Surprise! A New Post
Surprising myself by getting this post out there so soon after the last one. Amazingly, I'm on call, have finished all my e-work, and have time to sit here and wax poetical. Or wax something.
This past weekend I went to a conference on medical matters called PriMed Updates. PriMed conferences are rather interesting. They started in Boston with a large, 3 day primary medicine conference that was sponsored by some of the insurance plans, local hospitals and by the pharmacy industry. The speakers tend to be excellent and well known in their fields. The speakers are still quite good in the Updates, but I finally noticed some interesting things about the whole concept.
First, I want to say that it was refreshing to go to a fairly large conference of this sort that didn't have an entire huge room filled with drug company displays. Mind you, the displays are always interesting, in a carnival sort of way. They haul in thick and lush carpets and huge displays. They bring in interesting little food thingies, capuccino, ice cream and do things like check your cholesterol for you. All very interesting and entertaining. Probably just a drop in the bucket compared to what they spend on television DTC marketing. Yet you can't help but wonder how it is they have so much money to spend in this lunatic way, and yet have to charge such immense fees for their products.
Updates, as I said, didn't have this sort of thing going on. There were very modest pharmaceutical displays that were very easy to ignore. The most I did while I was there was snatch a pen. That part wasn't bad.
The cracks in the smooth presentation became visible, or at least audible, when one of the presenters started his talk with a diatribe about how upset he was that he wasn't allowed to use his own slides. The slides pertained to an article he had just had published in the NEJM about Eisenhower's heart attack and how it tanked the stock exchange. Apparently, the whole show was written ahead of time, and not necessarily by the presenters. That really makes me think. Who was it who wrote the show and made the Powerpoint presentation?
After that, I listened far more closely. You see, I have some real objections to the matters presented at these conferences. No one ever seems to pay any attention to cost-effectiveness in treatment, to outcomes, or to inexpensive medications that patients can afford. Well, a few people paid attention, but most of them don't. They don't pay attention to compliance issues with patients either, and deal with side effects by saying they don't exist (often). I can understand their frustration with the amount of meaningless bullshit out there on the internet and its effect on patients, because I share it, but not everything a patient tells you is wrong, just because it doesn't fit in with your preconceived notions of what should be happening.
The cholesterol talk was really illuminating. The current state of the art focuses almost solely on the LDL cholesterol levels. Interestingly enough, this is a calculated number. You can measure it directly, but it always seems a bit weird when you get the result (i.e. not what you'd expect), and all the tests were done on the basis of the calculated number anyway, so I tend to not bother ordering it unless the triglycerides are really really high (they throw this result off). We do know that HDL levels are very important also, and should be as high as possible. Now, there are a few patients that have a high total cholesterol and a high HDL. I see enough of them to know the condition isn't rare. Yet, for some reason, no one has ever done an outcome study on them to know exactly what their risk is for vascular disease. Every conference I've been to in at least the past 5 years I have asked what to do with them, and every presenter has said I should treat the LDL and ignore the HDL. It's maddening.
However, I have now, finally, figured out what the deal is here. The drug companies have no medication that will raise the HDL on patent. Let me repeat that: The drug companies have no medicaiton that will raise the HDL on patent. You see, the bulk of outcome studies, the ones that look for outcomes related to cholesterol and to changes in outcomes with treatment, are all funded by the drug companies as they test their new medications. They have no interest in testing for anything that won't earn them money. In fact, they have a disincentive to look for benefits from anything that will compete against their drugs. Sadly, the government, supposedly by the people and for the people, has no interest in pursuing those things either. For instance, Niacin, a B vitamin, can raise HDL cholesterol. It has more side effects than statin drugs in effective doses, but it's pretty cheap. I asked if it would help for patients and the response I got was, "It's never been shown to help. Statins have been shown to help."
You have to listen closely to catch it, but it's there. The comment isn't, "niacin has been shown not to help," it was "it's not been shown to help." What this means is that no one has actually tested it to see if it improves outcomes. Who knows? Do the pharmaceuticals care? Hell, no! They wouldn't profit from checking anyway.
I find myself wondering if there isn't a place somewhere in this world for a foundation that sponsors studies looking at orphan types of treatments. These are treatments that will never have a high profit margin, but might be really, truly effective; treatments that no one ever uses because we don't know if they'll work or not. I don't mean just alternative medicine treatments. I have great problems with these products. I don't think there is anything particularly saint-like about the people who run alternative medication companies, or anything any different from the profiteering that goes on at pharmaceuticals. As concerned as we are that the FDA doesn't provide enough oversight over pharmaceuticals, they provide far less over the alternative medications. Product purity and contents are a real issue with these people. Yet there are treatments we have forgotten and that have never been pursued because no one's going to earn a lot of money on them.
