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Hooimeyer A, Lines T, Mirzaei J, Pande P, Ganeshamoorthy S, Fabbri A, Parker L, Dunn AG, Mintzes B. Conflict of interest policies at Australian medical schools. Intern Med J 2024; 54:62-73. [PMID: 37255333 DOI: 10.1111/imj.16148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/28/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Pharmaceutical industry exposure is widespread during medical training and may affect education and clinical decision-making. Medical faculties' conflict of interest (COI) policies help to limit this exposure and protect students against commercial influence. AIMS Our aim was to investigate the prevalence, content and strength of COI policies at Australian medical schools and changes since a previous assessment conducted in 2009. METHODS We identified policies by searching medical school and host university websites in January 2021, and contacted deans to identify any missed policies. We applied a modified version of a scorecard developed in previous studies to examine the content of COI policies. All data were coded in duplicate. COI policies were rated on a scale from 0 (no policy) to 2 (strong policy) across 11 items per medical school. Oversight mechanisms and sanctions were also assessed, and current policies were compared with the 2009 study. RESULTS Of 155 potentially relevant policies, 153 were university-wide and two were specific to medical schools. No policies covered sales representatives, on-site sponsored education or free samples. Oversight of consultancies had improved substantially, with 76% of schools requiring preapproval. Disclosure policies, while usually present, were weak, with no public disclosure required. CONCLUSION We found little indication that Australian medical students are protected from commercial influence on medical education, and there has been limited COI policy development within the past decade. More attention is needed to ensure the independence of medical education in Australia.
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Affiliation(s)
- Ashleigh Hooimeyer
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Janet Mirzaei
- School of Medicine, University of Notre Dame Sydney, Sydney, New South Wales, Australia
| | - Preshita Pande
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Sylviya Ganeshamoorthy
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Alice Fabbri
- Department for Health, University of Bath, Bath, United Kingdom
| | - Lisa Parker
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Adam G Dunn
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Barbara Mintzes
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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2
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Graham SS, Sharma N, Karnes MS, Majdik ZP, Barbour JB, Rousseau JF. A Content Analysis of Self-Reported Financial Relationships in Biomedical Research. AJOB Empir Bioeth 2023; 14:91-98. [PMID: 36576202 PMCID: PMC10182247 DOI: 10.1080/23294515.2022.2160509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
INTRODUCTION Financial conflicts of interest (fCOI) present well documented risks to the integrity of biomedical research. However, few studies differentiate among fCOI types in their analyses, and those that do tend to use preexisting taxonomies for fCOI identification. Research on fCOI would benefit from an empirically-derived taxonomy of self-reported fCOI and data on fCOI type and payor prevalence. METHODS We conducted a content analysis of 6,165 individual self-reported relationships from COI statements distributed across 378 articles indexed with PubMed. Two coders used an iterative coding process to identify and classify individual fCOI types and payors. Inter-rater reliability was κ = 0.935 for fCOI type and κ = 0.884 for payor identification. RESULTS Our analysis identified 21 fCOI types, 9 of which occurred at prevalences greater than 1%. These included research funding (24.8%), speaking fees (20.8%), consulting fees (18.8%), advisory relationships (11%), industry employment (7.6%), unspecified fees (4.8%), travel fees (3.2%), stock holdings (3.1%), and patent ownership (1%). Reported fCOI were held with 1,077 unique payors, 22 of which were present in more than 1% of financial relationships. The ten most common payors included Pfizer (4%), Novartis (3.9%), MSD (3.8%), Bristol Myers Squibb (3.2%), AstraZeneca (3.1%), GSK (3%), Boehringer Ingelheim (2.9%), Roche (2.8%), Eli LIlly (2.5%), and AbbVie (2.4%). CONCLUSIONS These results provide novel multi-domain prevalence data on self-reported fCOI and payors in biomedical research. As such, they have the potential to catalyze future research that can assess the differential effects of various types of fCOI. Specifically, the data suggest that comparative analyses of the effects of different fCOI types are needed and that special attention should be paid to the diversity of payor types for research relationships.
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Affiliation(s)
- S Scott Graham
- Department of Rhetoric & Writing, Center for Health Communication, The University of Texas at Austin, Austin, TX, USA
| | - Nandini Sharma
- Moody College of Communication, The University of Texas at Austin, Austin, TX, USA
| | - Martha S Karnes
- Department of English, The University of Texas at Austin, Austin, TX, USA
| | - Zoltan P Majdik
- Department of Communication, North Dakota State University, Fargo, ND, USA
| | - Joshua B Barbour
- Moody College of Communication, The University of Texas at Austin, Austin, TX, USA
| | - Justin F Rousseau
- Departments of Population Health and Neurology, The Dell Medical School at The University of Texas at Austin, Austin, TX, USA
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3
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Grundy Q, Huyer LD, Parker L, Bero L. Branded Care: The Policy Implications of Pharmaceutical Industry-Funded Nursing Care Related to Specialty Medicines. Policy Polit Nurs Pract 2023; 24:67-75. [PMID: 36069065 DOI: 10.1177/15271544221121749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
An increasing proportion of new drugs approved for market worldwide are now high cost, specialty medicines. Pharmaceutical marketers face the challenge of convincing payers, prescribers, and patients that the cost and complexity of care associated with specialty medicines is worth the trouble, and now offer patient support programs, free of charge, to patients prescribed their drug. We conducted a secondary, qualitative, interpretive analysis of 24 interviews with leaders of patient groups and members of hospital formulary committees in Australia to describe the work of pharmaceutical company-employed or contracted nurses who provide support to patients prescribed specialty medicines, and to prompt discussion around the policy implications of relying on industry-funded nursing care within publicly funded health systems. Participants affirmed the value of specialist, holistic, person-centered nursing care, but perceived gaps within the public health system related to the availability and provision of nursing care for people living with chronic disease. Consequently, participants described the pharmaceutical industry as addressing health system gaps through sponsorship or direct provision of medication-related nursing care, but recognized that care was contingent on commercial interest. Participants highlighted a number of ethical and policy concerns stemming from industry-funded nursing care of people prescribed specialty medicines related to patient safety, continuity of care, inducement to prescribe, and health equity. This analysis suggests that outsourcing necessary medication-related care to pharmaceutical companies has implications for the health system and equitable, sustainable pharmaceutical policy that extend far beyond the care encounter.
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Affiliation(s)
- Quinn Grundy
- University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada.,129263University of Colorado Anschutz Medical Campus, Centre for Bioethics and Humanities, Aurora, Colorado, United States
| | - Larkin Davenport Huyer
- University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada
| | - Lisa Parker
- The University of Sydney, Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Lisa Bero
- The University of Sydney, Charles Perkins Centre, Sydney, New South Wales, Australia.,129263University of Colorado Anschutz Medical Campus, Centre for Bioethics and Humanities, Aurora, Colorado, United States
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4
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Abstract
Almost any medicine can be purchased online from abroad. Many high-income countries permit individuals to import medicines for their personal use. However, those who import medicines face the risk of purchasing poor-quality products that may not work, or that may even harm them. Many people are willing to accept this risk for the opportunity to purchase more affordable medicines. This is especially true of individuals from low socioeconomic backgrounds who already struggle to afford the medicines they need if they are not subsidised by insurers or if copayments are high. As medicine prices and out-of-pocket healthcare spending continue to climb, the online marketplace provides an important alternative for individuals in high-income countries to source medicines. In this article, I argue that doctors have a responsibility to help patients access medicines online and I propose a framework that can be used to facilitate responsible personal importation.
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Affiliation(s)
- Narcyz Ghinea
- Philosophy Department, Faculty of Arts, Centre for Agency, Values and Ethics, Macquarie University, North Ryde, NSW, Australia
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5
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Ferner RE, Aronson JK. Medicines legislation and regulation in the United Kingdom 1500-2020. Br J Clin Pharmacol 2023; 89:80-92. [PMID: 35976677 PMCID: PMC10087031 DOI: 10.1111/bcp.15497] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
The initial purposes of regulation of medicines in England, and latterly in the United Kingdom, were principally to raise government revenue, to discourage murder by poisoning and to regulate the activities of pharmacists. It was only much later that regulators sought to ensure that medicines were of good quality, reasonably safe, and at least somewhat effective, and to curtail misuse of drugs. Here we survey the history of the regulation of medicines and poisons in England from the perspective of clinicians with an interest in therapeutics.
