This document discusses factors that contribute to irrational drug use and increased healthcare costs. It identifies 10 reasons for rising healthcare expenses, with numbers 3 through 10 adding no value. These include action without evidence, regulations and compliance costs, inefficiency, perverse incentives, defensive medicine, errors, profits taken from the system, and fraud. The document also discusses issues with drug promotion and marketing, medical journals' dependence on pharmaceutical advertising, and the manipulation of scientific studies. Overall, it examines the influence of industry on prescribing practices and the lack of evidence-based pharmacotherapy.
A slide series to learn and appreciate the importance and the potential of Personalized/Individualized Genomic Medicine. It briefly goes through the idea of biotechnology and the advancements we have made in biology and technology. A series of applications for genomic medicine is then explored, not failing to mention the challenges we have to overcome as well, for the next medical revolution.
A case for personalized medicine is presented.
A slide series to learn and appreciate the importance and the potential of Personalized/Individualized Genomic Medicine. It briefly goes through the idea of biotechnology and the advancements we have made in biology and technology. A series of applications for genomic medicine is then explored, not failing to mention the challenges we have to overcome as well, for the next medical revolution.
A case for personalized medicine is presented.
AlphaImpactRx Barclays Oncology Webinar 1 Dec 2015Lesley Bailey
AlphaImpactRx and Barclays Capital conducted a webinar on the emerging dynamics of today’s US oncology market on Tuesday, December 1st from 12-1 pm EST.
Mark Purcell, head of Barclays global pharmaceutical equity research team and Stacy Mecham, SVP, Oncology Franchise at AlphaImpactRx presented the latest data in immuno-oncology, including late-breaking news on PD-L1 testing, as well as developing trends in breast cancer and CLL treatment to get you ready for the upcoming ASH and San Antonio Breast Cancer conferences.
Competition across the immuno-oncology battlefield is heating up behind the recent launches of Opdivo and Keytruda, and it promises to get more crowded in the near future. We’ll provide unique insight generated from the AlphaImpactRx point-of-care data to help you understand who’s gaining traction, and where it’s being gained, in both NSCLC and melanoma. We’ll provide a first look into the prevalence and influence of PD-LI testing in its early days, as well as a view of the latest treatment strategies emerging in the competitive breast cancer and CLL markets.
A slide series to learn and appreciate the importance and the potential of Personalized/Individualized Genomic Medicine. It briefly goes through the idea of biotechnology and the advancements we have made in biology and technology. A series of applications for genomic medicine is then explored, not failing to mention the challenges we have to overcome as well, for the next medical revolution.
A case for personalized medicine is presented.
A slide series to learn and appreciate the importance and the potential of Personalized/Individualized Genomic Medicine. It briefly goes through the idea of biotechnology and the advancements we have made in biology and technology. A series of applications for genomic medicine is then explored, not failing to mention the challenges we have to overcome as well, for the next medical revolution.
A case for personalized medicine is presented.
AlphaImpactRx Barclays Oncology Webinar 1 Dec 2015Lesley Bailey
AlphaImpactRx and Barclays Capital conducted a webinar on the emerging dynamics of today’s US oncology market on Tuesday, December 1st from 12-1 pm EST.
Mark Purcell, head of Barclays global pharmaceutical equity research team and Stacy Mecham, SVP, Oncology Franchise at AlphaImpactRx presented the latest data in immuno-oncology, including late-breaking news on PD-L1 testing, as well as developing trends in breast cancer and CLL treatment to get you ready for the upcoming ASH and San Antonio Breast Cancer conferences.
Competition across the immuno-oncology battlefield is heating up behind the recent launches of Opdivo and Keytruda, and it promises to get more crowded in the near future. We’ll provide unique insight generated from the AlphaImpactRx point-of-care data to help you understand who’s gaining traction, and where it’s being gained, in both NSCLC and melanoma. We’ll provide a first look into the prevalence and influence of PD-LI testing in its early days, as well as a view of the latest treatment strategies emerging in the competitive breast cancer and CLL markets.
Ομιλία - Παρουσίαση: “Βιοδείκτες: Η Κλινική τους Αξία και η Σχέση τους με τον ΕΟΠΥΥ”
Νικόλαος Τσούλος, MSc, MBA, Βιοχημικός, Διευθύνων Σύμβουλος GeneKor Medical SA
Your fast-pass to the news, insights, and storylines you need to know.
Watch the full webinar here http://ow.ly/4mOGmk
Hosted by Master of Ceremonies Ian Lloyd, senior director of Pharmaprojects and data integration, this webinar spotlights the blockbuster trends and rising stars of global R&D 2016 as seen in this year’s Annual Review.
