Contributing Member of the Healthcare Councils

All News Analyses by this Author

Ghana Targets Health Tourism Boom: More Evidence of Globalization

October 31, 2009

Analysis of:Ghana targets health tourism boom | news.bbc.co.uk

Just as high tech products are manufactured in Asian countries for a fraction of the cost, medical procedures will be provided in less developed countries for a fraction of the cost in the not so distant future.It will initially be low tech procedures such as cosmetic operations and minor procedures and will go on to more complex procedures like orthopedic and cardiac surgeries.

The Logical Next Step for Abbott

September 15, 2009

Analysis of:Abbott To Acquire Evalve, Inc., A Leader In Minimally Invasive Cardiac Valve Repair Technology | www.medicalnewstoday.com

With this acquisition Abbott establishes its position as a major player in the field of interventional cardiology and treatment of structural heart disease.The field of structural heart disease therapy is the fastest growing area of interventional cardiology and Abbott is getting in at the ground floor.In addition to Edwards and Medtronic which have aortic valve stents in the pipeline, the Evalve system is the most advanced valve repair system.

Generic Losartan Will Probably Not Make Huge Impact in Malaysia

August 6, 2009

Analysis of:Ranbaxy launches generic Losartan in Malaysia | www.pharmabiz.com

The advent of generic Losartan is going to provide a cheaper version of an effective antihypertensive drug for Malayan doctors and patients. The benefits will not only result from savings compared to brand name Losartan but also from savings compared to other similar compounds like Valsartan, Irbesartan and Telmisartan because some patients will be switched from these medicines to generic Losartan.  

Making the Best of Heath Care Reform Will Require Increased Efficiency

June 29, 2009

Analysis of:New Study Says an Insurance Exchange Could Save U.S. Trillions | www.healthcarefinance.news.com

Health care reform is coming and, in a nutshell, it will mean lower reimbursements for physicians, lower profits for the insurance companies and broader coverage but less high-end benefits (such as plastic surgery) for the insured. The belief is that by offering more competition and higher efficiency we can arrest the rapid increase in health care cost. In reality, the only method shown to decrease health care costs or to slow their increase is decreasing or limiting access to health care.

A Kit For Research Use

June 3, 2009

Analysis of:AnaSpec Introduces Industry's First FRET-Based Thrombin Assay Kit | www.medicalnewstoday.com

The FRET-based thrombin activity assay kit is basically a kit to measure the enzymatic activity of thrombin, arguably the central enzyme of the coagulation cascade, in various samples. The kit is meant for research as there is little clinical information about the significance of thrombin levels and, except in extremely rare circumstances, there is no need to determine the thrombin activity in order to change a patient's clinical management.

Good for PR, but how valid?

May 18, 2009

Analysis of:In patients' hunt for care, doctor database 'a place to start' | www.usatoday.com

To say that you can identify physician thought leaders in the community by their prescription patterns and the committees they are on is an interesting proposition. Obviously, USA Today may think that the fact that pharmaceutical companies are willing to pay lots of money for the information contained in the database constitutes good enough validation. The concern is this: is this a good enough criterion? And who validates the database? What are the control parameters to show that physician A is a thought leader and physician B is not, other than the fact that physician A appears in the database and physician B does not. The database may result in more referrals for the physicians whose names are in the database, but again, do the patients want somebody who influences the prescription patterns or somebody who takes good care of them? Conversely, does the fact that a doctor is not on the list (i.e. that he is not a thought leader) mean that he he/she is not  a good doctor?

Good In Theory, But Not In Practice

April 5, 2009

Analysis of:Novel Stent Fares Worse Than Bare Metal in STEMI Patients | www.tctmd.com

The concept of coating a stent with antibodies to proteins on the surface of endothelial progenitor cells (a somewhat more mature type of stem cells) is attractive in theory. The stem cells would accelerate the growth of endothelium over the stent and participate in healing of the vessel. Unfortunately, the concept did not prove to be viable in practice. This may be because it does not work, or because of the thrombus usually present in arteries of patients with myocardial infarction and the resultant inability of the stent to attract stem cells. Either way, this negative study will make it difficult to enroll patients in other studies with this stent.