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Affiliation(s)
- Robin E Ferner
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK.,West Midlands Centre for Adverse Drug Reactions, City Hospital, Birmingham, UK
| | - Jeffrey K Aronson
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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6
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Farah S, Bilszta JL. Teaching medical students how to interact with the pharmaceutical industry: A scoping review. GMS J Med Educ 2022; 39:Doc57. [PMID: 36540557 PMCID: PMC9733477 DOI: 10.3205/zma001578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/24/2022] [Accepted: 08/04/2022] [Indexed: 06/17/2023]
Abstract
Objectives: The influence of the pharmaceutical industry is of significant concern in physician prescribing decisions; medical students may not be fully equipped with the knowledge or skills to manage interactions with industry prior to graduation. The aim of this study was to evaluate the characteristics of educational interventions undertaken to improve students' knowledge, attitudes, and skills in managing interactions with the pharmaceutical industry. Methods: A systematic search of Ovid Medline, EMBASE, CINAHL and ERIC databases identified 3210 primary studies with keywords related to "pharmaceutical industry" and "undergraduate medical education". Eleven articles were included for review. Results: Disparate methods of teaching medical students how to interact with the pharmaceutical industry were identified, making it difficult to compare the effectiveness of different educational interventions. All the included studies achieved the aims of the described intervention, at least in the short term, suggesting perhaps any education related to interactions with the pharmaceutical industry can aid students in managing these situations. Conclusions: The lack of an evidence-base means more research into the identification of educational interventions which engender durable changes in students' knowledge, attitudes, and skills to manage interactions with the pharmaceutical industry are required. Any intervention will likely be context-dependent, as a universal approach is hindered by the fact different countries have different laws governing pharmaceutical industry-physician interaction.
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Affiliation(s)
- Samiyah Farah
- University of Melbourne, Melbourne Medical School, Department of Medical Education, Melbourne, Australia
| | - Justin L. Bilszta
- University of Melbourne, Melbourne Medical School, Department of Medical Education, Melbourne, Australia
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7
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Mitchell AP, Mishra Meza A, Trivedi NU, Bach PB, Gönen M. Physician Payments from Pharmaceutical Companies Related to Cancer Drugs. Oncologist 2022; 27:857-863. [PMID: 35946837 PMCID: PMC9526499 DOI: 10.1093/oncolo/oyac160] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Drug manufacturers claim that the purpose of financial payments to physicians is to facilitate education about new drugs. This claim suggests 2 testable hypotheses: payments should not be associated with drug revenue and payments for each drug should decline over time as physicians become educated. MATERIALS AND METHODS We used open payments data on industry payments. We included payments for cancer drugs without generic/biosimilar competitors and used federal data sources to measure Medicare spending (a proxy for overall drug revenue) and a number of prescribers. We used generalized estimating equations (GEE) to model the drug-level association between industry payments and Medicare spending. Separately, we used GEE to estimate the change in payments with respect to the duration of time since initial FDA approval. RESULTS The sample included 89 drugs and 361 drug-year observations. The total value of industry payments for oncology drugs increased, from $53 333 854 in 2014 to $90 343 731 in 2018. There was no association between log-transformed mean, per-physician industry payments, and per-physician Medicare spending (estimate -0.001, 95%CI, -0.005 to 0.004). Payments for individual drugs decreased over time; estimated payments in the subsequent year for a drug with mean, per-physician payments of $1000 in the index year was: $681* for drugs 0-4 years since approval, $825 for 5-9 years, and $679* for ≥10 years (*P < .05). CONCLUSIONS Although industry-sponsored education may also serve marketing purposes, the absence of association between industry payments and Medicare spending and the decline in payments subsequent to approval are consistent with claims that industry payments function to facilitate physician education.
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Affiliation(s)
- Aaron P Mitchell
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Akriti Mishra Meza
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Mithat Gönen
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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8
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Apollonio DE. Marketing Antipsychotics to Correctional Facilities: A Review of Pharmaceutical Industry Documents. J Correct Health Care 2022; 28:325-328. [PMID: 36190495 PMCID: PMC9835282 DOI: 10.1089/jchc.21.04.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This retrospective qualitative review describes the marketing of antipsychotics by pharmaceutical companies to prisons and jails to increase prescribing. This review relied on internal pharmaceutical industry documents released in litigation and stored in the Drug Industry Documents archive at the UCSF Industry Documents Library. At least two pharmaceutical companies directly marketed antipsychotics to correctional facilities to increase sales, using targeted promotions and indirect "educational" advertising and by seeking control of state advisory boards that made formulary decisions. Further research on how medications are marketed is needed, along with stronger conflict-of-interest policies to reduce industry involvement on advisory boards that approve medications. National regulations that restrict pharmaceutical manufacturers from involvement in formulary decisions and prescribing guidelines would likely improve the provision of health care to people who are incarcerated.
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Affiliation(s)
- Dorie E. Apollonio
- Department of Clinical Pharmacy, University of California, San Francisco, California, USA
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9
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Sorum P, Stein C, Wales D, Pratt D. A Proposal to Increase Value and Equity in the Development and Distribution of New Pharmaceuticals. Int J Health Serv 2022; 52:363-371. [PMID: 35546103 PMCID: PMC9203670 DOI: 10.1177/00207314221100647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The process of developing and marketing new pharmaceuticals in the United States is driven by a need to maximize returns to shareholders. This results all too often in the production of new medications that are expensive and of marginal value to patients and society. In line with our heightened awareness of the importance of social justice and public health—and in light of our government‘s alliance with private companies in bringing us COVID-19 vaccines—we need to reconsider how new pharmaceuticals are developed and distributed. Accordingly, we propose the creation of a new agency of the Food and Drug Administration (FDA) that would direct the whole process. This agency would fund the research and development of high-value medications, closely monitor the clinical studies of these new drugs, and manage their distribution at prices that are value-based, fair, and equitable.
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Affiliation(s)
- Paul Sorum
- Internal Medicine and Pediatrics, 1092Albany Medical College, Albany Medical Center Internal Medicine and Pediatrics, Cohoes, NY, USA
| | | | - Danielle Wales
- Internal Medicine and Pediatrics, 1092Albany Medical College, Albany Medical Center Internal Medicine and Pediatrics, Cohoes, NY, USA
| | - David Pratt
- 167519Schenectady County Public Health Services, Schenectady, NY, USA
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10
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Cabiedes-Miragaya L, Galende-Domínguez I. COVID-19 vaccines: a look at the ethics of the clinical research involving children. J Med Ethics 2022; 48:medethics-2021-107941. [PMID: 35144979 PMCID: PMC8844969 DOI: 10.1136/medethics-2021-107941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
Currently, millions of minors are being inoculated against SARS-CoV-2 in many countries in the world. Ethical concerns about clinical research involving children have barely been addressed in the literature, despite the fact that the paediatric population is particularly vulnerable within this context. Children should be included in the research plans for COVID-19 vaccines. Nevertheless, it is necessary to critically assess to what extent clinical trials are being conducted according to methodological and ethical criteria that allow us to conclude that the results are valid and, in consequence, how far the vaccination plans for children are scientifically justified.The principal aim of this article is to analyse critically the process of clinical research on COVID-19 vaccines involving children, highlighting the ethical concerns that arise, including the need to stratify the results from older adolescents separately for analysis before proceeding, if further research is warranted, in descending age order. The development of COVID-19 vaccines is examined, with a special look at the participation of children throughout their clinical development, including a review of the clinical trials registered in three international databases. We also offer some additional considerations about the inclusion of minors in vaccination plans. Finally, we conclude with some recommendations, with particular emphasis on the following ethical duties: research in children should be carried out only once the relevant research in adults has previously been conducted; issues that concern children's needs and rights should be specifically addressed; and, therefore, the highest standards of ethical and scientific quality should be met.
