“The scandal isn't what's illegal, the scandal is what's legal”

This quote, attributed to Michael Kinsley, is applicable to a very disturbing trend that is having an increasing impact on antimicrobial availability: the acquisition of exclusive marketing rights (usually by small private firms) to inexpensive generic drugs in order to jack up their prices astronomically. The antimicrobials pyrimethamine, albendazole, cycloserine, flucytosine, and doxycycline have all experienced price increases of up to 5000%, and there have been several recent posts on the Emerging Infections Network about how this is limiting availability of these agents for those who desperately need them. 

I hope this NY Times story about the pyrimethamine saga draws more attention to this trend, and leads to some regulatory reforms to prevent this obvious price gouging. Because you-guessed-it, there is nothing illegal about this under U.S. law.

Fortunately, because it engenders bad press when people suffer and/or die due to unavailability of an essential drug, some of these “pharmaceutical companies”* will immediately send out the drug at a reduced price (or even without charge) if contacted by the treating physician. Such saints, these folks are….

*I put that term in quotes, because the company that owns marketing rights to pyrimethamine is founded and run by a hedge fund manager

Ask your doctor

No introduction needed apart from John Oliver - Marketing to Doctors. If you'd like to search for a specific physician or hospital, the CMS Open Payments site is now online. If you're interested in viewing the COI policy that covers "your bloggers", you can see it here.

"At the end of the day, the drug companies own medicine"

The title of this post is a quote by Eric Campbell of Harvard Medical School in an investigative piece in yesterday's Milwaukee Journal Sentinel. The article focuses on conflict of interest among physicians who write practice guidelines for academic societies.

Here's a summary graphic from the article:

This article is worth reading, but it's disturbing.

Dollars for Doctors

The NPR show On the Media aired a very interesting story today on the pharmaceutical industry's use of gifts and payments to physicians to influence drug prescribing. What I like about this interview of ProPublica journalists is that you get a sense of how nonmedical people view this issue. You can listen to the podcast here and see ProPublica's webpage on this topic here.

In the realm of infection prevention, the industries are different (e.g., microbiologic diagnostic testing supplies and equipment, cleaning products, and antimicrobial/antiseptic coated devices), but the core issue is essentially the same--allowing industry to influence practice and policy by targeting individual practitioners, professional societies and lawmakers.

Photo: ABC News

This should be interesting...

New rules that mandate reporting of all physician payments from drug and device manufacturers should be out soon. I favor this transparency, provided the information is detailed and accurate. For example, receiving money from a company for doing a valid research study on one of their products is a bit different than receiving money to travel around the country on a speaker’s bureau. Let’s hope the publicly available data includes information about the reason for the payment, and the recipient of the payment (e.g. the medical school, to support Dr. X’s research study, or directly to Dr. X).

It will also be interesting to see if makers of diagnostic devices will be included—clearly the makers of devices that touch or are inserted into patients will be required to report payments, but it isn’t clear to me if the same holds true for makers of new diagnostic tests. As we’ve discussed before in this blog, such transparency is also extremely important.

Hospital epidemiologists are killing pharma

Photo: 2old2play. com

A new report shows that the hospital acquired bacterial infections market for the time period 2010 through 2017 is expected to decline by a negative CAGR of 3.4% (click here if, like me, you need help understanding a CAGR). One of the major reasons cited for this decline in the market for these antibacterial drugs is a reduction in healthcare associated infections.

If you are interested in learning more about what's in this report, click here and submit your credit card information. For only $3,500 (about the same price as a course of fidaxomicin), the report can be yours.  

Needed: Some new antibiotics

The New York Times, 11/6/10

This morning's New York Times has an article by Andrew Pollack on the problem of the pharmaceutical industry's lack of interest in developing new antibiotics. From an economic perspective, it's hard to entice companies to develop drugs that a patient might need for a few weeks, when other drugs may be required for years. Yet the problem of multidrug-resistance, particularly for gram-negative organisms, continues to accelerate. Pollack points out the lack of consumer advocacy on this issue, noting that advocacy has focused on reducing transmission of infections in hospitals, rather than the development of new therapeutics.

Let the “false pandemic” debate begin!

Last Spring, we had quite a few posts about whether the emergence of H1N1 should be termed a pandemic. Turn back the clock, ‘cause it looks like we’re going to have that debate all over again. What self-respecting pandemic virus kills fewer people than seasonal influenza?

Read it for yourself, but the Council of Europe just passed a resolution calling for an investigation into the role of big pharma in the WHO decision to declare a pandemic. An emergency debate is scheduled for later this month…..pass the popcorn, this should be interesting.

Revenge of the gram-negatives!

A new report for the pharmaceutical industry states that the market for drugs to treat hospital-acquired gram-negative organisms will increase by $1 billion over the next 10 years. The report notes that the market for gram-positive drugs has been more lucrative, but now the opportunities for gram-positive drugs are declining. Let's hope that Pharma is successful in its quest for new gram-negative drugs given the worsening problems we are encountering with highly resistant gram-negative infections and few agents available currently for their treatment.