Comments on: Drug Money & Prescribing For Better Outcomes

By: Bob Freeman

Bob Freeman — Wed, 23 Apr 2008 02:33:56 +0000

Jaynesday, I gave you an incomplete answer by stating the definitions without context: meta-analyses, while being strong on analytics, is relatively subjective and somewhat controversial in that it relies on the literature, which may be somewhat dated. (this is also true of systematic, critical lit reviews). This can be overcome somewhat by performing “rolling” meta-analyses that are updated as new studies come available. (See the Cochran web site for more information–Google any of the key words like “evidence-based medicine” “meta-analysis” “Cochran”)

On the issue of data sources: the FDA clinical trial registry can be accessed and additional info can be obtained under the Freedom of Information Act. Company web sites are also a source (assuming they decide to disclose negative research) under “data on file”. This is in addition to the data bases I described earlier.

By: Jaynesday

Jaynesday — Wed, 23 Apr 2008 01:39:55 +0000

Bob,
Thanks for the explanation.

By: Bob Freeman

Bob Freeman — Wed, 23 Apr 2008 01:12:12 +0000

Evidence-based medicine or EBM relies on conducting meta-analyses of published and unpublished studies, the selection of which is based on predetermined criteria. EBM can also come from systematic literature reviews. The difference between the two approaches is basically this: meta-analysis is a statistical protocol for combining data from studies whereas a systematic literature review is a formal, critical assessment of the findings. The study that found that SSRIs do not have the relative effectiveness over placebo was a meta-analysis that included both published and unpublished clinical trials. Previous effectiveness was estimated from published studies exclusively.

You can also do data mining to set up retrospective cohort studies. Case-control studies usually fail to establish causality because you lace a denominator to construct risk ratios, etc. Data bases may be from Medicare and Medicaid files, managed care organizations’ data sets, patient registries, etc.

By: Jaynesday

Jaynesday — Wed, 23 Apr 2008 00:35:41 +0000

Sorry for my ignorance on this subject but it sounds very interesting. Could someone tell me the origin of the databases? Where does the data come from?
Thanks

By: Bob Freeman

Bob Freeman — Tue, 22 Apr 2008 22:40:27 +0000

Prior to the Pharmacia & Upjohn merger (a wedding made in Hell) Upjohn was a good corporate citizen in Kzoo: they endowed the Kalamazoo Area Math & Science Center and continued to stock its corporate fleet with GM autos out of loyality to a Michigan company Those are a couple of isolated examples. I was there when the company removed its wording offering “continuous employment” (tenure, basically) from the HR manual–it was a gut-wrenching decision. It was common to see three generations of a family employed there.

By: Justice in Michigan

Justice in Michigan — Tue, 22 Apr 2008 20:49:53 +0000

Indeed. They seem to be the Vandals of the industry. Great when you are under their protection. Disposable otherwise. When they left here, I wrote a piece called, “Our town goes generic.”

As you may know, Upjohn played a rhetorical role when Michigan’s preemption law was adopted, via Engler, in 1995. One of Engler’s aides noted it was specifically “to protect the Upjohn Company.”

Given that a lawsuit could be brought against the company in any other state, that made no sense. But then, there is much about all this that makes no sense.

Anyway, as you know, Michigan has suffered its share of out-migration. So very glad to hear about those former Pfizer folk who wanted to stay, and that they got to.

By: Bob Freeman

Bob Freeman — Tue, 22 Apr 2008 18:43:13 +0000

Justice, I used to live in the Kalamazoo area when The Upjohn Company was strong. It’s very sad to be in the area and see the decimation that Pfizer did both in both Kzoo and Portage. A famous building, No. 88, which won major architectural awards, was razed.

By: Jack2

Jack2 — Tue, 22 Apr 2008 17:47:45 +0000

Off topic-ish, but I’d take that $430 million (or, more likely a small fraction of it) to set up a uniform eprescribing system for doctors and pharmacies. I don’t think anything would improve healthcare safety more for less money - it just needs more pizaz.

By: Justice in Michigan

Justice in Michigan — Tue, 22 Apr 2008 17:29:53 +0000

Thanks, Bob. That’s great to hear!

By: Bob Freeman

Bob Freeman — Tue, 22 Apr 2008 17:21:02 +0000

Justice, RTI in NC did a nice thing for some ex-Pfizer outcomes research people whom they hired. Rather than relocate them to NC, they set up a branch office in Ann Arbor. I don’t know the headcount involved–I have a number of former colleagues who were very pleased to stay in Michigan.