PharmedOut January Newsletter

Recent Project News
On December 8, PharmedOut was mentioned in The New York Times article "Paid to Promote Eye Drug, and Prescribing It Widely". The story focused on the controversy surrounding Lucentis versus Avastin, two near-identical drugs made by Genentech and used to treat the same eye disease, except that the former is forty times more expensive than the latter. As the article reveals, "a new federal database shows that many of the doctors who were the top billers for Lucentis were also among the highest-paid consultants for Genentech, earning thousands of dollars to help promote the drug."

	How could medical professionals do such a thing? As Dr. Fugh-Berman told the Times, "that’s why a sandwich is so effective — no one wants to feel like they were being bought off for $5 ... That’s why they convince themselves that the drug is better."

	The Times article was picked up by many other outlets, and was included in the American Medical Association's Morning Rounds briefing.

In conjunction with the George Washington University Milken Institute of Public Health and the D.C. Department of Health, we have just released an online CME module, free to D.C. prescribers ($20 for prescribers outside of D.C.). It is the first of several modules that will be part of a new virtual center for pharmaceutical education called DCRx (D.C. Center for Rational Prescribing). From the D.C. DOH December newsletter: 

	"This initiative is part of an ongoing and continued effort by the DOH to address pharmaceutical detailing that may unnecessarily inflate healthcare costs and to proffer evidence-based continuing education on pharmacotherapeutics..."

	Generic Drugs: Myths and Facts covers the FDA standards for approving generic drugs, differences and similarities between branded and generic drugs, and common myths about generic drugs.

	You can access the module, available for 1.0 CME credit, at www.dc.gov/dcrx!

Dr. Fugh-Berman appears in a San Jose Mercury News documentary on psychotropic prescribing in foster care, where the drugs are used to sedate traumatized kids. The documentary is the fifth part of Mercury News's "Drugging Our Kids" series; watch the 40-minute documentary and view the rest of the coverage here.

Along with December came PharmedOut's end-of-the-year fundraising campaign. We seek to raise $25,000 fund the June 11-12, 2015 conference, as well as a redesign of PharmedOut.org in order to make it a more useful and navigable resource. Donations of any size are greatly appreciated, tax-deductible, and 100% goes to PharmedOut. They can be made online here by selecting “other” as Designation and writing “PharmedOut” in Special Instructions, or by a check made out to Georgetown University and mailed to us at:

	PharmedOut

	Department of Pharmacology and Physiology

	Georgetown University Medical Center

	Med-Dent SE402

	3900 Reservoir Road NW

	Washington, DC 20057

PharmedOut's Resource of the Month: When PharmedOut first began in 2006, we conducted interviews with former drug reps and posted them online. They continue to yield thousands of views. Check them out here!

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January's PharmedOut Fodder: The Rising Costs of Prescription DrugsDrug pricing has been a recent subject of debate, regarding both brand-name and generic treatments. In previous months, we addressed the enormously high prices of branded cancer drugs like Zaltrap and hepatitis C drug Sovaldi — examples of "corporate chutzpah" that contribute to the high costs of health care.

Rising prices of generics are concerning for the same reason, and are startling patients who were used to their affordable drugs. The Generic Pharmaceutical Industry Association estimates that generic drugs saved the American health system nearly $1.5 trillion dollars from 2004–2013, but that may change; while in 2010, consumers and insurers paid an average of $13.14 per prescription for the most popular generics, they paid $62.10 in 2014 — a 373 percent increase.

Some experts attribute the rising costs to factors like raw material shortages, medical advancements, and consolidation in the industry. We also point to the rigged competitive market for generic drugs.

When a company's drug patent expires (typically about 10 years after being marketed), generic drugmakers have the opportunity to sell generic versions. But, the company that originated the drug may also produce a generic version to compete with other generics and its own brand-name drug.

The FDA has granted that company's generic version the title of "authorized generic." This label may make the drug appear superior to other generics, especially to patients hesitant to take a generic drug. Lower profits for generic drugmakers might discourage them from continuing to produce the drug. For example, the heart drug digoxin used to be offered by eight generic drugmakers, but after its "authorized generic" was released in January 2014, only three manufacturers remain, and the price has gone up 637 percent.

For now, the Senate has convened panels to investigate price increases for prescription drugs, and we implore regulators to monitor the impact of branded drugs, generic drugs, and "authorized generics" on costs in our public and private health care systems.

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News Round-Up 

(for more, please follow @pharmed_out on Twitter!)

November 27: In These Times: "Drug Shills Dispensing Pills: A psychiatrist questions Big Pharma’s influence on her profession." http://inthesetimes.com/article/17353/drug_shills_dispensing_pills

December 1: The Morning Call: "Karen Hicks: FDA should not approve sex drug for women" http://www.mcall.com/opinion/mc-sex-drugs-for-women-hicks-yv-1201-20141201-story.html

December 2: Straight.com: "Thea Cacchioni: How the sexual pharmaceutical industry tried to hijack the FDA" http://www.straight.com/news/781176/thea-cacchioni-how-sexual-pharmaceutical-industry-tried-hijack-fda

December 2: WSJ Pharmalot: "Doctors Try to Influence a Medical Journal Poll on Testosterone Treatments" http://blogs.wsj.com/pharmalot/2014/12/02/doctors-try-to-influence-a-medical-journal-poll-on-testerone-treatments/

