Friday, August 01, 2008

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.


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