Now you Europeans can waste your money on aliskiren, too
Novartis has gotten their pointless direct renin inhibitor approved by the European equivalent of the FDA.
How utterly snooze-worthy. Now you Europeans can waste your tax dollars money on the drug, too! Hooray!
Bonus Tekturna story:
Doctor writes a prescription for Tekturna for one of his patients. (One of our drug delivery guys, actually.) Gives him a free sample card, even though he doesn't have insurance and thinks he's doing him a favor. He gets 30 Tekturna for free, and the next month rolls around. That'll be $100, please, even with the employee discount I gave him because he amuses me.
He almost shit a brick.
Remember, folks: giving patients a FREE SAMPLE is great, but it's a complete WASTE OF EVERYONE'S TIME if they are without insurance or if their insurance doesn't cover it.
Mr. Delivery Guy comes back a week later with a prescription for lisinopril, after I write him a note to give to his bonehead physician.
[tags]Tekturna, aliskiren, Rasilez[/tags]
Plan B: You know you did something right when you've pissed everyone off
I'm a firm believer that one of the most important aspects of democracy is not a given outcome of a political debate, but is instead the constant push and pull of the ideas behind a decision. The decision to make Plan B available without a prescription was a long time in coming, and I support it fully.
I think it's somewhat sad that it's been overly politicized, but I guess that's the price of doing something controversial in a country where the "religious right" has a lot more clout than is warranted. Politicians on both sides think the FDA has gone too far or hasn't gone far enough. I'd say that the agency has done a good job with their Plan B policy so far, if for no other reason than the fact that no one's completely happy with it.
Some of the nonsense on both sides is actually pretty funny, particularly when viewed with an eye towards history — especially the stuff from the right:
Coburn and other social conservatives said that the high doses of hormones in the pills carry risks, and that making them more easily available will encourage sexual activity and result in more unwanted pregnancies and sexually transmitted diseases.
That, my friends, is Grade A political BS. Opponents of oral contraception said the same stuff about "The Pill" when it first came out. It was then, and still is, a complete load of crap.
First of all, Plan B will prevent unwanted pregnancies. That's why it exists, and it does its job quite well. That whole STD thing… is anyone else having 1960s flashbacks here? Hello, these arguments were made when the pill first came out. They were unsubstantiated then, how is today any different?
"This is a bad decision for women, for girls, for parents and for public health," said Wendy Wright of Concerned Women for America, which led a campaign to block the decision. "The FDA's decision today will only make things worse for American women."
I'd love to hear the logic behind that one, backed up with some numbers. But wait, that'll never happen because the numbers won't be there, and the only thing the right will be able to come up with will be anecdotes here and there. And I'd put some serious money on that.
What does concern me is the current administration's emphasis on teaching abstinence. I think a rigorous sexual education program would go a long way in preventing STD transmission — but that, of course, is a bad idea because it will encourage teenagers to have sex. (Insert a humongous roll-eyes emoticon here.) Nevermind that the US has the highest rates of teen pregnancy and STD transmission of any first world country. Clearly the abstinence emphasis isn't working.
But the left isn't entirely reasonable either.
Plan B's backers, meanwhile, criticized the agency for not allowing the drug to be sold to everyone.
"We urge the FDA to revisit placing age restrictions on the sale of Plan B," said Sens. Hillary Rodham Clinton (D-N.Y.) and Patty Murray (D-Wash.). But because the decision represents "real progress" and an "important step in restoring the American people's faith in the FDA," the senators said, they were lifting a hold they had imposed on von Eschenbach's confirmation as FDA commissioner.
I don't think it's a good idea for it to be sold willy-nilly to anyone that wants it. Ideally it'd be only sold to the person who is going to use it so its use can be more closely monitored, and the procedure for using it — and how it works — can be made clear to the woman who needs it.
So we've got Plan B available OTC. Now it'd be nice if the lay public got on the "Plan B is not abortion" bandwagon. Because it's not.
[tags]Medicine, pharmacy, Plan B, abortion, politics, healthcare policy[/tags]
Money for organ donation redux
Yesterday I got a bit carried away in my post on organ donation. I didn't say it in that post because it seemed fairly obvious to me that the reason it's verboten by Uncle Sam is to ostensibly protect individuals from being exploited for their organs. To me that seems like it would simply force the practice underground, whereas I think it would be better to have it out in the open and regulated for the safety of all parties involved. (I think the same thing about prostitution, as you might guess.) I am not aware of a thriving black market for human organs in the United States, however such markets exist in other countries.
Anyway, the whole point of yesterday's post was to mention baby steps towards creating a legitimate market for organs. A Jerusalem district court ruled that Israeli HMOs must pay kidney donors NIS 63,000 (~$14,300) to cover their expenses, but it stopped short of saying whether they're allowed to pay for a kidney:
The Western world generally forbids organ trade. In Israel the ban came in a directive by the CEO of the Health Ministry. But Jewish law (halakha) does allow payment for organs and even considers selling one to be a mitzvah.
