High Prices for Drugs Attacked at Meeting

Cancer specialist criticizes new-treatment costs in high-profile speech

He said that one step toward controlling prices would be allowing Medicare to negotiate prices directly with pharmaceutical companies, which it is currently barred by law from doing.

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8 Facts that Explain What's Wrong with American Healthcare

Excellent article- worth the time to read in full .
Uvealblues
Link
Some highlights:

The reason that American health care is expensive is all about the price: when we go to the doctor, it costs more than when, say, someone in Canada goes to the doctor.

Part of this is about the price per unit of health care in the United States. From prescription drugs to imaging scans, nearly everything costs more when it's prescribed in America. Take the heartburn medication Nexium: the exact same medication costs $215 here and $23 in the Netherlands.

Most other countries have some form of price controls; the government negotiates with drug companies and device makers for lower prices, and the government has the power to win those negotiations. The United States doesn't do that. It leaves the negotiations up to individual insurers. And they tend to lose.

There are more nuanced ways that our health-care prices are more expensive, too. Harvard University's David Cutler points out that we have much higher administrative costs than most other countries — and those costs get tacked onto the bill when we go to the doctor. The average American doctor spends All those extra billing specialists' salaries have to get paid somehow — and that gets worked into our prices.

The National Institute for Health Care Management estimates that, in 2009, about half of health spending ($623 billion) went towards 5 percent of the population. On average, these are people who use $40,000 of health care annually.

As to who makes the most money, it's mostly drug companies and device manufacturers — the people who make the things that insurance companies buy. They typically run profit margins around 20 percent.

Should Doctors Care About Cost?

Excellent perspectives here: Link
Dr. Shapiro in the third letter  down points out that Congress has allowed Drug Companies exorbitant pricing on their products. While Medicare and Ins. companies try to "nickel and dime" doctors, who are operating at very low profit margins as it is, drug companies can charge 2000$ a month for medications injected into patient's eyes, and medicare wants to totally eliminate paying ophthalmologists for exams when pt's get injections. If medicare decides to cut out doctor payments for 12 exams a year per patient, it still will not equal what medicare pays for one dose of an injected medicine per month, such as Lucentis. If a patient is getting one of these expensive drugs in both eyes monthly, it costs medicare 48, 000$/year. The payment to the physician is a small fraction of that amount.

In an excellent segment on 60 minutes (link here), which one congressman pointed out was the "ugliest night he had ever seen (in Congress),  it is pointed out that pharmaceutical companies paid 100 million dollars a year to lobbyists (and that was in 2007). Their lobby is bigger than defense and oil according to a recent meeting I attended last week. It is the biggest lobby in the world. 

The whole video is a definite must watch, but at ~5:20 into the video it clearly states that the Bill prohibited the Government, with its massive purchasing power, from negotiating the price of drugs with pharmaceutical companie!. It is thus  no surprise that this bill was written by the pharmaceutical industry. 

It is no surprise that Tom Scully, Medicare's lead negotiator on the drug bill told the chief actuary to withhold  at the congressional hearings,his revised estimates that it would cost you the tax payer, 500 billion dollars for the first ten years. At the same time he prohibited this revised estimate from being announced, he was negotiating to be a lobbyist for the pharmaceutical companies. It is no surprise that 15 of the key congressman who got the drug bill based shortly thereafter got lucrative jobs working for pharmaceutical companies, either.
Uvealblues

For Drugs That Save Lives, a Steep Cost

We approve drugs and devices without considering cost-effectiveness, or even having a clue about price. We don’t ask for estimates and then are surprised when the nation is stuck with a $2.7 trillion annual health care bill.
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In the case of the naloxone device, the question is germane because the drug itself is very old, and long off patent. A simple syringe filled with a dose of naloxone should cost about $3, said Dan Bigg, director of the Chicago Recovery Alliance, which has long deployed the drug in communities to reverse overdoses. He says giving the shot is “no more complicated than basting a turkey. It’s a no-brainer: You pull up this liquid and inject it into the muscle.”

