Saturday, October 9, 2004
Are Drug Company Profits Really That Fat?
Drug companies are widely perceived by the public to make huge amounts of money for their investors. Is that true? Well, it depends....
New England Journal of Medicine, August 26, 2004, 'The Pharmaceutical Industry--Prices and Progress':
"
"Year after year, the pharmaceutical industry has ranked at or near the top of Fortune magazine’s annual list of the most profitable American industries, which are rated in terms of accounting returns as a percentage of either stockholders’ equity or total assets. But here, too, there is an element of fallacy. Under standard accounting practice, outlays for research and development are written off in the year they occur. But, in fact, such expenditures are an investment, yielding fruit many years after they are incurred. They ought, in principle, to be included in the company’s assets and then depreciated over an appropriate time period. When they are not, the capital base to which profits are related in standard measures tends to be undervalued, and percentage returns on that capital base are overstated. A
government study found that, when appropriate corrections were made, the true returns on investment by the pharmaceutical industry during the 1980s were only 2 to 3 percent higher, on average, than “normal” competitive rates of return, which were estimated to average roughly 10 percent (excluding the effects of inflation). 19,20 This differential of 2 to 3 percent might have been attributable, at least in part, to technological risks not readily avoided through the portfolio strategies available to financial market investors. 21 Whether the differential has remained within that range in recent years has not been tested by broadly accepted analyses."
--F.M. Scherer, Ph.D., Kennedy School of Government
"
Given that the pharmaceutical industry does its R&D from private funds, is the most research intensive of all industries, and has improved our quality of life like few industries have or ever will.....'the first thing we do, let's kill all the lawyers'.
Device To Improve Venipuncture Accuracy
Vein contrast enhancer improves chances you'll get stuck only once:
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"Herbert Zeman has invented a device he calls the vein contrast enhancer (VCE) that is aimed at reducing failed
attempts at hitting the vein the first time during blood tests, injections, and IV drip insertions. The device
uses infrared LEDs to point out areas of high blood concentration, which, if the patient is in fact human, are
veins. The LEDs illuminate the skin at a wavelength of 740 nanometers which is highly-absorbed by blood and
dispered by fat and other tissue. The result is an image that represents the location of veins. This image
is then projected back onto the skin using a “hot mirror” that ensures accuracy within 0.06mm.""
[Via Engadget]
Media Underplaying Duelfer Report
Michael Barone joins with David Brooks in...:
""U.S. 'Almost All Wrong' on Weapons" read the headline on the October 7 Washington Post. "Report on Iraq Contradicts Bush Administration Claims" read the subhead. But these headlines conceal the real news in the report of Iraq Survey Group head Charles Duelfer. For the report makes it plain that George W. Bush had good reason to go to war in Iraq and end the regime of Saddam Hussein...."
[
read the rest]"
Like I said, don't just be content to let some reporter tell you what is says. Go look for yourself...
[Via Instapundit.com]
David Brooks: The Report That Nails Saddam
The Report That Nails Saddam:
"" ...I have never in my life seen a government report so distorted by partisan passions. The fact that Saddam had no W.M.D. in 2001 has been amply reported, but it's been isolated from the more important and complicated fact of Saddam's nature and intent.
But we know where things were headed. Sanctions would have been lifted. Saddam, rich, triumphant and unbalanced, would have reconstituted his W.M.D. Perhaps he would have joined a nuclear arms race with Iran. Perhaps he would have left it all to his pathological heir Qusay.
We can argue about what would have been the best way to depose Saddam, but this report makes it crystal clear that this insatiable tyrant needed to be deposed. He was the menace, and, as the world dithered, he was winning his struggle. He was on the verge of greatness. We would all now be living in his nightmare."
"
[Via Bush-Cheney '04 Blog]
Friday, October 8, 2004
Kerry's Malpractice Reforms Would Do Little
Kerry once again referred to the 'plan' he and his doctor-suing trial lawyer running will implement as tort reform. Declarations and Exclusions disarticulates his 'plan' nicely:
""Pre-filing certification is already required in some states, and there is nothing here to suggest any safeguards to ensure that the reviewing doctors are themselves objective and reliable. Under current law a medical malpractice case is generally not viable without at least one expert witness who will opine that the defendant doctor fell beneath accepted practice standards. Pre-screening may simply require the plaintiff's attorney to find that expert sooner rather than later.
