Readers Comments

Below are some of the comments and feedback we received from our readers regarding Therapeutics Letter 59.

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Very good, congratulations!

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Once again a thought provoking issue!

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The article is very interesting and very clear. We are going to signal it in the December ISDB Newsletter.

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Again, this is an excellent letter.  I like the example at the end of a theoretical benefit of spending less on meds. The public needs to be aware of this as well as physicians.

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Thanks for bringing me up to date via e-mail with the Therapeutics Initiatives.
I want to tell you how much I have appreciated the letter for the previous years.
It became the only source of drug information I relied on. Keep up the good work!

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Great article and pertinent to nurse practitioners for sure.
May I add that physicians are not the only prescribers now in Canada. There are just over 1,200 nurse practitioners and the number is increasing yearly -- who will be eligible to prescribe medications as well and it would important to include these folks as well in your message so that collectively physicians and nurse practitioners have to power to address this issue.

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Thank you for sending this. The content is very useful, as is your suggestion to offer a website with costs of prescriptions.
I was most interested by the sentence: "Canada now spends 25% more on pharmaceuticals than on doctors", which can be a powerful communication gun towards the physicians. Physicians do not feel concerned by the health expenditures, because it often remains a theoretical concept for them. Such a sentence is a way to make them deeply concerned, if they realise that they can not dissociate their own fees from their drug costs, within a tight national economic constraint. This figure would be even more efficacious if we could give along time the evolution of the ratio drug costs / physician costs: do you have such information?

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It is a constant wonder to me when healthcare spending is discussed in the media as well as among healthcare professionals and providers that we continue to lament the spiralling costs of prescription and OTC drugs while at the same time, look for (ask for) more money to spend on them.  If a formula for determining "me too" drugs has been established we need to convince government formularies to reject coverage and/or limit choices in each category of pharmaceutical treatment regimes.  Our doctors need to be better trained in healthcare and not depend on the pharmaceutical industry to "cure" their patients.  Too often our doctors are graduating with one tool in their treatment arsenal - a prescription pad.  Which brings to mind the adage:  If the only tool you know how to use is a hammer, pretty soon everything begins to look like a nail.  As we all know or should remember to acknowledge there is no "pill for every ill".

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Please convey to the TI group my congratulations on the content and message of this edition of the Therapeutics Letter. It finally addresses, point-blank, the issue of massive irrelevancy and redundancy in the drug industry. It also points, indirectly, to industry's ability to manipulate rank-and-file physicians into acting as agents for its sales strategies. Well done!
I hope one day the penny will drop, and the TI will ask the pointed question: "If not drugs, then what?" If it does so, then I hope it will answer that question on evidentiary grounds alone, using the same rigor, comprehensive approach and attention to detail that have characterized its scrutiny of drug therapy. If it does, I think it will find that true primary prevention (lifestyle change, psychobiological approaches and community-based support for healthy living) are everything that drug therapy is not -- inexpensive, replete with corollary benefits, and sustainable for the very long
term.

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Thank-you for your thoughtful article.  There is currently a tool that provides the cost of prescription drugs in BC (and other details such as PharmaCare coverage etc.).  Please see below:
http://www.medi-mouse.com/drug/drugfind.php


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Thank you so much for your Therapeutics Letter!
Yes, please put my name on the list of those wanting to know drug costs per dose, your new initiative. I suggest you consider sending along with the cost, a recommendation of an equally effective alternative older drug and its cost. It will drive home the message emphatically as numbers speak volumes. You need to find the right carrot to change prescribing patterns of doctors. Perhaps we should have TI reps pay us a visit in our clinics the way drug reps do and then have a system to monitor change by accessing prescribing patterns from the next door pharmacist, just the way drug companies do. Keep up the great work!

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This was an excellent edition of the Therapeutics Letter.  I was going to refer to it in our upcoming newsletter and encourage NDs across BC to link to your site for
more info.

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Congratulation for the excellent article and for performing this analysis.
I personally believe that the evaluation of the Added Therapeutic Value of new drugs should finally be considered at regulatory level. Until recently, evaluating the quality, safety and efficacy of new drugs made complete sense. Nowadays, new drugs cannot be considered as if they were in a vacuum and drug companies should be required to submit adequate comparative (superiority) trials as part of their applications.
This is what we lobbied for during the last review of the European Pharmaceutical Legislation. The EU parliament came to agree to this principle but unfortunately the EU Council did not take it into account in the final text of the legislation. I hope this principle will be applied by other countries soon...
Well done again.