But experts expect that Evzio could well be priced close to $500.

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For many years, drug manufacturers have justified the high price of new drugs by citing their investments in research and development. But it has become harder to claim that it takes, say, $1 billion to bring a new drug to market, since many medicines originate with government-funded research, 

Editor’s blog: Significance of no statistical difference - See more at: http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/editor-s-blog-significance-no-statistical-difference#sthash.Kja7CIBI.dpuf

Seattle—As of Tuesday afternoon at this year's Association for Research in Vision and Ophthalmology (ARVO) meeting, all of the head-to-head comparison studies involving the efficacy and the safety of ranibizumab (Lucentis) and bevacizumab (Avastin) are officially IN.

The final verdict (NO drumroll, please): bevacizumab and ranibizumab are statistically NO different in the treatment of neovascular age-related macular degeneration (AMD).

Link

On Tuesday, the results of the Inhibition of VEGF in Age-related Choroidal Neovascularisation 2 (IVAN2) Study and the Groupe d’Evaluation Français Avastin versus Lucentis (GEFAL) Study, the French comparison study, were presented. The conclusion for both studies pretty much coincided with the results presented in the Comparison of AMD Treatment Trials (CATT), CATT2, and the original IVAN studies that were presented at previous ARVO meetings: That both drugs are basically equal (with some minor differences) in the treatment of AMD.

Hopefully, the debate between the use of both drugs is finally put to rest and ophthalmology can move forward (unless the French ophthalmic community decides to drag this on for another year with a GEFAL2). The foregone conclusion of these trials pretty much came to the same conclusion on most points that "there was no statistical difference between ranibizumab and bevacizumab."

Most of the ophthalmic community should be good with those conclusions. Even Genentech, the manufacturer of both drugs, has pretty much accepted these conclusions. The bevacizumab supporters have proven their point that their drug is just as good as the FDA-approved drug—at a fraction of the cost.

This is where a "statistical difference" can be found—the price. Ranibizumab costs about $2,000 an injection, while bevacizumab costs less than $100. That is a really big statistical difference, especially to a patient who has limited income or whose insurance may not be so generous to pay. To help patients get their treatments, physicians have that right to utilize that off-label option.

Ally for the Poor in an Unlikely Corner

Andrew Witty is not quite as young or as buff as Anderson Cooper, but he does do interviews in shirtsleeves from the slums of Nairobi and rural hospitals in Uganda.

Andrew Witty, named GlaxoSmithKline's chief executive in 2008.

What makes that unusual is that Mr. Witty is not a roving CNN anchor, but the chief executive of GlaxoSmithKline, the world’s second-largest drug company.
Besides being the youngest person in such a post — he was appointed in 2008 at age 43 —
he is also making a name for himself by doing more for the world’s poor than any other leader of a colossus of Big Pharma.

The Happy Hospitalist comments on Drug Reps

What Happened To All The Drug Reps?
My the times they are a changing. From American Medical News comes this piece about the changing landscape of pharmaceutical detailing in the doctor's office. With many blockbuster drugs going off patent, few in the pipeline, new rules regarding "gifts" and a recession, it appears that the days of the drug rep might be limited. Peaking at 102,000 reps in 2007, the industry expects no more than 75,000 by 2012.

British Balance Benefit vs. Cost of Latest Drugs

For years, Britain was almost alone in using evidence of cost-effectiveness to decide what to pay for. But skyrocketing prices for drugs and medical devices have led a growing number of countries to ask the hardest of questions: How much is life worth? For many, NICE has the answer.

Top health officials in Austria, Brazil, Colombia and Thailand said in interviews that NICE now strongly influences their policies.

“All the middle-income countries — in Eastern Europe, Central and South America, the Middle East and all over Asia — are aware of NICE and are thinking about setting up something similar,” said Dr. Andreas Seiter, a senior health specialist at the World Bank.

