I am stunned that you would think that the JHE editors would need your permission to offer us a chance to reply to your comment. Asking the authors of the original published article if they wish to reply to a comment or letter is standard editorial practice at academic journals (it is also the fair thing to do). That is also usually where it ends. Very few commenters are given any opportunity, as you were, for a rejoinder.

Perhaps, though, you are referring to your narrative in the piece published in the student-run journal mentioned above, in which in a fair reading of the text you make the claim that the editors sent us a draft of your comment sometime between March 2, 2004 and the end of April 2004 (when your initial comment was accepted) for our expert advice and fact-checking. You offer no evidence for that. I would like to know what you think is evidence for that assertion, because that claim is patently false. The first time that we received any version of anything you wrote, or even any indication that you were working on a comment, was in mid-May 2004. We were also not asked for expert advice or to fact-check the comment. We were simply asked if we wanted to reply to the comment.

With regard to the Tufts Center financial disclosure web page, I did not have any trouble getting it from the drop-down menu from my computer at work today, but I did have trouble with my laptop last evening. The problems that I had last evening were with all of the drop down pages for all of the top level sections.

Let me suggest that you hold the cursor over a top level area for a couple of seconds before you try to move down into the drop-down area. In any event, we clearly were not trying to withhold the financial disclosure page (if that is what you were insinuating). If it is an issue, then it is an issue for the drop-down pages generally. In addition, you can always get the financial disclosure page, or any other page, by clicking on the site map. There are links to all of the pages there. Nonetheless, I have suggested that the issue of a too-sensitive (if that is the way to put it) set of drop-down menus on the site be put to the Tufts Center’s website vendor for a fix. I am told, however, that the website is do for an overhaul soon anyway.

We’ve written short piece to let you decide for yourself whether you have ever been (or would like to be) treated as we were, read:
http://www.thejabberwock.org/blog/pdf/light001.pdf

On financial disclosure, at the Tufts Center website (http://csdd.tufts.edu/) under “About us” (top right) there is a drop-down that says “Financial Disclosure”. However I can’t open it because the whole drop-down menu disappears much too quickly to allow me to click anything but the first of five items. Previously, you could see the financial information, under “About us”.

What kinds of pressures were the editors of the Journal of Health Economics under when they suddenly pulled from production the entire critique, reply, and response which they had already accepted and set forward to Elsevier for page proofs? What pressures led them to go silent for over 2 months and then send back the set with nearly all of the response they had accepted now deleted? Very unusual.

Atlex has it exactly right. By the way, Joe, $802 million is not in the title of the paper, and the abstract notes the difference between cash outlays and full opportunity costs, that the numbers are pre-tax, and the drugs are self-originated (which are not a “vanishingly small” portion of these companies portfolios).

Dan, I am not familiar with anyone other than Public Citizen putting the number at around $100 million. I would also argue that neither Public Citizen nor Marcia Angell can be called “independent analysts” in this area, given what seems like a fairly transparent anti-corporate bias. But we need not focus on idealogical or other biases here. One can make an objective assessment about their claims and estimations. The criticisms of a study deserve as much scrutiny as the study itself.

In an initial response to Light and Warburton’s comment, we wrote about the logical and methodological flaws in these writings. That was much too much space for the journal to absorb, so we wrote a full paper on the topic, referenced it in our journal reply, and posted it on the Tufts Center website for easy access to all. The Public Citizen data analyses are deeply methodologically flawed, and in ways that substantially bias downward the cost estimates. In addition, claims made by both Public Citizen and Angell about taxes, sample composition, and opportunity costs are conceptually flawed. You can find our critique of their critiques here: http://csdd.tufts.edu/_documents/www/Doc_231_45_735.pdf. I encourage you to read it with an open mind, and then draw your own conclusions.

Regards,
Joe DiMasi

Last I checked, Marcia Angell is not a financial analyst. When investors look to make decisions, they consider opportunity costs when determining if the likely return justifies the risk of the investment. Pharmaceutical products are not only costly to bring to market, they take years from inception to approval, and come at an incredibly high risk. The Angell’s of the world may not like how investors view this, but it’s hardly a bogus view.

Atlex

Marcia’s book, released in 2004, The 802 million to bring a drug to market was stated in 2001, as determined by a group of economists, which was headed by Joseph DiMasi at the Tufts Center. To no suprise, it was reinforced often by the industry’s lobbying group PhRMA. The figure was announced at a press conference in Philadelphia in November of that same year. Marcia also states that The Tufts Center is largely supported by the pharma industry. The 802 million figure, as she references the NYT, is based on a very select and small amount of certain drugs that were the most expensive, and this was done deliberately. (page 42)

Other groups such as Public Citizen, as well as independent analysts, more thoroughly determined that the cost to bring a drug to market was around 100 million dollars, after taxes and so forth, only a few years ago.

Needless to say, the wide disparity between the two figures is likely because the industry has to justify the high cost of thier medications to avoid price controls.

Point taken. From my discussion with Light the other day, I understood this to have been an issue. I will attempt to clarify.

Regards
ed

It wasn’t the connection-to-industry-funding part of the sentence to which I was referring. I was concerned about inferences that readers might draw from the “a point not noted in the original JHE article” part. That could be read by some that something untoward was done that Light and Warburton wanted point out.

Firstly, my comment fills out the picture here by noting that nothing of the kind was required. Secondly, as far as I know, while Light and Warburton wanted to raise industry funding as an issue, they did not criticize us or the journal regarding acknowledgments (at least not in any version that I saw).

Their comment was not fundamentally about author associations (again, at least not any version I saw). It was about data and methodology, and we had rebuttals for each and every one of their points. Those interested can read the entire set of published exchanges and make up their own minds.

Thanks,
Joe

There may not have been a request, but the connection to industry was as an issue, at least far as I understand it. That’s why I noted it.

Regards
ed