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Selected news articles which highlight important policy issues.

News: Weekly Archives

News for the week of 04-26-2007

Prostate cancer test's accuracy cited
Los Angeles Times, 4-26-07

Editor's Notes:

The L.A. Times reports on the potential discovery of a new biomarker for prostate cancer that may be significantly more accurate than the current PSA (prostate specific antigen) test, which has a very high rate of false positives. Each false positive test may expose men to a painful and unnecessary prostate biopsy.

A new prostate test that relies on measuring levels of a blood protein called EPCA–2 accurately found cancer 94% of the time, a significant improvement over the current PSA test, according to a study released Wednesday.

Each year, about 1.6 million men undergo biopsies because they test positive on a PSA test—but only about 230,000 of them actually have cancer.

The new test for EPCA–2—or early prostate cancer antigen—not only detected prostate cancer but also determined whether it had spread to other parts of the body, according to the study published in the journal Urology.

"It could allow us to help patients decide if they need a biopsy or if it's tame or has the ability to invade outside the prostate," said Robert H. Getzenberg, director of research at the James Buchanan Brady Urological Institute at Johns Hopkins University in Baltimore and a coauthor of the study.

The test still faces large–scale clinical trials and review by the Food and Drug Administration, but it could be available in early 2008, said Getzenberg, who is a consultant to Seattle–based Onconome Inc., which is developing the test technology.

Prostate cancer is the second leading cause of cancer death in men after lung cancer, according to the American Cancer Society. About 27,000 die from prostate cancer a year, the society said.

As biomarker tests like this one become more accurate, they have the potential to not only to save lives through early diagnosis, but to help lower health care costs by eliminating needless testing and treatment.

[permanent link]

Most doctors get money, gifts from industry; Research questions sellers' influence
USA Today, 4-26-07

Editor's Notes:

USA Today reports on a study this week in the New England Journal of Medicine that finds that most doctors receive "gifts" from industry (pharmaceutical and device manufacturers), including receiving free trinkets, lunch, or consulting fees.

(For an alternative perspective on industry-physician contacts and potential conflicts of interest, see this article from Dr. Thomas Stossel.)

What this all means is very much open for debate, but it is generating plenty of angst in the media that unscrupulous companies are using blandishments to get doctors to prescribe their wares over that of their competitors'.

Virtually all doctors in a national survey of six specialties reported some sort of relationship—from free lunches to payments for consulting and lecturing—with medically related industries such as those for drugs or medical devices, a report says today.

Researchers mailed surveys and a $20 check to a random sample of 3,167 practicing anesthesiologists, cardiologists, family practitioners, general surgeons, internists and pediatricians in late 2003 and early 2004. Slightly more than half responded.

According to the article, however, the vast majority of this contact included free drug samples, which doctors typically give away to patients who may not have prescription drug insurance, and food that is provided over the course of a briefing on new medicines. Payments for travel and consulting are much less frequent occurrences.

There is a legitimate concern that companies may, in effect, be offering doctors kickbacks for prescribing their drugs, but the evidence to date is that routine contacts between pharma reps and doctors are, if anything, beneficial on the whole.

After all, while critics like to tout the effects that even small gifts may have on physicians' prescribing habits, the entire field is highly competitive, with new information reaching doctors from a variety of sources all of the time.

In an ideal world, physicians would receive information on new medicines and medical devices from an unbiased, neutral source. But such a source doesn't exist and probably can't. Alternative information systems are likely to come with their own shortcomings and biases.

Second, the real problem afflicting American health care isn't industry marketing—it's moral hazard. Patients and doctors don't pay for health care out of their own pockets directly, third party insurers do. This means that, all other things being equal, doctors may prescribe a more expensive drug or treatment (or unnecessary testing, for that matter) to a well insured patient that may only have marginal benefits over a cheaper treatment. This is what seems to have happened in the case of Vioxx, where the most heavily insured patients were the most likely to receive the expensive Cox–2 inhibitor.

But the solution to this is not to limit marketing, but to give consumers more information and control over their own routine health care spending and decisions. In Medicare Part D, for instance, where seniors can chose their own prescription drug coverage, many seniors favor low–premium plans that emphasize generics as first line treatments. Seniors that want more access to branded drugs can find, and pay for, plans that maximize that access.

Last but not least, we must realize that doctors are extraordinarily busy, and may have very little time to review the latest literature on new medicines. Marketing perks—free pens, drug samples, and free lunches—are all a way of compensating doctors for their time and still giving them valuable information in the process.

The authors of NEJM study recognized this tradeoff themselves when they paid physicians $20 to fill out their survey.

[permanent link]



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