By Gary Pepper, M.D.
A survey by metabolism.com reveals that a vast majority of the public believe doctors in the US are overly influenced in their decisions by the pharmaceutical industry. 500 visitors to the website participated in the survey. 419 (84%) answered yes to the question, “Do you feel that US doctors’ decisions are overly influenced by pharmaceutical industry money?” 56 (11%) were not sure, and only 20 (4%) voted no to this question. Continue reading
by Gary Pepper, M.D.
Chances are, if you have diabetes you have heard about a new class of drugs to treat high blood sugar (glucose). The first of these new medications to gain FDA approval in the U.S., in 2013, is Invokana manufactured and promoted by Janssen Pharmaceuticals and Johnson & Johnson. In the last year and a half the number of these drugs known as SGLT2 inhibitors, has multiplied faster than tribbles to include Farxiga, Xigduo, Jardiance and Invokamet. Prescriptions for these medications are also showing explosive growth, increasing 300% since January 2014. A recent forecast by Express Scripts calls for this one class of drugs to be responsible for about a 20% increase in the yearly cost of prescriptions per all members per year for the next 3 years . The explanation behind the eager adoption and dissemination of this brand new class of medications may eventually serve as a tragic lesson for diabetic patients and for the medical community in general.
In a blog at metabolism.com several months ago, website visitors were asked to join an email campaign addressed to Dr. Mack Harrell, President of the American Association of Clinical Endocrinologists (AACE). The purpose was to ask help reversing the existing practice recommendation # 22.4 published by the AACE in 2012, calling for a ban on the use of Armour Thyroid in the treatment of hypothyroidism. With over 800 individuals participating, the campaign appears to have achieved some success as the latest AACE treatment guidelines released last month no longer stipulate that desiccated thyroid is unfit for treatment of hypothyroidism. Instead the statement is issued, “ We recommend that levothyroxine be considered as routine care for patients with primary hypothyroidism, in preference to use of thyroid extracts. “, and…. “ Furthermore, there are potential safety concerns related to the use of thyroid extracts, such as the presence of supraphysiologic (unnaturally elevated, ed.) serum T3 levels and paucity of long-term safety outcome data.” Continue reading
Here is a clear example of how the new Diabetes Treatment Guidelines and big Pharma have failed to protect the needs of diabetics who are disadvantaged by economic circumstances and disease. This is the story of one of my patients, an elderly, blind and impoverished woman with blindness due to diabetes. She managed to maintain some degree of independence and did not complain about what a lousy hand life had dealt her. One of the ways she remained independent was by using a device known as an insulin pen. The pen is an all-in-one device equipped with a needle , contains an insulin reservoir and is adjusted to a specific insulin dose by a twist of its dial. With this device she was able to inject her insulin dose daily by herself with sufficient accuracy to control her diabetes. The older method of using a separate syringe and insulin vial required too much dexterity and vision for her to use safely and would have require someone to help her on a regular basis. The type of insulin she uses, NPH, dissolves slowly so her risk of low blood sugar (hypoglycemia) was less than if she used the newer insulins which contain rapid acting insulin. What’s more, NPH insulin is still relatively inexpensive, costing about one half the price of the newer insulins.
I became aware of her problem at her visit with me last week. I learned the NPH insulin pen was being discontinued and there is nothing on the market to replace it. The only insulin pens now available contain insulin with rapid action or are at least twice as expensive as her present pen. What could have caused this sudden shift in the medical supply chain? I recently reviewed the American Association of Clinical Endocrinologists (AACE) new Diabetic Treatment Guidelines (see http://www.metabolism.com/2010/01/18/diabetes-treatment-guidelines-flawed/ ) which dismisses NPH insulin as out moded and recommends the newer (more expensive) insulins be used in its place. The company’s decision to stop making NPH insulin pens coincides almost simultaneously with this new AACE policy statement. In my mind the close timing of the corporate and the professional actions implies cross communications between them. Could the AACE decision to downgrade the use of NPH in some way support corporate economics? I wouldn’t be suprised at all.
Diabetes is the most common cause of blindness in the U.S. . My guess is that there are more blind, and poor diabetics who could make good use of the inexpensive NPH insulin pen. In the case of my patient, we are scrambling to put together a support plan for her so she can maintain her independence, her pocket book and still control her diabetes to a reasonable degree. I hope others in her position can find a similar support network.
Gary Pepper, M.D. Editor-in-Chief, Metabolism.com