Why ‘medicine for the rich’ is sometimes inevitable

stockmarket

The issue: Poor people can’t afford high-cost drugs privately

Player #1: The Australian PBS, which has just released this year’s list of top 10 pharmaceuticals by expense (see table below)

Player #2: The Social Medwork, a new company which imports high-end drugs, for a fee

My verdict: Sorry, that’s life. The public can’t afford to pay for everything.

THE DILEMMA posed by high-cost pharmaceuticals isn’t one likely to go away any time soon.

With hepatitis C treatments clocking up their first $1 billion in just four months, PBS budgeters must be sweating.

However, they would also be relieved that they didn’t cave in to the campaign – backed by the manufacturer but involving patient advocacy groups and some doctors – to approve the drugs earlier at an even higher cost, as happened in the US.

Coming second on the PBS expense list, at half a billion, are two macular degeneration drugs with their own cost controversies.

The manufacturer of ranibizumab (Lucentis) has been heavily criticised for purchasing the patent on its only competitor but not doing the head-to-head study that might have allowed approval for the cheaper drug. Back then, Lucentis cost 50 times the price of its competitor, and it remains the gift that keeps on giving, near the very top of this year’s PBS spending. Merry Christmas, shareholders.

At the top end of the market, where high-rollers spend public funds on the promise of clinical benefit, it is no surprise that a new player has entered the room. A Netherlands-based company has just created a new niche for those customers who can afford it. Continue reading

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GP Sceptics podcast 5: Lyme disease…don’t get sold a lemon

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Ten thousand miles away…Australia’s closest lyme-carrying tick

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To coincide with today’s Senate inquiry on how to catch Lyme Disease in Australia (short version – you can’t), Justin and Liz interview infectious disease expert Prof Frank Bowden, from Australian National University.

Frank swats aside a series of claims by Australian lyme disease proponents, but sounds stumped when Justin asks whether sentinel chickens or sentinel ticks are better at keeping watch.

The conversation takes a few twists, lurching from false positive US lab results to unrelated matters such as whether having sex before the game enhances or detracts from sports performance. You’ll have to listen to find out the answer.*

*Or you could always cheat and read the reference below  gp_sceptics_small

References:

Infectious: A doctor’s eye-opening insights into contagious diseases

Frank Bowden’s book, published 2016, including the chapter “Lyme is the new black”

Sexual Activity before Sports Competition: A Systematic Review

Frontiers in physiology June 2016

sentinel-chicken-neko-richiko

By Neko Richiko

 

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GP Sceptics podcast 4: Addiction

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Justin and Liz invite Dr Hester Wilson into the pod to chew on some baclofen; is it really the latest promising drug for alcohol addiction? A recent Australian Doctor article (requires login) thinks so.

Hester is a Sydney GP who specialises in drug and alcohol medicine. And she’s also a fine soprano: we don’t let her leave without singing a snippet of Cosi Fan Tutte.

Liz’s dilemma for ‘what would Justin do?’ channels one of these:wookie

 

…and Justin’s factoid concerns a mysterious case of smartphone blindness.

Liz applies the Mindspace framework for pharmaceutical marketing.

Neko Richiko, our unofficial calligrapher, sums up this podcast:

neko-richiko-learning-points

References:

“Bacloville” baclofen study  — Berlin slide presentation teaser prior to study publication. 2016

Transient Smartphone Blindness NEJM, June 2016

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Homeopathy: US mandates ‘No evidence’ labels

arnica-pills

Bottle claiming to contain one trillion trillion trillion trillion trillionth of this flower.

The US Federal Trade Commission (FTC) has just issued an enforcement policy statement requiring marketers of homeopathic products to ‘effectively communicate the lack of scientific evidence’ on product labels.

The move is being heralded as the first time that homeopathic products will legally require a label stating that they don’t work.

Numerous submissions to the FTC report cited the Australian 2015 comprehensive assessment of evidence by the NHMRC, which concluded there is no reliable evidence that homeopathy is effective for any health conditions.

Although the evidence overwhelmingly supports the new FTC policy, much of their report deals with legal issues, possibly pre-empting industry arguments that regulating advertising claims might be inconsistent with the US First Amendment around free speech.

The FTC policy does not constitute a new law, but it clarifies the minimum standards for homeopathic health claims, which until now have largely been left to self-regulation. Homeopathic products will now “be held to the same truth-in-advertising standards as other products claiming health benefits.”

