[Rob P]

It would not surprise me, if in the fullness of time, it will be demonstrated that big pharma has been deploying similar techniques to the metro-chemical industries when it comes to absorbing new techniques and so shielding their income streams and profits.

Tinfoil hat time.

Rob P

[PaulB]

If companies think that they can now save considerable amounts of money and reducing their risk (that they will fail the tests) by selling their drugs without certification, that is precisely what they will do. They will say to the NHS "this drug is available. Its certified in the USA so it must be safe .

They would be breaking the law if they did that.... You can't say "we sell this for that disease" unless you have am MA that specifies "that disease"

If the company thinks that they can make a profit they'll licence it

This isn't about science trumping marketing. It could be about EU red tape, making certification too expensive and not having reciprocation arrangements with other jurisdictions.

There (rightly) isn't reciprocity, but much of the trial data used to support an MA application will be the same across jurisdictions

Rumours of something working, or not working, have killed people (MMR & Autism etc). Safety has to come first.

Arrggghhh.... MMR does not cause autism

So to me is - can safety be assured. If the answer is yes - then this is great, and perhaps the cost of drugs will be able to come down.

[/quote]

The answer in this case seems to be yes. (How this was done is covered briefly in the judgement)

[Flyin'Dutch']

FD - am I right in my assertion that a physician can pretty much prescribe whatever they like? Someone told me that when I started in this industry and I've never bothered to research it further.

Legally yes they can.... almost. Legally you can’t prescribe many drugs of addiction to an addict without a special licence. Cannabis and its derivatives are even more tightly restricted, but that’s about it.

There are other “financial” deterrents too, so absolute clinical freedom has gone, but there’s still a fair bit of relative freedom.

@riverrock

Hmm, not so sure I would concur with PaulB's assertion.

There is a massive drive/encouragement/pressure to prescribe the cheapest generic drug possible.

When this was first done the NHS came out with some rubbish about the reasons why and how we should 'sell' it to the patients.

Believing that most patients are reasonable beings i much preferred to be straight up and honest and explained to the patients that the NHScan only spend the money once and therefore prefers to buy best value drugs rather than expensive branded stuff.

And guess what - most patients do.

The drive was at times ridiculous with generic providers taking it in turn to drop and raise prices in turn, leading to us requiring to swapping back and forth.

Most generic swapping is fine - for some drugs it isn't but we know which ones they are. There are of course patients who swear by brand A or B, the same phenomenon is of course seen in other market segments.

[Flyin'Dutch']

It would not surprise me, if in the fullness of time, it will be demonstrated that big pharma has been deploying similar techniques to the metro-chemical industries when it comes to absorbing new techniques and so shielding their income streams and profits.

Tinfoil hat time.

Rob P

Come off it Rob, you know that some industries have been playing these tactics.

Tobacco industry anyone?

[PaulB]

FD - am I right in my assertion that a physician can pretty much prescribe whatever they like? Someone told me that when I started in this industry and I've never bothered to research it further.

Legally yes they can.... almost. Legally you can’t prescribe many drugs of addiction to an addict without a special licence. Cannabis and its derivatives are even more tightly restricted, but that’s about it.

There are other “financial” deterrents too, so absolute clinical freedom has gone, but there’s still a fair bit of relative freedom.

@riverrock

Hmm, not so sure I would concur with PaulB's assertion.

There is a massive drive/encouragement/pressure to prescribe the cheapest generic drug possible.

We're saying the same thing... all that you described was in my "throwaway" line about financial deterrants. I guess it should have said "financial and other deterrants" You're describing some of the "other".

Back to the case in question and given that the pharmaceutical industry exists to make money for it's shareholders, how do we make sure that drug research is clinically relevant?

For example, given how expensive it is to get a drug to market, is it any wonder that there are few if any antibiotics on the horizon? Who'd want to spend 100's of millions of £ to launch a drug that gets used once for 5 days, when you can spend that money to develop a drug that a patient will need for the rest of their lives?

[Rob P]

Come off it Rob, you know that some industries have been playing these tactics.

Tobacco industry anyone?

