Blue Mass Group

Reality-based commentary on politics.

Drug makers love ignorance

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via Krugman, we see that PhRMA would like to keep us as their pet mushrooms: Kept in the dark, and fed nothing but @#$%.

 WASHINGTON — The drug and medical-device industries are mobilizing to gut a provision in the stimulus bill that would spend $1.1 billion on research comparing medical treatments, portraying it as the first step to government rationing.

This is, of course, the kind of thing they've been pushing in Massachusetts, fighting disclosure of research payments. And the political establishment usually complies, even to the point of somehow getting our own Commissioner of Public Health to parrot their arguments.

Our ignorance is their goldmine. Remember that next time you get a prescription.

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  2. If they get what they want with TN Governor Phil Bredersen as HHS secretary, life will be good for Pharma.

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    p>It seems the choices are Bredersen, who would turn the department over to the drug companies and Sebelius, who by rights should be the next Senator from Kansas.  No word if Rahm has gotten over the fact that Howard Dean stole his lunch  in second grade, or whatever the reason is for his grudge.

  4. about Medicare’s solvency, which the house’s 2008 report puts at 11 years. $1.1 billion to research treatments’ cost-effectiveness could go a long way toward extending Medicare’s lifespan. Big Pharm’s “slippery slope” arguments are flimsy and transparent. Eventually, we’re going to have to find a way to magically increase the size of Medicare’s trust fund (not likely), cut benefits, or lower the average cost of healthcare for beneficiaries. If this provision can do the latter, I’m all for it.

  5. Does anyone acknowledge all the benefits we enjoy because of these pharma companies? How many of us are alive today, can walk, run or jump today, can enjoy sex, can see, fight cancer… all do to advances in medical equipment and drug treatment?

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    p>People have to stop think of Big Pharma (and really all corporations) like they are evil. Is Motorola evil because they invent things and make profits which they pay to American stockholders who may be retired in Florida? Profits and so many other things related to corporations are not a bad thing and we have to stop demonizing them. Ask anyone with high cholesterol if they would still be alive without Lipitor?

    • Lyme disease is no picnic.  If big pharma doesn’t find a cure, I’m not sure who will. I hope they make big money while they’re at it, they’d deserve it.

      • Do you think maybe you ought to know whether the drug that’s prescribed to you for it works or not? Or, works better or worse than the alternatives? And don’t you think that research ought to be public?

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        p>For crying out loud, no one’s saying companies shouldn’t make drugs, or even that they shouldn’t make money off of it. It’s that we should know what products are effective, and for what, and what alternatives exist.

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        p>These things aren’t in conflict with each other, except insofar as PhRMA has an absolutely maximalist approach to defending its “turf” — which means withholding information from the rest of us. They shouldn’t get to do that.

        • They have intellectual property rights and those should be respected. The FDA has authority to tell us if a drug works or not. If it doesn’t work the FDA should not approve it. I believe people have access to all clinical trial information.

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          p>Better it worse? What’s better, a Ford or a Chevy? 1% milk or 2%? Aspirin or Advil? We aren’t machines and no 2 of us are alike. Again, clinical trial data is available for Viagra and Levitra but your mileage may vary… Which one is better??? Who knows but it might be fun to do some research.

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          p>There are no secrets about whether a drug works or not, check it out. As for withholding information, each drug has a sheet with copious amounts of data (in very small print). Have you heard a recent drug advertisement with 3 minutes of side effects announced right on the TV? There are no secrets.

          • … are required to post things about their products all the time.  I don’t see how pointing out that we’re talking about private companies is a trump against a reporting requirement.

          • Clinical trial information generally tells you if the drug is safe (within limits) and if it is more effective than a placebo (i.e. nothing) in treating a disease.  A clinical trial will not tell you if Drug A is more effective than Drug B, as drugs are not usually tested “head to head” in industry financed trials.  

            • Most private companies make products that consumers can evaluate more easily than drugs.  Can you compare blood pressure meds, or cancer meds, or surgeries to see which one will work better for you?