But not all is rosy… Continue reading

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With Obamacare gone, how will Trumpcare affect US health?

trumpcare

The world is a less certain place than it was this time yesterday, and the health industry has not escaped waking up with that feeling of ‘what just happened?’

US President elect Donald Trump vowed through his campaign to ‘immediately repeal’ Obamacare, but it seems no one has any idea what Trumpcare will look like. The Affordable Care Act will be afforded no longer, and health analysts are scrambling to find much more than election sound bites to predict what might replace it.

To consult the modern oracles, one need never travel further than the stockmarket. As investors fled US-dollar exposed shares yesterday, health insurance stocks were caught in the maelstrom.

Repealing Obamacare entirely would leave 20 million without health insurance, and although few believe the Republicans will go so far, Trump is predictably unpredictable. That’s enough to spook health insurers and owners of private hospitals. Continue reading

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Mothers, don’t plan on early delivery unless it’s medically necessary.

1. pregnancy

Important new findings today suggest that planning to have your child born before 39 weeks’ gestation may be associated with worse brain developmental outcomes, once your child reaches school age.

 

SOMETIMES there is no choice in having to pre-book an early birth. If your pregnancy is high-risk or complicated by a particular medical condition, then planning an early delivery, by C-section or going to the hospital for induction, may be the safest option.

However, increasingly the delivery of babies is pre-planned without necessarily a pressing medical need. In fact, in Australia, planned births now account for around half of all deliveries at 37 and 38 weeks’ gestation. Today’s news it that your child may be more likely to have unforeseen complications down the track.

What is this new study?

A study published today in Paediatrics linked the birth records of 153,730 children born in NSW in 2002-7 with the child’s performance some years later, as graded by their teacher in the triennial Australian Early Development Census (AEDC).

Continue reading

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GP Sceptics pod3: Pain

gp_sceptics_small    pain

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Sceptical medicos Justin Coleman and Liz Sturgiss take on a world of pain.

What doesn’t work for back pain? (Hint: most things)

Are opioids taking over the world?

We look at various cognitive biases when doctors make decisions. Liz tries to persuade Justin that we all want to be normal. Then she spoils her argument by pulling out a toy plane.

Refs:

Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial Lancet, 2014

Paracetamol for low back pain Cochrane Review, 2016

Innovative pain therapy with a fixed combination of prolonged-release oxycodone/naloxone: a large observational study under conditions of daily practice. Current Medical Research and Opinion, 2010.

Cognitive biases (Wikipedia list)

Targin promo, as described in the podcast:

targin-promo-of-nothing

Continue reading

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GP Sceptics podcast 2: Diabetes

gp_sceptics_smallSugar Cubes by howzey

 

 

 

 

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Liz Sturgiss and I decide to tackle diabetes – do we even know what we are diagnosing, or is it a ‘category error’? Does metformin have anti-aging properties? If so, why isn’t Justin taking it?

Justin’s Factoid focuses on wacky newspaper headlines about medical research, then Liz makes him squirm with her nasty ethical dilemma.

Refs:

Is T2DM a category error? Lancet 2013

The epidemic of pre-diabetes: the medicine and the politics. BMJ 2014;349:g4485

Choosing Wisely Australia recommendations

Testing times! Choosing Wisely when it comes to monitoring type 2 diabetes. MJA 2015

 

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Starts at 60 interview

startsat60

This week I was interviewed by ‘Starts at 60’ to discuss the role a GP might play for older people, with particular reference to how the Choosing Wisely Australia program can improve consultations.

Starts at 60 only took off a year ago, but is already incredibly popular – 20,000 people have watched this video in the first 48 hours. The other possibility is that it’s me who’s popular. Okay, nope.

Click on the photo above to watch the video. Warning: it takes half an hour, so bring some tea and toast.

 

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GP Sceptics podcast 1: Big Soda

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In the first of the GP Sceptics podcast series, Dr Justin Coleman and Dr Liz Sturgiss team up to dissect, analyse and sometimes trash medical research that is relevant to GPs.

This first podcast looks at the influence of Big Soda on health research. The good, the bad and the fizzy.

Refs:

Relationship between Research Outcomes and Risk of Bias, Study Sponsorship, and Author Financial Conflicts of Interest in Reviews of the Effects of Artificially Sweetened Beverages on Weight Outcomes: A Systematic Review of Reviews. PLOS One, Sept 2016

Relationship between Funding Source and Conclusion among Nutrition-Related Scientific Articles PLOS Medicine 2007

Big Soda sponsored 96 health groups — a big conflict of interest, study says. Washington Post, Oct 2016

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