What has the tobacco industry to do with the urban myth of the inventors who discovered miracle fuels to replace petrol/diesel being bought off by "big oil" who then suppress the invention?

It's bollox as a moment's thought will reveal.

Rob P

[Flyin'Dutch']

Come off it Rob, you know that some industries have been playing these tactics.

Tobacco industry anyone?

What has the tobacco industry to do with the urban myth of the inventors who discovered miracle fuels to replace petrol/diesel being bought off by "big oil" who then suppress the invention?

It's bollox as a moment's thought will reveal.

Rob P

Rob,

I never claimed anything about urban myths.

What I said was that big players in markets are happy to suppress anything that harms their bottom line.

That is the oil industry, big pharma, the tobacco industry, IT, aviation.

There are various ways to achieve that, including buying patents, publishing or withholding research, commissioning 'research' buying small start-ups, bribing, lobbying legislature etc.

Just as the NRA has lobbied and successfully ensured that there is no funding for research in the US into gun violence.

I'll grant you that most in the above line up go about it less brazen than the NRA.

[PaulB]

If a nationwide contract was awarded to one company for one of these products then the rest would stop making it and the incumbent could then charge what they like because otherwise the patients would go without, and that can't happen.

Whilst acknowledging all you say, even with all these efforts, the drug supply is more fragile now than it has ever been. Medicines just go out of stock.... for weeks at a time, sometimes months at a time, despite the efforts of all the people you mention. (I'm not criticising them at all.)

That said, the basic tenet of AR's post was that secondary care (that's largely hospitals) don't allow loss leading by manufaturers. In the old days, compamies would offer branded medicines at huge discounts to hospitals as they knew that getting them used in hospital would lead to GPs prescribing that medicine (at full price for the rest of the patient's life). Pressure on budgets meant that hospitals took the cheaper medicine. Now, this is largely reversed and the cost to the NHS as a whole is considered as part of the purchasing decision.

[riverrock]

Arrggghhh.... MMR does not cause autism

So to me is - can safety be assured. If the answer is yes - then this is great, and perhaps the cost of drugs will be able to come down.

The answer in this case seems to be yes. (How this was done is covered briefly in the judgement)

That was my point - essentially a rumour caused people to stop getting their kids immunised and some died.

Glad safety has been assured in this, which to me is the priority.

[cockney steve]

Plenty of talk about Big Pharma ruthlessly exploiting life-saving drugs for the benefit of their shareholders.
Very little about themorality of exploiting the weak and sick for obscene profits.
Perhaps some would go along with the idea of euthanasia clinics which take a handsome one-off profit to remove a long-term burden from the State Think Big Pharma would put up a stout rebuttal of such an immoral idea which would undermine their lovely gravy-train.

There was, recently a case of a medicament , the rights to which were sold to another company, who increased the price obscenely ,by several thousand percent. They were successfully prosecuted. but such reaction is all too rare.

[cockney steve]

Plenty of talk about Big Pharma ruthlessly exploiting life-saving drugs for the benefit of their shareholders.
Very little about themorality of exploiting the weak and sick for obscene profits.
Perhaps some would go along with the idea of euthanasia clinics which take a handsome one-off profit to remove a long-term burden from the State Think Big Pharma would put up a stout rebuttal of such an immoral idea which would undermine their lovely gravy-train.

There was, recently a case of a medicament , the rights to which were sold to another company, who increased the price obscenely ,by several thousand percent. They were successfully prosecuted. but such reaction is all too rare.

[Flyin'Dutch']

CS to be fair - that was in the land of the brave, the US.

[PaulB]

There have been similar attempts here, especially with rarely used meds and single suppliers.

TBH continuity of supply is the biggest problem in the UK at the moment.

[Flyingfemme]

In the past week I have heard about a shortage of epi-pens and the continuous blood sugar monitors used by diabetics. Growth too fast for the suppliers or managed price fixing?

[PaulB]

Epi-pens have been one of the meds’ involved in price fixing (few suppliers so they can do what they want.)

When I started my career you could reasonably expect that 100% of ordered items would be delivered in half a day (order am, deliver pm).

More recently it can be as low as 50%