expect to get that money back! And there’s nothing wrong with that.
Just like Farm Aid of the 1980s, this Pharm Aid blog aims to provide an outlet of awareness, information and opinions.
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