Today's News and Commentary

About the public’s health

Antibiotic Prescribing for Children in United States Emergency Departments: 2009–2014: This study found that when children go to a non-pediatric ER, they are more likely to receive inappropriate antibiotics. What to do with such information? Increase pediatric ERs or enhance training of all ER physicians to prescribe appropriately?

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Social Determinants of Health Key to Value-Based Purchasing Success: I have previously written about the importance of considering social determinants in caring for individuals and populations. This article is a nice overview of this topic and highlights the need to incorporate social determinant dimensions when designing and evaluating value-based services.

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Associations of Income Volatility With Incident Cardiovascular Disease and All-Cause Mortality in a US Cohort: 1990 to 2015: Associations between health and wealth, as well as socioeconomic status are well-known. This study takes those concepts a step further. The volatility of income also plays a role, increasing morbidity and mortality by nearly twofold.

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Government shutdown: In addition a previous blog entry about the effect of the shutdown, add two more problems. FDA Commissioner Gottlieb has resorted to Tweets to communicate important messages, such as drug recalls. Further, according to the Washington Post, the FDA, “which oversees 80 percent of the food supply, has suspended all routine inspections of domestic food-processing facilities…” The irony is that imported food will still be examined. So much for encouraging purchase of American products.

About pharma

Partisan stances remain on how to lower drug costs: Today Sen. Bernie Sanders is set to announce the liberal Democratic plan for reducing drug prices. Measures are expected to include: pegging prices agains international benchmarks; CMS contracting directly with pharma manufacturers to get best prices (rather than relying on on private Medicare Part D plans to do so); and allowing Americans to import “safe” drugs from other countries. On the other side of Congress, Republican Senator Chick Grassley (who is chair of the senate finance committee) has come out against direct negotiations with manufacturers.
These two opposing stances on drug company negotiations have been going on since passage of the Medicare Modernization Act (MMA) in 2005, which created the Part D program. Democrats have always favored federal purchasing while Republicans have defended the ability of “free markets” to control prices. If Democrats gain control of both chambers and the White House in 2020 we may see their wish become reality.

Read about the Sanders proposal

Read about the Grassley statement

Prescription Drug Pricing: An Overview of the Legal, Regulatory, and Market Environment: Continuing the above theme, this paper, from the American Enterprise Institute, is an excellent topical review.

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‘Marketers are having a field day’: Patients stuck in corporate fight against generic drugs: In a Washington Post front-page story today, reporters tell how drug companies are spreading stories that generic biologically-derived drugs are inferior to the branded versions. In an interview, FDA Commissioner Scott Gottlieb said: “I am worried that there are either deliberate or unintentional efforts by branded companies to create confusion” about the safety and effectiveness of unbranded biologic drugs… The messages “can potentially undermine consumer confidence in biosimilars in ways that are untrue.’’
Of course, the motive is profit. How much is the difference if the generics are used? According to the article, “savings to the U.S. health-care system that have been estimated at $54 billion to more than $200 billion over 10 years.”

Read this in-depth article

Novartis puts AI on the job to help reps say the right things to the right doctors: Continuing a theme of marketing, Novartis’ pharma CEO Paul Hudson announced at this week’s annual JP Morgan conference that the company is using artificial intelligence in its marketing efforts, but in a novel way. The AI
will help drug reps  “plan better, move better and make sure when they show up to see a healthcare professional, they are talking about the things that the healthcare professional is absolutely interested in…” Perhaps in addition to educating themselves about their products, salespeople will have to bone up on certain sports or esoteric hobbies that interest their customers.

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New strategy may curtail spread of antibiotic resistance: Antibiotic resistance has become a huge health problem worldwide. This phenomenon relies on bacterial ability to share genes in small packages (called plasmids) that confer the protection. If the plasmids can be modified so they cannot be spread among bacteria, resistance can be reduced. This article explains what researchers at Washington University are doing in this area of research. It could create a new category of antibacterial agents that would be used with traditional antibiotics.

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