Even in the United States, rising costs have led some in Congress to propose an institute that would compare the effectiveness of new medical technologies, although the proposals so far would not allow for price considerations. At the present rate of growth, medical costs will increase to 25 percent of the nation’s gross domestic product in 2025 from 16 percent, with half of the increase coming from new drugs and devices, according to the Congressional Budget Office.

Experts Conclude Pfizer Manipulated Studies

The drug maker Pfizer earlier this decade manipulated the publication of scientific studies to bolster the use of its epilepsy drug Neurontin for other disorders, while suppressing research that did not support those uses, according to experts who reviewed thousands of company documents for plaintiffs in a lawsuit against the company.

Dare Not Speak Its Name

The latest entry from the always excellent Doc Gurley blog:

Doc Gurley Pop Quiz!*

“Dare not speak its name” refers to (choose one):

1) Traditional Jewish law about the four-letter name for God
2) George Carlin’s send-up of TV censorship [WARNING: definitely R-rated video]
3) The CIA’s role in Guantanamo Bay interrogations
4) Homosexuality - Lord Alfred Douglas’ description of his relationship with Oscar Wilde
5) The pharmaceutical drugs Chantix and Ambien

Answer: all of the above. Chantix and Ambien (oops, was I not supposed to say those names?) have joined the ranks of God, gays, torturers, and seven kinds of profanity. How can that be?

Co-Payments for Expensive Drugs Soar

In ophthalmology, this exact scenario is faced by patients who have to pay 400$ co-pays for Lucentis for Macular Degneration. Fortunately, we have an excellent alternative in Avastin--the total cost of which is less than 50.00 total (vs Lucentis at >2000.00$).


Health insurance companies are rapidly adopting a new pricing system for very expensive drugs, asking patients to pay hundreds and even thousands of dollars for prescriptions for medications that may save their lives or slow the progress of serious diseases.

With the new pricing system, insurers abandoned the traditional arrangement that has patients pay a fixed amount, like $10, $20 or $30 for a prescription, no matter what the drug’s actual cost. Instead, they are charging patients a percentage of the cost of certain high-priced drugs, usually 20 to 33 percent, which can amount to thousands of dollars a month.

The system means that the burden of expensive health care can now affect insured people, too.
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But the result is that patients may have to spend more for a drug than they pay for their mortgages, more, in some cases, than their monthly incomes.

Congress Asks Pfizer: Why Is Dr. Jarvik Qualified To Pitch Lipitor?

Dr. Robert Jarvik is the inventor of the Jarvik artificial heart, right? You know that because he's the pitch-man for Lipitor, a heavily advertised cholesterol drug. Have you ever stopped to ask yourself why inventing an artificial heart qualifies the man to pitch a drug?

Dr. Drug Rep

I applaud the honesty of this doctor in writing of his experiences as a paid rep. for big pharma. The tactics used by big pharma in some ways resemble those of big time "drug" lords as well-depicted in the excellent movie, "American Gangster."

On a blustery fall New England day in 2001, a friendly representative from Wyeth Pharmaceuticals came into my office in Newburyport, Mass., and made me an offer I found hard to refuse. He asked me if I’d like to give talks to other doctors about using Effexor XR for treating depression. He told me that I would go around to doctors’ offices during lunchtime and talk about some of the features of Effexor. It would be pretty easy. Wyeth would provide a set of slides and even pay for me to attend a speaker’s training session, and he quickly floated some numbers. I would be paid $500 for one-hour “Lunch and Learn” talks at local doctors’ offices, or $750 if I had to drive an hour. I would be flown to New York for a “faculty-development program,” where I would be pampered in a Midtown hotel for two nights and would be paid an additional “honorarium.”

Prescription Drugs: Where's the Free Market?

...Such abuses should not be surprising to anyone who appreciates the value of a competitive market. The root cause of all of these problems is government-granted patent monopolies that allow the pharmaceutical industry to sell drugs at prices that can exceed the cost of production by a factor of a hundred, or more. Last fall, Wal-Mart began selling hundreds of generic drugs for $4 per prescription. The vast majority of brand drugs could also be profitably sold for $4 per prescription, if it were not for the patent monopoly granted by the government.