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I appreciated your April-July TI newsletter. However, I have a couple of questions:
1) How much of our drug costs are incurred by those who have extensive coverage for their medications? Specifically I wonder about employees with supplemental insurance, First Nations, income assistance recipients and government employees with benefits, including RCMP and military.
2) Is there any plan to provide us physicians with a "classification" like the French one that gives us the scoop on which drugs are "me too" copies?
My experience over many years has been one of extreme frustration when it comes to prescribing. Those who don't have to worry about costs (see question 1) are usually the most demanding of expensive and unnecessary prescribing whereas those who pay for all drugs without assistance often deprive themselves of needed therapy due to cost. It's for this reason that I am virulently opposed to a National Drug Plan! Canadians have become too complacent about medical costs and the addition of such a plan would undoubtedly break the bank.
We need much more in the way of patient education in order to reduce our unnecessary pharmaceutical costs. You wouldn't believe the number of times I have had a mother in the ER at night demanding an antibiotic for their child because of a non-bacterial ear infection. And... I have also encountered those who insist on azithromycin because their child is "immune" to amoxil! When I point out the cost differential, their response is "no problem, we're covered!" Of course, they are completely resistant to any discussion of their child being "immune to amoxil". And ... in the middle of the night, I'm not interested in "education". All I want to do is get back to sleep to prepare for the day following. At the other end of the spectrum are those who are in their 60's and 70's who, having abused their bodies for 50 years, are now reaping the rewards of their lifestyle and demanding medical cures. It simply amazes me how many obese, sedentary folks are on antihypertensives, a statin, metformin and some sort of NSAID to reduce pain.  I doubt it will ever change.
Thanks for your efforts…

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"Yes, I am all in favor of any measure whatsoever which will start raising awareness about the cost of what we prescribe. I understand the annual cost increases for PharmaCare, per day, are sufficient to fund an additional family physician's fees for a year. Money frivolously wasted on medications is just as important as money we waste on unnecessary or incorrect investigations, tests and procedures.
 
To initiate some change many steps could be helpful, in particular:
 
- provide accurate drug cost information for commonly prescribed medications in usual quantities and usual doses
- in a format which would download to my Palm Pilot would be ideal, Internet second choice
- data from my community would be most useful since price varies geographically, which many probably don't realize
- data for specific pharmacies or specific retailers is also needed since there is quite significant price variability from store to store even within a few blocks of each other, another point of which that most patients and many physicians are unaware (10% to 30% or more in my experience)
- the data collection would need to have provision for frequent updates because the pharmacies or manufacturers will be quick to game any system or create pricing ploys to discredit the process
 
Without sounding too paranoid one could easily suspect that there has been a lot of effort put into the current marketplace, so called, to obscure price information and create a world where the prescriber is unaware and feeling no sense of responsibility for the cost issues even while they write the prescriptions.
 
My feeling is that there is also a marketplace evolving where some real price competition and transparency about costs would be welcome, and I doubt it will come from our leaders.
 
Some interesting "market driving" options could include:
- allowing/requiring price data to be included in all pharma promotional material and print advertising
- encouraging or requiring pharmacies to advertise their usual prices and usual dispensing fees for all or a select list of commonly prescribed drugs - patients will quickly identify where they will receive the best price/service for their needs
- somehow extracting current price data, by specific store, including product cost and dispensing fees from the PharmaCare database (where it all exists now and has done so for a decade) and making that available online for physicians and patients
- taking serious steps, a la New Zealand, to manage the market place to the benefit of the consumer/payer rather that the sellers/purveyors - many different options
- Internet pharmacies in Canada to serve US customers are somehow acceptable "competitive business practice" but a similar model could work well in BC for BC customers, should the idea be promoted?
 
If there is any group formed to further some of these initiatives I would be pleased to play some sort of a role.
 
I like the tone and content of TI 59. One minor quibble, why is it necessary to use a 1996 cost comparison chart for "Me-Too" vs "Vintage" drugs? The spread is probably equal or greater in 2006.
 
Thanks for the opportunity to comment.

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