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Affiliation(s)
| | - Inés Galende-Domínguez
- Community of Madrid Ministry of Health, Directorate General for Research, Education and Documentation, Madrid, Spain
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11
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Abstract
Orphan drug policy often gives 'special treatment' to rare diseases, by giving additional priority or making exceptions to specific drugs, based on the rarity of the conditions they aim to treat. This essay argues that the goal of orphan drug policy should be to make prevalence irrelevant to funding decisions. It aims to demonstrate that it is severity, not prevalence, which drives our judgments that important claims are being overlooked when treatments for severe rare diseases are not funded. It shows that prioritising severity avoids problems caused by prioritising rarity, and that it is compatible with a range of normative frameworks. The implications of a severity-based view for drug development are then derived. The severity-based view also accounts for what is wrong with how the current system of drug development unfairly neglects common diseases that burden the developing world. Lastly, the implications of a severity-based view for current orphan drug policies are discussed.
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Affiliation(s)
- Monica Magalhaes
- Center for Population-Level Bioethics, Rutgers University, New Brunswick, New Jersey, USA
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12
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Medicines Australia Code of Conduct: breaches 2020-21. Aust Prescr 2021; 44:206. [PMID: 35002035 DOI: 10.18773/austprescr.2021.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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13
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Al-Jumaili AA, Younus MM, Kannan YJA, Nooruldeen ZE, Al-Nuseirat A. Pharmaceutical regulations in Iraq: from medicine approval to postmarketing. East Mediterr Health J 2021; 27:1007-1015. [PMID: 34766327 DOI: 10.26719/emhj.21.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/10/2021] [Indexed: 11/09/2022]
Abstract
Background Recent information on regulation of the pharmaceutical sector in Iraq is scarce. Aims This report summarizes the regulations governing pharmaceutical products in Iraq, assesses the challenges faced and makes recommendations to tackle these issues. Methods The Iraq pharmaceutical country profile 2020, prepared by the Iraqi Ministry of Health in collaboration with the World Health Organization (WHO) in 2020, was the main source of information. Results Despite all the efforts by the Ministry of Health to provide adequate and safe medicines, the Iraqi pharmaceutical sector has several challenges, including inadequate budget allocated to the ministry, shortages in essential medicines, underutilization of electronic technologies in the management of regulation-related work, a large number of substandard and falsified medications in the private sector and a stagnant national pharmaceutical industry. Conclusion The Ministry of Health needs more financial support from the federal government to fund its activities and technical support from international health organizations to provide training and resources.
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Affiliation(s)
| | | | | | - Zinah E Nooruldeen
- Department of Health Systems, World Health Organization Country Office, Baghdad, Iraq
| | - Adi Al-Nuseirat
- Department of Health Systems, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
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14
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Richard E. Selecting the target population for new Alzheimer drugs: challenges and expectations. J Med Ethics 2021; 47:615-616. [PMID: 34400543 DOI: 10.1136/medethics-2021-107767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Edo Richard
- Neurology, Radboudumc, Nijmegen, Gelderland, Netherlands
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15
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Fundytus A, Wells JC, Sharma S, Hopman WM, Del Paggio JC, Gyawali B, Mukherji D, Hammad N, Pramesh CS, Aggarwal A, Sullivan R, Booth CM. Industry Funding of Oncology Randomised Controlled Trials: Implications for Design, Results and Interpretation. Clin Oncol (R Coll Radiol) 2021; 34:28-35. [PMID: 34479769 DOI: 10.1016/j.clon.2021.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/24/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022]
Abstract
AIMS Most randomised controlled trials (RCTs) in oncology are now funded by the pharmaceutical industry. We explore the extent to which RCT design, results and interpretation differ between industry-funded and non-industry-funded RCTs. MATERIALS AND METHODS In this cross-sectional analysis, a structured literature search was used to identify all oncology RCTs published globally during 2014-2017. Industry funding was identified based on explicit statements in the publication. Descriptive statistics were used to compare elements of trial methodology and output between industry- and non-industry-funded RCTs. RESULTS The study sample included 694 RCTs; 71% were funded by industry. Industry-funded trials were more likely to test systemic therapy (97% versus 62%; P < 0.001), palliative-intent therapy (71% versus 41%; P < 0.001) and study breast cancer (20% versus 12%; P < 0.001). Industry-funded trials were larger (median sample size 474 versus 375; P < 0.001) and more likely to meet their primary end point (49% versus 41%; P < 0.001). Among positive trials, there were no differences in the magnitude of benefit between industry- and non-industry-funded RCTs. Trials funded by industry were published in journals that had a significantly higher median impact factor (21, interquartile range 7, 28) than non-industry-funded trials (impact factor 12, interquartile range 5, 24; P = 0.005); this persisted when adjusted for whether a trial was positive or negative. CONCLUSIONS The vast majority of oncology RCTs are now funded by industry. Industry-funded trials are larger, more likely to be positive, predominantly test systemic therapies in the palliative setting and are published in higher impact journals than trials without industry support.
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Affiliation(s)
- A Fundytus
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - J C Wells
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - S Sharma
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
| | - W M Hopman
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - J C Del Paggio
- Department of Oncology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - B Gyawali
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - D Mukherji
- American University of Beirut Medical Center, Beirut, Lebanon
| | - N Hammad
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - C S Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Aggarwal
- Institute of Cancer Policy, King's College London, London, UK; London School of Hygiene and Tropical Medicine, London, UK
| | - R Sullivan
- Institute of Cancer Policy, King's College London, London, UK
| | - C M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
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16
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Larkin J, Pericin I, Collins M, Smith SM, Byrne D, Moriarty F. GPs' perceptions of their relationship with the pharmaceutical industry: a qualitative study. BJGP Open 2021:BJGPO. [PMID: 34353789 DOI: 10.3399/BJGPO.2021.0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/24/2021] [Indexed: 12/03/2022] Open
Abstract
Background The pharmaceutical industry invests heavily in promoting medications to physicians. This promotion may influence physicians’ prescribing behaviour and lead to inappropriately increased prescribing rates. Aim To understand GPs’ experience of interacting with the pharmaceutical industry, and explore their views and perceptions of the impact of this interaction in general practice in Ireland. Design & setting A qualitative design was used, and GPs practicing in Ireland were eligible. Method A combination of purposive and snowball sampling techniques was applied and semi-structured interviews were conducted. Thematic analysis was used to develop themes from the data. Results Twenty-one GPs and one GP trainee participated. Five themes were developed: 1) GP and pharmaceutical industry interface; 2) the industry’s methods of influence; 3) the uncomfortable relationship between GPs and industry; 4) GPs’ perceptions of being unconsciously influenced; and 5) GPs’ lack of knowledge of relevant regulations. Participants interacted with pharmaceutical representatives in their surgery and through continuing professional development (CPD). Reported methods of influence included biased information and the offer of gifts. Most participants felt their prescribing was unconsciously influenced. A minority felt that they were only influenced in a way that improved their prescribing. Conclusion The study shows that there can be a lack of clarity among GPs about relevant regulations and about the potential impact on prescribing of interactions with the pharmaceutical industry. Education of trainees and GPs has the potential to address this. Restrictions on interactions with the pharmaceutical industry may also play a role, although alternative CPD funding sources would need to be established.
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17
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Preston C, King C, Hinds M, Burnett F, Extavour RM. Pharmaceutical procurement among public sector procurers in CARICOM. Rev Panam Salud Publica 2021; 45:e57. [PMID: 34025728 PMCID: PMC8132958 DOI: 10.26633/rpsp.2021.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/15/2020] [Indexed: 11/24/2022] Open
Abstract
Objective. To examine multiple aspects of the medicines in CARICOM procurement markets, including manufacturer headquarters location, regulatory history, and type (innovator versus generic); the proportion of World Health Organization (WHO) essential medicines; and the most expensive medicines procured. Methods. An analysis of procurement information from selected CARICOM procurers. Four public sector procurement lists were obtained based on public availability or sharing of data from public sector procurers. Analyses were based on parameters available or deduced from these data. Results. The majority of products come from manufacturers headquartered in North America and Europe (63%–67%). The percentage of medicines procured from generic companies is 60%–87%; and 25%–50% of medicines procured are on the WHO Essential Medicines List. Wide price variations exist in the most expensive medicines purchased. Conclusions. The analysis identifies vulnerabilities and opportunities in the procurement situation of CARICOM states, particularly related to quality and rational use of medicines. This analysis represents a baseline that governments and other stakeholders can use in the future.
