Pithy Loquacity

Category: Drugs

  • Doctors influenced by Rest and Fluids Industry

    This physician enjoyed an all-expenses-paid trip to Aspen, just for telling his patients to “relax.”

    I have noticed that medical satire from theonion.com is awfully good. Hats off to the writers(?writer). In keeping with the current flaying of pharma-physican backslapping ties; The Onion investigates and finds ulterior motive in prescription of just fluids and rest for common cold rather than antibiotics ;-0

    The investigation—the full details of which will be disclosed in this newspaper over the coming months—documented thousands of instances in which sick patients were repeatedly instructed, often verbatim, to “lie down and drink plenty of liquids.” This treatment, recommended a staggering 4 out of 5 times on average, was in each case prescribed by a physician known to have recently enjoyed a golf vacation courtesy of Big Rest and Fluids.

    “You have no idea how deep this goes,” said Dr. X, a physician who wished to remain anonymous. “They’ve got everyone, from the pediatricians and family doctors, right on down to the school nurses. We’ve had the cure for the common cold for nearly 40 years, but it’s still ‘rest and fluids, rest and fluids.’ Why? Because these guys are getting paid through the nose, that’s why.”

    The ending of the article is pretty good too…

    h/t

    The complete article from The OnionTechnorati Tags: ,

  • On Generics and Drug affordibility in India.

    I had previously written about compulsory licensing of expensive anti cancer drugs in India and the expected benefits to the patients. Just after this news came out, there was reaction from the Govt. sources  stating that no they had no plans for such measures as cancer was not an “epidemic or national emergency”.
     
    There is an interesting interview with Ranjit Sahani, country president of Novartis in India  who is arguing for better IP protection and pointing out that generics do not solve the issues as they remains out of bound to most of the patients.

    But here, generics alone do not solve the issue. Generic versions of Glivec are far too expensive for the poor in India. Furthermore, generic-makers in India have yet to come forward with an access program for generic imatinib mesylate (Gleevec’s generic name). For example, in India the cost of a one-year treatment with generic imatinib is $2,100, or 4.5 times the average annual income. Even our critics recognize that generic versions of Gleevec are not the solution for the poor in India. This is why approximately 99% of patients on Gleevec receive it free. There is no market for Gleevec in India…

    You can read the whole article here. (via Pharmalot).

    He also discusses the issue of epidemic and national emergency as regards to HIV and Diabetes

    There continues to be some ambiguity around what constitutes an epidemic situation. In 2007, India reported 2.5 million HIV infections, a prevalence rate of 0.36%, with less than 15% of HIV-positive people receiving [antiretroviral] treatment. That said, India has about 60 million diabetic patients [30 million diagnosed and another 30 million undiagnosed]. By sheer volume, wouldn’t that constitute an emergency? If examined carefully, limited cases would qualify as a national emergency, an epidemic, for example. HIV and cancer by the very nature of these illnesses are an emotive issue, which is why they get the volume of publicity.

    Most Indian practitioners are aware of the huge disease burden in our country and the dismal situation here but the figures he quotes is sobering.

    He also talks of differential pricing of drugs but I think it will be hard to put in practice or prevent misuse. Another point he makes ( naturally being a pharmaceutical seller) that the price of drug is fraction of the total cost of treatment.

    Despite a significantly higher cost for the private sector, an analysis of the cost structure shows that the amount spent on medicine is a fraction of that spent on diagnosis and doctors’ fees.

    I feel that were it not so, the number of patients completing their treatment/ patient compliance will go down even more. The fact is physician compensation/procedure costs are also rock bottom. For example where in world you get a cholecystectomy for Rs 3000/- or an abdominal ultrasound for Rs 300? Unless the economic condition improves the return on medicines will remain around the present levels.

    Interesting read over all.

  • Educating doctors?

    Recently there were two pieces of news regarding the relationship between doctors and the pharmaceutical industry. In one the convener of RANZ college of  Psychiatrists(RANZCP)  decided to resign when his attempts to end drug company sponsorship of CME and Conferences was vehemently opposed by fellow members.

    Psychiatrists back sponsorship deals | The Australian

    A SENIOR member of the Royal Australian and New Zealand College of Psychiatrists resigned as convenor of its 2009 congress after his peers unanimously voted down a proposal to dump drug company sponsorship.

    A similar story from Australian papers regarding sponsorship of a weekend seminar for Gastroenterologists is panned here.

    “A drug giant spent more than $514,000 on a weekend seminar that included just six hours of “education content”.

    The symposium by Australian-based AstraZeneca included gourmet meals, alcohol and two nights free accommodation.

    A new report shows “Big Pharma” is prepared to spend millions showering doctors with hospitality in the hope they will prescribe their drugs.

    It reveals drug companies spent $31 million on educational events in the second half of last year, including $16 million on meals, airfares and accommodation.

    Drug companies funded 14,643 functions during the period, 52 of which are under investigation for possible breaches of new industry rules.

          Read the full article here. How drug companies wine & dine doctors.
           (from herald sun,au)

    In general doctors perceive that they can be dispassionate about their clinical decisions even after being sponsored by the drug companies. The situation in India is no different, if not more “inter wined”. As can be witnessed by the reluctance of Psychiatrists; it is not easy to let go of the easy money provided by the pharma companies.

  • Compulsory Licensing for breast cancer drugs in India?

    Stated briefly; in general  the treatment of breast cancer in India at present is suboptimal. I was reading a book regarding evolution and changes in management of breast cancer and what struck me was that we are still stuck in last decade. Most of the patients present very late in disease process. Breast cancer screening is practically non existent. A number of tests which have become routine like ER and PR status are not available even in teaching government hospitals leave alone general hospitals. And not everyone can afford to get it done from private centers given the cost. This problem extends to post operative period as well with a number of patients unable to afford tamoxifen for the long duration prescribed. In this context it is apparent that majority of patients cannot afford more recent and advanced drugs available.

    There is this article in today’s Economic Times.

    NGO to seek compulsory licensing of cancer drugs- Pharmaceuticals-Healthcare / Biotech-News By Industry-News-The Economic Times

    NGO to seek compulsory licensing of cancer drugs.

    At this time the prices of anti cancer drugs is out of reach of general Indian population with prices in excess of

    Some of the drugs identified by CPPA for compulsory licensing include Genentech’s and Roche’s Herceptin (Rs 1.3 lakh i.e Rs 130,000 per injection, to be taken 10-15 times), Roche’s Mabthera (Rs 1 lakh per injection, to be taken 10-12 times) and Tarceva (Rs 48,000 for 30 tablets, dosage details not known), Novartis controversial drug Glivec (Rs 1 lakh for a month’s treatment), Astrazeneca’s breast cancer drug Arimidex (Rs 3429 for 14 tablets, to be taken for 1-2 years) and Zoladex (Rs 8,910, dosage details not known), GSK’s Hycamtin (price and dosage details not available).

    Keeping in mind that per capita income in India is about 580 $ or Rs 23,000 and the fact that health insurance is an exception rather that a norm any disease (leave alone breast cancer) will leave the entire family in penury. Despite these facts a few patients would like to go for these drugs. What I do not understand is the reluctance of pharma majors to market these drugs and at a lower price. They will be making a profit even if 20% of the patients buy their products. Or are they afraid of these drugs undercutting their high value markets back home?

    Do you think this move will be justified?

    There is a similar news piece regarding HIV drugs and Cipla. From Pharmalot.
    (updated)