Thursday, July 31, 2008

The elephant in the pill bottle

A US Senator is hot and bothered about outsourcing by big pharma, says a piece at Outsourcing-Pharma, and the Congressional Record may shortly feature some interesting info:

Sen Brown has asked for specific information on the mechanisms Merck uses to track the chain of custody for reach ingredient used in its products, procedures to check that each facility in the supply chain adheres to its operating procedures and standards, and whether the US Food and Drug Administration (FDA) “periodically inspect every facility” that makes ingredients for the company.

He also asks for a detailed breakdown on the percentage of production that is outsourced to US providers, a ranking of the top 10 countries the company outsources to, and the estimated average and median wages paid at companies producing active pharmaceutical ingredient s(APIs) for Merck in each country.

He's done the same thing to Pfizer, apparently scandalized by something he found in the 2Q results, specifically a big hike in profits “due in part to cost-cutting measures,” Outsourcing-Pharma notes. Maybe he can't be blamed. According to the website, an FDA official made a serious accusation.

In April at a meeting of the Senate Health, Education, Labor and Pensions (HELP) Committee, says Brown, an FDA official “acknowledged that American drug companies outsource operations due to cost factors and the existence of weaker drug safety standards abroad.”

Or maybe Brown just didn't understand what he was being told at the time. He certainly doesn't seem to understand the drug industry. He seems to think that Pfizer's 17% outsourcing should be called "heavy reliance". Has he looked at the generics industry? Obviously no, because he probably would have had a stroke over 100% outsourcing.

Who needs food?

Here's a story from NPR purporting to compare Britain's National Healthcare System with healthcare in the US. It actually compares only two cases, one in the US and one in the UK. That would be okay if they were used to illustrate statistical data, but there is no such data provided. The reporter, Joanne Silberner, instead tries to create the appearance of statistics by offering a "scorecard":

So the scorecard comes to this.

Linda Oatley of Buckland, England, had several months' delay in getting coverage for a new treatment. She also has to pay a small fee for weekly physical therapy. Overall, she's happy with the National Health Service.

"In the end, if you ask the right questions, go to the right places, you can get the care you need from the get-go," she says.

And the scorecard for Jeff Rubin? A year and a half of cutting drug dosages, a repossessed house and bankruptcy.

A few years ago, he wouldn't have supported a British-style system, with its slower drug approvals and limited ability to pick your own doctors.

Now, he feels differently. He says his healthy friends might not agree, but the free care from the start that Linda Oatley got and the ability to focus on his illness and not his finances sound pretty good.

Overall, it's a long piece full of meaningless color that could easily have made space for real information, but NPR is more interested in propagandizing.

Ironically I encountered this piece in the UK's Daily Mail within a day or two of the NPR report. The juxtaposition is pretty devastating. Here are the first few paragraphs, which demolish the "argument" of the NPR piece.

At least 30,000 patients were left starving on NHS wards last year, despite ministers’ pledges to make proper nutrition in hospitals a priority.

Last year, Health Minister Ivan Lewis admitted that some patients were given a single scoop of mash as a meal.

Others were ‘tortured’ with trays of food placed just beyond their reach while nurses said they were too busy to help them eat.

And now, official figures show that between 2005 and 2007, there was an 88 per cent rise in reported cases of poor nutrition leading to a serious deterioration in a patient’s health.

Last year, NHS whistleblowers reported 29,138 such errors to the National Patient Safety Agency – up from 15,473 in 2005.

They refer to elderly patients who are not properly fed and those given the wrong types of food, causing their health to worsen.

Let's do a little editing to make the NPR story more accurate:

A few years ago, [Jeff Rubin] wouldn't have supported a British-style system, with its slower drug approvals, limited ability to pick your own doctors and starvation.
But that wouldn't suit Silberner's agenda, would it.

I love this comment beneath the Daily Mail story:

Most of you are missing the point. You are blaming the inept nurses etc.

The government caused inept nurses and the current lack of money, decent food and lack of proper care. A government gets what it pays for. What it wants, it gets.

If, on the other hand, you consider that current hospital climate results in the death of many elderly pensioners, "useless eaters", then it all begins to make sense.

Doesn't it.