December 2: Harvard Business Review: "Consumers Deserve to Know Who’s Funding Health Research" https://hbr.org/2014/12/consumers-deserve-to-know-whos-funding-health-research

December 3: The Washington Post Wonkblog: "CDC: Prescription painkiller deaths drop for the first time in a decade" http://www.washingtonpost.com/blogs/wonkblog/wp/2014/12/03/cdc-prescription-painkiller-deaths-drop-for-the-first-time-in-a-decade

December 7: Vox: "A paper by Maggie Simpson and Edna Krabappel was accepted by two scientific journals" http://www.vox.com/2014/12/7/7339587/simpsons-science-paper

December 9: The New York Times: "Patients Prescribed Narcotic Painkillers Use More of Them for Longer, Study Finds" http://www.nytimes.com/2014/12/09/business/patients-prescribed-narcotic-painkillers-use-more-of-them-for-longer-study-finds.html

December 9: The BMJ: "Discontinuation and non-publication of surgical randomised controlled trials: observational study" http://www.bmj.com/content/349/bmj.g6870

December 10: The BMJ: "Clinical trials: what a waste" http://www.bmj.com/content/349/bmj.g7089

December 12: The Huffington Post: "Abilify Is Top-Selling U.S. Drug -- But New Reports Question Long-Term Antipsychotic Use, Cite Need for Personalized Services" http://www.huffingtonpost.com/art-levine/abilify-is-top-selling-us_b_6282684.html

December 15: Medical Marketing & Media: "FDA 2014 approvals outpace those of 2013" http://www.mmm-online.com/fda-2014-approvals-outpace-those-of-2013/article/388389/

December 15: WSJ Pharmalot: "Senate Bill Offers 15 Years of Data Exclusivity for Drugs for Unmet Needs" http://blogs.wsj.com/pharmalot/2014/12/15/senate-bill-offers-15-years-of-data-exclusivity-for-drugs-for-unmet-needs

December 16: Medical Marketing & Media: "Pfizer brings humor to menopause marketing" http://www.mmm-online.com/pfizer-brings-humor-to-menopause-marketing/article/388673/

December 17: The New York Times: "Pharmacy Executives Face Murder Charges in Meningitis Deaths" http://www.nytimes.com/2014/12/18/us/new-england-compounding-center-steroid-meningitis-arrests.html

December 17: WSJ Pharmalot: "A Flip Flop? CME Payments to Doc Must be Reported to Sunshine Database" http://blogs.wsj.com/pharmalot/2014/12/17/a-flip-flop-cme-payments-to-doc-must-be-reported-to-sunshine-database/

December 17: The BMJ: "Televised medical talk shows—what they recommend and the evidence to support their recommendations: a prospective observational study" http://www.bmj.com/content/349/bmj.g7346

December 17: news@JAMA: "JAMA Forum: Will a New Website Empower Patients to Ask Their Physicians About Financial Relationships With Industry?" http://newsatjama.jama.com/2014/12/17/jama-forum-will-a-new-website-empower-patients-to-ask-their-physicians-about-financial-relationships-with-industry/
December 21: San Jose Mercury News: "Finding Yolanda" http://webspecial.mercurynews.com/druggedkids/?page=pt4

December 22: WSJ Pharmalot: "Dubious Ties and Surrogate Markers Expand the Market for Diabetes Drugs" http://blogs.wsj.com/pharmalot/2014/12/22/dubious-ties-and-surrogate-markers-expand-the-market-for-diabetes-drugs

December 22: The New York Times: "Painkiller Abuse, a Cyclical Challenge" http://www.nytimes.com/2014/12/23/upshot/painkiller-abuse-a-cyclical-challenge.html

December 23: Reuters Investigates: "Veterinarians face conflicting allegiances to animals, farmers - and drug companies" http://www.reuters.com/investigates/special-report/farmaceuticals-the-drugs-fed-to-farm-animals-and-the-risks-posed-to-humans/

December 23: Reuters: "Blood pressure apps may be dangerously wrong" http://www.reuters.com/article/2014/12/23/us-bp-apps-idUSKBN0K11QF20141223

December 24: BoingBoing.net: "Pfizer threatens pharmacists, doctors if they take its name in vain" http://boingboing.net/2014/12/24/pfizer-threatens-pharmacists.html

December 27: Vox: "Meet the anti-Dr. Oz: Ben Goldacre" http://www.vox.com/2014/12/27/7423229/ben-goldacre

December 29: Medical News Today: "Less than half of UK prescriptions for antipsychotics issued for main licensed conditions" http://www.medicalnewstoday.com/releases/287232.php

December 29: The Boston Globe: "Groups unite against curbing painkillers" http://www.bostonglobe.com/news/nation/2014/12/29/opiate-prescribing-crackdown-massachusetts-opposed-industry-backed-patient-group/aAjGBp2NTHkfPfTSZrhF9N/story.html

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Check These Out!
Think we need more transparency when it comes to clinical trials? So do we! Read and comment on the NIH initiative here.

The Lown Institute will hold its annual conference in San Diego on March 8-11, 2015. "Road To RightCare" aims to "change the existing culture of medical overuse and underuse, so that patients receive the care they want and need." Find out more.