In a precedent-setting ruling on Monday by the Jerusalem District Court, Judge Joseph Shapira instructed HMOs to pay 31 kidney donors NIS 63,000 each to cover expenses. Shapira stipulated that the ruling is not on the more fundamental issue of whether payment should be allowed for the kidney itself.
An interesting ruling. But since most kidneys are donated by living relatives, it would almost seem a little odd for an HMO to be giving money to the donor outside of expenses. It would seem like it would be the responsibility of the private parties to handle that sort of thing.
I believe Levitt is wrong in his blog post on the topic when he says that these people are getting an extra $13,000 in their pockets. It reads to me that the Israeli HMO's are merely covering the expenses of the second party involved rather than allowing them to take home some extra pocket cash. How do you all read it?
[tags]Medicine, organ donation, economics, healthcare, Israel, ethics[/tags]
The economics of organ donation
Conceptually, economics is a fascinating field to me, and it's an invisible factor that's often overlooked by the mainstream media and by independent writers and bloggers. Naturally, for every action, there are consequences, no matter if the decision is a policy decision or a financial decision, or something in between. The threads that connect everything to everything else are some of the most interesting facets of the world we live in. Healthcare is certainly no exception.
The authors of Freakonomics (an excellent book, by the way) have covered the economics of organ donation in a New York Times article from July 9, 2006. ("Flesh Trade: Why Not Let People Sell Their Organs") All jokes about people selling kidneys on eBay aside — which has been tried — there doesn't seem to be anything inherently unethical about doing so. While I wouldn't sell one of my kidneys (though I might give one away) I don't see anything wrong with the practice for those interested in doing so. Levitt and Dubner agree, noting that the practice could help alleviate the organ shortage:
MRSA infections in prisons on the rise
I have a special place in my heart for microbiology in general, and superbugs in particular. Ever since microbiology lab, I've loved playing with bacteria. In fact, I still have a urea agar slant vial that's a lovely shade of flourescent pink — thanks to proteus vulgaris — that I stoletook from lab. (They were just going to throw it away!) It was hanging from my rearview mirror in my car for a while, and now it sits on my desk, an old friend from a favorite class. It looks something like this, only the agar is translucent rather than opaque, and is quite pretty when it catches the sun just right. Maybe I'll take a picture of it one of these days. I'm surprised it's as vibrant pink as it is — it's quite old.
Alas, I'm showing my nerdy side. On with the real news…
MRSA is turning into a real problem in prisons. Not only for prisoners, but for guards as well. I've been watching this blog for a while, and following the comments therein. There's some scary stuff going on:
K Schacht Says:
Until recently I was employed as an part-time instructor in two of our local jails. I had been working just a few months when suddenly I began to not feel well, and then the symptons developed… which were misdiagnoised for several months. Finally, I was correctly diagnoised with MRSA, but six months later I’m still ill and the antibiotics are not working.
Yes, I’m mad and yes I do feel the jails have a culpability of informing and educating not only outside and inside staff, but the inmates as well.
I had no idea of this risk and was not informed at each jail orientations. The choice of exposure was not an option and the lack of information has prolonged and perhaps worsened my health.
Should the HPV vaccine be mandatory?
I've covered the approval of Merck's HPV vaccine extensively in the last month or so. It's great news for women everywhere, both here in the United States, and especially in the third world. The question now is "should it be mandatory?" Of course ACIP recommended the vaccine, as I predicted they would, so it's certainly something to consider.
An editorial by someone published in the NYT this past week questions whether the vaccine should be mandatory. Of course, there are some vaccines that are required for anyone entering a public school, for instance. Gardasil could be among these required vaccines (MMR, etc.) for girls aged 9-26. (So that means college students as well.)
I don't see the problem with making the vaccine mandatory. While there are some reasons that this might not be necessary — cancer-causing HPV can only be contracted through sexual contact — there aren't any reasons listed that are compelling safety issues.
So we have a sexually-transmitted disease, and a vaccine to prevent it. Should the vaccine be mandatory?
Pharmacists as prescribers of medication
I was reading on Kevin, MD the other day a post about pharmacists "wanting" to prescribe. The article was about Canada, but we're rapidly moving in that direction here in the United States as well, with the PharmD degree being the only one that's offered.
This article is pretty long, so you may wish to get a cup of coffee or something before you read it, but I do think it's very relevant to healthcare today. The sections:
- The retail misconception
- Healthcare as a collaboration
- A problem of medical records?
- Making a diagnosis vs determining treatment options
- Pharmacists are already prescribing today
- Who's more qualified?
- Random talking points
- Conclusions