I am a recent Emory graduate who is preparing for consulting interviews with topics related to the Healthcare industry. As a learner and a young person interested in learning about the future of healthcare in general, I fould your article extremely insightful.

I do have one question that I would like to better understand: You comment that, “Traditional sales and marketing will have less influence on product availability at the prescription drug plan level and even less influence on physician prescribing practices.” What actions, then, can drug producers take to ensure their products get into the prescribed available streams of medications by doctors (becoming competitive for the future), given that non-performers will be phased out and traditional marketing by drug companies may be less relevant in the treatment selection process.

Many thanks!

I really like what you’re doing here. The pharmaceutical industry has turned into a callous profit-driven machine that is insensitive to the human element unless such sensitivity has political value to make them appear “almost human.”

Off-label promotion needs to be stopped because there’s not enough research involved in determination of metabolic pathways involved in alternative therapeutic indications especially when such indications are potentially being treated by other drugs. There’s not enough resources in any company to research the effect of their drug on other disease states, and whether use of such a drug might exacerbate symptoms. There’s most certainly not enough resources to study drug interactions from people being treated for multiple conditions.

A very “innocent” example is Lyrica. Pfizer made Lyrica for the treatment of fibromyalgia, however many psychiatrists have been using it as an anxiolytic to avoid the use of benodiazepines. Interestingly, Lyrica is MORE addictive than benzodiazepines, and the withdrawal. Hence, psychiatrists have created “addicts” by using a drug for purposes other than it’s evaluated therapeutic indication.

There’s another are of the pharmaceutical industry that needs to be regulated, and that’s the common practice of “rip-off clone” drugs. Enclosed is an article (1500 words) that details my point.

http://lennoxtutoring.com/2012/06/21/pharmaceutical-industry-hidden-secrets/

If you need to delete the link, I understand. I looked for an email address for you, however could not find it.

Please keep up the good work on this excellent blog. I would enjoy a chat with you some day.

Kindest Regards,
Joseph R. Lennox, Ph.D.

Keep in mind that many of these products are generic drugs and generic drug companies run on very thin profit margins. Maintaining the facility, process, and quality system requirements to manufacture prescription drugs to cGMP compliant standards is expensive, even for generic drugs and especially for sterile injectable products. Fixing manufacturing or quality problems, even for easy-to-manufacture products, is not a simple or inexpensive process. Diagnosing the problem, determining a fix, and then putting in place a solution followed by validation (practice runs to get it right and prove it works consistently, run after run) all take expertise, money, and time. This can be further compromised by older facilities and outdated equipment or machinery. I’m sure many of the products on the shortage list also probably have complex processes (not easily or inexpensive to fix) for making either the active pharmaceutical ingredient and/or the final finished product.

Whether the government should help pay for these fixes to maintain a supply of critical medicines is more a political, philosophical issue. I personally see this as a market issue. If the market feels they are critical medicines and patients need them, the market and patients should be willing to pay a price that better represents their value. mike@pharmareform.com