Monthly Archives: December 2009

Margaret McCartney

I feel very bad that I haven’t written about this until now: an email from Simon Singh reminds me that the Keep Libel Laws out of Science campaign, as run by Sense about Science, has moved up a gear. The campaign started when Simon was being personally sued for writing about chiropractic for a newspaper article. His case is now at the appeal stage, due to be heard in Febuary 2010.

Sense about Science have joined forces with English PEN and the Index on Censorship: they are hoping for a large response to a petition to campaign for a change to the law altogether. My name is there; please consider signing up. Debate in science is essential. I suspect we’d still be doing blood-letting otherwise.

I’m also grateful for this series of festive science experiments Simon links to  - from  Quirkology - highly recommended – from Professor Richard Wiseman. Fun for the children (and the grown ups.) Remember to put some bicarbonate of soda on your shopping list.

Margaret McCartney

Miracles and medics are unlikely bedfellows, especially when the mattress is hard, unforgiving and demands a weight of evidence. Doctors witness unlikely things all the time in the normal swing of medical life, and it is usually difficult to seduce them into the opinion that unseen hands were at work.

The Roman Catholic Church itself imposes strict liturgical standards before it declares a miracle. Take, for example, the case of Jack Sullivan, a 71-year-old American deacon who had spinal surgery in 2001, in a bid to stop his vertebrae impinging on his spinal cord. His condition had been deteriorating towards paralysis, but at operation, his case was discovered to be hopeless. The fault in the spine was much worse than thought. Sullivan prayed to Cardinal John Henry Newman, a 19th century convert to Roman Catholicism – and recovered. Sullivan’s surgeon told him: “Jack, there’s no medical explanation for what happened to you: if you want an answer, ask God!”

Continue reading “Magical medicine”

Andrew Jack

It seems that Sanofi-Aventis, the French pharmaceutical group, is finally happy with its “succession planning”, after formally announcing plans for a new chairman to replace Jean-Francois Dehecq, the charismatic executive who built the company through dozens of mergers over three decades.

Mr Dehecq had previously modified the company’s statutes once to extend his mandatory retirement age, but this time – with his 70th birthday approaching and his own “dauphin” as chief executive replaced – he has relinquished the reins in favour of Serge Weinberg.

That maintains a separation of powers between the new French non-executive chairman and the German-Canadian chief executive, Chris Viehbacher, appointed last year: a rather more British than American (or traditionally French) approach to governance.

But Mr Weinberg, a product of the French elite political establishment and investment banking, is very different from his predecessor. Not only has he no experience in pharmaceuticals. He has a track record of resigning as head of from family-controlled businesses to which he has been appointed, at both the retailer and luxury goods group Pinault Printemps Redoute and the hotel business Accor.

That could suggest either stormy times ahead, or a victory for Mr Weinberg’s demand for a less family-dominated approach to capitalism, as Sanofi-Aventis bids adieu both to the strong influence of its founding chairman and the two largest shareholders which are a legacy of those past mergers – l’Oreal and Total.

Margaret McCartney

The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) has a difficult job, given that it is meant to license all medications to ensure the public are using properly tested medications safely. But it is doing a difficult job increasingly badly.

Over the last few years it has made a number of decisions which seem neither fact-based nor helpful. One of these, in 2006, was the decision to allow manufacturers of homeopathic preparations to make health claims about their products, in spite of a lack of evidence. This seemed a rather dangerous precedent. We need strong evidence and information about medicines, and the MHRA should be upholding rigorous standards.

Then we have the move to make antibiotics for eye infections, themselves of questionable value, available from pharmacists without a doctors’ prescription. And now we have another: the decision to approve the purchase of tamsulosin, or Flomax, from a pharmacist, again without the need for a prescription.

The MHRA say that obtaining the drug, which is used to treat prostatic enlargement, will “encourage men to play a more active role in their healthcare”. I find this argument utterly patronising. I fail to see how going along to a pharmacist, who will do a questionnaire, supply two weeks worth of the drug, and then, after a further meeting, four weeks more, followed then by instructions to see a GP, improves anything at all.

The thing about benign prostatic hypertrophy is that it needs to be diagnosed. That means a discussion, an examination, and, possibly, referral for further tests. NICE are due to bring out guidelines next year: but here are some guidelines from the European Association of Urology, and the NHS Centre for Reviews and Dissemination, who say much the same.

The MHRA say that the questionnaire pharmacists will use has been “developed and validated by Boehringer Ingelheim” (the manufacturers of Flomax.) They also say that they have reduced the time a man can have the prescription for, without seeing a doctor, from 10 to six weeks after consultation. I find both these decisions questionable, and the petition for pharmacy-only prescribing from Boehringer is, I think, inconsistent. They point out that NHS guidance says cases of prostate cancer are no more frequent in men with mild prostate enlargement than the general population. But they ignore guidance saying that all men should have a rectal exam in making a diagnosis. For that is the key – diagnosis.

