'Robo-pills' boost Rx compliance

Novartis is testing microchips embedded in prescription drugs to remind patients to take their medicines.

A receiver on the patient's shoulder picks up the signal. If the patient forgets, the chips sends patients a text message.

20 patients using valsartan (Diovan) increased compliance from 30% to 80% after six months, reported the Financial Times.

It adds new meaning to the term "telemedicine."

Labels: drug companies, drugs, medication, medication adherence

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posted by Ryan DuBosar at 12:01 PM   0 Comments

Madison Ave. medicine

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posted by Stacey Butterfield at 9:00 AM   0 Comments

Look that free drug in the mouth

Last winter, we (and the CDC) got riled up about pharmacies eliminating co-pays for antibiotics because it could encourage overuse of the drugs and antibiotic resistance. A new Wall St. Journal article points out that drug manufacturers are doing the same thing with medications for some chronic illnesses. And sure enough, pharma's co-pay rebates are also likely to have negative consequences for society.

Specifically, the elimination of the co-payment on a brand name drug (Lipitor was one cited by the article) pulls patients away from generic options and pushes up drug costs for the insurer. (The drug makers aren't offering the same kind of deals to third-party payers; for them, medication prices have only increased as co-pays went down.) Luring business away from generic competitors was explicitly the point of the rebates, explained one pharma exec quoted in the article.

Massachusetts is the only state that currently bans the practice, but it will probably become a hotter topic as health reform progresses. Under the current system, the complaints of insurance companies that have to pay a little more for drugs isn't going to elicit a lot of sympathy from consumers and legislators. But if a public plan option results in tax dollars paying for these brand-name medications, that'll be a different story.

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posted by Stacey Butterfield at 9:00 AM   0 Comments

The doughnut hole will need a new name

Yesterday, pharmaceutical companies agreed to shrink the Medicare doughnut hole by offering a 50% discount on meds purchased while a patient in the hole. The full price of the medicines will continue to count toward getting back out the other side. Given this development, the gap in coverage is going to need a new name to convey its smaller size--maybe the icing in the eclair or the Oreo filling?

More seriously, the most interesting thing about this change is how it benefits everyone involved. The advantages to patients are obvious. But the seemingly altruistic move by big pharma will probably benefit their bottom line, too, according to an analyst interviewed by the New York Times.

"'Because of the discounts,' he said, 'Medicare beneficiaries are likely to continue filling prescriptions in the doughnut hole, whereas in the past many stopped taking their medications because the drugs were unaffordable to them.'"

It makes you wonder why they didn't do it sooner. Was this strategy reserved until it would have the biggest possible PR impact as a contribution to health reform?

And if the talk of doughnuts and Oreos has made you desperately crave some junk food, my apologies. The NYT also has an interesting article about this psychological torment.

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posted by Stacey Butterfield at 2:30 PM   0 Comments

Is health care the new Hummer?

Rationing is in. First, we learned that we all need to cut back on our carbon output, then it was discretionary spending that had to be restricted. Now, some health care analysts are pointing out the painful truth that the only affordable, equitable way to provide health care may be to ration it.

Daniel Callahan of the Hastings Center has recently stirred controversy on the issue, with a New York Times blog post describing his rationing plan. Basically, he suggests that Medicare coverage for very expensive therapies (like open-heart surgery) be cut off once patients hit age 80. By the way, it seems important to note that Dr. Callahan himself is 78. "Our society can not, and should not, promise open-ended, progress-driven medical care that is indifferent to costs," he concluded.

Sound outlandish? Not to the Brits, who are already doing something along these lines. Another NYT article discusses NICE, the British government institute that decides whether a therapy is cost-effective enough to be covered. Their cut-point right now for life-extending cancer drugs is about $22,000 for per 6 months of life gained. The policy raises a whole heap of protest from pharma companies (who the article pretty well puts through the ringer) and patient advocates. Even so, numerous other countries are looking at the British example to deal with their ballooning health care costs, the NYT says.

"What price is life?" asks a woman in the article whose husband was denied an expensive drug. It's a tough question, but one which bureaucrats, health experts and politicians might soon have to answer. Is rationing the only solution?

