The 10 Most Promising New Drugs

BusinessWeek has selected ten of the most promising drugs to be launched over the next ten years based on Standard & Poor’s ratings. They are Amgen’s Denosumab (Osteoporosis), AstraZeneca’s Brilinta (Arterial Thrombosis), AstraZeneca/Bristol-Myers Squibb’s Onglyza (Diabetes), Bristol-Myers Squibb’s Belatacept (Organ Transplants), Lilly’s Effient (Platelet Inhibitor), King’s Embeda/Remoxy (Pain), Merck’s Cordaptive (Atherosclerosis), Novartis’ Afinitor (Oncology), Novo Nordisk’s Liraglutide (Diabetes, Obesity) and Sanofi-Aventis’ Multaq (Atrial Fibrillation).

Effectiveness of Pharma Sales and Marketing

This BNET article outlines the latest to-20 ranking drug companies by sales and marketing productivity. It shows that productivity is increasing, despite recent lay-offs in sales forces. But, according to many, there is a long way to go.

BNET produced the numbers by dividing a company’s revenues by its spending on SG&A, producing a revenue yield per $1 of SG&A. The majority of SG&A costs are sales force and advertising expenses. The yield is a rough guide to how well a drug company martials its marketing resources each quarter.

This news comes as the debate about the need for sales reps continues. Many have suggested that the knowledge economy and IT will dramatically reduce the human interface of sales. However others, such as futurist Alvin Toffler, argue that one cannot do without the human interface. Technology may reduce it, but the human touch cannot be replaced. Already in Australia, electronic detailing is fast growing in popularity.

But IMS Health says pharma sales need an even bigger overhaul.

The pharma-market analysis firm says the industry should re-deploy about $15 billion in promotional spending because–to put it bluntly–those dollars aren’t yielding enough sales. Instead of viewing doctors’ offices as ground zero for most marketing efforts, drugmakers should broaden their focus to include drug-benefit plans. 

This analysis is supported by some interesting stats in this  Business Week article ‘The Doctor won’t see you now‘:

Big Pharma companies are learning that storming doctors’ offices with multiple overlapping salespeople is woefully inefficient. Fewer than 25% of visits to physicians result in actual face time, says investment bank Leerink Swann & Co. in a Jan. 3 report. That’s a lot of wasted effort for folks who typically cost their employers $200,000 per year. Other companies that could benefit from sales-force cuts include GlaxoSmithKline PLC (GSK ) and Sanofi-Aventis (SNY ), say Leerink analysts. Lehman Brothers Inc. (LEH ) adds Schering-Plough Corp. (SGP ) to that list and predicts that a 20% reduction in sales expenses across the industry would lift large-cap pharma earnings by 3%. Spokespeople for those companies say they have no current plans for cuts.

Pharmaceutical companies that have already shrunk their sales forces are finding innovative ways to do more with less. Bristol-Myers Squibb Co. (BMY ), which has cut 1,300 salespeople since 2004, tracks physicians’ prescribing patterns and adjusts its promotional activity accordingly. A full 18 months before its cholesterol-lowering drug Pravachol lost patent protection last April, the company halved the sales calls dedicated to the drug and instructed reps only to call on doctors who were already prescribing it. “We figured those who hadn’t prescribed it yet weren’t going to start now,” says Tony Hooper, Bristol’s president of U.S. pharmaceuticals. Despite the changes, prescription rates didn’t falter. Between 2000 and 2006, overall productivity per rep jumped more than 40%, Bristol says.

Some companies, including Bristol and Merck, are supplementing often brief physician visits with “e-detailing.” They might, for example, point doctors to interactive Web sites that teach them about new drugs and that can be updated instantly with fresh clinical-trial data to support their sales pitches.

For some interesting analysis on total marketing spends by pharma, see this article.

National Registration and Accreditation Scheme

The new system will for the first time create a single national registration and accreditation system for ten health professions: chiropractors; dentists (including dental hygienists, dental prosthetists and dental therapists); medical practitioners; nurses and midwives; optometrists; osteopaths; pharmacists; physiotherapists; podiatrists; and psychologists. The new arrangement will help health professionals move around the country more easily, reduce red tape, provide greater safeguards for the public and promote a more flexible, responsive and sustainable health workforce. For example, the new scheme will maintain a public national register for each health profession that will ensure that a professional who has been banned from practising in one place is unable to practise elsewhere in Australia.