This past weekend I went to a conference on medical matters called PriMed Updates. PriMed conferences are rather interesting. They started in Boston with a large, 3 day primary medicine conference that was sponsored by some of the insurance plans, local hospitals and by the pharmacy industry. The speakers tend to be excellent and well known in their fields. The speakers are still quite good in the Updates, but I finally noticed some interesting things about the whole concept.
First, I want to say that it was refreshing to go to a fairly large conference of this sort that didn't have an entire huge room filled with drug company displays. Mind you, the displays are always interesting, in a carnival sort of way. They haul in thick and lush carpets and huge displays. They bring in interesting little food thingies, capuccino, ice cream and do things like check your cholesterol for you. All very interesting and entertaining. Probably just a drop in the bucket compared to what they spend on television DTC marketing. Yet you can't help but wonder how it is they have so much money to spend in this lunatic way, and yet have to charge such immense fees for their products.
Updates, as I said, didn't have this sort of thing going on. There were very modest pharmaceutical displays that were very easy to ignore. The most I did while I was there was snatch a pen. That part wasn't bad.
The cracks in the smooth presentation became visible, or at least audible, when one of the presenters started his talk with a diatribe about how upset he was that he wasn't allowed to use his own slides. The slides pertained to an article he had just had published in the NEJM about Eisenhower's heart attack and how it tanked the stock exchange. Apparently, the whole show was written ahead of time, and not necessarily by the presenters. That really makes me think. Who was it who wrote the show and made the Powerpoint presentation?
After that, I listened far more closely. You see, I have some real objections to the matters presented at these conferences. No one ever seems to pay any attention to cost-effectiveness in treatment, to outcomes, or to inexpensive medications that patients can afford. Well, a few people paid attention, but most of them don't. They don't pay attention to compliance issues with patients either, and deal with side effects by saying they don't exist (often). I can understand their frustration with the amount of meaningless bullshit out there on the internet and its effect on patients, because I share it, but not everything a patient tells you is wrong, just because it doesn't fit in with your preconceived notions of what should be happening.
The cholesterol talk was really illuminating. The current state of the art focuses almost solely on the LDL cholesterol levels. Interestingly enough, this is a calculated number. You can measure it directly, but it always seems a bit weird when you get the result (i.e. not what you'd expect), and all the tests were done on the basis of the calculated number anyway, so I tend to not bother ordering it unless the triglycerides are really really high (they throw this result off). We do know that HDL levels are very important also, and should be as high as possible. Now, there are a few patients that have a high total cholesterol and a high HDL. I see enough of them to know the condition isn't rare. Yet, for some reason, no one has ever done an outcome study on them to know exactly what their risk is for vascular disease. Every conference I've been to in at least the past 5 years I have asked what to do with them, and every presenter has said I should treat the LDL and ignore the HDL. It's maddening.
However, I have now, finally, figured out what the deal is here. The drug companies have no medication that will raise the HDL on patent. Let me repeat that: The drug companies have no medicaiton that will raise the HDL on patent. You see, the bulk of outcome studies, the ones that look for outcomes related to cholesterol and to changes in outcomes with treatment, are all funded by the drug companies as they test their new medications. They have no interest in testing for anything that won't earn them money. In fact, they have a disincentive to look for benefits from anything that will compete against their drugs. Sadly, the government, supposedly by the people and for the people, has no interest in pursuing those things either. For instance, Niacin, a B vitamin, can raise HDL cholesterol. It has more side effects than statin drugs in effective doses, but it's pretty cheap. I asked if it would help for patients and the response I got was, "It's never been shown to help. Statins have been shown to help."
You have to listen closely to catch it, but it's there. The comment isn't, "niacin has been shown not to help," it was "it's not been shown to help." What this means is that no one has actually tested it to see if it improves outcomes. Who knows? Do the pharmaceuticals care? Hell, no! They wouldn't profit from checking anyway.
I find myself wondering if there isn't a place somewhere in this world for a foundation that sponsors studies looking at orphan types of treatments. These are treatments that will never have a high profit margin, but might be really, truly effective; treatments that no one ever uses because we don't know if they'll work or not. I don't mean just alternative medicine treatments. I have great problems with these products. I don't think there is anything particularly saint-like about the people who run alternative medication companies, or anything any different from the profiteering that goes on at pharmaceuticals. As concerned as we are that the FDA doesn't provide enough oversight over pharmaceuticals, they provide far less over the alternative medications. Product purity and contents are a real issue with these people. Yet there are treatments we have forgotten and that have never been pursued because no one's going to earn a lot of money on them.
posted by Samuraidoctor | 9:47 PM
0 Comments:
Post a Comment
<< Home