Large American pharmaceutical companies must decide which end of the drug development / delivery to patent pipeline they wish the American taxpayer to subsidize. They cannot have it both ways. First, let me say that there has been a free-for all demonization of the drug companies or the more pernicious appellation Big Pharma. Large pharmaceutical companies provide jobs, support community services and charities. They provide the drugs and treatments that ...

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Here is an interesting survey from Quintiles, the large clinical outsourcing company, on how different groups perceive the value of new drugs. The first problem is that not everyone can agree on what's valuable. Surveying managed-care people and physicians, the number one factor mentioned is cost. Biopharma respondents mentioned cost, but were more weighted toward outcomes (which, for example, was a factor in only 10% of the physician responses). Patients ... ...

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In general I support embargoes in medical journalism. Although the current system is far from perfect and contains all sorts of wrinkles and unexpected consequences, I support the system because it allows journalists a bit more time to work on complicated stories and to try to get them right. Recently, though, I came across the single worst abuse of an embargo that I have encountered in the course of my ...

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The inspector general of HHS recently reported that nearly half of the anti-psychotic drugs fed to the demented elderly in nursing homes are inappropriately prescribed. That’s about one in fourteen nursing home residents. Forget about cost, which is over a quarter billion dollars a year.  “Government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions,” wrote Daniel R. Levinson, the HHS I.G. wrote ...

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One of the reasons cited for our expensive health care system is that drugs cost more in America (part of our capitalistic system).  In June of 2003, a study was published in the New England Journal of Medicine about the use of a form of progesterone to delay the birth of certain preterm infants. This particular hormone is found in the human body, but the formulation studied ...

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There is do doubt that the way pharmaceutical companies market drugs to both doctors and consumers sways prescribing and drives up health costs.  Prescription drug costs have outpaced other health care spending and are predicted to exceed the growth rates for hospital care and physician services going forward from 2010-2019. Two researchers (Howard Brody, MD, PHD, University of Texas Medical Galveston and Donald Wright, PhD,  University of Medicine and Dentistry ...

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A young man on my sobriety-based detox program (only after showing positive for opiates) admitted to heroin-usage, but hedged the matter saying it was "5 days ago." His implicit presumption was that an isolated episode, days ago -- compared to continuous, more recent, heroin-usage -- would lessen the likelihood of his getting kicked off the program. Is his story of "no heroin [ingestion] in the last five days," likely, the whole ...

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We have to crush pills sometimes.  Either the patient (through aversion or physical limitation from stroke) can’t swallow whole pills so we crush them and put them in applesauce, or the patient gets their pills through a tube, so we crush them and dissolve them in water. When I started nursing, we had a mortar and pestle.   Anyway, this is what we used ...

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While diligently perusing a stack of unread journals, a piece in the July 25, 2011 issue of Modern Healthcare caught my attention. Titled "What's the Agenda?" this special report deftly navigated the murky waters of "physician participation on advisory boards" and managed to present an accurate appraisal of the issues. Here is a brief recap. Back in the days before "medical ethics" issues were commonplace, pharmaceutical and medical device manufacturers were accustomed ...

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The reality is that my job constantly challenges my sanity. Sometimes, I just want to scream. Patient:  "Doc, I don’t want to put any poisons in my body!  Isn’t there a 'natural' remedy I can take?" Doc: "No, I want you to take my poison!  I haven’t poisoned my quota of patients this month and need to reach my goal." Poisoning patients really isn’t good for business.  Why would a patient believe that ...

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