Decidedly Fiction

March 9, 2009

Analysis of:Multivitamins: Fact or Fiction | www.usatoday.com

While several studies have shown times and gain that multivitamins are not useful for cancer or heart disease prevention, the TV programs are replete with ads promoting specific formulations for men below or over age X and for women in different phases of their life.  Nobody seems to mind that none of the touted benefits have been proven, and the thinking is that a. there doesn't seem to be a health downside to taking multivitamins b. it's certainly better than taking drugs or smoking cigarettes, so, if the individual pays for the multivitamins himself or herself, there's no problem. So far there has been little data to refute these arguments, so I suspect that multivitamins will be around for a long while.

Only a Matter of Time And Only Time Will Tell

February 19, 2009

Analysis of:F.D.A. Panel Endorses Lilly Blood Thinner | www.nytimes.com

It's very likely that prasugrel will be approved by the FDA (possibly with restrictions for small persons and for elderly persons). However, whether prasugrel will be adopted by the cardiology community is unclear. While studies have shown that it is more effective than clopidogrel the increased effectiveness also translates into more severe bleeding in the patients taking prasugrel. Because the benefits of prasugrel are not so much bigger than clopidogrel's, and the latter has a better safety profile, clopidogrel will remain the marketleader for a while.

Que sera sera

February 9, 2009

Analysis of:ASTELLAS PROPOSES TO ACQUIRE CV THERAPEUTICS | www.astellas.us

It seems that the greatest obstacle that Astellas has to overcome is the attitude of CVT. If they mange to turn the leadership of CVT around, this still looks like a risky deal unless they are looking for a secondary gain related to one of CVT's pipeline products (like Tecadenoson or Adentri [developed with Biogen]) or related to their own (Astellas') products (like Adenoscan) and the competition they can suppress/control. Ranexa has some good data behind it, but it will probably not develop into a blockbuster, because the impetus for mechanical revascularization as a treatment for angina is bigger for physicians and patients prefer to have a stent placed and get done with it. The blockbuster potential is for Ranexa to become the drug of choice in patients with diastolic heart failure (heart failure with preserved ejection fraction).

The Goal Is (And Should Be) 100%

January 23, 2009

Analysis of:Journal of the American College of Cardiology - | content.onlinejacc.org

All devices in patients with biventricular pacemakers are programmed for 100% left ventricular pacing. In the study by B. Koplan and colleagues, patients who were biventricularly paced over 92% of time [75% of all patients] derived a greater benefit than the other [25% of]  patients. The salient points are that most patients are biventricularly paced over 92% of the time. The causes for less biventricular pacing were dislodgement of left ventricular lead, atrial arrhythmia and specific setting of the pacemaker called ventricular rate regulation, which allows the pacing in the presence of rapid atrial arrhythmia. This study provides some insight in the ways that biventricular pacing improves the condition of patients with heart failure, but it is not definitive.

No one will be spared (but some will be affected more than others)

January 5, 2009

Analysis of:Medical devices not immune to recession worries | www.boston.com

It is naive to think that the medical device industry will be spared during this recession. Hospitals are struggling because of the credit crunch and may postpone the acquisition of expensive products such as MRI and surgical robots, but may also put pressure on the device manufacturers by picking the lower cost products or by paying lower prices. The other factor will be the loss of medical insurance that goes with the loss of jobs. This may lead to a decrease in elective procedures and a resultant decrease in demand for artificial hips, knees, heart valves and even intravascular stents and pacemakers/defibrillators.

If That's What Patients Want, It Will Come

December 8, 2008

Analysis of:The doctor will see all of you now | www.boston.com

This method can certainly ease patients access to doctors and shorten long waiting times. As long as the insurers will pay full amount for each patient and doctors won't start abusing the system by making huge groups to get to bill more, it can prove a viable alternative. It's probably less suitable for some specialties (urology, dermatology, gynecology) and very suitable for others (endocrinology, nephrology, preventive medicine), but there may come a time where this type of visit will be standard and there will be a premium for an individual visit.

A closer look

November 11, 2008

Analysis of:Taking Statins To The Next Level | www.forbes.com

The JUPITER trial showed that people with what is regarded as normal ('bad') cholesterol and elevated C-reactive protein benefit more from the choleterol lowering drug rosuvastatin (Crestor, Astra-Zeneca) than from placebo. The first question is: is this true only for this particular type of statin (rosuvastatin) or do the others have the same effect? We don't know, but the latter is probably true, even though Crestor may have the strongest effect. The second question is: should everybody start taking a statin (or specifically rosuvastatin) if their C-reactive protein is high and their bad cholesterol is normal? We don't know yet and until we understand the risk/benefit ratio better, it is useful to remember that quitting smoking, exercising regularly and eating a healthy diet can lower C-reactive protein too.