For the latest details see Health Workforce Australia.

The global Pharma vs Government Battle

Lines are being drawn across the world and increasing pharma battles are displayed in our media. In Australia, much of the possible reform centers around the PBS regulations. While in the US, the debate is being carried far wider to include issues such as comparative effectiveness research and reforming the patent system. What will be the outcome? Is targeting pharma for cost reductions a good idea?

In this WSJ op-ed, Eli-Lilly boss John Lechleiter argues the benefits of pharma innovation. He cites the independant research saying pharmaceuticals have added 40% to our life expectancy in the last 20 years. He reminds us of the 800 new anti-cancer drugs currently in development – not to mention the countless other therapeutic areas. He sums up by saying that government involvement is more likely to create hurdles to better healthcare than to make it cost effective.

This argument has not been bought by everyone. It seems the US Democrats are preparing to counter the idea that treatment ‘choice’ will be limited. 

These discussions are important, for no person wants to stifle innovation. The recent increase in pharmaceutical company mergers may be seen as an indicator that pharma companies will engage in less innovation as product pipelines converge. These mergers are also a sign that not all companies are doing so well. And to me, this is where the real debate should lie – generating value for money in a profit making market.

In 2006-07, Australia spent 14% of it’s health budget on pharmaceuticals. This amounts to about 1% of our GDP. We are below average OECD spending on health and medicines. While spending on health and medicines is growing, so is demand for better treatments. The real question is: are we getting value for money?

Many would argue no. In the 2006 PBS reforms, the government implicitly stated that it believed pharmaceutical companies were making too much profit (read this press conference for some interesting comments by the then health minister Tony Abbot). In this recent interview with Bill Clinton, a famously failed health reformer, he compares pharma to America’s Wal-mart saying that for most of the 90’s and 00’s, pharma probably had an 18% profit margin, while Wal-mart has 5-6%.

It may well be that pharma profit margins are high. But how do we measure too high? Do we believe that if it was a truly free market, then profit margins would not be so high – rather, they would be in the 5-6% range seen in other industries? Perhaps. I think it is difficult to determine what profit margins should be when we are unable even to put a good number on the benefit pharmaceuticals give to our population. After all, won’t we pay more for things we value more? The other side of this profit margin discussion is that the pharmaceuticals market will never be a ‘free’ one while the current level of government regulation is in place. While dictating that only the cheapest generic be available to treat a certain condition across the entire country may save on short-term costs, it will also limit company interest in competing in that sector, thus reducing competition and further innovation.

Clinton was quick to say we shouldn’t bash the drug makers. They are doing us a good service, and we agreed to fund their work all along. But, he argues, we’ve got to limit the rise in costs. He suggests they target profit margins, and improve the link between the patent and research process (a century old system). There is also a big battle developing over plans for cost-effectiveness research in the USA.

Whatever happens, I believe it is essential that government, media and industry all educate themselves well on the complexity of the health industry and the various options we face. Many of the reform suggestions we hear today seem quite limited in scope – perhaps for political reasons. In the final analysis, we have to ask ourselves what we actually want to achieve from all these reforms. If we focus exclusively on clawing back money because we believe profits are too high, we could be committing a fundamental error of economic judgement – the consequences of which will not be obvious for some time.

The Long Term Benefits of Self-Control

In this great New Yorker Article, read how self-control tests in children were predictive of everything from future body weight and illicit drug-use to high-school performance and career progression. It notes that part of self-control is the way in which you view the world – a ‘strategic allocation of attention’. It also gives evidence that self-control is more important than IQ. Fascinating reading:

In the late nineteen-sixties, Carolyn Weisz, a four-year-old with long brown hair, was invited into a “game room” at the Bing Nursery School, on the campus of Stanford University. The room was little more than a large closet, containing a desk and a chair. Carolyn was asked to sit down in the chair and pick a treat from a tray of marshmallows, cookies, and pretzel sticks. Carolyn chose the marshmallow. Although she’s now forty-four, Carolyn still has a weakness for those air-puffed balls of corn syrup and gelatine. “I know I shouldn’t like them,” she says. “But they’re just so delicious!” A researcher then made Carolyn an offer: she could either eat one marshmallow right away or, if she was willing to wait while he stepped out for a few minutes, she could have two marshmallows when he returned……read on

Computer virus infects millions of Medical devices

From FiercehealthIT:

Well, here’s a piece of malware that’s pulling a particularly vicious trick–infecting medical devices at hospitals around the world. The Conficker worm has infiltrated many critical medical devices, including MRI machines. To date, no patients seem to have been harmed, but no one’s sure what’s next.

