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Healthcare News of Note through 11/11/2012

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November 12, 2012 – Comments (0)

Healthcare News Week of 11/5/12

Thinking about having your genome sequenced?  I know I am (sometime anyway).  One blogger doesn’t think she wants that information quite yet and details why.

Whether to stent or have bypass surgery is often a question to patients requiring one or the other.  A multiyear 1900 patient study of diabetic patients with multi-vessel problems has come down on the side of surgery.

One of the reasons I’m not too keen on investing in big pharma right now is the European debt situation.  It looks like the companies are trying to come up with creative ways to keep countries with large pharma debts supplied.

I continue to believe that the state run insurance exchanges are going to result in a shift in how health insurance is purchased and reimbursed.  The largest state markets are worth watching, as the MA experience is that the smaller regional (limited network) operators were the more competitive.  In California, many are vying for a place on the exchange, but with only a couple offering statewide coverage.  I’ll be watching for news from Florida as well.

Bloomberg reports that the incidence of diabetes in China is growing.  Yet many can not afford the treatments that are widespread in the more developed world.

More commentary on compounding pharmacies and their efforts to act more and more like manufacturers.  Pharmalot provides a well considered editorial piece on the subjectA NEJM Perspective piece looks at this subject as well.  My own opinion continues to be that once you are distributing a drug to multiple sites and not just ‘to order’, you must register as a manufacturer.

For someone of my age, for whom the 20th century doesn’t feel all that far off, I find it more than a little premature to talk about top 10 anything of the 21st.  But … I for those who are really all that interested in what the top selling drugs have been, century to date anyway, GenEngNews has compiled a list.  It should come as a surprise to no one that Lipitor and Plavix top the group.  The question is, if the blockbuster era truly has ended, will these leaders persist for decades to come?  Will only inflation displace them?  Or is the next phase of truly mega-selling therapeutics just around the corner?

Pfizer may be back on the blockbuster track with the approval of the oral RA drug Xeljanz (tofacitinib).   But the sales status relies on the drug fetching > $2,000 per month.  I’m concerned about the pricing of this drug, which seems based more on the pricing of competitive biopharmaceutical Humira, than a reasonable value to patient or reasonable profit factor.  I expect pushback.  I don’t know of a lot of instances where a biopharmaceutical has been replaced effectively with a small molecule drug, but expect this to happen more often in the future, and it may be bad precedent setting to allow the more traditional drug type to command the same pricing.

Pharma lingo.  Who can tell me the difference between efficacy and effectiveness?  No?  It seems efficacy is a measure of effectiveness in controlled settings, such as a clinical trial, and the term effectiveness should be used only for real world results.  Pharmalot expounds on the importance of using the lingo properly.

Clinical trial monitoring and management are not often career paths considered in the traditional academic curricula.  But there is clearly a need.  Parexel is sponsoring a program through one college to provide a certificate program in the field.  A Parexel VP explains.  I think this is a great idea, and more industries should do this kind of academic partnering.

The latest issue of IVD Technology has a nice article on the economic drivers of patient-centric diagnostics (sorry, I find Scribd to be very very annoying, but could not link another way).  The article talks about patient collected samples and engagement in their diagnosis.  Very much worth a read as these trends will indeed drive changes in health practices.

What drives the growth in healthcare spending?  Is it technology?  A recent study has found that the spend on medical technology has been relatively flat over the past 20 years, in contrast with a prior CBO report that found about half the spend increase was due to technology. Qmed summarizes.  I’ve seen solid arguments that health care is ‘the last necessity’, and that spend necessarily rises as societies gain control over the primary necessities of food, clothing, shelter & gainful employment.  If true then costs can not truly be reined in by economically successful societies.

The long march toward electronic health records continues as the 3rd stage of meaningful use criteria are put out for public comment.  The period to obtain the second stage has seen delays, so we’ll have to see how ‘on track’ the next phase can be.

Nature Reviews Drug Discovery looks at the Wet AMD market in its ‘From the Analyst Couch’ series.

Ralph

Helical Investor

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