Category: Expert Opinion

Categories : Expert Opinion Medical IndustryTags :

Like 60s Cars, Brand Drugs Have no Price Competition

On By ModernMedia

Brand name drugs, like American cars in the 1960s, are subject to broadly rising prices with little evidence of competing on cost.

Before the oil embargo by Arab countries in 1973 allowed competition from more affordable, fuel efficient cars that we take for granted today, the Big Three car manufacturers, Ford, Chrysler and General Motors, would annually announce price increases at about the same time. Any adjustment by one manufacturer, for example, in size, was quickly matched by competitors.New research analysed the prices for five classes of drugs, and found them to be increasing in lock-step from 2015 to 2020. These classes are direct-acting oral anticoagulants (DOACs), P2Y12 inhibitors, glucagon-like peptide-1 (GLP-1) agonists, dipeptidyl dipeptidase-4 (DPP-4) inhibitors, and sodium-glucose transport protein-2 (SGLT-2) inhibitors.

The study had limitations due to not taking into account measures such as rebates, which would affect the price for the patient. However, even if these were taken into consideration, the researchers believe the overall prices would still increase and have to be borne by some patients who would not benefit from certain rebates. “Rebates, list prices, and net prices have been growing for brand-name medications, and rebate growth has been shown to positively correlate with list price growth, thereby impacting costs faced by patients paying a percentage of (or the full) list price,” the researchers noted. “Therefore, the lock-step price increases of brand-name medications, without evidence of price competition, raise concerns and would be expected to adversely affect patient adherence to medications and thus clinical outcomes.”

Unlike the oil crisis which broke open the automobile market to foreign competitors, the solution with “Big Pharma” is less clear. The researchers recommend policies which would limit such lock-step price increases, reduced patent exclusivity periods, and quicker introduction of generic equivalents.

Source: MedPage Today

Journal information: Liu P, et al “Trends in Within-Class Changes in US Average Wholesale Prices for Brand-Name Medications for Common Conditions From 2015 to 2020” JAMA Netw Open 2021; DOI: 10.1001/jamanetworkopen.2020.35064.

Categories : COVID Expert OpinionTags :

UCT Expert Talks COVID and Warns of Third Wave

On By ModernMedia

If South Africa does not pursue a rapid vaccination programme to achieve herd immunity, it may face a third wave as a consequence, warned a leading local expert.

Professor Marc Mendelson of UCT’s Division of Infectious Diseases and HIV Medicine at Groote Schuur Hospital made these statements while speaking during a virtual Summer School lecture on Saturday, titled “COVID-19 Insights and Lessons”.

“Without rapid vaccination of at least two thirds of the population, we [South Africa] are not going to get to population immunity, and without that, we will see another wave,” Mendelson warned.

However, he emphasised that much had been accomplished in the battle against COVID. “It is associated with a scientific endeavour that we have never seen before. We’re definitely better off a year down the line, but there are a huge number of things that we need to answer. As a country we still face deep problems with severe issues around vaccine strategy, and we haven’t even talked about vaccine denial,” he said.

Criticism has been directed at the South African government because of its failure to start a vaccination programme, despite its huge case load and status as Africa’s most wealthy nation. A leaked phone call from a Pfizer executive has only added to this, as it was revealed that for months SA health officials had not been responding to requests for vaccine discussions.

Regarding COVID transmission, he said that the virus resided in the upper respiratory tract as well as the lungs, and that it could be expelled in aerosol droplets. The clinical and epidemiological evidence suggested that larger, heavier droplets carried the virus.

“The household infection rates were high. A very large number of cases, the vast majority [in fact], were within families in close proximity [to one another]. This, epidemiologically, suggests that large droplets play a role in transmission.

“If you want to reduce transmission from large droplets, then you need to increase the distance you are from someone. Also, because droplets drop onto surfaces … you will need to clean surfaces and wash your hands well. This is the science behind the use of masks, handwashing, social distancing and ventilation.”

However, he added that a number of studies had found the virus in remote corners of hospitals at a distance from patients, suggesting that it had been carried there by smaller, aerosolised particles.

“If you want to reduce aerosols, one way of doing that is to improve ventilation. The more the air is changed, the [quicker] it will dilute small droplets,” he said.

Source: University of Cape Town

Categories : COVID Expert OpinionTags :

AI Solutions Are No Magic Bullet Against COVID

On By ModernMedia

A leading researcher in the field of medical image analysis has cautioned against the rush to provide AI solutions to the COVID pandemic, arguing that the need to help out must not compromise scientific principles.

Prof Hamid Tizhoosh, head of KIMIA Lab, Faculty of Engineering at the University of Waterloo wrote a piece on Medical-News.Net where he laid out the problems involved in such “quick fix” solutions.

He explains that AI researchers often make “toy” datasets which they use to experiment with in their own labs. In the middle of the pandemic, it is difficult to collaborate with radiographers who have their hands full dealing with COVID patients’ images.

AI research requires the acquisition and curation of large amounts of high-quality data, and currently there is an absence of this. While there are still few publicly available X-ray images or CT images of COVID patients’ lungs, they are beginning to crop up on the internet. AI researchers and enthusiasts are scraping together these images for their data sets and supplementing them with those of pneumonia patients, which are much more readily available. The results of their AI work are being released in papers that are not peer reviewed, yet some claim to be authoritative solutions.

Tizhoosh draws attention to the validity of this data. In one instance, he saw that the data included a pneumonia case from a paediatric patient. He cautions that, “AI is neither a ventilator nor a vaccine nor a pill; it is extremely unlikely that the exhausted radiologists in Wuhan, Qom or Bergamo download the Python code of our poorly trained network (using insufficient and improper data and described in quickly written papers and blogs) to just obtain a flawed second opinion.”

He concludes that the AI developments must come after appropriate images are made available by hospitals, that ethics approval is received and the data is properly de-identified.