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More on conflicts of interest: and here too:

Economic ties that could bias drug trials and patient care might remain hidden due to tangled disclosure rules at medical journals, a new study reveals.

Researchers found that of 131 cancer journals, only 112 had policies requiring researchers to state conflicts of interest, such as drugmaker stock ownership or speaker fees. And among journals that did have such policies, the rules were all over the map.

“Journals can’t even agree on what a conflict of interest means,” said Dr. Aaron S. Kesselheim of the Harvard Medical School in Boston. “It is certainly confusing to authors and to readers.”

Scores of studies have shown that when researchers have a financial stake in their work, their reports are more likely to promote drugs and downplay side effects.

Medicynical note: It’s hard not to be a little cynical. There’s nothing new here. We’ve the perfect system to make money not to deliver effective health care. In our country big money trumps reason.

Fine editorial by a bioethicist James Drane: 

Those opposed to any change in the present U.S. health-care system claim that it is already the best in the world, therefore why change it. In fact, an assessment of all health-care systems by the World Health Organization ranks the U.S. system at 37th in the world, right ahead of Slovenia. Five different performance standards were used to measure health systems.

And:

Although the term public welfare is not used in public discussion of health-care here in the U.S., it does belong, and it is not socialism. Public welfare, in fact, is a term found in the first sentence of the Preamble of the U.S. Constitution, ratified in 1788. “We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquillity, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.” One purpose of government, stated in the Constitution, is to promote the general welfare. It refers to the goods that all people need to be free and to enjoy prosperity.

And concludes:

In democracies, citizens are responsible for choosing the moral values of their societies. Voters create good societies through good laws and humane policies. When a large percentage of the population lives in abject poverty, when children die unnecessarily, when elderly persons suffer in isolation, when 46 million people have no health care, the common good is not being achieved and the general welfare is not being provided.

Medicynical Note:  Our democracy’ s approach to health care has it’s grotesque aspects;

• Political parties (and politicians) selling themselves to highest bidder, an action sanctioned by the Supreme Court
• Sanctioning “free” ER use as an alternative to a health care access for all citizens
• Actually, over 50 million are uninsured (and rapidly rising)
• Health Insurers who don’t want to insure those needing health care
• Pharmaceutical suppliers gouging the sickest and most helpless in our culture

And so on. 

Our health care non-system is already viewed with incredulity in other industrialized nations.  They are amazed that the “leading nation of the world” would tolerate such an abomination.

To Obama’s great credit he’s taken the first faltering steps in leading towards a more rational humane universal health care system.  The question is whether we’ll evolve further into an efficient coherent economical system or de-evolve into a health disaster and a dead end.

Substantial reduction in transmission of HIV virus with early treatment:

Men and women infected with HIV reduced the risk of transmitting the virus to their sexual partners by taking oral antiretroviral medicines when their immune systems were relatively healthy, according to findings from a large-scale clinical study sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

Medicynical Note: The study was done in a population that was 97% heterosexual but it is likely the same benefit would accrue in gay couples.

We’ve talked in the past week about the quality and costs of care in the United States. Our patent (government sanctioned monopoly) system is part of the problem.

Big PHARMA maintains that it is essential to have exclusive patents now up to 20-25 years in length to assure profits that will allow continued research and development of new drugs. As a result of Pharma’s effective congressional lobby, pharmaceuticals are the only uncontrolled, i.e. not open to negotiation and price setting, of the health care expense areas. Hospitalization, doctor’s fees, laboratory costs are all negotiable and discounted by the various health care payers. As a result, the rate of increase of spending on pharmaceuticals far exceeds that of other areas–13% a year since 1980. More on health care costs here and here.

Patent law has been carefully crafted to maximize profits of the drug industry. During the patent protected period drug companies can and do charge whatever they wish for a product. As a result, over the past 30 years drug prices have risen exponentially to unimagined levels and the industry has enjoyed record profitability “one example is that in 2002, the combined profits for the ten drug companies in the Fortune 500 ($35.9 billion) were more than the profits for all the other 490 businesses put together ($33.7 billion).”