During this presentation, Ian Lloyd & Scrip Managing Editor, Alex Shimmings cover:
>> Year-on-year growth
>> Clinical phases trends
>> Top companies and the shape of the industry
>> Mergers and acquisitions
>> Trending therapies, diseases, drug types and delivery routes
>> Mechanisms and drug targets
This webinar is the essential pharma R&D trend and forecast overview you need to be positioned for success in 2016.
Watch the full webinar here http://ow.ly/4mOGmk
Analyzing ASCO 2016: Developments, takeaways, and implications from the confe...Pharma Intelligence
In conjunction with a Key Opinion Leader, Dr. Peter Lee MD Chair, Department of Immuno-Oncology at City of Hope Comprehensive Cancer Center, CA, several Informa analysts discuss the major developments of the conference and key take-aways via a Webinar.
Watch our recording of Biomedtracker's Robert Jeng, Ph,D., Citeline's Allison Bruce, Scrip's Mary Jo Laffler, and Datamonitor Healthcare's Zachary McLellan as they download and debrief following the always-exciting ASCO weekend.
View and listen to the full webinar here https://www.youtube.com/watch?v=7yMsCb3R5X8
First immunotherapy for early stage triple-negative breast cancerDoriaFang
On July 27, Merck (MSD) announced that the FDA approved its blockbuster PD-1 antibody therapy Keytruda in combination with chemotherapy, as a neoadjuvant therapy before surgery, then continued as single agent as an adjuvant therapy after surgery, to treat high-risk early-stage triple-negative breast cancer (TNBC) patients.
Anti cancer peptide drug conjugates (pd cs) an overviewDoriaFang
Currently, ADC drug research has experienced a pile-up of targets, overlapping indication layouts and similar forms. There is an urgent need for a number of manufacturers to come up with new ideas to solve the existing problems. Some companies have taken an alternative route and laid out peptide-drug conjugate (PDC), which is relatively less competitive.
Global gene therapy market & pipeline insightKuicK Research
“Global Gene Therapy Market & Pipeline Insight” Market Highlight:
Gene Therapy Market Overview
Significance of Gene Therapy in Cancer Therapeutics
Current Applications of Gene Therapy to Cancer Treatment
Gene Therapy Market Dynamics: Drivers, Challenges & Future Outlook
FDA & AMA Guidelines for Gene Therapy
Gene Therapy Pipeline by Phase, Indications, Country & Company
Gene Therapy Pipeline: 246 Drugs
Marketed Gene Therapy: 2 (Gendicine & Rexin-G)
Cancer Gene Therapy Pipeline: 69 Drugs
Ομιλία - Παρουσίαση: “Βιοδείκτες: Η Κλινική τους Αξία και η Σχέση τους με τον ΕΟΠΥΥ”
Νικόλαος Τσούλος, MSc, MBA, Βιοχημικός, Διευθύνων Σύμβουλος GeneKor Medical SA
Your fast-pass to the news, insights, and storylines you need to know.
Watch the full webinar here http://ow.ly/4mOGmk
Hosted by Master of Ceremonies Ian Lloyd, senior director of Pharmaprojects and data integration, this webinar spotlights the blockbuster trends and rising stars of global R&D 2016 as seen in this year’s Annual Review.
During this presentation, Ian Lloyd & Scrip Managing Editor, Alex Shimmings cover:
>> Year-on-year growth
>> Clinical phases trends
>> Top companies and the shape of the industry
>> Mergers and acquisitions
>> Trending therapies, diseases, drug types and delivery routes
>> Mechanisms and drug targets
This webinar is the essential pharma R&D trend and forecast overview you need to be positioned for success in 2016.
Watch the full webinar here http://ow.ly/4mOGmk
Analyzing ASCO 2016: Developments, takeaways, and implications from the confe...Pharma Intelligence
In conjunction with a Key Opinion Leader, Dr. Peter Lee MD Chair, Department of Immuno-Oncology at City of Hope Comprehensive Cancer Center, CA, several Informa analysts discuss the major developments of the conference and key take-aways via a Webinar.
Watch our recording of Biomedtracker's Robert Jeng, Ph,D., Citeline's Allison Bruce, Scrip's Mary Jo Laffler, and Datamonitor Healthcare's Zachary McLellan as they download and debrief following the always-exciting ASCO weekend.
View and listen to the full webinar here https://www.youtube.com/watch?v=7yMsCb3R5X8
First immunotherapy for early stage triple-negative breast cancerDoriaFang
On July 27, Merck (MSD) announced that the FDA approved its blockbuster PD-1 antibody therapy Keytruda in combination with chemotherapy, as a neoadjuvant therapy before surgery, then continued as single agent as an adjuvant therapy after surgery, to treat high-risk early-stage triple-negative breast cancer (TNBC) patients.
