Health Business Blog

Clarinex, Nexium, Nexperdal?

J&J is stealing a play from AstraZeneca and Schering-Plough. AZ couldn’t come up with a worthy successor to Prilosec, so when the drug went off patent the company introduced the infamous Nexium, which is the substance the body turns Prilosec into. Basically you get Nexium when you swallow Prilosec, yet Nexium managed to become a multibillion product. Clarinex is just a tiny tweak on Claritin, introduced when Claritin’s patent expired.

Now J&J is faced with the expiration of its blockbuster for schizophrenia, Risperdal. When a patient takes Risperdal the body converts it to paliperidone. So just like AZ, J&J is going to market paliperidone as the next thing. J&J claims paliperidone is better than Risperdal, but that’s doubtful. From the Wall Street Journal:

The research backing J&J’s claims for paliperidone seems a little thin. Clinical tests, involving 1600 patients, pitted it against a sugar pill, not Risperdal or other antipsychotic drugs…

“They can’t claim its better than risperidone [Risperdal’s generic name] because they didn’t do the comparison,” said [Duke psychiatry professor] P. Murali Doraiswamy.

Basically, J&J is proving that paliperidone is better than nothing. That’s not a very high standard.

Meanwhile doctors, health plans, and patients haven’t set a very high standard either. Doctors continue to accept Nexium samples and prescribe the drug, most payers still have it on formulary, and patients continue to insist on the purple pill. Time to wise up!

J&J hasn’t picked a brand name for paliperidone yet. Here are a few suggestions:

• Nexperdal
• Ripofferdal
• Desperal

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Was it the sugar or the caffeine?

From Reuters, via Mickey:

Oslo teens who drank the most sugary soft drinks also had more mental health problems such as hyperactivity and distress, Norwegian researchers reported on Thursday.

Their study of more than 5,000 Norwegian 15- and 16-year-olds showed a clear and direct association between soft drink intake and hyperactivity, and a more complex link with other mental and behavioral disorders.

For hyperactivity, there was a direct linear relationship — the more sodas a teen drank, the most symptoms of hyperactivity he or she had.

The worst problems were seen in boys and girls who drank four or more soft drinks a day. Ten percent of the boys and 2 percent of the girls drank this much.

The researchers said it was possible that other substances in the soft drinks, such as caffeine, were to blame for the symptoms, and they did not check other possible sources of refined sugar in the children’s diets.

The failure to control for caffeine intake makes it unclear whether this study really demonstrates anything non-obvious. There are anecdotal reports of people who are very affected from non-caffeinated refined sugar products, so the sugar / hyperactivity hypothesis remains a reasonable one. However, studies of large populations have had trouble demonstrating an effect, and this study does not seem to move the ball forward or backward on that question. A possible model for a sugar – hyperactivity link could be yet undiscovered diseases that affect behavior and have a sugar triggers as seen with the muscle disease hypokalemic periodic paralysis.

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Pharmacists should step up if doctors won’t

From the Associated Press in the Wall Street Journal:

In recordings of 185 patient visits, doctors failed to mention a new drug’s side effects or how long to take the drug in about two-thirds of the visits. The research suggests that patients and their doctors must work harder, said Patrick O’Connor of HealthPartners Research Foundation in Minneapolis. “Patients need to ask, ‘‘What are the most important medicines in my treatment, the ones that will help me live long enough to see my grandchildren grow up?’”

That’s a nice quote Dr. O’Connor, but do you really expect docs to “work harder” and react positively when patients ask them such trite questions? My suggestion is to bring the pharmacist into the loop, to provide information at the time of dispensing and reinforcement at refill time. It would help if pharmacists had access to the patient’s medical record.

If pharmacists are too busy maybe the Phoenix police department can fill the gap.

