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posted by Fnord666 on Wednesday March 08 2017, @10:13AM   Printer-friendly
from the who-knew? dept.

https://www.eurekalert.org/pub_releases/2017-03/s-wtr030617.php

More than three in every five Americans see a doctor who receives some form of payment from industry. This is according to a new survey led by Genevieve Pham-Kanter of Drexel University's Dornsife School of Public Health in the US. It is the first nationally representative study to examine the prevalence of industry payments among the general population of patients.

[...] The survey was done in light of the Patient Protection and Affordable Care Act, which addresses concerns that industry payments could lead physicians to make decisions that are not in the best interest of their patients. Since 2013 the Act requires pharmaceutical and medical device manufacturers to report gifts and payments they make to healthcare providers. This information is publicly available on the Centers for Medicare and Medicaid Services' Open Payments website.

[...] The survey highlighted that 65 percent of respondents had visited a physician who accepted an industry payment. This was particularly the case for those visiting family medicine physicians (63 percent) and obstetricians and gynecologists (77 percent).

The Open Payments website can be found at: https://www.cms.gov/OpenPayments/index.html

References:
Pham-Kanter, G. , Mello, M., Lehmann, L., Campbell, E., Carpenter, D. (2017). Public Awareness of and Contact with Physicians Who Receive Industry Payments: A National Survey, Journal of General Internal Medicine, DOI: 10.1007/s11606-017-4012-3


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  • (Score: 2) by AthanasiusKircher on Wednesday March 08 2017, @02:56PM (3 children)

    by AthanasiusKircher (5291) on Wednesday March 08 2017, @02:56PM (#476453) Journal

    Thank you for your commentary on this -- really insightful (and distressing).

    One question about Durlaza, since you're a physician: you say "Durlaza is just aspirin," but it's not. I admittedly didn't know anything about Durlaza until I read your post, but a quick internet search brought up stuff like this [pharmacytimes.com] in the first links.

    Basically, if I understand this correctly, one primary mechanism that aspirin uses to prevent repeated heart attacks, etc. is by inhibiting platelet production (which prevents build-up of blood clots in bad places). But that production is (if the link is to be believed) mostly inhibited while aspirin is active in your system. Traditional aspirin, though, has a short half-life and thus would only be inhibiting platelet production for a brief window of a few hours after consumed. Durlaza is apparently engineered to do a smoother time-release over a 24-hour period.

    I do note, however, that that article "was sponsored by New Haven Pharmaceuticals," so I don't have a way to judge how much it could be distorting that information. But IF the time delay is really important in producing the desired clinical effect, it would seem that Durlaza isn't exactly "just aspirin."

    My question for you: is that distinction as clinically important as the link would suggest? Perhaps the benefit isn't enough to justify $200/month (instead of, say, just advocating a smaller aspirin dose taken regularly 3-4 times/day), but that doesn't mean there's no difference. I'm certainly not an expert in pharmacology, but I do know that the time-release profile and half-life of drugs is often critical for the control of their effects.

    Starting Score:    1  point
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  • (Score: 5, Informative) by mmcmonster on Wednesday March 08 2017, @05:23PM (2 children)

    by mmcmonster (401) on Wednesday March 08 2017, @05:23PM (#476547)

    The journal articles fail to mention: Aspirin irreversibly and completely stops platelet functions. An 81mg dose will basically de-activate all platelets in the bloodstream. The only way the body gets platelet action is that it continually creates new platelets. The reason why 81mg aspirin dose is chosen to treat heart and vascular disease is that trials with higher doses (and with higher drug levels in the bloodstream) have not shown any added benefit over the 81mg dose. Given this, it lies on the manufacturer of Durlaza to prove that higher blood levels are of any benefit.

    If a medication (regardless of type) is approved by the FDA, it just has to show non-inferiority to another medication that is already approved in the same class. In order for an ethical physician to prescribe it, it has to show benefit over the generic medication of the same class.

    Durlaza would need a trial showing it's superiority not just in a lab trial (in vitro) but in real world trials in real people (in vivo), which it won't even try (because the manufacturer knows that it's just aspirin).

    • (Score: 3, Interesting) by mmcmonster on Wednesday March 08 2017, @05:28PM (1 child)

      by mmcmonster (401) on Wednesday March 08 2017, @05:28PM (#476553)

      I forgot to mention:

      Platelets have a lifespan of about 7 days. So if you want to stop aspirin prior to a surgical procedure (typically for brain or spine surgery) they want you off of aspirin for 7 days. Because they know that a single dose can effect overall clotting function (because platelets help form the initial clot) for that long.