Anti cancer peptide drug conjugates (pd cs) an overviewDoriaFang
Currently, ADC drug research has experienced a pile-up of targets, overlapping indication layouts and similar forms. There is an urgent need for a number of manufacturers to come up with new ideas to solve the existing problems. Some companies have taken an alternative route and laid out peptide-drug conjugate (PDC), which is relatively less competitive.
Global gene therapy market & pipeline insightKuicK Research
“Global Gene Therapy Market & Pipeline Insight” Market Highlight:
Gene Therapy Market Overview
Significance of Gene Therapy in Cancer Therapeutics
Current Applications of Gene Therapy to Cancer Treatment
Gene Therapy Market Dynamics: Drivers, Challenges & Future Outlook
FDA & AMA Guidelines for Gene Therapy
Gene Therapy Pipeline by Phase, Indications, Country & Company
Gene Therapy Pipeline: 246 Drugs
Marketed Gene Therapy: 2 (Gendicine & Rexin-G)
Cancer Gene Therapy Pipeline: 69 Drugs
This was a lecture in the course "Significant Medical Conditions in Seniors" presented at Peer Learning in Chapel Hill, NC, USA in 2016 by Michael C. Joseph, MD, MPH.
Prescription Medicines: International Costs in ContextPhRMA
Our new Prescription Medicines: International Costs in Context explains how medicines benefit patients, health care systems, and the global economy. Advances in treatment are tacking some of the world’s greatest public health challenges. These treatments provide critical savings for health care systems by reducing the need for more costly services. What’s more is the profound impact that biopharmaceutical companies have on the global economy, including the creation of high-skill jobs, R&D investment, and medicines that improve worker productivity.
Virginia Llera - Cómo optimizar la investigación en Enfermedades RarasFundación Ramón Areces
La Doctora Virginia Llera, Virginia A. Llera ofreció una conferencia el 17/09/2014 en la Fundación Ramón Areces. Llera es la Fundadora de la primera organización de Enfermedades Raras y drogas huérfanas en Latino América y Caribe, GEISER, y Presidenta del Foro Internacional, ICORD (International Conference on Rare Diseases & Orphan Drugs). Su conferencia, titulada 'Optimizando los procesos de investigación en enfermedades raras y medicamentos huérfanos', tuvo lugar dentro del ciclo sobre patologías poco frecuentes organizado por Fundación Ramón Areces en colaboración con Vall d'Hebron Institute of Research, Barcelona.
Graham was invited to the weekly seminar series by the Royal Brompton Hospital to deliver a presentation on health economics pertinent to Respiratory medicine. They care for a large number of patients with complex lung diseases at the institution and juggle the varied issues of resource (human, structural or financial). As one of many examples, high cost drugs for treating relatively unusual conditions comes up for debate all too frequently. The audience included consultant physicians, senior and junior trainees, nurses and other allied health professionals.
Date: 7 March 2019
Location: The Royal Brompton, London, UK
Australia Lung Cancer Drugs Market Analysis Sample ReportInsights10
Lung cancer is the fifth most common type of cancer affecting the Australian population, therefore the Australian lung cancer drugs market is projected to grow during the forecast period. The market is segmented by type, treatment, end user, route of administration, and distribution channel. To get a detailed report, contact us at - info@insights10.com
Clinical trials established in 2005 the efficacy of Ranibizumab (Lucentis, Genentech) for the treatment of neovascular age-related macular degeneration (wetAMD), the leading cause of legal blindness in the United States.This disease is affecting people over the age of 65 with a prevalence of 1.6 million and 200000 new cases per year in the USA .While awaiting approval for ranibizumab from the Food and Drug Administration, ophthalmologists began treating neovascular AMD with off-label use of bevacizumab (Avastin, Genentech), since the drug had a target specificity similar to that of ranibizumab and was available at low cost for about 50$ per monthly injection Vs 1950$ for Lucentis monthly injection.
Ranibizumab received the FDA approuval in 2006 to treat specifically the wetAMD,there was a huge debate about the cost effectiveness and the reimbursement of Lucentis in comparaison with Avastin for treating the eye disease.
This paper explores the dilemma from different angles.First,it make the emphasize on the need of realizing a head to head comparative study between the two drugs and the means to finance and to launch this study since many roadblocks have been identified.
Then, it explores and analyzes the Genentech reaction facing this problem and their strategy to emphasize on the higher risk of death with Avastin, as compared to Lucentis in one hand and in the other hand their strategy to extend the ophthalmologic indications for Lucentis, including diabetic macula edema (DME).
