ppp 04-13-09

Quote of the day: The democracy will cease to exist when you take away from

those who are willing to work and give to those who would not.

– Thomas Jefferson

As a kid I looked forward to blustery spring weather. Not so much the rain and cold as sustained winds. I would buy a kite kit at the local dairy store and a big ball of string. The balsa wood skeleton had to be put into the paper skin and the ends of the horizontal beam tied together to form a bow (like a bow and arrow). A bridle string was attached to the vertical stick about 1/4 of the way from the top and the bottom. The big ball of string was attached to the bridle of the kite and we were off… at least the first time. If the wind was strong enough at ground level, letting out string would be enough for the kite would take to the air. With little wind, we would have to run with the kite to get it airborne. Before we learned “the trick” our kites would leap into the air, make a big circle and crash into the ground. “The trick” was the use of a tail on the kite. We made tails out of old pieces of cloth and tied them to the bottom of the kites. The weight of the tail kept the kite upright and limited the circling and back and forth swaying of the kite. Because all the neighborhood kids were competitive, we all sought to have our own kite fly the highest. The trouble with a kite tail was that too little and the kite would spin out of control and too much tail made the kite too heavy to fly very high.

We have recently seen many industries spin wildly out of control due, in part, to the lack of corporate ethics. Think of each company or industry as a kite and sound corporate ethics as the tail. The companies in trouble all lacked a clear set of proper corporate ethics so government intervention will now be imposed as the tail. The goal should be to add enough regulation to make the companies fly straight and upright. My fear is that so much additional government regulation will be added to these already struggling companies so that the “tail” will be too heavy for them to get back off the ground. Having the government buy them or “nationalizing” them will not make them run any better… I have never seen a tail soar with a kite attached to it.

Pharmaceutical companies have not had many of these same problems, mainly because the FDA is their main tail. When they do get into trouble it is because someone violated an ethical principle or FDA rule. Much of the wind has been taken away from the brand name companies as they continue to lose patent protection on their main products. Many have suffered recently as their stock prices have fallen with the rest of the market but generally they are sound businesses who eliminate excess expenses quite readily in order to remain financially viable (unfortunately for those down-sized). The FDA has generally been doing a good job so I hope they will restrain themselves from adding to the governmental weight and allow the industry to recover and, once again, soar with the eagles.

Now I’ll take some of your recent advice (as found in your responses to my editorials)... I WILL go fly a kite (this time, however, I get to do it with my grandson). Yes, I will use a tail.

ps. Best answer this week to the question "How are you?" was "I'm too blessed to be stressed!" - Tammy: a previously frazzled nurse who reminded herself that she was not on a respirator, was able to eat and ambulate on her own, and would sleep in her own bed that night.

pps. Please note that some of the links may not be up for very long and that

Not education vouchers this time. Novartis has developed a new drug for malaria and was awarded a “Priority review voucher” for a future drug that they wish reviewed by the FDA. While this is part of an incentive program to entice pharma companies to develop drugs in certain areas… it just doesn’t feel right.

Last week the FDA was going to pull a lot of “unapproved” narcotics. The drugs had all been on the market before laws were made to require FDA approval. Families of hospice patients and others made their needs known so the FDA agreed to allow the products to remain on the market. It may just pay to petition the government after all. Now that morphine has been addressed we need to focus on the immediate release oxycodone and hydromorphone products also needed for break-though pain.

Seroquel already brings in almost $5 billion each year. If the FDA panel recommendations are approved then you will see even more use in patients who have tried antidepressants but still need something more. Not recommended as a first line drug against depression due to its side effect profile.

Most Americans would say PRICELESS but the British government isn’t quite as generous. Cancer drugs exceeding about $121.19 per day are considered excessive (British threshold is 30,000 pounds per year of life). National health care for the US anyone?

The number of prescriptions written but never filled (AKA ABANDONED PREDCRIPTIONS) rose again last year. About 7% of brand name drugs were never filled while only about 4% of generic Rx were abandoned. Could it be that physicians are writing more or that people can’t afford them? Authors attribute lower fill rates to economics but this is the Wall Street Journal and pushing the economic reason they would further the call for national health care coverage. (Yeah… maybe I am a skeptic)

If you believe (as I do) that prescription drugs for chronic conditions such as diabetes, high blood pressure, depression, asthma, heart disease, etc actually saves money by disease/complication avoidance/reduction then ANY reduction in medication compliance is a bad thing. So urge your patient to avoid being “Penny wise and pound foolish!”

Connecticut courts say that drug reps are not sales people because they do not take orders or deliver the goods. If the ruling stands then all hours over 40 per week (and we know that they all work hard, long hours… well beyond 40) the pharmaceutical companies will be on the hook not only for those hours but at a rate of time and a half. If this really does happen then you can expect those bonuses to disappear and they might have to take vacation for those days between Christmas and New Year’s Day.

People who work in a supportive and positive environment were less likely to need antidepressant medications than those in quarrelsome, unsupportive, and prejudiced places. Maybe all of the money spent on “team building” by some employers will save them some money on their drug benefit plan for antidepressants. For your own sakes… stay positive at work!

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