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              p>And it’s hard for the consumer to even know their costs, never mind compare them.

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              p>Professionals, doctors or insurers, can read and understand the studies to compare them, but only if someone does them!  And without bias.

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              p>My understanding is that most research on drug effectiveness is presently sponsored or influenced one way or the other by drug companies themselves.  Not reassuring.  

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              p>We need more government involvement.

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        • but I get tired of hearing about “evil drug companies”.  I won’t bore you with the details but I suffer daily.  My life has changed drastically since I became host to these spirochetes, so clearly I have a bias here. With my disease there is no prescription that works. There still exists a lot of disagreement in the medical community regarding the disease, so I’m really kind of desperate.  Do you blame me for perhaps being over the top on this one?  How’d you like to go from being a healthy 50 yr old to a sick 60 yr old in 2 weeks. That’s what it was like for me and that was two years ago this month.  

        • Like I asked, which is better Viagra or Levitra, Aspirin or Ibuprofin… Clearly there are so many differences between our bodies (genes/metabolisms…) that comparisons are hard if not impossible. Which is a better drug for breast cancer… depends on your genes. Drug companies decide on a therapeutic target (Sarcoma) and try to develop a drug. If there is already an existing drug, then they target it only if it can be more effective or have less side effects. The FDA will decide if this new drug is safe and effective. Is this new drug going to be actually better in patients… who knows. It them becomes the job of the drug company to get Doctors to prescribe this new drug to find out.

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          p>What do you propose should be the process or are you just bitching?

              • But the statement still seemed wrong to me.

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                p>”It them becomes the job of the drug company to get Doctors to prescribe this new drug to find out.”  There have been numerous studies that higher costs don’t necessarily result in better outcomes.  Your absolutely right that the drug company will want to get Doctors to perscribe their products more, but that’s true independently of any actual product effectiveness.

                Additionally, doctors prescribe a lot of useless treatments because, in the aggregate, they don’t know what works. It’s a bit shocking and a bit scary to realize how little evidence we actually have on treatment effectiveness. Recent years, for instance, have cast a lot of doubt on both angioplasties and cardiac bypass surgery. Lumbar back surgeries are widely thought to be bunk in health policy circles, but lots of doctors still think they work (after all, it’s surgery, it must work!). Hysterectomies are generally harmful, but they’re still used. Celebrex and Vioxx are off the market now, but folks thought they were great five years ago. And on, and on, and on. These are hugely popular surgeries and medicines that are only now being tested in a controlled and smart manner.

                If you reworked all the incentives for doctors tomorrow, they wouldn’t overprescribe as much, but they might not get any better at prescribing care that’s actually of high quality. That sort of transformation requires a whole lot of evidence, which means funding a whole lot of comparative effectiveness research. Currently, that’s not happening, and so a lot of the data comes from medical device manufacturers, pharmaceutical companies, and so forth. It’s not exactly pure and unbiased information. That’s why so many health wonks are so big on things like comparative effectiveness boards. If we spent a couple hundred million a year testing treatments, we’d make it back tenfold in cuts to total health spending.

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                p>Also this:

                The study cost $130,000,000 and included 42,000 patients. It compared the effectiveness of four types of blood pressure drugs: a calcium channel blocker, an alpha blocker, an ACE inhibitor, and a simple diuretic.  The diuretic performed best. …So what happened? Not a whole lot. The Times tells the story:, and even includes a graph:

                Diuretics sales jumped, but only by a few percentage points. “[They] should have more than doubled,” says Curt Furberg, who chaired the study. And in a world where doctors prescribe medications based on a simple reading of the latest evidence, maybe they would have doubled. But we don’t live in that world. We live in a world where pharmaceutical companies have big budgets and sophisticated public relations teams. Pfizer, for instance, put up $40 million to ensure that their Cardura, their alpha blocker, was included in the study. That proved a mistake. Patients on Cardura were more than twice as likely to require hospitalization for heart failure.