Finally it explores what value should be put on safety in health technology assessments HTAs by developing that we can’t just consider the dollar value of medicine alone but we need to consider the cost of adverse events caused by the treatment and the cost of living with these adverse events
Similar to ONCOPHARMACOECONOMY-I, Prof. Dr. F. Cankat Tulunay (20)
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. DOCTORS
PHARMACISTS
DRUG
COMPANIES
MOH
ACADEMICIANS PATIENTS
SOCIAL
SECURIT
AGENCY
F.C. Tulunay, 2009
3. Actual Reasons For Healthcare
Expenses
• Ten reasons why it costs so much. Two of the ten add value: #1 and
#2 improve the quality and length of our lives. Numbers 3 through
10 add no value. THAT is where you can save money without losing
something we want.
1. Treatments available now that did not exist before
2. More people living longer
3. Action without evidence
4. Cost of regulations and compliance
5. Inefficiency
6. Perverse incentives
7. Defensive medicine
8. Adverse outcomes and errors
9. Profits taken out of healthcare system
10. Embezzlement and fraud (outright theft).
4. USA
• USA spends $2 trillion on
healthcare.
• $680billion (34%) "goes to" the
doctors
• $600b (30%) to hospitals
• $340b (17%) to outpatient services
• $300b (15%) to for medications.
5. Costs of Cancer
NIH estimated the 2008 overall annual costs of cancer were as
follows:
• Total cost: $228.1 billion
• Direct medical costs (total of all health expenditures): $ 93.2
billion
• Indirect morbidity costs (cost of lost productivity due to
illness): $ 18.8 billion
• Indirect mortality costs (cost of lost productivity due to
premature death): $116.1 billion
• About 24% of Americans aged 18 to 64, 13% of children had no health insurance
for at least part of the past year.
• This year, about 562,340 Americans are expected to die of cancer -- that's
more than 1,500 people a day. Cancer is the second most common cause of death
in the United States, exceeded only by heart disease. Cancer accounts for nearly
1 out of every 4 deaths in the United States
American Cancer Society. Cancer Facts & Figures 2009. Atlanta, GA. 2009.
8. LIFE AFTER CANCER – costs of cancer care
National Cancer Institute ● Cancer Trends Progress Report – 2005 Update ● http://progressreport.cancer.gov
9. Efficacy, safety, and cost of new anticancer drugs
Silvio Garattini, director and Vittorio Bertele', head, regulatory policy laboratory
Mario Negri Institute for Pharmacological Research, 20157 Milan, Italy
Correspondence to: S Garattini sgarattini@marionegri.it
BMJ. 2002 August 3; 325(7358): 269–271
• New anticancer drugs reaching the European market
in 1995-2000 offered few or no substantial
advantages over existing preparations, yet cost
several times—in one case 350 times—as much
• The greatest changes have been 4500 fewer deaths
from childhood tumours and 4000 fewer from
lymphomas (Hodgkin's disease) each year over the past
four decades.
• Among solid tumours, advances have been made in
treating breast cancer, in which tamoxifen increases 10
year survival by 6% for node negative and 11% for node
positive tumours,3 and chemotherapy increases survival
by 7% and 11%, respectively.4
• For most other common solid tumours such as those of
lung, oesophagus, stomach, or pancreas, only limited
survival gains have been achieved.2,5,6
10. • U.K. rejected NEXAVAR for liver
cancer
• Nexavar was estimated to cost
65,900 pounds ($102,000) for every
“quality adjusted year of life,”
Not:
• NEXAVAR: 200 mg 112 tab: 8.270 TL
ödenmez (SGK)
11. Miracle Cancer Drug Extends Life With
$48,720 Cost
March 05, 2010
It was called SU11248 (SUTENT), and
Pfizer Inc. had just acquired the company
developing it. Tumors were shrinking in two
thirds of the digestive tract cancer
patients in the clinical trial Demetri had
been running since February 2002. One
dying man’s malignancy had stopped growing
so suddenly after five doses that it was a
“miracle,” the oncologist said.
13. • Sunitinib is recommended, as a
treatment option for people with
unresectable and/or metastatic
malignant gastrointestinal stromal
tumours if:
• imatinib treatment has failed because
of resistance or intolerance, and
• the drug cost of sunitinib (excluding
any related costs) for the first
treatment cycle will be met by the
manufacturer.
• The use of sunitinib should be
supervised by cancer specialists with
experience in treating people with
unresectable and/or metastatic
malignant gastrointestinal stromal
tumours after failure of imatinib
treatment because of resistance or
intolerance.
14. SUTENT
• Costs
• Sunitinib is marketed by Pfizer as Sutent, and is subject to patents and
market exclusivity as a new chemical entity until February 15, 2021
• Sutent is one of the most expensive drugs widely marketed. Doctors
and editorials have criticized the high cost, for a drug that doesn't
cure cancer but only prolongs life.
• In the U.S., insurance companies have refused to pay for all or part of
the costs of Sutent.