Successful Collaboration Is Better Than Individual Failure

October 20, 2008

Analysis of:Health Firms to Study Clots in Stent Patients | online.wsj.com

This plan to start a large trial to determine the optimal antiplatelet therapy. after [drug-eluting] stent implantation makes sense both scientifically and economically for the involved stent companies (Johnson & Johnson, Boston Scientific, Medtronic and Abbott). Sanofi-Aventis and Bristol Myers Squibb, who market clopidogrel (Plavix) are likely also interested to have more precise data out there about the issue, before the rival compound, prasugrel, gets FDA approval. The optimal length and intensity of antiplatelet therapy after drug-eluting stent placement is not known and the trial will be specifically designed to answer this question.

Signs That the Is Party Over?

October 10, 2008

Analysis of:Pfizer shifts focus to cancer and biotech drugs | ap.google.com

The growth of the big pharma companies in the past 20-30 years has to do with the fact that the medical community was willing to accept large trials (some with surrogate endpoints) as proof that a new treatment is good and that it can replace the old one. Since the problems with Troglitazone, Cerivastatin, Rosiglitazone and Ezetimibe, safety is being emphasized by the medical community and by the political oversight. Showing safety is much more tough than showing efficacy and the trials are much more expensive and thus much more risky and this is probably why Pfizer is pulling out. The heart disease drug market is unlikely to see any new blockbusters like Atorvastatin and Amlodipine again and the new drugs will probably just bring small incremental improvements. The market is crowded and there is little chance for a big hit. Pfizer will continue to develop (anti)thrombosis drugs and that's a market where big hits are still possible, and in fact expected.

Not All That Shines is Gold

October 2, 2008

Analysis of:Anemia Drugs Linked to Stroke Study Deaths: FDA | health.usnews.com

The anemia drug erythropoietin and its congeners have been used extensively in patients with renal failure and in patients with cancer to boost the red cell count. However, erythropoietin also helps reduce programmed cellular death and is involved in the growth of new vessels. Because of these features it was always considered an attractive therapy for patients with heart attacks or strokes. Unfortunately, it can also increase the risk of thrombosis (blood clotting), which is how heart attacks and strokes occur in the first place. The usage in patients with renal failure has decreased after studies showed that increasing the red blood cell count too much in these patients can be detrimental. The results of this FDA warning are also going to lead to a reduction of usage as physicians become more cautious even though the population studied in the trial is different from the usual patients receiving erythropoietin.

The trial that is all about hype

August 28, 2008

Analysis of:Heart Stents No Better Than Drugs for Chest Pain Over Time | www.bloomberg.com

The general public hears the bullet that stents are no better than medications, but the reality that this trial (COURAGE trial) had major flaws, the main being that only 10% of the patients screened participated in the trial. 90% were excluded. Thus, the patients enrolled were not necessarily the typical patients. Also, very few of the new, drug-eluting stents were used. That being said, the initial study, published in 2007, showed that stents were no better than medications in terms of reducing deaths of myocardial infarctions. This second report suggests that in this particular group of patients, the stents are not better at reducing chest pain/improving quality of life.

Improved User Friendliness Is the Key

April 21, 2008

Analysis of:CV Therapeutics and Astellas Announce FDA Approval for Lexiscan(TM) (regadenoson) Injection | www.pipelinereview.com

Regadenoson is similar to the drug it's set to replace, adenosine, in terms of its ability to increase coronary flow and detect coronary artery disease. However, it's easier to use (it's given as a bolus as opposed to an infusion over 3-5 minutes) and seems to have less side effects. It also has a longer half life than adenosine, meaning that it's effects last longer. The main issue will be whether nuclear labs will switch from the older drug to the newer drug  for the convenience, or whether the (presumably) higher price will be an issue. Either way, the detection of coronary disease per se will probably not improve.

Troubled Times on the Lipid-Lowering Drugs Market

April 3, 2008

Analysis of:Discontinuation of Development of TAK-475, A Compound for Treatment of Hypercholesterolemia | www.pipelinereview.com

The decision by Takeda to halt development of TAK-475, is not surprising considering the problems faced now by companies trying to get regulatory approval for new lipid-lowering drugs. TAK-475 was not more potent, but was thought to have a better safety profile than statins. However, because the safety profile of the statins currently on the market is great, the improvement would not have made much difference. Moreover, the cost of bringing TAK-475 to the market would have been significant and the prospect of it getting a meaningful market share was not too good.

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