tag:blogger.com,1999:blog-8550428.post1235907617933711550..comments2024-03-28T13:38:36.788-04:00Comments on Pharma Marketing Blog: Without Free Gifts from Pharma to Docs, Would Research be Useless?Vladhttp://www.blogger.com/profile/04114063498108633047noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-8550428.post-92049726362899657442011-10-12T11:54:20.690-04:002011-10-12T11:54:20.690-04:00Again, I am not saying that old drugs are better t...Again, I am not saying that old drugs are better than new ones. I only question your best evidence that new drugs are better than old ones. Not only that, but how much better are they when everything is considered, including side effects, increased copays, etc. that lead to non-compliance? If you don't take the drug -- because you can't afford it -- it is definitely NOT better. Also, some drugs may be "better" for certain patients than for others -- an argument the drug industry often makes to justify "me too" drugs -- new drugs that are virtually identical to competing drugs (not necessarily older drugs).<br /><br />Based on our conversation, I would say that "better" is difficult to define and quantify. This may be the real reason why pharma gives gifts to doctors who, all else being equal, would prescribe competitor's drugs. In other words, gifts to physicians may not help physicians in general get the latest drug information, but will help switch physicians from one new (expensive) brand drug to another new (expensive) brand drug. Old vs new is a moot point in that scenario.PharmaGuyhttps://www.blogger.com/profile/10211557578124130640noreply@blogger.comtag:blogger.com,1999:blog-8550428.post-39195815620940403202011-10-12T11:27:42.479-04:002011-10-12T11:27:42.479-04:00Lichtenberg uses several measures, all related to ...Lichtenberg uses several measures, all related to patient outcomes. (for example, survival probability, perceived health status, activity limitations.) I agree -- more data would be better, but I am not aware of any. However, I am not aware of ANY data saying old drugs are better, and would be amazed if there were any. Just because the FDA does not require evidence does not mean that Pharma companies do not consider it. It is hard to sell worse products. No one requires that new computers be better than old ones. If you are depending on drugs getting worse over time you are betting on a weak horse.Paul Rubinhttps://www.blogger.com/profile/01431186958242777126noreply@blogger.comtag:blogger.com,1999:blog-8550428.post-23594346197049695352011-10-12T07:26:06.553-04:002011-10-12T07:26:06.553-04:00You still have not defined what you mean by "...You still have not defined what you mean by "better." That could be anything. For example, a pharma company is seeking new approval for an already approved drug because it has added one additional score to the pill so it can be divided three ways instead of just two ways. Or a new approval can be based on a once-per-day dosage rather than 2 times per day. Etc. The real test of "better" is if the new drug is proved to improve health outcomes in the real world (not just clinical trials). That's not something the FDA looks at, although it may make assumptions based on clinical trial evidence.<br /><br />So you need to better back up your statement that "on average new drugs are better." I question your "best evidence" when you cite 3 papers by the same author - Lichtenberg. That's cherry-picking the data to prove your point. When you say this is the "best evidence," should I just take your word for it? If you had cited multiple studies by several different, independent authors, then your claim would be more credible in my eyes.PharmaGuyhttps://www.blogger.com/profile/10211557578124130640noreply@blogger.comtag:blogger.com,1999:blog-8550428.post-81906093864683776502011-10-11T23:56:49.614-04:002011-10-11T23:56:49.614-04:00Last point: I do not claim that every new drug is ...Last point: I do not claim that every new drug is better, only that on average new drugs are better. It would be quite surprising otherwise. A drug company is not going to spend the huge amount needed to get a drug approved if it does not think the drug is in some way (e.g., reduced side effects) better than existing drugs. A company needs something to promote to get physicians to change prescribing behavior. Mistakes may be made, but on average we would expect new drugs to be better, and this is what the evidence shows.Paul Rubinhttps://www.blogger.com/profile/01431186958242777126noreply@blogger.comtag:blogger.com,1999:blog-8550428.post-12441563007605186432011-10-11T19:22:00.307-04:002011-10-11T19:22:00.307-04:00I have not claimed that FDA approves harmful drugs...I have not claimed that FDA approves harmful drugs, so I am not obliged to cite evidence for that. I merely criticize your claim that every new drug FDA approves is better than older versions of drugs that treat the same condition. FDA does not require that the drugs it approves are better than competing, older drugs. All that is necessary for drug approval is that the new drug do no harm and is better than placebo (ie, nothing).PharmaGuyhttps://www.blogger.com/profile/10211557578124130640noreply@blogger.comtag:blogger.com,1999:blog-8550428.post-31621672434952742462011-10-11T18:03:03.264-04:002011-10-11T18:03:03.264-04:00A few points in response to the comments on my pie...A few points in response to the comments on my piece in Annals of Emergency Medicine. (My piece is called an op-ed but it was actually an invited editorial because my research was cited in an article announcing the new ACEP policies.)<br />1. The “best evidence” I cite is Columbia Professor Frank Lichtenberg’s work in the benefits of new drugs. This may be criticized (although I have not seen any critiques in the literature) but it is based on analysis of patient outcomes. The two articles I cite critical of pharmaceutical promotion explicitly do not cite any patient related outcomes. I have not seen any systematic research showing that old drugs are better than new drugs. Also, the research with which I am familiar shows that the FDA is overly restrictive. I have not seen any rebuttal evidence indicating that the FDA is too lax. While some harmful drugs may be approved, the issue is the net benefit for patients, and the evidence I am familiar with shows that net patients are harmed by delays of useful drugs which more than outweigh any harm from harmful drugs that are approved. This evidence may exist, but PharmaGuy does not cite it. <br />2. I agree that many forms of communication are useful. One of them is probably gifts. If we stop or restrict gifts, then other methods will substitute, but in the judgment of pharma’s marketing professionals these other methods will be somewhat less effective. The issue is not “either-or” issue, and I am not claiming that gifts are “required.” It is “more or less.” Stopping preferred methods does not mean that no information is conveyed; it just means that less information is conveyed or more must be spent on providing information. <br /><br />Paul H. Rubin, Samuel Candler Dobbs Professor of Economics, Emory UniversityPaul Rubinhttps://www.blogger.com/profile/01431186958242777126noreply@blogger.com