• In the UK NICE refused (late 2008) to recommend suntinib for late
stage renal cancer (kidney cancer) due to the high cost per QALY,
estimated by NICE at £72,000/QALY and by Pfizer at £29,000/
QALY.[21] It was also refused by NICE in 2008 for the treatment of
kidney cancer.[22] This refusal/guidance was updated Feb 2009 after
negotiations on price for the first course of treatment
• TÜRKİYEDE BİR SİKLÜS İLAÇ GİDERİ: 17.346 TL
15. 'We'll sell our house for this
drug (sutent)'
• The treatments are used for advanced kidney cancers
• A row has broken out over the funding of four drugs
for advanced kidney cancer after the drugs advisory
body NICE said they should not be available on the
NHS.
• Andrew Crabb, from Abingdon in Oxfordshire, got the
news on the first anniversary of his diagnosis with the
disease - but says he will do everything he can to carry
on receiving his drug.
BBC news, 7 August 2008
16. • FOLOTYN is a folate analogue metabolic inhibitor indicated for the treatment of patients with
relapsed or refractory peripheral T-cell lymphoma (PTCL). This indication is based on overall response
rate. Clinical benefit such as improvement in progression free survival or overall survival has not been
demonstrated. (FDA Prospektüs)
• The drug was approved by the Food and Drug Administration in late September as a treatment for
peripheral T-cell lymphoma, 30.000 dolar/month
• In the clinical trial, the median duration of use was 70 days, which would cost roughly $70,000 to $80,000.
But some patients used the drug for many months.
• Folotyn has not yet shown an effect on longevity. In the clinical trial that led to approval of the drug, 27
percent of the 109 patients experienced a reduction in tumor size. The reductions lasted a median of 9.4
months.
• But considering all the patients in the trial, only 12 percent had a reduction in tumor size that lasted for
more than 14 weeks. The trial did not compare Folotyn to another drug or a placebo.
• Genzyme’s Clolar for pediatric leukemia costs about $34,000 a week, though the company says that only
two weeks of treatment are typically needed.
• GlaxoSmithKline is charging up to $98,000 for a six-month treatment course of Arzerra, a drug approved in
late October for chronic lymphocytic leukemia
• The colon cancer drug Erbitux, for instance, costs $10,000 a month and the drug Avastin about $8,800
when used to treat lung cancer.
17. GSK: Allen ROSES
• A SENIOR EXECUTIVE WITH
BRITAIN'S BIGGEST DRUGS
COMPANY HAS ADMITTED
THAT MOST PRESCRIPTION
MEDICINES DO NOT WORK
ON MOST PEOPLE WHO
TAKE THEM.
18. Dr. ROSES
• DRUGS FOR ALZHEIMER'S DISEASE
WORK IN FEWER THAN ONE IN THREE
PATIENTS,
• WHEREAS THOSE FOR CANCER ARE
ONLY EFFECTIVE IN A QUARTER OF
PATIENTS.
• DRUGS FOR MIGRAINES, FOR
OSTEOPOROSIS, AND ARTHRITIS WORK
IN ABOUT HALF THE PATIENTS, ,
19. Charles Nemeroff caught with his hands
in the Glaxo till…
• “…From 2000 through 2006, Dr.
Nemeroff received just over
$960,000 from Glaxo….”
20. GSK
COURT EXPOSED GSK/RESEARCHERS FRAUD
The court documents released as a result of one of the lawsuits in
October 2008 indicated that GSK "and/or researchers may have
suppress
MISLEADING PUBLIC
For 10 years, GlaxoSmithKline's marketing of the drug stated that
it was "not habit forming". In 2002, the U.S. Food and Drug
Administration published a new product warning about the drug, and
the International Federation of Pharmaceutical Manufacturers
Associations (IFPMA) declared GSK guilty of misleading the public
about paroxetine on US television. ed or obscured suicide risk data
during clinical trials"
21. Drugs Giants GlaxoSmithKline In
Iraq Probe
• Pharmaceutical companies
GlaxoSmithKline and AstraZeneca have
been linked to an investigation into bribes
allegedly paid to Saddam Hussein's
former regime.
• The oil-for-food programme was supposed to
allow the Iraqi government to sell limited
amounts of oil to buy foreign food and
medicines.
22. Is there an EVİDENECE-BASED
pharmacotherapy?
PHARMACOTHERAPY
26. 7U RATIONAL DRUG USE
7R
l Uygun endikasyon l Right indication
l Uygun ilaç l Right drug
l Uygun yol, doz ve süre l Right route, dosage, duration
l Uygun hasta l Right patient
l Uygun hasta bilgilendirilmesi l Right patient information
l Uygun değerlendirme l Rigtht evaluation
l Uygun fiyat l Right price
Hastaların klinik ihtiyaçlarına “Patients receive medications
göre, ihtiyaç duyduğu dozda, appropriate to their clinical
sürede ve kendisi ve toplum needs, in doses that meet
için en ucuz maliyette ilaç their own individual
bulabilmesidir. requirements, for an adequate
period of time, and at the
(WHO 1985)
lowest cost to them and their
community.” (WHO, 1985).
