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| 5/23 |
| 2008/1/25-2/2 [Health/Disease/General, Health/Women] UID:49010 Activity:nil |
1/15 Does the AMA prevent doctors from representing companies or
drugs? If so, why does the Dr. of artificial heart (Robert Jarvis)
appear on TV ads?
\_ http://urltea.com/2kxk [freakonomics blog]
"I was surprised to discover that many of the manuscripts on Vioxx were
prepared and written by Merck or medical writing companies that Merck
had commissioned. The company then often paid academics to become authors.."
Good comments, too. Search for "Posted by SB", among others.
"I was surprised to discover that many of the manuscripts on Vioxx
were prepared and written by Merck or medical writing companies that
Merck had commissioned. The company then often paid academics to
become authors.." Good comments, too. Search for "Posted by SB",
among others. ...This site leads to other good stuff, such as
http://urltea.com/1k68 [cato-unbound.org] "Note that someone willing
to pay $1,000 to gain 2.5 days of life should be willing to spend
about $1,000,000 to gain six years by living rurally, and $2,000,000
to gain fifteen years via high exercise. These figures seem to me to
overestimate the observed eagerness to live rurally or to exercise."
\_ 80 columns imposed
\_ Do rural dwellers really live an average of six years longer?
Source please? |
| 5/23 |
|
| urltea.com/2kxk -> freakonomics.blogs.nytimes.com/2008/01/24/what-dont-we-know-about-the-pharmaceutical-industry-a-freakonomics-quorum/ freakonomics&posall=TopAd,Position1,Top5,SFMiddle,Box1,Box3,Bottom 3,Right5A,Right6A,Right7A,Right8A,Middle1C,Bottom7,Bottom8,Bottom9,Inv 1,Inv2,Inv3,tacoda,SOS,ADX_CLIENTSIDE&pos=Top5&query=qstring&keywords= ? this post in particular, highlighting an interview with the CEO of Genentech, that made me want to post a quorum on the subject. So we've gathered up some willing and able candidates -- Dr. Cyril Wolf -- and asked them the following question: What's something that most people don't know, pro or con, about the pharmaceutical business, whether from an R&D, economic, or political perspective? I hope you will find, as I did, plenty of surprises and illumination. Thanks to all of them for their thoughtful contributions. Harlan Krumholz, professor of medicine, epidemiology, and public health at Yale: Science and the public good in a capitalist society depend on the free flow of unbiased information, but it doesn't always work that way. Events are revealing that many pharmaceutical companies, along with their consulting academic physicians, have engaged in practices that obscure or misrepresent information about their products. Does the public realize the depth of these practices, and their implications for patient care? Most physicians continue their education and keep up to date with new science by attending lectures given by experts, with the assumption that the information they hear is unbiased. But pharmaceutical companies regularly pay high-profile scientists and physicians, either directly or indirectly, to speak on topics relevant to their products. At a scientific meeting in Europe, I watched an American colleague -- a famous cardiologist who was being well compensated for his participation -- practice his upcoming speech in front of drug company marketers. After his practice talk, they replaced some slides with ones that presented their drug in a more favorable light. The speaker initially resisted the change, but finally acceded, and his talk the next day was a strong endorsement of his sponsor's drug. Another important way for physicians to learn about new therapies, and for scientists to disseminate the results of their studies, is through medical journals. The expectation is that these articles pass through rigorous review, and represent strong science. However, when I worked as an expert in litigation related to Vioxx, an anti-inflammatory drug marketed by Merck, I was surprised to discover that many of the manuscripts on Vioxx were prepared and written by Merck or medical writing companies that Merck had commissioned. The company then often paid academics to become authors, placing their names at the head of scientific studies that were already planned, performed, interpreted, and drafted by the company. Some of these articles had well known authors, and their impact was substantial. The authors' lack of involvement was not revealed, and, in some cases, the involvement of the company was not even mentioned. Then there is the problem of company studies, often completed with academics, that never see the light of day. Avandia, a blood-sugar-lowering drug, have illustrated this point. Conscientious physicians seeking to learn about those drugs would not have access to all the information available. For Avandia, the information on the unpublished studies became available only because of litigation; even though the data were placed in the public domain, the location was not widely publicized. It was these unpublished studies, eventually uncovered, that led to concerns about the drug's safety. Clearly, we are at a critical juncture in the history of the relationship between the pharmaceutical industry and physicians, and the health of patients hangs in the balance. Breaches in professional ethics, which can distort the knowledge upon which clinicians and patients depend, undermine trust in academic physicians and diminish the standing of the pharmaceutical industry. Academic medicine and the pharmaceutical industry are replete with ethical and talented individuals who dedicate their lives to fighting disease. The credit for many important advances in science lies with industry and its strong collaborative relationships with basic and clinical scientists. The current pattern of misbehavior that is exhibited by many, on both sides, is a pox on the profession and a danger to patients. A key question is: can industry and academics work together to cure this disease? D, pharmaceutical