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Police and the mentally ill

A Wall Street Journal article (With ‘Reality Visors’ Officers Try New Tack to Face Mentally Ill) was mainly encouraging. Police are learning to deal effectively and compassionately with the mentally ill rather than using aggressive techniques that are inappropriate and sometimes spark violent reactions. But I was a little surprised to read about what officers in Phoenix are up to:

[Police officers] …conducted home visits with… mentally ill residents to make sure they were attending therapy sessions, getting medical care and taking their medication. They urged the homeless mentally ill to move to shelters and voluntarily accept help for their illnesses… They even drive some patients to doctors’ visits.

Somebody in Phoenix should wake up and hire some psychiatric nurses to do home visits. Using police officers for that job is costly and ineffective.

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This is news?

Did anyone else notice how yesterday’’s announcement that health care premiums were rising at 7.7% was treated as such a big story? I got “breaking news” emails from most of the lists I subscribe to, and it was treated as a major item by today’’s newspapers. The angle was that premiums are rising twice as fast as wages, although in the full stories it was usually noted somewhere that the rate of growth is slowing.

This really isn’t news, never mind BIG NEWS. I wonder whether the focus on comparing premium increases with salary increases was what made everyone jump.

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People are not stupid

A new survey reveals the public’s level of awareness of medical errors and steps patients are taking to prevent errors or mitigate the damage caused:

Substantial numbers of Americans report taking certain actions aimed at improving the coordination of care and reducing the likelihood of a medical error. These include: checking the medication given by their pharmacist against the doctor’s prescription (70%); bringing a list of all their medications to a doctor’s appointment (54%); and bringing a friend or relative to a doctor’s appointment to help ask questions (45%).

These are all excellent ideas and I’m heartened that so many people are taking action. The harder –but even more critical– thing to do is to have an assertive, knowledgeable person who is committed to your health maintaining a vigil at your bedside when you are in the hospital. The survey takers didn’t ask, but I’ll bet a lot of people are figuring that out, too.

Read the full Kaiser Family Foundation/AHRQ survey here.

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Worse by the day

I’ve flown every day this week and as the blanket ban on liquids has been “eased” each day has been a little worse. Monday was ok. By then most everyone knew what to do and had adjusted. On Tuesday, the first day some liquids were allowed, most people hadn’t gotten the word and weren’t trying to bring anything on. However TSA people were barking at travelers, telling them if they didn’t take their containers out for separate screening the items would be confiscated. But they didn’t require plastic bags. Today was bad, as the screeners started examining items to see if they were 3 vs. 4 ounces. My journey through the “elite” line took what seemed like forever. What will tomorrow bring?

What does all this have to do with health care? Not much, except all that time in line took away the opportunity to write a legit post before takeoff.

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Health Wonk Review is up at The Century Foundation

The latest edition of the Health Wonk Review –billed as A Biweekly Review of the Best and the Boldest Entries from the Health Care Blogs– is up at The Century Foundation. It’s a little hard to find from the main website, which may explain why I’ve had so few visitors from by way of this edition. Anyway, there’s some good reading so have a look.

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Grand Rounds is up at Tech Medicine

Dr. Enoch Choi of Tech Medicine hosts Grand Rounds, the best of the week’s medical blogging. Hard to believe, but Grand Rounds is entering its third year!

Also a little hard to believe that three other blogs (eHealth, Driving in Traffic, Dr. Petty) submitted posts about new search engine Healia. All three were listed as “pro” while my posting was listed as “con.” I wish I could have been as positive but I couldn’t.

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Vaccines for non-fatal conditions

From CNN (Vaccine aims to wipeout ear, sinus infections)

U.S. researchers said Tuesday that they are starting trials of a new vaccine aimed at wiping out childhood ear and sinus infections and many cases of bronchitis in adults.

Unlike virtually all other vaccines on the market, this one will not be aimed at saving lives, but at preventing nuisance illnesses, the researchers said.

“We are now in an era where we look to vaccines that make life better,” said Dr. Michael Pichichero, a professor of microbiology, immunology, pediatrics, and medicine at the University of Rochester Medical Center, who is leading the trial.

Now that we have developed technologies to fight fatal illnesses it is easier to use similar strategies for things that are troublesome but not life-threatening. Be on the lookout for similar advances in ADHD and PMS.

Thanks to Mickey.

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