27. WHO advocates 12 key interventions to
promote more rational use:
1 Establishment of a multidisciplinary national body to coordinate
policies on medicine use.....NO
2. Use of clinical guidelines.....NO
3. Development and use of national essential medicines list...NO
4. Establishment of drug and therapeutics committees in districts and
hospitals...NO
5. Inclusion of problem-based pharmacotherapy training in undergraduate
curricula...NO
6. Continuing in-service medical education as a licensure requirement:
7. Supervision, audit and feedback...NO
8. Use of independent information on medicines...NO
9. Public education about medicines...NO
10. Avoidance of perverse financial incentives...NO
11. Use of appropriate and enforced regulation...NO
12. Sufficient government expenditure to ensure availability of medicines
and staff...NO
28. Factors affecting irrational
drug use
Rule and Regulations
Industry Regulatory agencies
Physician
Patient • Unethical
• Inadequate graduate • Political pressure
practice by • Inadequate
and post all means
• Wrong bgraduateeducation registration system
information • Fraud • Inadequate
• No drug information • Corruption reimbustment
• False informatin source
• No-oto system
• Press, TV • Over loaded patient control • No tratement
duty guidelines
• False beliefs
• Prescription • No rational drug
• Unable explane pressure: Pharmacist policy
problems • No
• Industry
• No relaible pharmacoeconomy
information • Patients • Inadequate • No..No..No..!!!!
source • Promotions education
• Self medication • Corruption
• Unethical drug
business!! • Unethical
• Komşusunun practice
ilacını kullanma • Corruption
• No prescription
• Economical! control Tulunay 2008
29. Outcomes of irrational drug use
Degeneration
of treatment Increased Psycho-social
quality Waste of risk of outcomes
resources
adverse
effect risk
• morbidity
• mortality • Unneeded
• Adverse reactions expectations from
• Decrease drugs
availability • Bacterial resistans
• Feeling of unhealing
• Increased price • Suicite
ECONOMICAL LOSTS
COST OF HUMAN BEING?
SHAME OF 21st CENTURY Tulunay 2008
30. Medical journals and pharmaceutical companies: uneasy bedfellows
Richard Smith, editor
BMJ 2003;326:1202-1205 (31 May)
• Free newspapers for doctors depend completely on
income from pharmaceutical advertising, but many
journals also depend heavily on such advertising
• The advertising is often misleading
• Editorial coverage is much more valuable to drug
companies than advertising, and scientific studies
can be manipulated in many ways to give results
favourable to companies
• Many medical journals have a substantial income
from supplements and reprints paid for by drug
companies
• In one sense, all journals are
bought by the pharmaceutical
HADİ RICHARD...BİZ BİRBİRİMİZE MUHTAÇIZ industry. The industry dominates
health care, and most doctors have
been wined and dined by it.
31. Future European health care: Cost containment, health care
reform and scientific progress in drug research
G.Emilien, Int.J.Health Plan.Manag. 12:81-101, 1997
• A= Terapoetic efficacy Top 25 products Top 50 products
internationally proven
• B= Second choise, open Not
for abuse A B C A B C necessary
• C= Non-effective drugs **
(1993)
Italy 11 7 7 25 15 10 21.2
• In Germany 4.128 billion
dolar worth suspicious drug
(1992) France 16 4 5 26 14 10 20.5
Germany 19 5 1 35 9 6 11.9
UK 24 1 0 46 4 0 NA
** % of total drug use
32. Another
!
GARDASİL.... 806 TL
CERVARIX.... 734 TL
33. 8 October 2009, BMJ 2009;339:b3884
Cost effectiveness analysis of including boys in a human
papillomavirus vaccination programme in the United States
Jane J Kim, assistant professor, Sue J Goldie, professor
1 Harvard School of Public Health, Department of Health Policy and Management, Center for Health Decision
Science, 718 Huntington Avenue, Boston, MA 02115, USA
• Given currently available information,
including boys in an HPV vaccination
programme generally exceeds
conventional thresholds (QALY over
100.000$) of good value for money,
even under favourable conditions of
vaccine protection and health
benefits
34. Hysteria over genital warts?
New York Times,2008
•
In a New York Times article published last year, Dr. Harper spoke about the fear-based
marketing of Gardasil by Merck: "'Merck lobbied every opinion leader, women's group, medical
society, politicians, and went directly to the people -- it created a sense of panic that says you
have to have this vaccine now..."