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Affiliation(s)
- Charles Preston
- Ex officer of Pan American Health Organization Washington, D.C United States of America Ex officer of Pan American Health Organization, Washington, D.C., United States of America
| | - Claire King
- Baylor Scott and White Medical Center Taylor, Tex United States of America Baylor Scott and White Medical Center, Taylor, Tex., United States of America
| | - Maryam Hinds
- Barbados Drug Service St. Michael Barbados Barbados Drug Service, St. Michael, Barbados
| | - Francis Burnett
- Organisation of Eastern Caribbean States Castries Saint Lucia Organisation of Eastern Caribbean States, Castries, Saint Lucia
| | - Rian Marie Extavour
- Caribbean Public Health Agency Port of Spain Trinidad and Tobago Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago
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18
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Mintzes B. Policing the promotion of prescription medicines - the new Medicines Australia Code of Conduct. Aust Prescr 2021; 44:4-5. [PMID: 33664540 PMCID: PMC7900277 DOI: 10.18773/austprescr.2020.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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19
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Medicines Australia Code of Conduct: breaches 2019-20. Aust Prescr 2020; 43:210. [PMID: 33363305 DOI: 10.18773/austprescr.2020.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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20
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Parker L, Bennett A, Mintzes B, Grundy Q, Fabbri A, Karanges EA, Bero L. "There are ways … drug companies will get into DTC decisions": How Australian drug and therapeutics committees address pharmaceutical industry influence. Br J Clin Pharmacol 2020; 87:2341-2353. [PMID: 33129226 DOI: 10.1111/bcp.14636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/17/2020] [Accepted: 10/23/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS One tool for protecting quality use of medicines in hospitals is a drug and therapeutics committee (DTC) that oversees medicines availability. Pharmaceutical industry marketing to prescribers is associated with less appropriate prescribing and increased costs. There is little data on decision-making practices of DTCs so it is unknown whether or how they might be vulnerable to pharmaceutical industry influence. This project explores DTC decision-making with a focus on how pharmaceutical industry influence on access and use of medicines is identified and managed. METHODS We used a qualitative methodology with individual interviews of 29 participants who were current or recent members of public hospital DTCs across New South Wales, Australia. Participants included medical, pharmacy and nursing staff and 1 citizen. Committees were linked to specific hospitals or regions, and some were affiliated with paediatric, neonatal, rural or mental health services. RESULTS Drug committee processes for oversight of medicines in public hospitals are vulnerable to pharmaceutical industry influence at several points. Applications for formulary additions are sometimes initiated and completed by company representatives. Conflict of interest disclosures among applicants and committee members may be incomplete. In some institutions, medicines are available from pharmaceutical companies without committee review, including through free samples and industry-supported medicines access programmes. Participants noticed the presence and impact of pharmaceutical company marketing activities to local clinicians, resulting in increased prescriber demand for products. CONCLUSION Improved DTC practices and review of hospital policies concerning pharmaceutical marketing activities might preserve the independence of evidence-based decision-making for safe, cost-effective prescribing.
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Affiliation(s)
- Lisa Parker
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine & Health, The University of Sydney, Australia
| | | | - Barbara Mintzes
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine & Health, The University of Sydney, Australia
| | - Quinn Grundy
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine & Health, The University of Sydney, Australia.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada
| | - Alice Fabbri
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine & Health, The University of Sydney, Australia.,Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, University of Southern Denmark, Denmark
| | - Emily A Karanges
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine & Health, The University of Sydney, Australia.,Centre for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia.,Orygen, Melbourne, Australia
| | - Lisa Bero
- University of Colorado Center for Bioethics and Humanities, School of Medicine and Colorado School of Public Health, University of Colorado Anschutz Medical Campus, USA
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21
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Milne-Ives M, Lam C, van Velthoven M, Meinert E. The Impact of Brexit on the Pharmaceutical Supply Chain of the United Kingdom: Scoping Review Protocol. JMIR Res Protoc 2020; 9:e17684. [PMID: 32965239 PMCID: PMC7542404 DOI: 10.2196/17684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background The continuing uncertainty around Brexit has caused concern in the pharmaceutical industry and among health care professionals and patients. The exact consequences of Brexit on the pharmaceutical supply chain in the United Kingdom will depend on whether a deal is reached and what it entails, but it is likely to be affected by the withdrawal of the United Kingdom from the European Union. Regulatory issues and delays in supply have the potential to negatively affect the ability of UK residents to receive an adequate and timely supply of necessary medicines. Objective The purpose of this protocol is to provide an overview and critical analysis of current perspectives on the effect of Brexit on the UK pharmaceutical supply chain. Methods The PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines will be used to structure this protocol. A systematic search of MEDLINE, EMBASE, PsycINFO, Healthcare Management Information Consortium (HMIC), Cochrane, Web of Science, Business Source Complete, EconLit, and Economist Intelligence Unit will be conducted, as well as a Google and Nexis.UK search for grey literature such as reports, opinion pieces, and press releases. Two reviewers will independently screen the titles and abstracts of identified references and select studies according to the eligibility criteria. Any discrepancies will then be discussed and resolved. One reviewer will extract data from the included studies into a standardized form, which will be validated by a second reviewer. Risk of bias will be assessed using the Cochrane Collaboration Risk of Bias tool for any randomized controlled trials; quality will be assessed using the relevant Critical Appraisal Skills Programme (CASP) checklists; and grey literature will be assessed using the Authority, Accuracy, Coverage, Objectivity, Date, Significance (AACODS) checklist. Outcomes include the agreement between sources on the potential, likelihood, and severity of the consequences of Brexit on the UK pharmaceutical supply chain. Results Results will be included in the scoping review, which will be published in 2020. Conclusions This scoping review will summarize the currently expected consequences of Brexit on the UK pharmaceutical supply chain. International Registered Report Identifier (IRRID) PRR1-10.2196/17684
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Affiliation(s)
- Madison Milne-Ives
- Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Ching Lam
- Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Michelle van Velthoven
- Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Edward Meinert
- Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,Department of Primary Care and Public Health, Imperial College London, London, United Kingdom.,Centre for Health Technology, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
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22
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Pokorny AMJ, Bero LA, Moynihan R, Mintzes BJ. Industry payments to Australian medical oncologists and clinical haematologists: a cross-sectional analysis of publicly available disclosures. Intern Med J 2020; 51:1816-1824. [PMID: 32744396 DOI: 10.1111/imj.15005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/12/2020] [Accepted: 07/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Payments to medical oncologists and clinical haematologists can negatively affect prescribing practice, but the extent of payments to these specialists is unknown in Australia. AIMS To analyse the extent of payments from the pharmaceutical industry to Australian cancer physicians as reported during the first collated period of the Disclosure Australia website. METHODS We performed a retrospective, cross-sectional analysis of payments made from November 2018 to April 2019, using a file downloaded from the Disclosure Australia website. We checked the names of listed medical practitioners against Medical Board of Australia records to assign specialties. The number of medical oncologists, clinical haematologists, other specialist physicians and non-specialist physician medical practitioners was calculated, along with the payments to each of these groups. RESULTS A total of A$7 332 407 was paid to 2775 medical practitioners. Of these, 236 were medical oncologists, 189 were haematologists and 1145 were other specialist physicians. This represents 31.7% of Australian medical oncologists and 30.9% of Australian haematologists, compared with 11.7% of all other specialist physicians and 1.1% of all other non-specialist physician medical practitioners. Medical oncologists received significantly higher payments (median A$2131.26) than other specialist physicians (median A$1376.00, 2-tailed P = 0.004) and other medical practitioners (median A$709.00, 2-tailed P < 0.001), while haematologists received significantly higher payments (median A$1519.95) than other medical practitioners (2-tailed P < 0.001), but similar payments to other specialist physicians (2-tailed P = 0.08). CONCLUSIONS Australian cancer physicians receive payments at a higher proportional frequency and in greater dollar amounts than other specialist physicians and other medical practitioners in general.