When I started my medical oncology practice in the 70′s the cost of anticancer drugs averaged under $100/month. By the 90′s the pricing of new drugs broached the $1000/month, and by 2005 we were in the area of $10,000/month for some new drugs. For more look here.

It’s an unfortunate fact that in cancer therapy pharmaceutical costs have become what is essentially a death tax on the desperately ill. Your give your money or your life is on the line. Consider the number of people each year facing a life threatening illness. Consider also that the cost of many of these new drugs/year exceeds the average and median incomes in the U.S.; exceeds the cost of new automobiles; and over the lifetime of a patient the cost of a single medication can exceed the cost of the home of most americans. (see previous post on imitinib) Instead of a benevolent health care system in which access to care and restoration of health are the goals, we have a system whose main purpose is to maintain the profits of the health care industrial complex. The result is wealth redistribution rather than a fair price.

Pricing of pharmaceuticals is not sustainable and is the equivalent of a market bubble that cries out for correction.

Medicynic:  This post is reprinted from 2006.  The Ryan plan is the same idea.  It formalizes a tax on whatever wealth you may have  from those with limited resources to the one of the wealthiest industries.  It’s rationing of care by wealth–the new American way? 

That we are suckers and fools when it comes to pricing of drugs is evident from the fact that we pay much more for drugs than any other place in the world.  It make no difference  if the drug was researched and developed here or overseas, we pay more, much more.

Check our this from Bloomberg:

In the years since 2007:

The average quarterly earnings growth for drugmakers was 10 percent since the first quarter of 2007.

But there are problems with generics:

Pfizer, Merck & Co. and Bristol Myers Squibb Co. are eliminating jobs, cutting costs and shedding business units to prepare for patent expirations. In 2011, drugmakers face generic rivals to products with $34 billion in yearly sales, a figure 34 percent higher than last year. Sales at risk from patent losses will swell to $147 billion by 2015,

But, price increases have the potential to ease the pain:

Most U.S. revenue growth in the pharmaceutical industry will come from price increases after some drug costs were raised more than 10 percent, Bernstein’s Anderson wrote in an April 12 note. Pricing outside the U.S. probably declined after cost reductions were implemented last year in at least 10 European countries, he said. (Emphasis by medicynic)

Medicynical Note:  What’s impressive is the fact that health reform is already having some effect on pricing and that the industry expects the effect of the reform to be lower prices, and lower profits.  It’s about time.

Amazing but true, with the economy in the dumps, unemployment remaining in the 10% range with huge numbers of people uninsured and unable to afford care our pharmaceutical industry raises prices. Their increase is not at the  rate of inflation or even near it,  but rather approaching 5-10 times that rate.  This is the “free market” runing amok.

According to MarketScan, payments for Pfizer Inc’s Lipitor rose 11.4 percent last year, compared with 5 percent annually from 2005 to 2010. That meant the cost of a daily dose of the cholesterol drug rose from $3.17 at the end of 2009 to $3.53 at the end of 2010. Lipitor, which will soon lose patent protection, had 2010 global sales of $10.7 billion.

Drugs with price rises in the mid teens included: cholesterol drug Crestor made by AstraZeneca Inc; blood-clot preventer Plavix sold by Bristol Myers Squibb Co and Sanofi-Aventis; and asthma treatment Singulair, from Merck & Co.

AstraZeneca’s antipsychotic drug Seroquel topped the list with a 16.5 percent price jump, according to MarketScan data, which is particularly telling since it comes from actual payments by insurers, rather than manufacturer list prices.

Medicynical Note:  If the drugs are effective the companies are saying pay us or die.  If these drugs are marginally effective or no better than generics (true of some of the drugs) we are experiencing a scam powered by advertising and collusion with suppliers and providers.

Drug manufacturers claim they need the increases to “develop” new drugs.  In reality they spend more on advertising and marketing than research and have higher profits and profit margins than the great majority of Fortune 500 firms.  Raising prices is gilding their lily.  Efficiency and value, not their department.