Revisions to clinical guidelines based on the latest research have resulted in appropriate increases in the use of medicines in recent years.
As long as I’m at it, the next chart in the pack has a rather ominous background message:
eye for pharmaBy Zuzanna Fimi?skaApr 11, 2014The 21st century pharma company is no longer solely a provider of molecules. To survive in the new reality, the industry must change its mindset and offer services, putting the customer at the center of their activities. In an uncertain climate, big pharma must understand its customers and deliver what they really need: value beyond the pill. While many companies have begun to do this in earnest, others hesitate and question whether patient services are warranted or appropriate. However, it is increasingly apparent that the industry has a role to play in patient support, and that much is at stake for the industry itself.
The importance of treatment adherence
According to the World Health Organization [WHO[ improving adherence would have a greater impact on health than any potential discovery in medicine. Even if the pharmaceutical industry one day discovered the much wished for “cure for cancer,” it is likely that it won’t be taken properly [oral anti-cancer therapies currently run about 60% adherence].
In addition to being potentially lethal, non-adherence is expensive. While there may have been a tendency in the past to assume that not taking prescribed medicines provided some degree of savings, the U.S. Congressional Budget Office (CBO), which serves as an independent, official scorekeeper of the fiscal impact of federal policy and proposed legislation, changed its stance on medication adherence in 2002, recognizing that the evidence of a direct connection between medication use and healthcare spending was sufficient to “score” a medical cost offset in its budgetary forecast. The CBO’s budget forecasting now assumes that medication adherence can lead to reductions in doctor visits and hospitalizations, and impact the rise of healthcare costs.
Change in paradigmAccording to eyeforpharma’s "The Importance of Patient Services" Whitepaper, the estimated impact from non-adherence ranges from $30 billion a year to $560 billion a year, although it must be pointed out that patients who do not adhere to a given treatment often end up on a different treatment, so the higher figures are undoubtedly not representative of the impact on the industry as a whole. This is not lost on the pharmaceutical executives. In 2011, business intelligence firm Cutting Edge Information conducted a survey of 18 drug companies. The study concluded that 25% of overall sales were diminished by patient adherence, while 31% of revenue can be preserved by patient support efforts. Nevertheless, offering patient-support services is often met with skepticism and fear. “People in pharma are scared,” said Isler. “Everyone agrees that the traditional model is broken, but nobody really knows the answer,” he admitted.
Entering into a dialogue with customers requires a shift in organizational structure. Companies need the right people with the right skill set, including experience in services and with customer interaction. “Pharma are mostly scientists and physicians, who are happy in their labs, but not talking to customers. It’s not natural for pharma to be a customer-focused industry, but now we need to be there, talking to our customers, instead of being this prescriptive black box that tells them what is good for them,” Isler concluded.
The days when pharma could safely build their business on a molecule are now gone and efforts must be made to ensure a shift in thinking necessary for the industry to remain relevant. To achieve this, companies need to overcome fears that have so far been crippling the revolution of pharma.
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expanding target populations by lowering threshholds
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encouraging polypharmacy
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staying on medications longer
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following guideline recommendations fully
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following up patients to insure medication compliance
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PHARMA getting into the business of dealing with patients and theiradherence
The PhRMA entities should stick to their knitting and they should respect the boundary between commerce and professional care. After being prosecuted for billions of dollars in fines for malfeasance and felonies, they have no business intruding into clinical interactions with patients. Dr. Mickey is right to be infuriated and discouraged. Zuzanna Fiminska is a propaganda parrot. Notice that her feel-good piece acknowledged no problems at all in the ethical behavior of PhRMA.
We should also note that having a drug “indicated” for a condition is not the same as saying the drug is worth using for that condition. The FDA oversees the claims of drug companies – through a Kabuki theater process that ignores comparative efficacy and clinical value.But the FDA does not regulate the practice of clinical medicine. PhRMA trades on that disconnect.
It has been shown that reducing the medications for elders in home care results in great improvements in their health and well-being. Just having to swallow as many pill as they’re prescribed can be a chore that reduces the quality of their days.
http://doctorskeptic.blogspot.com/2012/11/stop-medication-train-elderly-want-to.html
The targets of prevention themselves seem overly geared toward unnecessary diagnoses and medication. The BMI, for instance, is an index that is not intended for individual assessment and there are a thousands of apparent things to determine whether or not a person is at a healthy weight and has a healthy diet and exercise regimen, without weighing them; but the numerical target obsession rages on.
I suspect that a lot of preventive medication does not address a relationship with numbers that is as simple as it appears to be, either. I looked at the Cochrane group when your link still allowed access to non-members, and it appeared that the medicine I’ve been given to lower my cholesterol not only works, but is also synergistic when combined with vitamin D, which, according to them, does not really have much evidence to support its standard use for MS.
Decisions, decisions. Is there really a direct relationship between cholesterol and heart attacks? Some opinions differ, but what the hell— it makes my GP happy and I trust her.
“… they speak as if Medicine is their oyster to harvest.”
Well, circumstances suggest this is so. It’s a funny thing about privilege, once a person or institution has been indulged, putting it back in its place is a chore. When that person or institution gets wealthy enough to buy small countries from that privilege then putting it back in its place requires a lot of money and power. There’s an 800 pound gorilla in medicine, and it sits wherever it wants to.
The most promising thing I’ve run across in general medicine is the Stanford 25. Much of the art of general medicine has been lost in a sea of disembodied numbers. There are old, tried and true methods to help doctors find out what the problem is without lab tests, and it involves a very thorough physical exam that can spot warning signs to help narrow down a problem, instead of having a battery of random test performed, many of which may result in falsely rosy assessments.
