Denialism Blog

  • Welcome to Realbusiness 101.

    Earlier today, we learned that when faced with a regulatory deadline to test your products for lead, a good course of action is to lobby to delay or reverse the requirement. This afternoon, we learn the best course of action when your highly-profitable drug is about to lose patent protection. We’re all familiar with the tactic of simply making little changes to a drug and declaring the new version marginally better. Jonathan Rockoff explains that the minor improvement strategy can be combined with pricing tactic to steer consumers and insurers away from generics:

    Twice this year, Cephalon Inc. has sharply raised the price of its narcolepsy drug Provigil. The drug is now 28% more expensive than it was in March and 74% more expensive than four years ago, according to DestinationRx, a pharmaceutical software and data provider. The Frazer, Pa., company has said in investor presentations that it plans to continue to raise the price.

    The Provigil price increases — the drug’s average wholesale price is now $8.71 a tablet — are an extreme example of a common tactic pharmaceutical companies employ in the U.S. to boost profits and steer patients away from cheaper generics.

    It works like this: Knowing that Provigil will face generic competition in 2012 as its patent nears expiration, Cephalon is planning to launch a longer-acting version of the drug called Nuvigil next year. To convert patients from Provigil to Nuvigil, Cephalon has suggested in investor presentations it will price Nuvigil lower than the sharply increased price of Provigil.

    By the time copycat versions of Provigil hit the market the company is banking that most Provigil users will have switched to the less-expensive Nuvigil, which is patent-protected until 2023. In the meantime, Cephalon will have maximized its Provigil revenue with the repeated price hikes.

    “You should expect that we will likely raise Provigil prices to try to create an incentive for the reimbursers to preferentially move to Nuvigil,” Chip Merritt, Cephalon’s vice president of investor relations, told a Sept. 5 health-care conference, according to a transcript of the meeting.

    […]

    During his campaign, Mr. Obama promised to lower drug costs by, among other things, allowing the importation of cheaper medicines from other developed countries and increasing the use of generic drugs in public programs like Medicare.

    One approach often threatened by Democrats — allowing Medicare to negotiate prices with drug makers — would help control rising costs, drug-pricing specialists said. But fully preventing tactics like Cephalon’s would be difficult short of outright regulation of drug prices. Many other countries control drug prices, but most U.S. regulators and legislators have opposed such moves.

  • Dumb and Dumber: Toys From China & Lobbyists from NAM

    So you operate a toy company and along the way, you probably offshored your production to China to save money. And now that Americans have awakened to the obvious problems with your business plan, you want to still sell your toys to the public without testing them for lead.

    Your options: 1) sell your inventory before February 10, 2009, when the new lead regulations come into effect; 2) do nothing and just risk it; and/or 3) lobby to make the standards non-retroactive.

    Dear readers, would you be surprised if our friends who cut corners by offshoring to China would choose option 3? Melanie Trottman reports in today’s Journal that:

    …Mr. Woldenberg [a toy seller] said he believes that few, if any, of his company’s goods have lead in excess of the new standards, he has started to have the inventory tested. Meanwhile, he has written to the Consumer Product Safety Commission and congressional staffers, asking for an indefinite amount of time to sell off his older inventory.

    The National Association of Manufacturers and other trade groups have also asked regulators and Congress not to apply the new lead standard to products made before the standard was set.

    “There’s the potential loss of billions of dollars in inventory that is deemed safe for purchase on Feb. 9 but deemed unsafe Feb. 10” unless proved otherwise, said Jim Neill, an association spokesman.

    Deemed safe on February 9th but not on the 10th? We should ask Jim Neill how much lead he thinks is safe for his children–the February 9th or the February 10th standard.

  • Atheists Advertise!

    I never thought I’d see this. But here it is in all its glory. When I used to live in Georgia and drive past huge billboards that read “I heard that! — God,” or “You’re Welcome –God,” I imagined the day when atheist billboards would appear. I always wanted to buy a billboard that simply read, “God is Dead.” in part, to see whether Clear Channel would put it up, and in part, to hear the standard rejoinder said in Georgia–“Nietzsche is dead!” How profound!

    Today’s Journal covers atheists’ efforts in reaching out, and concludes with this astute observation:

    Still, leading activists say nonbelievers tend to be just as wary of organized atheism as they are of organized religion — making it tough to pull together a cohesive movement.

    “A pastor can say to his flock, ‘All rise,’ and everyone rises. But try that in an atheist meeting,” said Marvin Straus, co-founder of an atheist group in Boulder, Colo. “A third of the people will rise. A third will tell you to go to hell. And a third will start arguing….That’s why it’s hard to say where we’re going as a movement.”

  • Has Obama Taken Away Our Guns Yet?

    On Nov. 16th at 9:50 Pacific, the answer remains no, but this site will help us keep track of this important issue after Jan. 20.