and biotechnology industry consultant, and member of the board of drug companies including Biocryst Pharmaceuticals, Phyton, Genaera Corporation, and Avigen: My answer to this question is this: that the United States is subsidizing prescription drug prices for the rest of the world. Most people do not realize that when a prescription is paid for in the US, the payer (the patient, his or her insurance company, or the government) is subsidizing the cost of that same prescription in most countries outside the US The pharmaceutical and biotechnology companies price their products to get a return that will support research and development to discover new products. Almost all major new drugs are discovered and developed by these companies, and most are located inside the US We have a free market system here that supports this pricing, and helps sustain new R&D. However, countries like Canada, France, Germany, Australia, and others set the prices for prescription drugs sold in their countries, and for the most part they do not allow any premium pricing that can aid the industry in new R&D. The only solution to this problem would be for our government to force, through trade agreements, these countries to allow better pricing to help cover the cost of new R&D that their citizens will take advantage of, or for the US pharmaceutical and biotechnology companies to refuse to provide the fruits of their discoveries to countries that do not allow a fair return. Unfortunately, these remedies never happen because of political roadblocks. As the downside pressures on US prescription drug prices increase, and the lack of support continues from the rest of the world to participate in some help for new R&D, the future of finding new and unique lifesaving and quality of life pharmaceuticals appears bleak. As a result, future generations are likely to suffer from our shortsightedness. Cyril Wolf, practicing physician and prescription sales researcher: The best kept secret by the retail pharmaceutical industry is the obscene profits made on generic drugs by the large chain stores. Whereas brand name drugs are all purchased, and therefore sold, for around the same price, generics are obtained for a fraction of that cost. The price at which the generics are sold is determined by the sellers, who thus have the ability to make exorbitant profits on these drugs. It is for this reason that the chains are always encouraging the public to buy generic drugs "in order to save." The answer is "yes, but very, very little," since these drugs are sold at prices not much lower than those of the branded products and are certainly priced well above their cost. The travesty is that it is those who can afford it the least (ie, people without health insurance and Medicare recipients without drug coverage) who suffer the most from this. Below, I have tabled the prices of the commonly prescribed generic drugs at Costco, which does not mark its prices up excessively, compared to those charged by Walgreens and CVS in Houston, New York, and Los Angeles. Stuart Apfel, founder and president of Parallax Clinical Research and chief medical officer at Elite Pharmaceuticals: For the majority of people, the great appeal of biomedical science is the potential benefit it presents to human beings through curing disease, extending life, and improving the quality of life. As is generally well-known, biomedical science has achieved much in extending our knowledge of the complex biological processes that make up all living organisms, including ourselves. Over the past two decades, hundreds of billions of dollars have been spent successfully elucidating the genome, identifying genes that may lead to cancer, id... |
| urltea.com/1k68 -> www.cato-unbound.org/2007/09/10/robin-hanson/cut-medicine-in-half/ Robin Hanson Lead Essay September 10th, 2007 Car inspections and repairs take a small fraction of our total spending on cars, gas, roads, and parking. But imagine that we were so terrified of accidents due to faulty cars that we spent most of our automotive budget having our cars inspected and adjusted every week by PhD car experts. Obsessed by the fear of not finding a defect that might cause an accident, imagine we made sure inspections were heavily regulated and subsidized by government. To feed this obsession, imagine we skimped on spending to make safer roads, cars, and driving patterns, and our constant disassembling and reassembling of cars introduced nearly as many defects as it eliminated. Our public today is like a king of old whose military advisors spent most of their time and budget reading omens and making sacrifices, to gain the gods' favor, instead of hiring soldiers and talking battle strategy. These advisors knew omens and sacrifices mattered little, but they saw the king was comforted, and feared losing favor by talking of battle strategy. A truly loyal advisor would have told the king what he did not want to hear: "You are obsessing about the wrong thing." King Solomon famously threatened to cut a disputed baby in half, to expose the fake mother who would permit such a thing. The debate over medicine today is like that baby, but with disputants who won't fall for Solomon's trick. The left says markets won't ensure everyone gets enough of the precious medical baby. The right says governments produce a much inferior baby. I say: cut the baby in half, dollar-wise, and throw half away! Our "precious" medical baby is in fact a vast monster filling our great temple, whose feeding starves our people and future. Then let me speak plainly: our main problem in health policy is a huge overemphasis on medicine. The US spends one sixth of national income on medicine, more than on all manufacturing. But health policy experts know that we see at best only weak aggregate relations between health and medicine, in contrast to apparently strong aggregate relations between health and many other factors, such as exercise, diet, sleep, smoking, pollution, climate, and