As a result of patent monopolies, drug companies can sell drugs for hundreds of dollars that cost them a few dollars to manufacture. This situation invites the sort of corruption that NYT documents regularly in its pages.

Drug patents do serve a purpose: they provide an incentive to the industry to develop new drugs. However, there are other ways in which this research can be financed. The federal government already spends nearly $30 billion a year on biomedical research conducted through the National Institutes of Health. By doubling this amount, it could probably replace the research conducted by the pharmaceutical industry, most of which currently goes to develop copycat drugs (another problem of the patent system).

As another possible alternative, Nobel Laureate Joe Stiglitz has suggested a prize system, in which the government would buy out patents at prices determined by their usefulness. The patents would then be placed in the public domain so that all new drugs could be sold as generics.

Under the Influence

Click on this link for last week's "60 minutes" expose on the incredible entanglement between the government and big pharma...

A Republican congressman talks about the lobbyist-induced frenzy to pass the Medicare prescription drug bill in the U.S. House of Representatives in an interview with Steve Kroft. More...

If Crack Dealers Took Lessons From Walgreens, They Really Would Be Rich

Several weeks ago, I was talking to a physician in Houston, the sort of older gentleman family doctor you don’t see much of anymore. His name is Cyril Wolf. He’s originally from South Africa, but other than that, he struck me as the quintessential American general practitioner of decades past.

’d asked him a variety of questions — what’s changed in recent years in his practice, how managed care has affected him, etc. — when suddenly his eyes fired up, his jaw set tight, and his voice took on a tone of great exasperation. He began to describe a simple but huge problem in his practice: a lot of generic medications are still too expensive for his patients to afford. Many of his patients, he explained, must pay for their drugs out-of-pocket, and yet even the generic drugs at pharmacy chains like Walgreens, Eckerd, and CVS could cost them dearly.

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Here are the prices he found at Houston stores for 90 tablets of generic Prozac:

Walgreens: $117

Eckerd: $115

CVS: $115

Sam’s Club: $15

Costco: $12

Those aren’t typos. Walgreens charges $117 for a bottle of the same pills for which Costco charges $12.

Low-Cost Antimalaria Pill Available

This is truly an exciting watershed event in which a big pharma company (from France) will offer an effective anti-malarial at cost for the third world...

Neither version, at either price, will bring Sanofi much profit, “but in terms of symbolism, it means a lot,” Dr. Sebbag said.

A new, cheap, easy-to-take pill to treat malaria is being introduced today, the first product of an innovative partnership between an international drug company and a medical charity.

The medicine, called ASAQ, is a pill combining artemisinin, invented in China using sweet wormwood and hailed as a miracle malaria drug, with amodiaquine, an older drug that still works in many malarial areas.

A treatment will cost less than $1 for adults and less than 50 cents for children. Adults with malaria will take only two pills a day for three days, and the pill will come in three smaller once-a-day sizes for infants, toddlers and youngsters.

In Africa, malaria kills 3,000 babies and children each day, but combination drugs like this are not available for children under 11 pounds, and they require taking a larger number of pills each day, as many as 24 for some adult versions.

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Sanofi-Aventis, the world’s fourth-largest drug company, based in Paris, will sell the pill at cost to international health agencies like the W.H.O., Unicef and the Global Fund for AIDS, Tuberculosis and Malaria.

The rollout of the drug is the result of a two-year partnership between Sanofi and the Drugs for Neglected Diseases Initiative, a campaign started by the medical charity Doctors Without Borders to find new drugs for tropical diseases.

Doctors Without Borders, better known by its French name, Médecins Sans Frontières, has long been one of the harshest critics of the pharmaceutical industry, charging that it spent billions on drugs like Viagra, Ambien and Prozac for rich countries and almost nothing on diseases killing millions of poor people.

But, recognizing that new drugs would have to come from the industry’s major players, Doctors Without Borders founded the initiative in 2003 and began seeking partnerships. This is the first to come to fruition.