This behavior by drug companies -- using fear tactics to promote a particular disease in order to
sell the "treatment" -- is called disease mongering. Most of the pharmaceutical profits generated
today are based on precisely this tactic: Spread the fear, then sell the treatment.
Why is disease mongering so important to the profits of the drug companies? They figured out
many years ago that selling drugs only to those people who are sick was a very limited income
opportunity. To rake in the real profits, they needed to devise a way to sell drugs to healthy
people (i.e. people who don't need them). That's what cervical cancer vaccines really are: A
scheme to sell vaccines to people who aren't suffering from any disease at all.
That one of the industry's own researchers is willing to speak out against this is not just highly
unusual; it's also highly courageous. It makes you wonder: Who, exactly, is this Dr. Harper?
Dr. Diane Harper
• Dr. Harper is a graduate of the Massachusetts Institute of Technology. She studied additional courses at Stanford and received her medical degree
from the University of Kansas. She was a key researcher in both Gardasil and Cervarix vaccines, and she's one of the most experienced researchers
in the world on HPV-related diseases. She's done work for both Merck and GlaxoSmithKline.
35. Top researcher who worked on cervical
cancer vaccine warns about its dangers
8.10.2009 www.NaturalNews.com
• One of the key researchers involved in the clinical trials for both Gardasil and Cevarix cervical
cancer vaccines has gone public with warnings about their safety and effectiveness. Dr. Diane
Harper openly admitted the vaccine doesn't even prevent cervical cancer, stating, "[The vaccine]
will not decrease cervical cancer rates at all."
Dr. Harper also warned that the cervical cancer vaccine was being "over-marketed" and that
parents should be warned about the possible risk of severe side effects from the vaccine. She
even concluded that the vaccine itself is more dangerous than the cervical cancer it claims
to prevent!
Dr. Harper's warnings about cervical cancer vaccines are especially relevant considering her
expertise in the cost/benefit analysis of vaccines. Her conclusion is that cervical cancer
vaccines aren't worth the risks, nor are they worth all the effort being put into hyping them to
the public. "This may not be the best use of our resources at this time," she said in a Washington
Post article.
So why do cervical cancer vaccines continue to be pushed by doctors and health authorities
across the US, UK and other first-world nations? Because Big Pharma is the great corporate
puppeteer that's pulling the strings of legislators. With enough money and lobbyists, you can
always overcome scientific thinking with fear-based marketing and under-the-table deal-making.
Science-based medicine has no place in a world where disease is big business.
36. Press Release For immediate release
9th October 2009
ALLIANCE FOR NATURAL HEALTH CALLS FOR AN URGENT
SCIENTIFIC INQUIRY INTO THE HPV VACCINE USED IN THE UK
The Alliance for Natural Health (ANH) today calls for an
independent Inquiry into the safety of HPV vaccine, and appeals to
all Members of Parliament to press for this.
• Reports of serious and even lethal adverse reactions to the
Human Papilloma Virus (HPV) vaccine, Cervarix, manufactured by
GlaxoSmithKline, raises grave concern over the safety of the
vaccine. While its closely related vaccine, Gardasil,
manufactured by Merck, is recognised by the US Centers for
Disease Control (CDC) to trigger severe reactions, namely
hospitalisation, permanent disability, life-threatening illness or
death, equivalent data in the UK appears not to be publicly
available.
37. NEXAVAR?? (1month cost is 8.270 TL=5.500 USD)
Which one is wright!!??
Bayer
• Bayer, Onyx Pill Doesn’t Slow Breast • Wednesday - September 23, 2009 Phase II
Cancer in Study Study in Advanced Breast Cancer:
Sept. 30 (Bloomberg) -- Bayer AG and
Onyx Pharmaceuticals Inc.’s Nexavar cancer
• Nexavar® in Combination with
drug failed to slow the progression of breast Chemotherapy Demonstrates 74
cancer in the second of four studies that Percent Improvement in
combine the medicine with different types of
chemotherapy. Progression-Free Survival
• September 30, 2009 • First presentation of results at joint ECCO-
ESMO congress in Berlin, Germany
Mid-stage breast cancer trial of • Abstract # 3LBA
Bayer, Onyx's Nexavar misses Berlin, September 23, 2009 – Bayer
primary endpoint HealthCare AG and Onyx Pharmaceuticals,
Inc. today announced the full results from
Last Updated:September 30, 2009 00:30 their first collaborative group-sponsored
Preliminary results showed that a Phase II trial randomized, double-blind, placebo controlled
of Bayer and Onyx’s Nexavar (sorafenib) in Phase II trial showing that Nexavar®
combination with paclitaxel in patients with (sorafenib tablets) in combination with the
advanced breast cancer did not meet its oral chemotherapeutic agent, capecitabine,
primary endpoint of progression-free survival, significantly extended progression-free
the companies announced on Wednesday. Dimitris survival in patients with advanced breast
Voliotis, vice president of global clinical cancer by 74 percent. The data were
development oncology at Bayer, said the “data presented at the joint 15th European CanCer
require further analysis and interpretation before Organisation (ECCO) and 34th European
we determine the appropriate path forward." Society for Medical Oncology (ESMO)
• Multidisciplinary Congress in Berlin, Germany.