"Most courts encourage mediation in all cases, not just medical malpractice claims, in an effort to reduce crowded courtroom dockets. Mediation is almost always a preferable alternative to litigation, but the quality of mediators is variable and resolution always depends on both sides taking a realistic approach to the claim. There is, sadly, no way to legislate reason or good sense if any of the parties or lawyers don't have it to begin with.
"The proposal for barring attorneys who file multiple "frivolous" suits is likely to prove illusory. "Frivolous" is a high standard, generally requiring a showing that no reasonable attorney would ever have believed that the claim had merit. If a pre-screening requirement is also in place, the allegedly frivolous advocate will likely be able to escape by the simple expedient of having "reasonably relied" on the opinion of the reviewing doctor.
"In many states, the proposed changes to punitive damage law would be no change at all, while in others a "gross negligence" standard would actually expand punitive damage claims. Under current California law, for instance, "negligence" no matter how gross will not support a claim for punitive damages, which are permitted almost exclusively in cases of intentional wrongdoing and "despicable" conduct.""
Importing drugs from Canada, which imports drugs from, where?
Watching the second presidential debate tonight, one question the voters need more information on is importation of drugs from Canada. Allow me to quote a letter to the editor of the New England Journal of Medicine:
""Pharmaceuticals valued at approximately $300 million (all amounts are expressed in U.S. dollars) were imported into Canada in 2002 [
reference] from countries without mutual-recognition agreements about manufacturing practices. [
reference] Twenty-five such countries (including China, India, Brazil, Hungary, Slovenia, Ecuador, Thailand, Croatia, Chile, South Africa, Argentina, and Indonesia) each exported $300,000 to $59 million worth of pharmaceuticals to Canada. [
reference] In 2002, the value of imports from Thailand, Indonesia, Argentina, Ecuador, Chile, and Brazil were 264 percent, 296 percent, 500 percent, 501 percent, 512 percent, and 3270 percent higher, respectively, than they were in 1999. In the first three quarters of 2003, the value of imports from Iran increased to $1.5 million (a 2372 percent increase over the total value in 2002).
"Because drugs from Internet suppliers may originate outside Canada and the United States, neither government takes responsibility for their safety. Canada should take prompt action to prevent large-scale, unregulated, cross-border sales to avoid any negative outcomes from drugs whose origin is unclear and whose quality is unknown.""
Contrary to what Senator Kerry would have you think, drugs purchases in Canada are not necessarily made in the Unites States. You're indirectly buying them from Thailand, Indonesia, Argentina, Ecuador, Chile, Brazil, and Iran.
Consider the following as well: is importation of drugs from Canada sustainable? There's good reason to think not:
""The mass exportation of prescription medication to the United States threatens the preferential pricing set by the Patented Medicine Prices Review Board.2 Companies may also choose not to market medication in Canada in order to protect the larger and more lucrative U.S. market.3 At risk is nothing less than the ability of countries to set their own policy regarding pharmaceuticals. The availability of Canadian medication is not a viable long-term solution to the problems of drug costs in the United States and represents a substantial threat to the access and affordability of drugs in Canada." [
NEJM]"
12 October 2004: Brian Carnell responds here.
NEJM -- Prescription-Drug Prices
NEJM -- Election 2004: Prescription-Drug Prices (available free):
""At first blush, Kerry's positions appear to be more "consumer friendly" than Bush's. Kerry supports policies that create stronger downward pressure on prescription-drug prices than Bush's policies do. This more aggressive stance toward controlling today's drug prices must be considered in light of the effect of lower prices on the flow of new drugs that will be available to the next generation of consumers. Bush supports policies that protect the existing drug-price structures in the name of ensuring adequate economic incentives to innovate.