social status. Cutting half of medical spending would seem to cost little in health, and yet would free up vast resources for other health and utility gains. To their shame, health experts have not said this loudly and clearly enough. Non-health-policy experts are probably shocked to hear my claims. Most students in my eight years of teaching health economics have simply not believed me, even after a semester of reviewing the evidence. Heroic medicine is just too central to our culture, a culture where economists like me have far less authority than doctors. Worse, even most standard textbooks in health economics fail to make the point clearly. Children are told that medicine is the reason we live longer than our ancestors, and our media tell us constantly of promising medical advances. Millions of doctors are well aware that most medical journal articles describe gains from particular medical treatments, and these doctors usually give patients optimistic views about particular treatments. In contrast, few doctors know that historians think medicine has played at best a minor role in our increased lifespans over the centuries. And only a few health policy experts now know about the dozens of studies of the aggregate health effects of medicine. Worse, these studies can seem muddled, with some showing positive, some showing negative, and some showing neutral effects of medicine on health. So I want to say loudly and clearly what has yet to be said loudly and clearly enough: In the aggregate, variations in medical spending usually show no statistically significant medical effect on health. I want to dare other health policy experts to either publicly agree or disagree with this claim and its apparent policy implications. By "variations" I mean the large changes in medical spending often induced by observable disturbances, such as changing culture or prices, and by "aggregate" I mean studies of the health effect on an entire population of disturbances that affect a broad range of medical treatments. In contrast, the vast majority of medical studies look at the effects of particular categories of treatments on particular classes of patients. Note that a muddled appearance of differing studies showing differing effects is to be expected. After all, even if medicine has little effect, random statistical error and biases toward presenting and publishing expected results will ensure that many published studies suggest positive medical benefits. Auster, Leveson, & Sarachek, Journal of Human Resources, in 1969 . It found that variations across the 50 US states of 1960 age-sex-adjusted death rates were significantly predicted by variations in income, education, fractions of white collar and female workers, and the existence of a local medical school, but not by variations in medical spending, urbanization, and alcohol and cigarette consumption. Later studies using robust controls to compare similar regions tend to give similar results. a Byrne, Pietz, Woodard, & Petersen Health Economics 2007 study found no significant mortality effects of funding variations across 22 US Veterans Affairs regions over six years. Skinner and Wennberg 1998 study, which together used the largest dataset I know of: five million Medicare patients in 1989 and 1990 across 3,400 US hospital regions. Regions that paid more to have patients stay in intensive care rooms for one more day during their last six months of life were estimated, at a 2% significance level, to make patients live roughly forty fewer days, even after controlling for: individual age, gender, and race; zipcode urbanity, education, poverty, income, disability, and marital and employment status; This same study, using the same controls, also estimated that a region spending $1,000 more overall in the last six months of life gave local patients somewhere between a gain of five days of life and a loss of twenty days of life (95% confidence interval). study in the Journal of the American Medical Association of 3,600 adults over 75 years found large and significant lifespan effects: a three year loss for smoking, a six year gain for rural living, a ten year loss for being underweight, and about fifteen year losses each for low income and low physical activity (in addition to the usual effects of age and gender). Note that someone willing to pay $1,000 to gain 25 days of life should be willing to spend about $1,000,000 to gain six years by living rurally, and $2,000,000 to gain fifteen years via high exercise. These figures seem to me to overestimate the observed eagerness to live rurally or to exercise. Of course all of these studies look at correlation, not causation, between health and medicine. So they all leave open the possibility that someday studies with better controls will show stronger effects. For this reason, discussion of the health effects of medical spending variations usually turns eventually to our clearest evidence on the subject: the RAND health insurance experiment. From 1974 to 1982 this experiment spent about $50 million to randomly assign over two thousand non-elderly families in six US cities to three to five years of a specific medical price, ranging from free to full price, provided by the same set of doctors. Being assigned a low price for medicine caused patients to consume about 30% (or $300) more in per-person annual medical spending, though less for hospital spending and more for dental and "well care." The RAND experiment was not quite large enough to see mortality effects directly, and so the plan was to track four general measures of health, combined into a total "general health index," and also 23 physiological health measures. Their main result: "For the five general health measures, we could detect no significant positive effect of free care for persons who differed by income ... At a 7% significance level they found that poor people in the top 80% of initial health ended up with a 3% lower general health inde... |