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Affiliation(s)
- Adrian M J Pokorny
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Medical Oncology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Lisa A Bero
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Raymond Moynihan
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Barbara J Mintzes
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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23
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Pasetes SV, Ling PM, Apollonio DE. Cognitive performance effects of nicotine and industry affiliation: a systematic review. Subst Abuse 2020; 14:1178221820926545. [PMID: 32547048 PMCID: PMC7271274 DOI: 10.1177/1178221820926545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Studies assessing the cognitive performance effects of nicotine show inconsistent results and tobacco industry funding has been correlated with study outcomes. We conducted a systematic review of the primary literature assessing the cognitive performance effects of nicotine and assessed potential associations between tobacco and pharmaceutical industry affiliation and reported study conclusions. METHODS We searched PubMed, EMBASE, PsycINFO, BIOSIS, and Web of Science for peer-reviewed journal articles published between 2009 and 2016 that: (1) were randomized controlled trials; (2) investigated the effects of nicotine on cognitive performance in a laboratory setting; (3) administered nicotine to healthy adults (18-60 years); and (4) included participants were nonsmokers or minimally deprived smokers (⩽2 hours of abstaining from smoking). Study disclosures and tobacco industry documents were reviewed to determine industry funding. RESULTS Searches yielded 3,771 abstracts; 32 studies were included in the review. The majority of studies investigated the effects of nicotine on attention (n = 22). Nicotine had a non-uniform effect on attention: studies reported positive (41%; n = 9), mixed (41%; n = 9), and no effect (18%; n = 4). The majority of study authors had received prior tobacco industry funding (59%; n = 19), however over half of tobacco-industry funded authors did not report this (53%; n = 10). CONCLUSIONS Nicotine does not appear to be associated with consistent cognitive performance effects. Although no association was found between reported outcomes and tobacco or pharmaceutical industry funding, findings likely underestimate the influence of industry funding due to strict inclusion criteria and incomplete data on pharmaceutical industry funding. CLINICAL TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Sarah V. Pasetes
- Department of Clinical Pharmacy,
University of California, San Francisco, USA
| | - Pamela M. Ling
- Department of Medicine, Division of
General Internal Medicine, Center for Tobacco Control Research and Education,
University of California, San Francisco, USA
| | - Dorie E. Apollonio
- Department of Clinical Pharmacy,
University of California, San Francisco, USA
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24
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Cohen D, Recalt A. Withdrawal effects confounding in clinical trials: another sign of a needed paradigm shift in psychopharmacology research. Ther Adv Psychopharmacol 2020; 10:2045125320964097. [PMID: 33224467 PMCID: PMC7656873 DOI: 10.1177/2045125320964097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/09/2020] [Indexed: 11/24/2022] Open
Abstract
Randomized controlled trials' ability to produce evidence useful for people to decide whether to take, continue taking, or stop taking psychotropic drugs has been intensely critiqued, along with the trials' commercial, ideological, and regulatory contexts. This article applies the critique to the topic of withdrawal effects confounding the outcomes of relapse-prevention trials where prescribed psychotropic drugs are discontinued. Until recently, the complexity and reach of withdrawal and post-withdrawal effects were neglected by mainstream psychiatry, but not by lay users of prescribed psychotropics. This article discusses withdrawal effects as part of the pharmacology of psychotropic drugs but shaped by psychosocial factors, and possibly shaping the presentation of psychological distress generally. It outlines biases and misconceptions in assumptions, design, and reporting of general efficacy trials and findings from a recent review of 80 discontinuation trials. In theory, relapse-prevention trials are tautological and exaggerate efficacy. In publications, they pay little attention to the central feature of their design, favor abrupt or rapid discontinuations, do not attend to environmental factors, and provide insufficient data to allow re-analyses. Thus, relapse-prevention RCTs likely confound the detection of their main outcome of interest: "relapse." Using slower tapers, active placebo controls, and specific covariates in analyses would reduce the risk of withdrawal confounding, and better reporting would reduce the opaqueness of trials. The crisis in psychopharmacology is fueled partly by the disconnect between claims of therapeutic efficacy from so-called best-evidence methods despite unchanging population-level indicators of psychiatric sickness. Only by "stacking the deck" against trial sponsors' hoped-for outcomes can psychopharmacology trials regain scientific credibility.
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Affiliation(s)
- David Cohen
- UCLA Luskin School of Public Affairs, 3250 Public Affairs Building, Los Angeles, CA 90095-1656, USA
| | - Alexander Recalt
- Department of Social Welfare, Luskin School of Public Affairs, and Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
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25
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Na X, Guo H, Wu S, Li J. Mining Pharmaceutical Product Data Related to Payment Pattern from the CMS Open Payments Data: A Case Study in Thoracic Surgery. Stud Health Technol Inform 2019; 264:1554-1555. [PMID: 31438228 DOI: 10.3233/shti190531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study used descriptive statistical analyses to investigate the payment characteristics and to discuss the regularity of highest paying industries. Payments by 4.70% of highest paying industries (N=446) accounted for 85% of the total (US $72,458,304) in 2014-2016. A tiny minority of highest paying industries control the majority of payments. Large payments from these industries are highly associated with few specific products. Furthermore, payment patterns among the industries include concentration and diversification.
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Affiliation(s)
- Xu Na
- Institute of Medical Information / Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Haihong Guo
- Institute of Medical Information / Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Sizhu Wu
- Institute of Medical Information / Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiao Li
- Institute of Medical Information / Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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26
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Hernandez I, Good CB, Gellad WF, Parekh N, He M, Shrank WH. Number of manufacturers and generic drug pricing from 2005 to 2017. Am J Manag Care 2019; 25:348-352. [PMID: 31318508 PMCID: PMC6734551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate how changes in generic drug prices and the incidence of abrupt price increases varied with the number of manufacturers supplying each drug. STUDY DESIGN Analysis of 2005 to 2016 monthly wholesale acquisition costs (WACs) and University of Pittsburgh Medical Center Health Plan counts of pharmacy claims for National Drug Codes (NDCs) for generic drugs. METHODS Each year, NDCs were categorized according to the number of manufacturers offering each combination of active ingredient and dosage form: 1 to 3, 4 to 7, and more than 7. For every month from January 2006 to January 2017, we estimated the 12-month change in WAC (eg, 12-month change in January 2006 was calculated as the difference in WAC between January 2006 and January 2005, divided by the WAC in January 2005), before and after weighting each NDC by counts of pharmacy claims. We evaluated the proportion of NDCs that had large price increases, greater than 20%, 50%, 100%, and 500% within a year. RESULTS Before 2010, price changes were higher for drugs supplied by a lower number of manufacturers; however, after 2010, prices increased sharply, and drugs supplied by 4 to 7 manufacturers showed increases similar to or higher than those supplied by 1 to 3. In 2013, prices increased by an average of 29% for drugs supplied by 1 to 3 and 4 to 7 manufacturers, and 10% for more than 7. Price changes increased after weighting by counts of pharmacy claims, demonstrating that price increases disproportionately affected widely used drugs. The proportion of NDCs from drugs supplied by 1 to 3 manufacturers that doubled in price within a year was 3.6 times higher in 2012 to 2015 than in 2005 to 2009 (4.6% vs 1.3%, respectively). CONCLUSIONS Increases in generic drug prices are concerning because they affected widely used drugs and suggest that generic drug prices may be increasingly insensitive to competition.
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Affiliation(s)
- Inmaculada Hernandez
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, 3501 Terrace St, 637 Salk Hall, Pittsburgh, PA 15261.