"The United States is entering uncharted waters in both of these key areas — the importation of prescription drugs and the role of the government in controlling their cost. A voter's choice between the candidates might well be guided by philosophy and a sense of whether profits in the pharmaceutical industry are high enough so that reductions in drug prices would not substantially impede the development of future drugs.
"Importation would have some predictable consequences: U.S. prices would decrease, the world would move toward a single price for a given drug, and Canada and Europe would probably make larger contributions toward the cost of research and development. The magnitude of the financial gain in the United States, however, is uncertain; my guess is that there would be modest price reductions for consumers in the United States and substantial price increases for Europeans and Canadians."
"
The fly in the ointment here is the American health consumer's desire to have the best medical care in the world, have it for free, and have it now. I think they like the idea that drugs will be cheaper---even if it means having fewer 'new' drugs going forward. There are great drugs in the pipeline. Great new ideas for how to better treat asthma and diabetes and heart disease. They'll still be there, but will it be as soon if we reduce the premium drug companies charge for new drugs? I don't think so. I personally would favor streamlining the drug approval process and shortening the time until generics are available first.
Thursday, October 7, 2004
Iraq Survey Group Report Available
The Iraq Survey Group report is available at the CIA website. They've broken out the 'Key Findings' as a separate PDF document. Don't just be content to let some reporter tell you what is says. Go look for yourself...
Wednesday, October 6, 2004
Factcheck.org Reviews Vice-Presidential Facts
FactCheck.org: Cheney & Edwards Mangle Facts
Tuesday, October 5, 2004
Let's Be Clear: Edwards Sued Doctors
Just one note on the debate before bed. John Edwards would you have you believe he's proud of representing the underprivileged against drug companies and insurance companies. He may have done some of that, but his specialty was suing doctors; most often for cerebral palsy and 'birth trauma'. (A causality which has been disproved.)
[via Overlawyered]
Harvest of Organs Was 'Homicide'
The Australian: Harvest of organs was 'homicide':
""A US coroner issued a homicide finding yesterday after determining that two hospitals allowed vital organs to be removed from a man before they had proven he was brain dead.
William Rardin's cause of death was "removal of his internal organs by an organ recovery team", ruled coroner Mark Young in Montrose County, Colorado.
He said he did not believe the case should be a criminal matter, but suggested it "should lead to a clarification of what the accepted standard is".
Mr Young said the two hospitals did not follow "accepted medical standards" or meet state guidelines in determining that Rardin, 31, was brain dead after he shot himself last month.""
What were the tests done at the hospital to determine brain death? Splashy headline, but we need more facts to really know what went on.
Donor card, anyone?
Medscape Bioterrorism Resource Center
Medscape maintains an excellent Medscape Bioterrorism Resource Center. Registration does not appear to be required for access to this resource, either.
""This Resource Center provides clinicians with the latest news, reference material, literature selections and continuing education about potential bioterrorism agents. It is designed to help healthcare professionals identify the signs and symptoms of such agents and thus be better prepared to respond in the event of a bioterrorism outbreak.""
Topics covered include:
Anthrax
Smallpox
Plague
Botulism
Tularemia
Viral Hemorrhagic Fevers
Biotoxins
The question I have to answer is:
a) should I have myself re-vaccinated and
b) should I approach my wife about having our two sons vaccinated.
Any informed opinions are welcomed
.
Brain MRI Successfully Adapted for Intraoperative Use
Brain MRI Successfully Adapted for Intraoperative Use in Germany.
A neurosurgeon's wet dream
FDA Public Health Advisory: Safety of Vioxx
FDA Public Health Advisory: Safety of Vioxx from the FDA and also a FAQ.
As far as I have been able to find out, the results that led to the early termination of the APPROVe trial have not been published. What seems to have happened is that the trial was terminated because interim analysis revealed the increased risk of heart attacks in those taking Vioxx for more than 18 months. Of note is the fact that the study enrolled fewer than three thousand patients, yet still possessed enough power to allow this conclusion, which suggests to me that complications were not rare (in which case a much larger study sample would have been needed to demonstrate this result).