I think someone here linked to that, and it’s a very encouraging development to root for.
http://www.npr.org/templates/story/story.php?storyId=129931999&ps=cprs
Prescribing being driven by pharmaceuticals is putting the fox in charge of the hen house and is such a blatant conflict of interest that sometimes it’s hard to believe that it’s necessary to even have this conversation. To me, the problem is a failure to support public and independent research, and long-term studies; an FDA that has too low standards, and a tendency for our public officials to let private corporations get away with murder.
Wiley, are you kitchen sinking again? Seems to me you are. I for one could care less about how you view your BMI or your cholesterol level, much less your Vitamin D supplements or your feelings about your doctor (whom you damn with faint praise). And when you segue to unsupported, backhanded dismissive comments about privilege and 800-pound gorillas my eyes glaze over. Then, when you airily dismiss laboratory tests as yielding falsely rosy results while you sing the praises of physical examinations that are notoriously unreliable I know you are ill-informed and I stop reading.
Wow Dr. Carroll, what did Wiley do to deserve that type of response? I thought she was raising some very important issues regarding the over prescribing, particularly with the elderly.
And yes, depending on the situation, laboratory tests can be very unreliable as people with thyroid disorders have found out. They were told they were fine only to find out that even though they were in the low range of normal, getting treatment greatly improved their situation.
hahaha it is most definitely a kabuki theatre process dr carroll.
AA: dr carroll seems to be a neuropsychiatrist… don’t argue/”debate” one unless you’re ready for a dose of scathing criticism. it comes with the territory if you want to be a good doctor– you can’t hold back punches.
while i applaud wiley for his high volume posts, i admit that i’ve not found them as informative as dr carroll’s shorter, ironic, and poignant posts. gotta side with him on this.
Oh, dear God, Dr. Carroll, please ignore my comments, they appear to trigger something with you.
sorry, just to add a little more:
the fact that guys of dr carroll’s stature have to post on this site (no offense dr mickey it’s great) is probably both disappointing and agitating for him. a dr of his calibre (or dr mickey’s calibre) do not enjoy making posts where they’re taking shots at pharma & the corporatization/institutionalization of medicine. these are men who should be able to voice their opinions behind the scenes and get action, but that hasn’t happened due to greed.
i don’t blame dr carroll for responding the way he has because he’d probably respond the same way behind the scenes. change needs to happen and it’s the neuropsychiatrists whose research/work/passion has suffered the MOST amidst all of this (IMO)
Patients have to make decisions about medication, too.
I wonder if this is not a cultural trend (polypharmacy, not Internet sniping) because of an underlying instinct in humans to reduce their surplus population.
Gadan, “guys of dr carroll’s stature,” who cannot accept criticism of psychiatry and its relationship to BigPrarma need to work out their own issues. It’s not a patient’s job to prop up a doctor’s ego. The ‘they , that is ” taking shots” here is laypeople talking about the problems with psychiatry and pharma that is the subject of Dr. Nardo’s blog. You’re a computer scientist working with psychiatric researchers, yes? Altostrata and I have extensive experience with psychiatry and psychiatric drugs. Whether or not you want to take us seriously is your problem, but if you consider yourself to be a more knowledgeable person on this issue than we are then you maybe are engaging with the same poor thinking that is responsible for the mess that is contemporary. No amount of understanding of abstraction and maths used to measure them negates experience. And it’s been well proven that the maths used to indicate that a medication is better than placebo, aren’t all that mathematically sound.
Also, a this point, the fact that so many high-ranking neurologists are mortified by the poor quality of interpretation of imaging results might inspire you to do some research, if you haven’t already, and start being more critical regarding sweeping conclusions being drawn from MRIs. A scientist who is not critical in their thinking and analysis is not a great scientist.
Dr. Carrol, if you have a problem with my criticism, then how about taking your argument to Dr. Nardo. IAll my criticisms are consonant with his. The patient is the person who takes the risks, Dr. Carrol. not the prescribing doctor. Your advanced degree in verbal abuse and disinterest in what laymen think about medications they’re prescribed and the risks that involves are duly noted.
Gadan, “guys of dr carroll’s stature,” who cannot accept criticism of psychiatry and its relationship to BigPrarma need to work out their own issues. It’s not a patient’s job to prop up a doctor’s ego. The ‘they , that is ” taking shots” here is laypeople talking about the problems with psychiatry and pharma that is the subject of Dr. Nardo’s blog. You’re a computer scientist working with psychiatric researchers, yes? Altostrata and I have extensive experience with psychiatry and psychiatric drugs. Whether or not you want to take us seriously is your problem, but if you consider yourself to be a more knowledgeable person on this issue than we are then you maybe are engaging with the same poor thinking that is responsible for the mess that is contemporary. No amount of understanding of abstraction and maths used to measure them negates experience. And it’s been well proven that the maths used to indicate that a medication is better than placebo, aren’t all that mathematically sound.
Also, a this point, the fact that so many high-ranking neurologists are mortified by the poor quality of interpretation of imaging results might inspire you to do some research, if you haven’t already, and start being more critical regarding sweeping conclusions being drawn from MRIs. A scientist who is not critical in their thinking and analysis is not a great scientist.
Dr. Carrol, if you have a problem with my criticism, then how about taking your argument to Dr. Nardo. All my criticisms are consonant with his. The patient is the person who takes the risks, Dr. Carrol. not the prescribing doctor. Your advanced degree in verbal abuse and disinterest in what laymen think about medications they’re prescribed and the risks that involves are duly noted.