New drugs for old: disinvestment and NICE
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c572 (Published 26 February 2010) Cite this as: BMJ 2010;340:c572
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The relationship between our profession and Pharma has been a steady
BMJ theme in recent years. Hughes and Ferners table on the strategies used
by Pharma to extend patent protection (evergreening) BMJ 2010;340:c572 is
an eye opener.
The production of me too drugs and evergreening are one side of the
equation by which some drugs with little benefit over existing cheaper
drugs enter the prescribing pool.The other side of the equation is the
subtle way these drugs gain currency . I'm referrring to the fact that
much medical education for prescribers is sponsored by Pharma, the
phenomenon of paid key opinion leaders and the use of sponsorship by
professional colleges to part fund their activities.
To maintain professional integrity surely it is time for doctors and
professional colleges to declare openly the payments made to them by the
Pharmaceutical industry
Competing interests:
None declared
Competing interests: No competing interests
New or old, patient preferences come first
The analysis "New drugs for old:disinvestment and NICE" by Hughes and
Ferner is an interesting read, shedding more light on evergreening
strategies.
It is acceptable that NICE has to base its recommendations on cost
effectiveness but consideration has to be given for patient preferences
and ways to improve adherence.This is of even more importance in mental
health where costs of non-compliance are huge.
I'm surprised to see Seroquel XL is on the disinvestment list stating
there was lack of evidence for improved adherence or performance. First of
all, cost effectiveness does not come into question as a 200mg and 300mg
of Seroquel XL costs the same as equivalent doses of Seroquel.Secondly,
the time to titrate Seroquel to the usual treatment dose in
Scizophrenia(400mg-600mg)is more than three times it takes to titrate
SeroquelXL.Time is of essence in acute psychosis with sooner the
titration,quicker the
remission.[http://www.medicines.org.uk/emc/medicine/21175]
Thirdly,lack of evidence does not equate to no evidence and we dont need
to have a meta analysis evidence for something that is considered as good
practice. After all, NICE bases a lot of its recommendations categorised
as good clinical practice.
Competing interests:
None declared
Competing interests: No competing interests