In March, researchers monitoring Conficker discovered that it had colonized medical devices, when they noticed that an imaging machine put a call out over the Net, something a standard imaging device would never do. As it turned out, Conficker was researching out for instructions that cause it to rewrite itself, making the infection worse.

Once researchers discovered the anomaly with the imaging machine, they looked further, and found more than 300 similar devices at hospitals around the world that had been infected. What’s more, thousands of other machines, including personal computers and medical devices within hospitals, were apparently networking with the central Conficker machine. At the peak of the infection, a working group estimates, there were more than 10 million devices infected worldwide.

The worm apparently slithered into the machines because they were using an unpatched version of Windows for embedded devices. Ordinarily, the fix would be simple–just install the darned patch. But given FDA rules, the manufacturer had to give 90 days notice before it could make the update. (Nice, huh?)

Electronic Health Records Speeding to Australia

I’ve been lamenting our slow uptake of EHR’s in australia. Now it seems we are going to have a glut of money to support their uptake.

NSW Health has committed $100 million over the next two years to replace existing paper-based health records in public hospitals with a state-wide electronic system aimed at improving patient care. Minister for Health, John Della Bosca, said the $100 million project will be rolled out to 188 hospitals across the state by the end of 2010. This move comes off the back of the Garling inquiry that recommended the implementation of the eMR into hospitals as a way of improving the sharing of information and communication among medical teams.

A second national inquiry, by the National Health and Hospitals Reform Commission (NHHRC), has released a supplementary paper to its Interim Report. It outlines support for person-controlled electronic health records for every Australian. NHHRC Chair, Dr Christine Bennett, said that the supplementary paper spells out the Commission’s position that an electronic health record is arguably the single most important enabler of truly person-centred care. “The timely and accurate communication of pertinent, up-to-date health details of an individual can enhance the quality, safety and continuity of health care,” Dr Bennett said.

The fundamental shift from doctor to patient centered healthcare is now recognised as key to progress.

The next step is to get software developers to create EHR’s that helps doctors, not hinders them.

A Public Drug Library

From Fiercebioresearcher:

The Johns Hopkins University School of Medicine has one of the largest public drug libraries in the world. And the stockpile of more than 3,000 drugs has proven a fertile field for researchers exploring new uses for old compounds.

Exploring the stacks has revealed that itraconazole–used to treat toenail fungus–may be effective against tumors as well as macular degeneration. And the leprosy drug clofazimine may also be effective against MS and psoriasis. “It takes 15 years and costs close to a billion dollars to develop a new drug,” pharmacology professor Jun O. Liu tells the New York Times. “Why not start with compounds that already have proven safety and efficacy?”

Liu and colleagues have been building the library for seven years and say it will be done in another two. And they are providing researchers with samples of a complete set for $5,000.

Academics often exaggerate research – is this a surprise?

In Australia today, we hear a lot about healthcare companies, particularly those that develop pharmaceuticals. Little of what we hear is good news. While the ‘breakthroughs’ are attributed to researchers and hospitals, the companies that fund and support the work get all the attention when something goes wrong – or when people behave less than ethically.

Having worked in both the academic and commercial R+D sectors, my experience has been that academics are more likely to skew results. I believe this is the case for a whole variety of reasons, including a lack of good oversight, funding pressures, and publishing success being too closely linked to career progression.

Now there is some evidence to support my gut feeling.

A study in the Annals of Internal Medicine looks at press releases that academic medical centers send out about their research. They concluded that of 200 releases studied, 29 percent exaggerated their findings.

I’ve not read the study in detail, so won’t comment any further. It is reported in the WSJ Health blog.

Easy glucose monitoring for Diabetics

Canadian biomedical engineers have designed an electronic skin patch for quick and painless blood glucose testing for diabetics.

We all know that the current method where blood is drawn from fingertips can be painful, inconvenient and time-consuming.

The researchers, who have patented their device called the Electronic Mosquito, said the patch is approximately the size of a deck of cards. It uses four micro-needles that “bite” sequentially at programmed intervals. The needles are electronically controlled to penetrate the skin deep enough to draw blood from a capillary, but not deep enough to hit a nerve. That means patients would experience little or no pain.