  • Carnivalia

    Just a quick rundown.

    Praxis #4
    , a surprisingly interesting carnival about academic life, is up at Martin’s place.

    Grand Rounds is up at Distractible Mind

    Tangled Bank is up at Ames’s place.

    And Skeptics’ Circle No. 100 is coming soon to Orac’s place! Stay tuned!

  • What the family values folks don't get about family

    On the weekends, my four-year old daughter comes to work with me. There isn’t much for her to do. She certainly isn’t allowed in patient rooms. She doesn’t help me make medical decisions. But we spend twenty minutes each way in the car laughing. We walk around the hospital, everyone greeting her, everyone her friend. One time, when she was actually admitted to the hospital, she wasn’t scared at all because, “all my friends are there.”

    Friday night, we went to services. My mother-in-law was singing, and she asked us to come. Normally, I’m not one for formal religious observances—it’s just not my thing. So rather than contemplating the nature of the universe, I watched my family. My daughter ran around saying “hi” to all of her friends (that’s everyone), cuddled her grandfather, sat on her pre-school teacher’s lap, played with her cousin. It was about family.

    When she is having one of her tantrums, and my wife can’t possibly take another minute of it, we trade places. When it’s all over, we all climb in bed together and cuddle and laugh. It’s family.

    I was watching Dan Savage and and some Family Research Council talking head on Anderson Cooper the other night. The were talking about the Prop 8 debacle in California, and it finally hit me for the first time—the “family values” groups have no idea what family is, not even a clue.

    If you read their websites, James Dobson and others are always talking about things like “Three Lies About Sex Before Marriage”, “Pornography”, and “The Gay Revisionist Agenda”.

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  • Abdominal adiposity and risk of death, or "belly fat'll kill ya'"

    ResearchBlogging.org

    Last week’s New England Journal of Medicine gave us some remarkable news, via the JUPITER Trial, adding additional evidence to the pile of articles on the cardioprotective effects of statins. This article is getting lots of press, which is great, but I’d hate to see this week’s edition of the Journal get lost. Specifically, there’s a huge population-based study on obesity and mortality. We’ve explored previously the dangers of obesity, and we’ve been fought the whole way by various denialists.

    Earlier studies have shown associations between excess body weight (as measured by body mass index (BMI)) and death, but this study did a few things differently. The latest study in the Journal, titled “General and Abdominal Adiposity and Risk of Death in Europe”, takes a look at a larger data set, and takes a closer look at different measures of obesity.

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  • WhiteCoat Underground Note

    I number of my posts have links to my old blog. I’ve moved my old blog to a new server, and the permalinks no longer work (and I’m probably to lazy to hunt them all down). If I send you to a blind link, sorry ’bout that. Just go to whitecoatunderground.com and search by title.

  • Why male circumcision and female genital mutilation are not morally equivalent

    NB: Believe it or not, I actually had to close comments, the first time I’ve ever had to do it. They had become so offensive without any useful content that it’s no longer worthwhile to keep it going. Sorry.

    I have repeatedly vowed to stay away from this topic, but in defense of my colleague, I must speak out. Harriet Hall, from sciencebasedmedicine.com wrote a brief piece examining the medical literature regarding male circumcision. As part of the discussion, she mentioned having performed many of these procedures during an earlier part of her career. In response to her interesting post, she received comments such as this one:

    Dr. Hall needs to confess her guilt for the intentional injury of scores of infant males and reexamine her motives in writing this document.

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  • Does alternative medicine have alternative ethics?

    We’ve talked quite a bit about ethics in this space, especially medical ethics and “blog ethics”. Today, though, we will specifically examine the nature of medical ethics as they apply to so-called alternative medicine.

    First, and perhaps most important, I am not an ethicist. I do not have the depth of reading, the knowledge of terminology, or the specific education to lead a formal discussion on ethics. What I am is a practicing internist, who must make ethical decisions on a daily basis. Most of these decisions are of necessity made “from the heart”, but it is not infrequent that I must evaluate a situation more formally and fall back on some of the ethical principles of my profession.

    Ethics are not static. They are not a divine gift bestowed on each of us as we don our white coats. They are a living part of our specific cultures, and of the profession we serve. Some of the modern principles of medical ethics are newer than others. Beneficence, non-maleficence, and confidentiality are ancient principles of medical ethics, which continue to be relevant today. Patient autonomy is a more recent value, reflecting a shift in how society views the relationship between patient and physician. These ethics must be mutable, as the profession itself is ever-changing. Despite this fluidity, there is an identifiable line of “doctor-hood” that has existed for at least the last century, and the members of this guild have always tried to adhere to some type of code of behavior.

    Alternative medicine poses real challenges to the principle of medical ethics. First, we’ll discuss who, in fact, is bound by these principles, then the way in which alternative medicine is or is not compatible with medical ethics.

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