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Affiliation(s)
| | - Darlette G Luke
- Investigational Drug Service, Fairview Health Services, University of Minnesota Medical Center, Minneapolis, MN
| | - Helen R Tamer
- Research Pharmacy, Michigan Medicine (University of Michigan), Ann Arbor, MI
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28
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Affiliation(s)
- Steve Morris
- SA Pharmacy, Adelaide.,SA Health, Adelaide.,Department of Health and Wellness, Government of SA, Adelaide
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29
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Hadland SE, Cerdá M, Marshall BDL. Reduced Opioid Marketing Could Limit Prescribing Information for Physicians-Reply. JAMA Intern Med 2018; 178:1426-1427. [PMID: 30285139 PMCID: PMC7086487 DOI: 10.1001/jamainternmed.2018.4366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Scott E Hadland
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts.,Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Magdalena Cerdá
- Department of Emergency Medicine, School of Medicine, University of California, Davis, Sacramento
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
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30
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Dhanani A, Parent du Chatelet I, Ioughlissen S, Maison P. [Supply disruptions and drug shortages: the example of benzathine benzylpenicillin]. Rev Prat 2018; 68:849-854. [PMID: 30869447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Supply disruptions and drug shortages : the example of benzathine benzylpenicillin. Despite collective mobilisation, drug shortages have increased in recent years, creating a strong impact on public health. Anti-infective drugs, mainly injectable antibiotics, are particularly affected by these shortages. Although the causes of these ruptures are multiple, they are mainly related to the effects of globalisation and industrial strategies of rationalisation of production costs. The shortage of benzathine benzylpenicillin illustrates the action of the French Medicines Agency (ANSM), and the various actors to guarantee access to care and limit the consequences for the patient. Beyond measures taken at national level by the regulatory authorities in connection with the pharmaceutical companies, it is necessary to set up a concerted action at European level to fight effectively against drug shortages.
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Affiliation(s)
- Alban Dhanani
- Agence nationale de sécurité du médicament et des produits de santé (ANSM), Saint-Denis, France
| | | | - Said Ioughlissen
- Agence nationale de sécurité du médicament et des produits de santé (ANSM), Saint-Denis, France
| | - Patrick Maison
- Agence nationale de sécurité du médicament et des produits de santé (ANSM), Saint-Denis, France
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31
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Pulley JM, Jerome RN, Shirey-Rice JK, Zaleski NM, Naylor HM, Pruijssers AJ, Jackson JC, Bernard GR, Holroyd KJ. Advocating for mutually beneficial access to shelved compounds. Future Med Chem 2018; 10:1395-8. [PMID: 29788759 DOI: 10.4155/fmc-2018-0090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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32
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Affiliation(s)
- Cynthia A Jackevicius
- From the Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA; Institute for Clinical Evaluative Sciences, Toronto, Canada; Veterans Affairs Greater Los Angeles Healthcare System, CA; Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Canada); and University Health Network, Toronto, Canada.
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33
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Moutel G. [Pharmaceutical industry: what changes in practices on the ethical level?]. Rev Prat 2017; 67:605-608. [PMID: 30512727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Grégoire Moutel
- Comité de déontovigilance des entreprises du médicament, Paris, France
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Abstract
INTRODUCTION The purpose of this study is to characterize contemporary trends in direct-to-consumer advertising of urological pharmaceutical products on American prime-time television programs. Television is the highest expenditure segment of the consumer drug marketing industry. The extent of advertising in urology and its potential impact on patients are not well understood. METHODS We retrospectively analyzed an indexed database of prime-time news broadcasts on 5 national networks in the United States. The database was queried with the names of 77 urological pharmaceutical products to identify all commercials that aired during a 36-month period between 2010 and 2013. Noncommercial segments were excluded. Descriptive and linear regression analysis was performed. RESULTS We analyzed 4,574 broadcasts, representing 3,067.5 hours of prime-time television. A total of 2,068 commercials for 8 products and 4 urological indications were aired, including sildenafil and tadalafil for erectile dysfunction; 2 testosterone products for hypogonadism; fesoterodine, oxybutynin and solifenacin for overactive bladder; and sipuleucel-T for metastatic castration resistant prostate cancer. Commercials for male oriented indications accounted for 90% of the sample. At least 1 urological advertisement was contained in 1,744 broadcasts (38%). The introduction of television marketing for newly approved testosterone supplementation products in 2012 corresponded to strongly linear growth in overall urological advertising, reaching peak levels in 2013. CONCLUSIONS Urological pharmaceutical products have been consistently advertised on television. Commercials have extensively targeted male oriented indications. Viewers of national news programs were exposed to urological advertising during about 40% of broadcasts with steadily increasing exposure since 2012. Providers should be aware of these trends to contextualize demand and monitor prescribing patterns.
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Affiliation(s)
- Kevin Koo
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Ronald L Yap
- Concord Hospital Center for Urologic Care, Concord, New Hampshire
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35
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Paumgartten FJR. Pharmaceutical lobbying in Brazil: a missing topic in the public health research agenda. Rev Saude Publica 2016; 50:70. [PMID: 28099661 PMCID: PMC5152825 DOI: 10.1590/s1518-8787.2016050006508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/15/2015] [Indexed: 11/21/2022] Open
Abstract
In the US, where registration of lobbyists is mandatory, the pharmaceutical industry and private health-care providers spend huge amounts of money seeking to influence health policies and government decisions. In Brazil, where lobbying lacks transparency, there is virtually no data on drug industry expenditure to persuade legislators and government officials of their viewpoints and to influence decision-making according to commercial interests. Since 1990, however, the Associação da Indústria Farmacêutica de Pesquisa (Interfarma - Pharmaceutical Research Industry Association), Brazilian counterpart of the Pharmaceutical Research and Manufacturers of America (PhRMA), main lobbying organization of the US pharmaceutical industry, has played a major role in the advocacy of interests of major drug companies. The main goals of Interfarma lobbying activities are: shortening the average time taken by the Brazilian regulatory agency (ANVISA) to approve marketing authorization for a new drug; making the criteria for incorporation of new drugs into SUS (Brazilian Unified Health System) more flexible and speeding up technology incorporation; changing the Country's ethical clearance system and the ethical requirements for clinical trials to meet the need of the innovative drug industry, and establishing a National Policy for Rare Diseases that allows a prompt incorporation of orphan drugs into SUS. Although lobbying affects community health and well-being, this topic is not in the public health research agenda. The impacts of pharmaceutical lobbying on health policies and health-care costs are of great importance for SUS and deserve to be investigated.
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Affiliation(s)
- Agnes Vitry
- School of Pharmacy and Medical Sciences, University of South Australia
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Saluja S, Woolhandler S, Himmelstein DU, Bor D, McCormick D. Unsafe Drugs Were Prescribed More Than One Hundred Million Times in the United States Before Being Recalled. Int J Health Serv 2016; 46:523-30. [PMID: 27302930 DOI: 10.1177/0020731416654662] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For some drugs, safety concerns are only discovered after they have been on the market, sometimes for several years. The U.S. Food and Drug Administration (FDA) has adopted several policies that could increase the likelihood of approving a potentially unsafe medication. We attempted to quantify the number of exposures in the United States to drugs that were newly approved but later withdrawn from the market. We obtained a list of all drugs approved and subsequently withdrawn from the U.S. market due to safety concerns between 1993 and 2010. Using a representative sample of outpatient physician office visits in the National Ambulatory Medical Care Survey, we estimated the number of visits in the United States at which these unsafe drugs were prescribed. Seventeen drugs were approved and later withdrawn during this 18-year period and were prescribed at 112 million physician office visits in the United States. Nine of these drugs were prescribed more than 1 million times before their market withdrawal. New drugs that are later withdrawn due to being unsafe are frequently prescribed in the United States. To minimize the negative health consequences of prescribing potentially unsafe medications, we should reconsider some of the FDA policies that encourage the rapid approval and dissemination of new drugs.