                So what did Pfizer do? Spin! “Rather than warn doctors that Cardura might not be suited for hypertension,” reports The New York Times, “Pfizer circulated a memo to its sales representatives suggesting scripted responses they could use to reassure doctors that Cardura was safe, according to documents released from a patients’ lawsuit against the company.”

                • But it appears diuretic sales changed direction and increased after the finding and alpha-blocker sales declined, which seems like a logical result to expect from the study.  
                  The foolish Doctors must not have been listening to those salesman after all. In addition, it looks like you can’t buy desired results in a medical study for 40 mil.

                • …congruous to effectiveness, then the market isn’t being dollar efficient.  The point, however, is that the meager effect the study did have would be erased if the study was simply kept private.  The skewed state of the market after the study came out indicates that information alone wasn’t corrective enough.  This suggests that marketing efforts on behalf of drug companies do work for them and are able to skew market share in their favor independently of cost or efficacy.  This problem used to be mitigated by regulations limiting drug marketing efforts, thus enhancing the value of information based on study rather than marketing, but that’s a separate issue.  The point is that even with that advantage on their side, they want to be able to move the ball the last yard by being able to hide the study information too by not only working against disclosure, but gutting any independent study too.  Now the ability of their marketing to move the markets in their direction doesn’t even need to compete with science much.  All the science they need is just to get approved by the FDA.

                • I have hypertension and went on diuretics. They didn’t do anything. Now the chart you show says diuretics should have helped me. My DR moved me to a ACE inhibitor which works great. Recently, due to a slight heart problem, I had to take beta blockers until my operation. I don’t care what great effects I may have gotten from BB but I discontinued after 4 days since the side effects were unacceptable. I’m sure these three meds taken by you or another person would have completely different results. My point is this study and so many other data points do not capture the problems.

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                  p>And I will still contend that big pharma is not evil and I’m glad we live in a country where products are allowed to be sold based on consumer’s choices and not the governments (assuming safety standards are met).

                • … who do you mean by ‘they’?  The drug companies?  They operate as expected for any for profit entity… they look after their bottom line.  I don’t blame them for it at all.  The problem is that their bottom line doesn’t always align with good or dollar efficient health outcomes.  If your talking about your doctor, he did the right thing.  They first tried the method most likely to succeed.  When that didn’t work they tried other methods.  Your anecdote of what worked for you doesn’t invalidate the study at all.

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                  p>Your last point about choice is irrelevant.  We’re not talking about taking away choice.  We’re talking about making the choices of people and doctors better informed, contrary to the market interests of many drug companies as demonstrated by their expending effort ($$) to kill it.

                • … for some independent studies in the stimulus bill.  That was the point of the post.  It’s actually a pretty good illustration of the collective action problem.  No single entity is incentivised to do such studies, despite the fact that such studies address the collective problem of dollar inefficiency of our system overall with regard to drug effectiveness.  Considering the problem of health care costs, solving this particular collective action problem seems like a no-brainer.  

                • I would also support these efforts to find the best meds, but with the understanding that less effective meds have their place. Thank again.

                • I don’t think the intent was ever to outlaw ‘less effective meds’.  It was to add to the body of knowledge generally available about effectiveness in order that people and doctors can make better informed decisions.

  6. And I wanted to link to Merril Goozner’s analysis (my fav health care blogger)

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    p>http://www.gooznews.com/archiv…

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    p>Here’s a taste:

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    p>

    But even getting the downpayment of $1.1 billion in money funneled through the National Institutes of Health, the Center for Medicare and Medicaid Services and the Agency for Healthcare Quality and Research has drawn opposition on the Wall Street Journal editorial page (where Scott Gottlieb, a fellow at the American Enterprise Institute is the leading voice), from patient advocacy groups who are the payroll of the pharmaceutical industry, and, I have to presume, the lobbying machine for the drug, device and durable equipment industries. Getting it out of the stimulus bill will be a major victory for all of those forces.

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