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posted by Stacey Butterfield at 11:21 AM   0 Comments

Nothing to disclose

Since we spend a lot of time covering the ways that physicians are potentially influenced by pharma companies, it seems only fair to tell you about a new article that says health care journalists might have the same problem.

Writing in BMJ, experts from the Center for Medicine and the Media describe how lavish prizes (e.g., 7500 euros + a international trip for writing about obesity), pharma funding for education (a sponsored professorship in a medical journalism school), and assistance from PR reps in finding sources (ever wonder where they get those patient anecdotes?) can compromise journalistic ethics.

The response from ACP Internist staff: What? Why didn't anyone tell us about all this free stuff?

Rest assured, dear readers, that we would be sure to let you know if we ever won any fabulous prizes, we have no specialized training, and we spend lots of time hunting down our own sources. But, just in case any of you were thinking of buying me a trip to Europe, I promise that such a gift would not cause me to be less critical of you. (My parents can vouch for that.)

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posted by Stacey Butterfield at 4:36 PM   0 Comments

Data-mining goes down in court

The pharma industry took a hit on Tuesday, when a federal appeals court upheld a New Hampshire law that bans data-mining, the practice in which physicians' prescribing records are sold to pharma reps. The opinion came down pretty hard on detailing tactics (calling them mind-boggling), and the ruling may inspire other states, especially those in the same New England judicial district, to follow suit, according the NY Times.

It's good news for docs who don't like pharma reps knowing more about their prescribing habits than they do, but bad news for the pharma and data-mining companies. The decision's also a potential blow to the AMA (which made 16% of its 2005 income selling the info).

First, the ban on free food and pens, now this, what next? Soon pharma's only option will be to buy ads on snarky medical blogs.

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posted by Stacey Butterfield at 2:00 PM   0 Comments

Flat bellies sell, bees not so much

Direct-to-consumer drug advertising may not work as well as is commonly believed, a study in the British Medical Journal found.

Canadian researchers looked at three heavily advertised drugs--Zelnorm, Nasonex and Enbrel--and compared prescription rates in English-speaking regions (which were subjected to U.S. TV ads) and French-speaking areas (which weren't). The Zelnorm ads caused a big jump (42%) in prescribing right after the ads started in English areas, but the other ads appeared to have no effect. And prescriptions for the IBS drug soon dropped off, even though ads continued.

Researchers speculated that the award-winning effectiveness of the ad (Remember those trim female abdomens with happy messages written on them?) and the lack of competition for the drug (no alternatives were approved) may explain its unique success, and the dropoff could be attributed to how the drug itself turned out not to work very well and be dangerous.

So what's it all mean? Perhaps some of you already thought this, but the study authors now believe that "a substantial portion of expenditure on such advertising--borne by governments, insurers, and patients in the form of higher costs or by companies as reduced profits--may be better spent elsewhere."

Is it time to say goodbye to the Nasonex bee?

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posted by Stacey Butterfield at 2:02 PM   0 Comments

FDA's new conflict-of-interest guidelines

Seems like everyone is getting on the conflict-of-interest bandwagon when it comes to drug companies.

New FDA guidelines prohibit the experts who advise during committee meetings to participate if they, their spouse or minor child have more than $50K financial interest in the companies that will be affected by their actions at the meeting.

Below $50K, the expert may get a waiver by the FDA to participate, but only if his or her input is deemed essential. The number of waivers given will be limited, and FDA will post on its Web site, in advance of the meeting, the reasons for each waiver.

Other changes:

-Advisory committee members must now vote all at once, insted of one-at-a-time. the aim is to avoid "momentum" that could sway people to vote in line with those who preceded them.

-Votes will be immediately announced at the meeting.

-Committee member votes will be posted on the FDA Web site.

-FDA will post the background materials it gives to committee members on its Web site at least 48 hours before the meeting starts.


What do you think of these guidelines? Is $50K a reasonable cutoff? How difficult is it to find experts who have little or no financial interest-- as from consulting or speaking fees-- in these companies? Do the voting and waiver rules go far enough to ensure transparency?

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posted by Jessica Berthold at 5:00 PM   0 Comments