07/11/2008 by admin.

The November 2008 issue of Drug and Therapeutics Bulletin (DTB) has two articles. The first is a review of ▼Alateris, the first licensed glucosamine (as hydrochloride) available for osteoarthritis. The second article reviews ▼ivabradine, the first of a new class of drugs for stable angina. The issue also contains short corrections for two previous DTB articles: What role for ▼tigecycline in infections? (August 2008) and ▼Retapamulin for impetigo and other  infections (October 2008).

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07/10/2008 by admin.

 Plans to make two antibiotics for treating urinary tract infections available to buy over the counter in the United Kingdom rather than being prescription only are governed by commercial rather than public health concerns, say doctors and pharmacists.

The Medicines and Healthcare Products Regulatory Agency (MHRA) is currently considering reclassifying trimethoprim and nitrofurantoin for the treatment of uncomplicated urinary tract infections, such as cystitis.

The move follows the agency’s approval earlier this month of a similar switch for the antibiotic azithromycin, for the treatment of chlamydia infection.

But members of the British Society of Antimicrobial Chemotherapy oppose the move, the GPs’ magazine Pulse reports (www.pulsetoday.co.uk, 28 Aug, “Fury over decision to make first mainstream antibiotic OTC”). In a letter to health ministers they express concerns that “approvals of this type are determined commercially and not on the basis of medical need.”

doi:10.1136/bmj.a1538

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07/10/2008 by admin.

An unprecedented attack on drug companies’ prices by the head of England’s drug approvals body shows that it is jockeying for a key role in the forthcoming overhaul of drug pricing, observers say.

Michael Rawlins, who chairs the National Institute for Health and Clinical Excellence (NICE), has criticised the industry for profiteering. In an interview in The Observer (www.guardian.co.uk, 17 Aug, “Health chief attacks drug giants over huge profits”) he said that drug companies aimed for “double-digit growth year on year … not least because their senior management’s earnings are related to the share price.”

“All these perverse incentives drive the price up,” he said.

His comments came after NICE was criticised fiercely for failing to approve a batch of new kidney cancer drugs (BMJ 2008;337:a1262, 14 Aug, doi: 10.1136/bmj.a1262).

Joe Collier, an emeritus professor of medicines policy at St George’s, University of London, said that Professor Rawlins was “jockeying for a central role in price negotiation” in the forthcoming overhaul—due to be announced in the next few months—of the pharmaceutical price regulation scheme.

Richard Barker, director general of the Association of the British Pharmaceutical Industry, said, “NICE was not created to set medicine prices—nor indeed to drive them down, as NICE’s chairman now seems to see as his mission.”

BMJ 2008;337:a1422

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07/10/2008 by admin.

 In the United States, commercial support for continuing medical education has grown steadily over the past decade. In 2006 it provided more than half, about $1.5bn (£0.75bn, 0.95bn) or 60%, of the income for educational programmes doctors must take to maintain their medical licences. Evidence shows that commercial support distorts what doctors learn.

In 2007  the Josiah Macy, Jr conference on Continuing Education in the Health Professions: Improving Healthcare Through Lifelong Learning (www.josiahmacyfoundation.org) recommended ethat organisations providing accredited continuing education should not receive commercial support from drug or medical device companies.

BMJ 2008;337:a1023 (http://www.bmj.com/cgi/content/full/337/aug14_1/a1023?eaf)

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07/10/2008 by admin.

 Doctors in the United States should brace themselves for a substantial decrease in conference dinners but a big increase in the quality of drug industry sponsored education. Responding to criticisms of the way that continuing medical education is funded by the drug industry and run by profit making, third party companies, Pfizer last month decided to cut education funding in 2008 from $80m to $60m (£43m to £32m; 55m to £41m). Its decision indicates a sea change in sponsorship of continuing education in the US that could have implications for the United Kingdom.

“Our analysis demonstrated that higher quality grants would increase the percent of funding that directly benefited learning while reducing expenditures on non-educational expenses like meals,” the company stated. By September it says some 90% of its funding will go into educational programmes run by academic institutions, hospitals, or medical societies.

