Archive: March, 2011
When I first started these weekly postings, my editor (who left the Inquirer last year) diligently sought to organize my prolix writing.
"What's the nut grab on this piece?" he asked.
I hesitated for a long moment, suspecting the possibility that I had stumbled into working with the Village People at the YMCA, so I asked him to clearly define the term.
On Wednesday, U.S. officials said they won’t stop special pharmacies from making a cheaper version of a new expensive drug called Makena that prevents preterm labor.
The Food and Drug Administration’s rare decision means that pharmacies can undersell the recently approved Makena, which went on sale this month at $1,500 per dose.
The decision was a victory for doctors and others, including Penn's Alexander Friedman, who have objected to the high price, because special compounding pharmacies have been making the drug for high-risk pregnant women for decades. The recent cost was $10 to $20 a dose and it is considered the standard of care for women in danger of delivering early.
In February, the drug’s maker warned pharmacies to stop making the cheaper version or they could face FDA enforcement. But the FDA said Wednesday that the pharmacies can continue making the cheaper version.
Five pieces of ceramic kitchenware purchased in Chinatown contained levels of lead many times higher than the legal limit, according to an analysis by Thomas Jefferson University doctors who have tested dozens of items sold by Philadelphia merchants.
They reported the results to the Food and Drug Administration, and a spokesman said Monday night that the agency would be following up with its own tests.
Although the two spoons and three plates appear to be clearly out of compliance - the lead standard for plates is 3 parts per million, and these contained 52, 130, and 145 ppm - it is unclear whether they caused any problems for infants, who are most at risk.
In last week’s blog I wrote about the problems that hospital staff often has in getting an accurate list of medications from patients when they come to the emergency room or are admitted. It’s critically important for doctors to know what you’ve been taking in order to properly perform a complete clinical assessment. Much the same is true when you go to the pharmacy to have prescriptions filled. With an accurate list, your pharmacist might be able to help you head off an adverse drug reaction or error that would require you to go to the hospital in the first place.
You may have heard from your doctor or pharmacist that it’s important to fill all your prescriptions at the same pharmacy so they maintain an accurate list for you. That would be nice, but in truth, with our fragmented healthcare system, it doesn’t always work that way. Insurance companies want to keep costs down for those who independently purchase insurance, or for employees and family members covered through work. They operate a pharmacy benefits management (PBM) firm or contract with one, which utilizes a mail-service pharmacy. These operations in turn encourage you to buy all long-term medicines through the mail. The insurance company provides incentives for that, often by allowing you to buy a 3-month supply of medicine from the mail-service pharmacy for the same co-pay as a 1-month supply from your community pharmacy. Still you will need to get prescriptions for short-term use from your community pharmacy. This includes antibiotics, pain medicine, and many other medicines used to treat a short-term illness or injury. (Read more here)
No matter where you get your medications, most often, a pharmacist checks that your doctor has prescribed a safe dose of the medicine and that it can be taken with your other medicines. Also, for payment, if you have a prescription plan and use it, your drugs must go through the plan’s computers, which will normally match what you’re getting with what’s on your record and alert pharmacists to potential problems. But if for some reason the medication you get at a community pharmacy isn’t covered, or you pay with cash, the mail-service pharmacist may know some of the medicines you take, while your community pharmacist knows of others, and none of them may know all the medicines you take. Therefore, they might not pick up a serious problem with how your medicines react together in your body.
Health reform turned one year old this week. It has certainly been a difficult year.
Legal challenges, repeal efforts, and charges that it will destroy American health care with socialism. Has a new law ever had it so tough?
The answer is yes. Just look at Obamacare’s big brother, Medicare. When it was enacted in 1965, Medicare’s opponents didn’t just warn it would create socialized medicine. They predicted it would lead to an entire Soviet-style economy.
Pharma and other health care manufacturing sectors have been furiously trying to forecast how Obamacare and other changes in the environment, such as the consolidation of medical practices, will affect their futures. As one example, previous postings here discussed how practice consolidation under hospital-dominated, Integrated Delivery Networks (IDNs), together with the universal adoption of Electronic Medical Records (EMR) by 2015, will lead to providers and payors selecting drugs through a process of "duelling databases."
The consequence of practice consolidation and EMR will be the final nail in the coffin for pharma's megacompany-blockbuster model. Companies that can prosper with a line of small, niche products will generate top value for their investors while the megacompanies capitalized at $160 billion after shortsighted mergers won't be able to grow their earnings per share by relying on small products.
Last week's public disclosure of a whistleblower lawsuit, filed in California during 2007, now calls into question the entire scope and process of pharmaceutical marketing. In that suit a former employee of Bristol-Myers Squibb (BMS) alleges the company engaged in a mammoth kickback scheme to induce California physicians to prescribe branded BMS products. These kickbacks obliged insurers and other payors to pay more for drugs than they otherwise would have.
I had the opportunity to spend a day at Abington Memorial Hospital last week as part of a special program held each year to recognize staff efforts to improve patient safety. I had a fascinating day attending various patient safety-related meetings and attending safety walk-arounds with members of the quality and safety team, a group of safety experts they’ve gathered to help set specific goals to protect patients. Many of these goals deal with medication safety.
At one of Abington’s safety committee meetings, we got into a discussion about the tremendous problems that nurses, doctors and pharmacists have in getting an accurate drug history from patients who come to the emergency room or are admitted. This is crucial information, not only to know what medicines need to be continued during a patient’s hospitalization, but also whether unwanted side effects are occurring and whether or not a drug dosing error, duplication, or omission might be the cause of a patient’s symptoms. Problems can also be identified that are due to drug allergies, and interactions between drugs, foods or herbal products. Problems you might be having with optimizing drug doses and eliminating the drug from your body also need to be considered.
During my visit we got into a discussion about the need for patients to maintain and carry with them a list of all their medicines, as well as give a copy to a family member or other person they can trust for emergencies. (Go here for more information, safety tips and a form you can use). It was mentioned how people sometimes forget to list eye drops, inhalers, medicine patches, and birth control pills. Also mentioned was that many people do not consider vitamins, herbal remedies, homeopathic medications, and even aspirin or other OTC drugs as medicines. All too often this information, while just as important, is left out, so list these items too.
The long-simmering “nature” vs. “nurture” debate was settled decades ago in a draw. Biology and environment both matter.
Some ramifications are so obvious that no scientific consensus was needed: A natural athlete, given the best coaches and training, will become a star; the rest of us can practice till we drop and never make the team.
Others are harder to fathom. New research suggests, for example, that older people who live in bad neighborhoods may have poorer cognitive function — but only if they have a specific form of gene.