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Affiliation(s)
- Sonali Saluja
- Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Steffie Woolhandler
- Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts, USA School of Public Health at Hunter College, City University of New York, New York, USA
| | - David U Himmelstein
- Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts, USA School of Public Health at Hunter College, City University of New York, New York, USA
| | - David Bor
- Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Danny McCormick
- Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts, USA
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Affiliation(s)
- Ray Moynihan
- Centre for Research in Evidence-Based Practice, Bond University, Queensland
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Winnette R, Zárate V, Machnicki G, DeMuro C, Gawlicki M, Gnanasakthy A. Patient-Reported Outcomes in Latin America: Implementation in Research and Role in Emerging HTA Systems. Value Health Reg Issues 2015; 8:49-55. [PMID: 29698171 DOI: 10.1016/j.vhri.2015.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 02/27/2015] [Accepted: 03/16/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are increasingly used to demonstrate the value of interventions and support health technology assessment (HTA). OBJECTIVE The objective of this work was to analyze trends regarding PROs in Latin America (LatAm), highlight challenges in the application of PROs in this region, and suggest solutions. METHODS A team of researchers with expertise in PROs conducted a nonsystematic PubMed literature search pertaining to the use of PROs in LatAm. The experts also drew on their experience working with PROs to assess the application of PROs in LatAm. RESULTS The literature search yielded more than 4000 publications, with an increasing publication rate in recent years. PROs are being used in LatAm in various study types: instrument validation, phase III international clinical trials, health service research. A large Inter-American Development Bank study demonstrates the growing importance of PROs in the region. The growth in local value sets for the EuroQol five-dimensional questionnaire in LatAm reflects the regional emergence of HTA systems. Operational challenges relate to ensuring the use of good-quality questionnaires that, at a minimum, have undergone appropriate cultural adaptation and ideally have established psychometric properties. CONCLUSIONS PROs are increasingly important in LatAm. Future efforts should aim to strengthen the operational and research infrastructure around PROs in the region. Innovation should be encouraged, including studying alternative methods of eliciting health utilities for economic evaluation. A wider scope around PRO uses for decision making by HTA bodies is an international trend with potential positive prospects in LatAm.
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Affiliation(s)
| | | | | | - Carla DeMuro
- Novartis Pharmaceuticals Corporation, Buenos Aires, Argentina
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Kleinke JD, McGee N. Breaking the Bank: Three Financing Models for Addressing the Drug Innovation Cost Crisis. Am Health Drug Benefits 2015; 8:118-126. [PMID: 26085900 PMCID: PMC4467013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/06/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND The introduction of innovative specialty pharmaceuticals with high prices has renewed efforts by public and private healthcare payers to constrain their utilization, increase patient cost-sharing, and compel government intervention on pricing. These efforts, although rational for individual payers, have the potential to undermine the public health impact and overall economic value of these innovations for society. The emerging archetypal example is the outcry over the cost of sofosbuvir, a drug proved to cure hepatitis C infection at a cost of $84,000 per person for a course of treatment (or $1000 per tablet). This represents a radical medical breakthrough for public health, with great promise for the long-term costs associated with this disease, but with major short-term cost implications for the budgets of healthcare payers. OBJECTIVES To propose potential financing models to provide a workable and lasting solution that directly addresses the misalignment of incentives between healthcare payers confronted with the high upfront costs of innovative specialty drugs and the rest of the US healthcare system, and to articulate these in the context of the historic struggle over paying for innovation. DISCUSSION We describe 3 innovative financing models to manage expensive specialty drugs that will significantly reduce the direct, immediate cost burden of these drugs to public and private healthcare payers. The 3 financing models include high-cost drug mortgages, high-cost drugs reinsurance, and high-cost drug patient rebates. These models have been proved successful in other areas and should be adopted into healthcare to mitigate the high-cost of specialty drugs. We discuss the distribution of this burden over time and across the healthcare system, and we match the financial burden of medical innovations to the healthcare stakeholders who capture their overall value. All 3 models work within or replicate the current healthcare marketplace mechanisms for distributing immediate high-cost events across multiple at-risk stakeholders, and/or encouraging active participation by patients as consumers. CONCLUSION The adoption of these 3 models for the financing of high-cost drugs would ameliorate decades-long economic conflict in the healthcare system over the value of, and financial responsibility for, drug innovation.
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Affiliation(s)
- J D Kleinke
- Independent medical economist, healthcare information technology expert, and author
| | - Nancy McGee
- Senior Director, Castlight Health. Castlight Health is a pioneer of the Enterprise Healthcare Cloud and a leading provider of cloud-based software for healthcare
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Pires C, Vigário M, Cavaco A. Package leaflets of the most consumed medicines in Portugal: safety and regulatory compliance issues. A descriptive study. SAO PAULO MED J 2015; 133:91-100. [PMID: 25337666 PMCID: PMC10496630 DOI: 10.1590/1516-3180.2013.7860023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 10/25/2013] [Accepted: 05/19/2014] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVES Package leaflets are necessary for safe use of medicines. The aims of the present study were: 1) to assess the compliance between the content of the package leaflets and the specifications of the pharmaceutical regulations; and 2) to identify potential safety issues for patients. DESIGN AND SETTING Qualitative descriptive study, involving all the package leaflets of branded medicines from the three most consumed therapeutic groups in Portugal, analyzed in the Department of Pharmacoepidemiology, School of Pharmacy, University of Lisbon. METHODS A checklist validated through an expert consensus process was used to gather the data. The content of each package leaflet in the sample was classified as compliant or non-compliant with compulsory regulatory issues (i.e. stated dosage and descriptions of adverse reactions) and optional regulatory issues (i.e. adverse reaction frequency, symptoms and procedures in cases of overdose). RESULTS A total of 651 package leaflets were identified. Overall, the package leaflets were found to be compliant with the compulsory regulatory issues. However, the optional regulatory issues were only addressed in around half of the sample of package leaflets, which made it possible to identify some situations of potentially compromised drug safety. CONCLUSION Ideally, the methodologies for package leaflet approval should be reviewed and optimized as a way of ensuring the inclusion of the minimum essential information for safe use of medicines.
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Affiliation(s)
- Carla Pires
- MSc. Doctoral student, Department of Social Pharmacy, School of Pharmacy, Research Institute for Medicines and Pharmaceutical Sciences, University of Lisbon, Lisbon, Portugal.
| | - Marina Vigário
- PhD. Associate Professor, Center of Linguistics of the University of Lisbon, Lisbon, Portugal.
| | - Afonso Cavaco
- PhD. Associate Professor, Department of Social Pharmacy, School of Pharmacy, Research Institute for Medicines and Pharmaceutical Sciences, University of Lisbon, Lisbon, Portugal.
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Ghinea N, Lipworth W, Kerridge I. Evidence, regulation and 'rational' prescribing: the case of gabapentin for neuropathic pain. J Eval Clin Pract 2015; 21:28-33. [PMID: 24986307 DOI: 10.1111/jep.12223] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2014] [Indexed: 12/15/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES In 2004, the pharmaceutical company Warner-Lambert paid US $430 million to resolve criminal and civil legal liability for aggressive off-label marketing of gabapentin. Perhaps surprisingly, however, regulatory and legal concerns regarding the marketing of gabapentin has not significantly impacted upon the attitude of doctors towards using gabapentin for neuropathic pain. In this paper, we attempt to understand the reasons for this discrepancy between clinical practice and regulatory/legal concerns through an analysis of published discussions about gabapentin prescribing. METHODS We performed a qualitative empirical analysis of the published clinical debate surrounding the use of gabapentin for the management of neuropathic pain. RESULTS The ongoing use of gabapentin for neuropathic pain was primarily driven by the perception that it was a safe, non-addictive drug with few drug interactions, by possible similarities between the physiology of chronic pain and other neurological conditions, by the well-established clinical precedent of using antiepileptic drugs in pain management, and by the lack of alternative options available in the market. Emerging evidence of lack of effectiveness and controversies about the integrity of the scientific record appeared to be of relatively little importance to practising clinicians. CONCLUSIONS Those who want to promote 'rational' prescribing need to recognize that prescribing is driven by many factors other than epidemiological data and regulatory indications and that even intensely negative publicity about medicines may not penetrate clinical reasoning. This suggests that a range of measures may be needed to 'incentivize' rational prescribing and to promote research integrity. Regulators must be more sensitive to the contextual issues that are relevant to clinical practice when evaluating drugs for approval and developing guidelines.
