Joel Lexchin

Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: A systematic review

Geoff Spurling and colleagues report findings of a systematic review looking at the relationship between exposure to promotional material from pharmaceutical companies and the quality, quantity, and cost of prescribing. They fail to find evidence of improvements in prescribing after exposure, and find some evidence of an association with higher prescribing frequency, higher costs, or lower prescribing quality.

The cost of pushing pills: a new estimate of pharmaceutical promotion expenditures in the United States.

In the late 1950s, the late Democratic Senator Estes Kefauver, Chairman of the United States Senates Anti-Trust and Monopoly Subcommittee, put together the first extensive indictment against the business workings of the pharmaceutical industry. He laid three charges at the door of the industry: (1) Patents sustained predatory prices and excessive margins; (2) Costs and prices were extravagantly increased by large expenditures in marketing; and (3) Most of the industrys new products were no more effective than established drugs on the market [1]. Kefauvers indictment against a marketing-driven industry created a representation of the pharmaceutical industry far different than the one offered by the industry itself. As Froud and colleagues put it, the image of life-saving “researchers in white coats” was now contested by the one of greedy “reps in cars” [2]. The outcome of the struggle over the image of the industry is crucial because of its potential to influence the regulatory environment in which the industry operates.

The cost of drug development: a systematic review

OBJECTIVES We aimed to systematically review and assess published estimates of the cost of developing new drugs. METHODS We sought English language research articles containing original estimates of the cost of drug development that were published from 1980 to 2009, inclusive. We searched seven databases and used citation tracing and expert referral to identify studies. We abstracted qualifying studies for information about methods, data sources, study samples, and key results. RESULTS Thirteen articles were found to meet our inclusion criteria. Estimates of the cost of drug development ranged more than 9-fold, from USD

Effects of Prescription Drug User Fees on Drug and Health Services Use and on Health Status in Vulnerable Populations: A Systematic Review of the Evidence

92 million cash (USD

Pharmaceutical research and development: what do we get for all that money?

161 million capitalized) to USD

Direct-to-Consumer Advertising of Prescription Drugs: The Evidence Says No

883.6 million cash (USD

The pharmaceutical industry as a medicines provider

1.8 billion capitalized). Differences in methods, data sources, and time periods explain some of the variation in estimates. Lack of transparency limits many studies. Confidential information provided by unnamed companies about unspecified products forms all or part of the data underlying 10 of the 13 studies. CONCLUSIONS Despite three decades of research in this area, no published estimate of the cost of developing a drug can be considered a gold standard. Studies on this topic should be subjected to reasonable audit and disclosure of - at the very least - the drugs which authors purport to provide development cost estimates for.

Reporting of Conflicts of Interest in Meta-analyses of Trials of Pharmacological Treatments

Rising pharmaceutical expenditures have led to the use of cost-sharing measures. The authors undertook a systematic review of the effects of cost sharing on vulnerable populations (the poor and those with chronic illnesses). Virtually every article reviewed supports the view that cost sharing decreases the use of prescription drugs in these populations. Copayments or a cap on the monthly number of subsidized prescriptions lower drug costs for the payer, but any savings may be offset by increases in other health care areas. Cost sharing also leads to patients foregoing essential medications and to a decline in health care status.

Bigger and Better: How Pfizer Redefined Erectile Dysfunction

Data indicate that the widely touted “innovation crisis” in pharmaceuticals is a myth. The real innovation crisis, say Donald Light and Joel Lexchin, stems from current incentives that reward companies for developing large numbers of new drugs with few clinical advantages over existing ones

Institutional Corruption of Pharmaceuticals and the Myth of Safe and Effective Drugs

There is little rationale for direct-to-consumer advertising of prescription drugs. Most new drugs offer little if any therapeutic advantage over existing products. Direct-to-consumer advertisements frequently downplay safety information. Physicians are highly ambivalent about prescribing advertised drugs requested by patients. There is no evidence that direct-to-consumer advertising results in any improvement in health outcomes.