38. FDA probe of Pfizer's anti-smoking
drug continues
April 6 2009
• The FDA is investigating reports of injury, visual
impairment and other problems connected with
the medication, which is designed to ease
smokers' withdrawal symptoms. The agency
began probing the problems last fall.
• The Federal Aviation Administration last year
banned the use of Chantix by pilots after a spike
in patients reporting blackouts, some of which
led to traffic accidents
39.
40. Innovation worries the decision maker
R&D Activity in Main Therapeutic Areas
R&D Activity in Main Therapeutic Areas
20%
Growth of sales 2004-2009*
18% Innovative approaches Oncology (L1, L2)
set to drive strong CNS (N3A, N5A, N6A)
16% growth in oncology Osteoporosis (M5B, G3H, H4A, H4V)
HIV antivirals (J5D)
14% Oral antidiabetics (A10B)
12%
Cardiovascular (C8, C9, C10A)
Epoetins (B3C)
1% A large number of innovative PPIs (A2B2)
candidate makes the oncology Anti-platelet inhibs (B1C)
8% pipeline the largest in the
industry
6%
4%
Size of bubble:
2% Forecast sales 2009
0%
-50 0 50 100 150 200 250 300 350 400 450 500
# phase II & onwards pipeline products
Source: IMS Management Consulting analysis
41. e.g. New drug vs. current care
(health care payer perspective)
Current
New
Current Net Savings
New New
Current
Cost of drug +TreatmentOther
Average
Costs
= Total Cost
physicians
hospital
surgery
other drugs 41
tests
42. e.g. New drug vs. current care (2)
New
Current
Current
New
New
Current
Cost of drug
+TreatmentOther =
Average
Costs
Total Cost
physicians
hospital
surgery
other drugs 42
tests
43. e.g. New drug vs. current care (3)
New
ts
Cos
Net
Current
New
Current
New
Current
Cost of drug +TreatmentOther =
Average
Costs
Total Cost
physicians
hospital
surgery
other drugs 43
tests
44. How do we value innovation?
• Steve Pearson, President of the Institute for Clinical and
Economic Review at Harvard, identified two options for judging
innovation.
• The first is by setting criteria for success before the innovation
has been introduced, such as measuring whether an intervention
works. Mr Pearson said this would be “difficult to do in a way
which makes sense”, as it is hard to define criteria for an
innovation’s success before the innovation itself has been
created.
• Another method of judging innovation would be to assess its
performance once introduced. This again poses difficulties, as it
depends on an agreed definition of “value”. Suggested
definitions include the speed of penetration of the innovation
into a healthcare system, or the destination of venture capital -
which he said could be cosmetic surgery in the case of the US.
• 9 December 2009 44
47. Evidence to support chronic myeloid
leukaemia drugs "very poor"
• NICE is unable to recommend the use of dasatinib and nilotinib for the treatment of chronic
myeloid leukaemia in patients who cannot tolerate the first-line treatment imatinib, after
finding that the evidence to support their use is “very poor”.
• Neither of the drugs fits the NICE end-of-life criteria, introduced to allow Appraisal
Committees to consider expensive medicines licensed for terminal illnesses, as the available
evidence on life extension is too weak.
• But even if the end-of-life criteria had been met, the exceptionally high costs of dasatinib
and nilotinib, taken together with poor quality evidence on the drugs’ effectiveness, would
not allow NICE to consider the drugs a cost-effective use of NHS resources.
• This latest draft guidance comes after the independent Appraisal Committee met, last
month, to discuss issues around the cost-effectiveness modelling raised during the first
public consultation.
• Professor Peter Littlejohns, clinical and public health director at NICE, said: “The
Committee heard from clinical specialists that in their opinion dasatinib and nilotinib are
clinically effective. However, the evidence available to support this was very poor, with no
studies comparing either drug to other treatments.
• “The cost of the drugs is also extremely high and before committing limited NHS resources
to fund them, we need to be sure they are effective. It would be heartening to hear that the
pharmaceutical company manufacturers are prepared to share some of the very high cost of
the drugs with the NHS.”
• The independent committee will next met on 9 March 2010 to consider any further evidence
before issuing the next draft guidance.
• 9 February 2010
47