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Affiliation(s)
- Narcyz Ghinea
- Australian Institute for Health Innovation, University of New South Wales, Sydney, New South Wales, Australia
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Rose DM, Marshall R, Surber MW. Pharmaceutical industry, academia and patient advocacy organizations: what is the recipe for synergic (win-win-win) collaborations? Respirology 2015; 20:185-91. [PMID: 25580960 DOI: 10.1111/resp.12458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 09/09/2014] [Accepted: 11/10/2014] [Indexed: 12/21/2022]
Abstract
Biological complexity and the need for highly differentiated medicines means that drug discovery and development have become increasingly challenging and expensive. Thus, new paradigms for research and drug development need to be created that bring together a wide array of expertise. One potential solution is collaboration between bio-pharma and academic research centres. Two examples are discussed, one with a large pharma company (GlaxoSmithKline) and the other a small biotech (Genoa Pharmaceuticals). Patient advocacy organization can also have role in assisting in the creation of these partnerships by informing patients of ongoing research and clinical trials, and supporting the development of networks that can provide major benefit for both basic research and drug development. A major 'hurdle' for the creation of these relationships is the issue of intellectual property. Examples are provided of how this issue can be resolved.
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Affiliation(s)
- Kjetil Ask
- Department of Medicine, Firestone Institute for Respiratory Health, McMaster University and St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Abstract
OBJECTIVES To determine the prevalence of conflicts of interest (COIs) among Danish physicians who are authors of clinical drug trial reports and determine the extent of undisclosed COIs in trial publications. DESIGN Cross-sectional study. SETTING The 100 most recent drug trial reports with at least one Danish non-industry employed physician author published in a journal adhering to the International Committee of Medical Journal Editors' (ICMJE) manuscript guidelines. For each article, two observers independently extracted trial characteristics and the authors' COIs. Disclosed COIs were compared to what was registered on the Danish Health and Medicines Authority's public disclosure list. PARTICIPANTS Trial authors who are Danish physicians. MAIN OUTCOME MEASURES Number of disclosed and undisclosed COIs. RESULTS One observer screened 928 articles and two observers assessed 120 articles for eligibility. The 100 included trials were published from February 2011 to May 2013 and included 318 Danish non-industry employed authors. Eighty-six of the 318 authors (27%) reported one or more COIs in the journal article. We found undisclosed COIs for 40 of 318 authors (13%) related to the trial sponsor or manufacturer of trial drugs. Seventy-nine of 318 authors (25%) had undisclosed COIs related to competing companies manufacturing drugs for the same indication and 136 (43%) had undisclosed COIs with any drug manufacturer. CONCLUSIONS Almost half of all authors had undisclosed COIs in clinical trials reported in journals adhering to the International Committee of Medical Journal Editors' manuscript guidelines. Self-declared COIs cannot be trusted, but public registries may assist editors in ensuring that more COIs are being reported.
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Affiliation(s)
- Kristine Rasmussen
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK The Nordic Cochrane Centre, Rigshospitalet Department 7811, 2100 Copenhagen Ø, Denmark
| | - Jeppe Schroll
- The Nordic Cochrane Centre, Rigshospitalet Department 7811, 2100 Copenhagen Ø, Denmark
| | - Peter C Gøtzsche
- The Nordic Cochrane Centre, Rigshospitalet Department 7811, 2100 Copenhagen Ø, Denmark
| | - Andreas Lundh
- The Nordic Cochrane Centre, Rigshospitalet Department 7811, 2100 Copenhagen Ø, Denmark Department of Infectious Diseases, Hvidovre University Hospital, 2650 Hvidovre, Denmark
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Abstract
Phamacoeconomics can aid the policy makers and the healthcare providers in decision making in evaluating the affordability of and access to rational drug use. Efficiency is a key concept of pharmacoeconomics, and various strategies are suggested for buying the greatest amount of benefits for a given resource use. Phamacoeconomic evaluation techniques such as cost minimization analysis, cost effectiveness analysis, cost benefit analysis, and cost utilization analysis, which support identification and quantification of cost of drugs, are conducted in a similar way, but vary in measurement of value of health benefits and outcomes. This article provides a brief overview about pharmacoeconomics, its utility with respect to the Indian pharmaceutical industry, and the expanding insurance system in India. Pharmacoeconomic evidences can be utilized to support decisions on licensing, pricing, reimbursement, and maintenance of formulary procedure of pharmaceuticals. For the insurance companies to give better facility at minimum cost, India must develop the platform for pharmacoeconomics with a validating methodology and appropriate training. The role of clinical pharmacists including PharmD graduates are expected to be more beneficial than the conventional pharmacists, as they will be able to apply the principles of economics in daily basis practice in community and hospital pharmacy.
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Affiliation(s)
- Akram Ahmad
- Department of Pharmacy Practice, Annamalai University, Annamalai Nagar, Tamil Nadu, India
| | - Isha Patel
- Department of Clinical, Social and Administrative Sciences, University of Michigan, Ann Arbor, MI, USA
| | | | - Guru Prasad Mohanta
- Department of Pharmacy Practice, Annamalai University, Annamalai Nagar, Tamil Nadu, India
| | - HaeChung Chung
- Department of Public Health Sciences, The Pennsylvania State University, Pennsylvania, USA
| | - Jongwha Chang
- Department of Public Health Sciences, The Pennsylvania State University, Pennsylvania, USA
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Abstract
The relationship between psychiatry and pharmaceutical companies has come under scrutiny during the past decade. Concerns are growing that financial ties of psychiatrists to the pharmaceutical industry may unduly influence professional judgments involving the primary interests of patients. Such conflicts of interest threaten the public trust in psychiatry. The goal of conflict of interest policies is to protect the integrity of professional judgment and to preserve public trust. The disclosure of individual and institutional financial relationships is a critical but limited first step in the process of identifying and responding to conflicts of interest. Conflict of interest policies and procedures can be strengthened by engaged psychiatrists, researchers, institutions, and professional associations in developing policies and consensus standards. Research on conflicts of interest can provide a stronger evidence base for policy design and implementation. Society has traditionally granted the medical profession considerable autonomy and may be willing to continue do so in the case of conflicts of interest. Nevertheless, concern is growing that stronger measures are needed. To avoid undue regulatory burdens, psychiatrists can play a vital role in designing responsible and reasonable conflict of interest policies that reduce the risks of bias and the loss of trust. Psychiatrists and the institutions that carry out research, education, clinical care, and practice guideline development must recognize public concerns about conflicts of interest and take effective measures soon to maintain public trust with a cultural change in the practice of psychiatry, from reactive treatment-seeking for mental illness to proactive advocacy for patients.
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Abstract
OBJECTIVE The pharmaceutical industry exercises pervasive influence in the mental health field. The internet has become a primary source of mental health information for the public and practitioners. This study therefore compared mental health websites funded and not funded by drug companies. METHOD A systematic literature review of studies examining the role of drug companies in the funding of mental health websites was conducted, followed by a meta-analysis of studies comparing drug company-funded (DCF) sites with sites not funded by the industry. RESULTS Mental health websites, in general, overemphasize biogenetic causal explanations and medication. Many mental health websites (42%) are either drug company owned (6%) or receive funding from drug companies (36%). A meta-analysis found that DCF sites are significantly more biased toward biogenetic causes (P < 0.01) and toward medication (P < 0.0001) than sites that are financially independent of the industry. CONCLUSION Practitioners are encouraged to inform patients about the bias inherent in industry-sponsored websites and to recommend, instead, more balanced websites that present a range of evidence-based information about causes and treatments.
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Affiliation(s)
- J Read
- School of Psychology, University of Auckland, Auckland, New Zealand
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