“This was not a love wedding, it was a reasonable wedding,” said Dr. Robert Sebbag, Sanofi’s vice president for access to medicines. “But reasonableness is often more important for a long marriage. They’ve seen we are not nasty people working against poor countries and seeking only profits."

Havidol

A great satire on big pharma advertising for the "new drug" Havidol (get it?)
IMPORTANT SAFETY INFORMATION
Problems can be avoided if you take HAVIDOL only when you are able to immediately benefit from its effects. To fully benefit from HAVIDOL patients are encouraged to engage in activities requiring exceptional mental, motor, and consumptive coordination. HAVIDOL is not for you if you have abruptly stopped using alcohol or sedatives. Havidol should be taken indefinitely. Side effects may include mood changes, muscle strain, extraordinary thinking, dermal gloss, impulsivity induced consumption, excessive salivation, hair growth, markedly delayed sexual climax, inter-species communication, taste perversion, terminal smile, and oral inflammation. Very rarely users may experience a need to change physicians.
Talk to your doctor about HAVIDOL

Behind Antismoking Policy, Influence of Drug Industry

Michael Fiore is in charge of revising federal guidelines on how to get smokers to quit. He also runs an academic research center funded in part by drug companies that make quit-smoking aids, and he personally has received tens of thousands of dollars in speaking and consulting fees from those companies.

Conflict of interest? No, says Dr. Fiore, who has consistently declared that doctors ought to use stop-smoking medicine. He says his opinion -- reflected in current federal guidelines -- is based on scientific evidence from hundreds of studies.


Now debate is growing about that evidence, and about who should be entrusted to interpret it. Some public-health officials say industry-funded doctors are ignoring other studies that suggest cold turkey is just as effective or even superior to nicotine patches and other pharmaceuticals over the long run, not to mention cheaper.

The Public Health Service, part of the Department of Health and Human Services, issued guidelines in 2000 calling for smokers to use nicotine patches, gums and other pharmaceutical aids to quit, with a few exceptions such as pregnant women. Dr. Fiore, a University of Wisconsin professor of medicine, headed the 18-member panel that created those guidelines. He and at least eight others on it had ties to the makers of stop-smoking products.

Those opposed to urging medication on most quitters note that cold turkey is the method used by the vast majority of former smokers. They fear the federal government's campaign could discourage potential quitters who don't want to spend money on quitting aids or don't like the idea of treating their nicotine addiction with more nicotine.

"To imply that medications are the only way is inappropriate," says Lois Biener, a senior research fellow at the University of Massachusetts at Boston who has surveyed former smokers in her state. "Most people don't want them. Most of the people who do quit successfully do so without them."
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Many clinical trials have randomly assigned smokers to take one of these products or a placebo. Such randomized trials are considered the gold standard in many medical fields, and they have consistently shown that nicotine-replacement therapy or other medicine confers a benefit.

But these trials have limitations. They tend to compare quitters who wanted medication and got it with those who wanted medication and didn't get it -- which is a different group from quitters ready to try going cold turkey. Also, clinical trials tend to attract highly motivated quitters who may not represent the population as a whole. Even the placebo group in these trials often boasts double the success rate of the population of quitters generally.

Studies of quitters outside clinical trials have shown no consistent advantage for medicine over cold turkey, the pharmaceutical industry's primary competitor. An unpublished National Cancer Institute survey of 8,200 people who tried quitting found that at three months, users of the nicotine patch and users of bupropion remained abstinent at higher rates than did users of no medication. But at nine months, the no-medication group held an advantage over every category of stop-smoking medicine. The study was presented at a world tobacco conference last summer.

Thailand widens scope of generic drugs

BANGKOK, THAILAND - Frustrated by the price of imported medicines, the Thai government said Monday it would suspend patents on two prescription drugs, one for treating AIDS and another for heart disease. The suspension would allow Thailand to import or manufacture its own copycat versions, cutting the cost of providing free healthcare to its 64 million people.