Medscape CME:Alvimopan Shortens Postoperative Ileus
From Medscape CME (registration required): Alvimopan Shortens Postoperative Ileus for 0.25 credits.
The Bomb In My Garden
I just started reading 'The Bomb In My Garden' (Amazon), written by the Iraqi scientist who was formerly the director of Saddam's nuclear centrifuge program. The back cover contains strong recommendations from both James Fallows and David Kay, both of whom are knowledgeable and trustworthy, in my view. Allow me to quote from the preface:
""There was no active nuclear program before the invasion of Iraq. However, Saddam certainly had the capabilities and, it must be presumed, the intention to restart it some day when the world was no longer watching him so closely. As long as tyrants like Saddam are willing to intimidate frightened scientists into doing their bidding, the threat of covert nuclear programs will continue. I hope that my story can help the public understand how such dangerous programs are developed so that they can be stopped wherever possible.""
Even if it takes a bunker-busting nuclear weapon, in my view...
Monday, October 4, 2004
MGHAnes
MGHAnes:
""Skyscape has released
MGHAnes™ which is the Skyscape version of Clinical Anesthesia Procedures of the Massachusetts General Hospital, 6th Ed.
| The best-selling handbook, Clinical Anesthesia Procedures of the Massachusetts General Hospital, Sixth Edition, is now available in PDA format. This easy-to-navigate handheld reference provides instant access to current, comprehensive, concise, consistent, and clinically relevant guidelines for anesthesia procedures throughout the preoperative, intraoperative, and postoperative periods. Coverage includes a comprehensive, alphabetical drug appendix, adult and pediatric resuscitation guidelines, malignant hyperthermia protocols, an anesthesia machine checklist, and information on complementary and alternative medicine and end-of-life issues |
""
[Via The Palmdoc Chronicles]
Vioxx: How Safe Is FDA Approval?
Vioxx: How Safe Is FDA Approval?:
""The problems with Vioxx, taken off the market last week, raise questions about the Food and Drug Administration's safety review process. Observers say longer clinical trials should be required.""
[Via Wired News]
Sunday, October 3, 2004
Take A Poll, Enter Drawing For iPod
Polling Point is doing a 2004 Media Bias Study. If you have an opinion on the job the mainstream news anchors are doing, why not take a few minutes and give them your opinion...and enter a drawing for a mini iPod Mini at the same time?!
Did Kerry Cheat in First Debate?
"No props, notes, charts, diagrams, or other writings or other tangible things may be brought into the debate by any candidate." So states the memorandum of understanding between the two campaigns regarding the debates. Yet, this video shows John Kerry taking something out of his pocket at the beginning of the debate and placing it on his lectern. Please explain, Mr. Kerry. Perhaps it was a picture of Teresa to inspire you?
[via American Daughter]
Menstrual Migraines and Period Control
Menstrual Migraines and Period Control:
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"Not all headaches are created equal: migraine headaches affect more than twice as many women as men. Interestingly, in 60-70% of women, the headaches are related to the menstrual cycle. Period-related headaches that occur from one week to 3 days before the start of your period are called premenstrual migraines. The ones that occur from 3 days before the start of your period to 2 days afterward are called true menstrual migraines....
""
[Via The Well-Timed Period]
What's Michael Moore Up To?
It seems Michael Moore is turning his camera on drug makers and health unsurers.
""Companies have warned their sales representatives to be on the lookout for camera phones and reports of Moore representatives offering $50,000 to doctors' offices to place hidden cameras or $5,000 to sales representatives willing to be filmed, according to a representative of one drug maker, who asked not to be identified.
"Moore's spokesman would not comment on any production activity or allegations of payments to drug company employees.""
Saturday, October 2, 2004
Pennsylvania malpractice roundup
Pennsylvania malpractice roundup:
""The IssuesPA/Pew Poll has found that a remarkable 26 percent of Pennsylvanians polled "said rising malpractice insurance costs have forced their family to change doctors in the past year", and that state residents polled also favored a constitutional cap on pain and suffering damages by a margin of 68 percent to 24 percent...""
[Via Overlawyered]