In January, a report by the influential Manhattan based philanthropic institution, the Josiah Macy Foundation, went even further, concluding that drug manufacturers should not support continuing medical education.1 It says industry sponsorship affects the independence of doctors, invites bias, endangers professional commitment to evidence based learning, and promotes and validates an “entitlement” mindset among doctors that education should be paid for by others. It also says the conference lecture circuit isn’t improving patient care, it’s simply about “promotion and physician welfare.”

BMJ 2008;337:a1399 (http://www.bmj.com/cgi/content/full/337/aug26_1/a1399?eaf)

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07/10/2008 by admin.

Continuing medical education has become so heavily dependent on support from drug and medical device companies that the ethical underpinnings and the reputation of the medical profession may be compromised. Continuing medical education is compulsory in Italy, and the Ministry of Health has recommended that local health authorities spend 1% of their total budget on educational activities. Nevertheless, most authorities spend much less than the recommended amount and up to 60% of the money comes from drug companies.

Here, Alfredo Pisacane gives an interesting  proposals for limiting the commercial support to continuing medical education including concentrating on small groups, agreeing objectives for educational activities, evaluating providers, health institutions committing resources, making use of new technology, creating a central fund, asking doctors to pay.

BMJ 2008;337:a973 (http://www.bmj.com/cgi/content/full/337/aug14_1/a973)

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02/10/2008 by Merav.

The October 2008 issue of Drug and Therapeutics Bulletin (DTB) has three articles. The first is a review of ▼aliskiren, the first of a new class of antihypertensive drugs. The second article reviews ▼retapamulin, a new topical antibiotic licensed for impetigo and other skin infections. The third article reviews ▼erdosteine, a mucolytic, and whether it has a place in COPD exacerbations. Go to http://dtb.bmj.com/ to have a read.

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22/09/2008 by Merav.

Bristol will be holding the pharmaware AGM in February 2009. The team would like to get some input from you, current members as to what content you would like to include in this AGM, especially if there is anything that you would like clarified or would help a new branch to grow. They would also like to know if anyone has any suggestions for the debate to be held at this AGM. Contact them at Bristol@pharmaware.co.u

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09/09/2008 by Merav.

Canada prohibits direct to consumer advertising of prescription drugs however, US advertising is crossing the border via cable TV and US magazines.

Law et al found that cross border advertising increased prescribing of a minimally effective drug with a poor safety profile, which subsequently led to its withdrawal. They used 3 drugs based on timing of the advertising and compared prescription in English speaking areas, where they are likely to watch and read US based media, with French speaking areas, where there is less exposure.

There was a 42% increase in prescribing of tegaserod after intensive US advertising campaigns (29 574 extra prescriptions over a two year period). In a pooled analysis of 29 clinical trials, 13 of 11 614 patients treated with tegaserod had heart attacks, strokes, or serious angina compared with one of 7031 patients on placebo. Among the extra prescriptions in Canada as a result of direct to consumer advertising, around 29 people would have experienced serious cardiovascular events over the two years.

Part of the concern is the ability to shift the balance of potential benefit to harm. Tegaserod is used to treat irritable bowel syndrome. “What for many people is a mild functional disorder—requiring little more than reassurance about its benign natural course—is currently being reframed as a serious disease attracting a label and a drug.”

Editorial: BMJ 2008;337:a985
Full Article: BMJ 2008;337:a1055

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09/09/2008 by Merav.

Spanish doctors have launched the No Gracias (”No thank you”) group, part of the No Free Lunch network. No Gracias was an initiative of the Federation of Associations for the Defence of Public Health (Federación de Asociaciones para la Defensa de la Sanidad Pública). No Gracias was established after cases of multinational drug companies offering incentives, such as gifts, meals and cash, to doctors to prescribe their products were reported.
No Gracias is steadily building support among healthcare professionals. Since the group’s launch less than four months ago 1200 people have signed up to its manifesto www.nogracias.eu/v_juventud/apartados/pl_entidades.asp?te=5016 - its in Spanish so good luck!
BMJ 2008;337:a1579

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