Looking for a Change

Pharmablogger is about to be on the street. Yep, I need a job (you can tell how personal this is because I'm back to using the first person singular). It's been about a year since I've posted here, and I have no idea if anyone will pick up on this entry. Perhaps I've been ousted from your respective Google reader lists from lack of activity, maybe I just frustrated you. But if you like what I've written, and feel that my kind of knowledge about the pharma industry may be valuable to your firm, then contact me, and we'll discuss any possibility. I'm not posting a resume online, because despite any redaction of personal information, my anonymity would be still be blown.

In all seriousness, PB is concerned about impending unemployment, and I would greatly appreciate any leads, any offers, etc. Thank you my friends.

The Good, The Bad

The Good

Some interesting news this week about Alzheimers research. First was the news published in Neurology about cutting the risk of dementia with statins. Some physicians believe that the primary benefit of statins derives from their anti-inflammatory properties, rather than, or in addition to, lowering plaque build-up, and this mechanism would go a long way toward explaining the dementia benefit (or so we're told. PB is not a healthcare professional).

Anyway, we're reminded of the benefits that are derived from both widespread use AND disuse of common medications, that are not always recognized until years after their introduction. The mass adoption of classes of medications in a short time period, such as statins have experienced, will inevitably have some kind of public health impact that is not understood or predicted by clinical studies. The negative example is the rate of breast cancer decline following the steep abandonment of Premarin. We may all have lucked out with the statin news, but there are going to be as many negative findings as positive ones, and if pharma is eager to put a new pill in the hands of as many patients as possible in as short a time as possible, they better be prepared to do the public health research necessary to tease out the data to expose the next Vioxx problem.

The other dementia news was the anti-Alzheimers compound that we heard about, helping to detangle the brain. We enjoyed WIRED magazine's take on this. Our first exposure to the story named the drug as Rember, which set off an alarm. Drugs in the pipeline usually don't get a proprietary name until closer to launch, during Phase III trials, so we thought this was some alternative therapy story. But no, there appears to be actual research going on. The compound is about a century old, though. "In the Pipeline" talks about it in depth. And those clever Quakers are going to make it easier for all of us to know when we've got the disease. PB still remembers asking a physician colleague years ago how the diagnosis is confirmed. By cutting open someone's head and examining it after death, was the response.

The bad?

How 'bout them medication error blues?

Lots and lots of them, up 3196% over some time period. More than every other form of accidental death, except for car accidents, COMBINED. Same death rate as homicides. The FDA has replaced riskmaps with REMS but PB's experience with reading these things is that they are generally siloed approaches to medication errors, or they deal only with the possible interaction with some other drug or class. That's all they are supposed to be, dealing with a single compound.

The FDA has published advice to hospitals and the public on how to minimize problems but we'd like to see that backed up by industry marketing muscle. Since the industry recently cut off possible sales and marketing reform legislation with the new PhRMA sales code, how about a similar effort to build a comprehensive technological approach to thwarting medication errors before Chuck Grassley convenes hearings on that issue as well? Don't just worry just about your own meds, worry about how how many people are dying as a whole.

Film fun

The truth is...at the supermarket?
OK, are there any other X-Filers out there who get a little freaked out by this?

Father knows best
A few years ago, Pharmablogger's sister gave us a copy of "Daddy Day Care," and our daughter, bless her heart, made it disappear faster than a dead hooker from Ben Affleck's trailer (hat tip: Kevin Smith).

Last night PB was watching a preview for Juno, when we began to think about our favorite "Dad" movies; films with Dad characters who are actually intelligent, caring, compassionate. So we decided to start a list here, and ask all of our reader to contribute their suggestions. No particular order to these.

1. Juno

Juno's dad says a few biting things to her when she announces her pregnancy, but he's a great supporter and friend to her, who simply didn't see this coming. Favorite line: "Hey there, big puffy version of Junebug!"

2. Fairy Tale

This is a bit of a cheat, because the Dad moment is very brief, coming at the very end, and that's all PB is going to say about it. Because if you have a daughter, you need to see this movie. PB cries at the end every time.

3. Bend It Like Beckham

Dad is played by Anupam Kher, who shows his true colors of affection to his daughter about halfway into the film, sneaking in to watch her play metric football, then finally intervening in the end to allow her to play in the finals, accepting her traveling to America for college, and so on. He's trying to balance holding on to family the traditions of his culture with his daughter's need to grow.

4 & 5. Bride and Prejudice & Pride & Prejudice

The same story, two different interpretations, two great dads. Both of these contain variations of PB's favorite Dad line in literature: Your mother will never speak to you if you don't marry him, and I will never speak to you if you do. What a great show of respect for a daughter, to tell her that she deserves someone who is at least her equal, even if that decision may impoverish the rest of the family. Anupam Kher again in the first film, and Donald Sutherland in the second.

6. Contact

Jodie Foster's Dad is played by David Morse, who learns that his daughter is gifted in math and science, and does a great job inspiring her to excel beyond all of her peers, and think outside the orthodoxy of her field. His influence is so strong that it lasts well after his death when she is a young teenager.

