ppp 10-13-08

Quote of the day: Courage is fear that has said its prayers.

Dorothy Bernard

Unless you are dead, or are in the group of US citizens who did not pay their loans and were foreclosed upon and have no money at risk, you know that the world stock markets are in freefall mode. Why would everything go to pieces after the announcement of the latest government rescue plan?

Members of both major parties were falling all over themselves to congratulate one and all for passage of the bailout but omitted one itsy bitsy detail… they forgot to managed the expectations of the markets and investors. After a lot of wrangling and jawing, back and forth negotiatiating and grandstanding the bill was passed. Most everyone assumed and EXPECTED that all would be well again the next day. The politicians may have hoped the same but there was no solid plan to inject the money into the financial system. The recovery will take time but everyone forgot to manage the expectations so when everything was not hunky-dorey within a few days fear griped the nation. This fear has fed the continuing decline.

One of the best bosses that I ever served instructed me in my primary job with dealing with large employers at a PBM. While I could run reports, answer questions and analyze trends and data for my clients I had to, as prime directive, manage their expectations related to drugs and drug spend. This meant giving both good news and bad news in a timely manner. If an expensive drug was to hit the market it was not enough to predict future outlays but to give the clients a reasonable estimate of the impact on the entire plan. As generic alternatives became available to supplant brand name drugs the same task appeared; manage expectations. Clinical programs: ditto.

The president finally addressed expectations last Friday. I pray that the message was not diluted and will finally be inculcated into the investors’ collective psyche: this will take awhile but we can emerge from this. I have listened to both sides and economic pundits and have come to believe that the administration that raised taxes and increased regulation were responsible for prolonging the Great Depression. I pray that these same fears do not cause politicians to repeat these mistakes and prolong our troubles. In the mean time I will have to manage my own expectations. Hang in there troops… the battle has just begun.

ps. Best answer this week to the question "How are you?" was “I can’t turn over without any help… but I’m OK. “

pps. Please note that some of the links may not be up for very long and that you should capture or print anything that you may wish to keep.

Recent tiotropium studies have pointed their fingers at the drug as a potential cause of death and/or cardiovascular events. This new study appears to exonerate the drug as a cause. More to come.

A lawsuit claims that Pfizer buried negative data on neurontin in an effort to expend its use outside of epilepsy. Expect more litigation. (Actually that could be said about almost every PPP article).

Zyprexa was promoted for off-label use (other that schizophrenia and Bipolar disorder) so 33 states will share in the settlement. More litigation is pending. States are increasingly eyeing pharmaceutical compaies to make up for other lost revenues. Sure is nice to know that trial lawyers will soon be getting a political boost.

Risperdal was approved for intramuscular injection as long as the muscle was the glutteous maximus. FDA recently approved the use of the deltoid muscle as an acceptable site. This should be a shot in the arm for the drug due to ease of use. This won’t increase the drug spend in a significant way but will likely increase the IM use of the drug.

Patients will have to have been seen at least once in person before a physician can prescribe medications over the internet. Seems like a common sense approach that should have been codified/enforced years ago. Legitimate mail order/online pharmacies have already been dong this so they should feel no effect from the new law. Maybe my SPAM inbox will not fill up quite so fast now.

Sherri McCoy takes over as head of J&J’s pharmaceutical group. She joined the company in 1982 as an associate scientist and will run the joint as of 1/1/10.

One of the nation’s top psychiatrists took money from drug companies in excess of $2 million but did not report all the income income. Also did not disclose conflicts of interest or fees to the University with which he is affiliated (against their rules). Nations top shrink, shrank for his duty.

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