7. Say Anything

Perhaps a controversial choice, since Ione Skye's Dad turns out to be a felon. But John Mahoney's relationship with his teenage daughter still remains something of a model for me. Sure, he puts her on a pedestal, but he's done a great job (another single Dad) encouraging her achievement, and giving her great values, despite his own personal failings. And there's that famous scene where she confesses that she "jumped on" John Cusack, and then expresses relief at her comfort at being able to tell her Dad something like that. Dad holds back his barely veiled concern, because he raised her to be honest, she was, and he knows he has to respect that, or undermine everything he ever told her in the past.

More when PB thinks of some, or you suggest something....

Baseball liner notes

Pharmablogger has noticed a trend toward feminization in sports, and a corresponding complementary trend in the opposite direction. We loved watching our daughter play softball this Spring, we note how baseball teams have worked hard to make ballgames more "family friendly," and we look forward to watching Ryan Howard leading cheers from the bench someday:

"We don't play with Barbie dolls, we just play with bats and balls.
We don't wear no miniskirts, we just wear pants and t-shirts."

We approve, since we would like to see our daughter win an athletic scholarship some day, and be capable of stuffing a field hockey stick up the rectum of any over aggressive suitor should the need arise.

And while PB once purchased a T-shirt at a breast cancer fundraiser that reads "Save Second Base," we must confess that the first time we saw those pink Phillies caps, we thought it must be Carlotta Tendant bobblehead night.

Anyway, we pause here to note some interesting (and dare we speculate, revealing?) quotes in the Inky last Friday. Mike Arbuckle, the Phils general manager, was discussing their latest trade for pitcher Joe Blanton, when he made this point about Blanton's appearance: "We feel his make-up is going to allow him to fit very well in a pennant race. He was attractive for a lot of reasons." I guess this move by the Phillies is just cosmetic.

Immunity?

Since the Supreme Court granted immunity to Medical Device manufacturers in February, there has been heightened discussion about the court taking the next logical step, granting immunity to FDA approved medications, which may occur in the next Court session.

Pharmablogger will devote additional coverage and discussion to this issue in the coming months. For an interesting contrast of media coverage, see July 18th edition of the Philadelphia Inquirer. In the same paper, there was a slightly paranoid sounding article about a meeting in Philly between Pharma execs, attended by a "high ranking official" from the FDA, who was the featured speaker on the topic of immunity. The points about faulty FDA review were spot-on, but PB wanted to specifically call out one sentence: "These corporations will cry that complete immunity pre-emption is necessary because the cost of litigation is suppressing their research and development. That is a lie. " Amen. One of the best-selling pharmaceuticals in the country is an anti-schizophrenia medicine, which has already had one large line extension with bipolar disorder, and the company is seeking approval for an even larger extension with a claim for general anxiety disorder, and major depression. The patient population for this drug could explode even more, with GPs prescribing it. Yet this drug is also a huge litigation magnet for this company already. No matter - full (development) steam ahead.

The second Inky article is about Merck's approval of a settlement sum for Vioxx litigants - $4.5 billion. Now, PB has no journalism experience, and the first article seemed timely based on the meeting that the author discussed. But is it possible that the Inky held the editorial for a short while, knowing that a Merck decision on the settlement funds was imminent? Just wondering.

Overtreated

If I haven't linked to this author, I should have. Shannon Brownlee wrote a good book, and she reiterates some of her arguments in this Washington Post article.

She gets a lot of milage from debunking osteopenia in this article, but as I read her criticism, something struck me as being inconsistant. True, most women with osteopenia will not break a hip, and true, most people with actinic keratoses will not have skin cancer. But my perspective has always been from the side effect world. The statistics that we use to determine a "signal" is similar to the statistics used to predict whether someone will come down with a serious ailment if they have a "pre-disease." So why is one predictive model more valid than another? Well, if you're taking a medication, there's an assumption that its actually doing something positive for you, to make the benefit/risk ration worthwhile. She's right about one thing - there is definitely a growing movement to treat conditions before they even are manifest by using surrogate markers such as low cholesterol or bone density. But don't throw out that surrogate marker philosophy completely. Isn't blood pressure a surrogate marker? Does anybody feel bad just because they have it, or don't they have to wait for the kidney damage first?

From NPR's "Talk of the Nation" - Saline issues?

Wax on, wax off

OK, if Peter Rost can devote unseemly amounts of column inches to Elliot Spitzer, than I'm going to feel free to wax poetical on the heels of our current financial crisis. The following is an excerpt from a poem I wrote a long time ago, called Who Wants to Play? from the perspective of an investment banker:

Our wages come not from the things we create,
but the miniscule squeezings of this or that rate.
I'll earn more than my father by producing much less.
He worked as a craftsman; I'll learn about stress.

The Fed is our lackey; it works toward our ends.
The families we shred, we demand that they mend.
You won't see it coming, then you'll blame the wrong fools.
You can't change a thing when you play by our rules.
We'll crush you beneath our invisible hand
'Cause you cannot resist what you don't understand.

Cheerful, huh? I was in an uncharitable mood at the time. Unlike today! I also wrote an Ode to the Federal Reserve back then. No, really. If you say pretty please, I may even publish it here.