The move does not, in reality, improve access to healthcare. Nor is there any evidence that men will take more of a role in their healthcare because of this scheme. Instead, people may have to pay more money, make more visits to healthcare professionals, and have their disorder treated outwith the usual and recommended way to a diagnosis. If this is an advance for healthcare, I think it is a very sorry one.

Andrew Jack

Pfizer, the world’s largest pharmaceutical company, has added a new variant to its growing UK strategy of raising its profile on public health issues. First  it “co-branded” with regulators to warn the public about the dangers of counterfeit drugs - many of which also happen to be internet-purchased fake versions of its own lucrative blockbusters.

Now it has launched a new awareness campaign around the importance of lowered cholesterol in conjunction with Heart UK, a British charity. A Pfizer-sponsored leaflet provides information on heart disease, including on its own product Lipitor, the world’s top-selling prescription medicine.

The company does not fall into the trap of preferentially pushing its own product, since it lays out simply in alphabetical order the details the entire class of relevant drugs, called statins. It just so happens that the “generic” prescribing name for Lipitor is atorvastatin, which puts it at the top of the list.

There again, in a sign of its independence, Heart UK’s own website lists the statins in a different order, beginning with simvastatin (Zocor), typically the National Health Service’s drug of first preference, if only because it is no longer patented and therefore available much more cheaply. than Lipitor

Andrew Jack

There is a some good news for “neglected diseases” in the latest research by the George Institute in Australia, to identify funding for research and development into illnesses traditionally receiving little support from pharmaceutical companies. 

Nearly $3bn was spent last year in the search for new medicines in areas such as malaria, pneumonia and dengue. Drug companies are providing support, and the governments of two of the richer developing countries with many such illnesses – Brazil and India – are for the first time among the “top five” public sector funders, as they take growing responsibility for their domestic disease burden.

The bad news is that funding is stagnant and remains a tiny fraction of the efforts invested into other, richer world, diseases. But at least developing country governments and companies are increasingly taking up the slack. Over time, that may help them not only tackle problems at home but help develop local expertise in drug development that will challenge the dominance of western pharmaceutical companies in the future.

Margaret McCartney

Well-meaning medicines can have devastating effects. Antipsychotic drugs, administered in nursing and care homes to dementia sufferers, are making headlines because of the fatal harm they supposedly cause.

This is not news: knowledge of the drugs’ adverse side effects has been festering for several years. What is new is the official attention now being paid to the problem.

Continue reading “Drugged and confused”

By Rebecca Knight

We’ve all encountered people that had terrible, miserable childhoods. People who were abandoned as babies, or who grew up in poverty; people whose parents were unstable, and had problems with alcohol, or drugs, or gambling; or worse: people whose parents were cruel, and abused them.

I often think that these people, after enduring such unhappy childhoods, are somehow “owed” adulthoods free of trouble. Surely they’ve suffered enough. In the interest of fairness, shouldn’t they be blessed with good health at least? But most of the time, I observe, these people are often the sickliest. They have trouble with their weight, or have diabetes, or suffer from heart disease, or battle depression. It seems unjust.

Margaret McCartney

Those of us who prefer Cochrane reviews for our evidence, and who know that the majority of pharmaceutical companies do not publish all of their research, will not be surprised by this publication in the BMJ today: Neuraminidase inhibitors for preventing and treating influenza in healthy adults: systematic review and meta-analysis. The lead author is Dr Tom Jefferson, who we’ve interviewed for the blog. Here’s the conclusion, about the impact of neuraminidase inhibitors oseltamivir and zanamivir :

” Neuraminidase inhibitors have modest effectiveness against the symptoms of influenza in otherwise healthy adults. The drugs are effective postexposure against laboratory confirmed influenza, but this is a small component of influenza-like illness, so for this outcome neuraminidase inhibitors are not effective. Neuraminidase inhibitors might be regarded as optional for reducing the symptoms of seasonal influenza. Paucity of good data has undermined previous findings for oseltamivir’s prevention of complications from influenza. Independent randomised trials to resolve these uncertainties are needed.”

Andrew Jack

Good news for those attempting to extend antiretroviral treatment to the many millions of people with HIV in developing countries who need medicines but do not receive them.

An extensive study over six years in Uganda and Zimbabwe supported by the UK’s Medical Research Council in Africa suggests that up to a third more patients could be offered treatment, even given existing stretched domestic resources, thanks to a simple trade-off.

The Dart study, published in the latest issue of the Lancet, suggests that regular laboratory monitoring for toxic effects is costly and unnecessary, diverting funds that could instead be used to provide more drugs to patients at an earlier point in the development of the disease.

The researchers, led by Diana Gibb, argue CD4 testing, to measure the breakdown of the body’s immune response, should take place after two years’ treatment to determine whether to switch to more expensive “second-line” therapies.

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Margaret McCartney is a Glasgow-based GP and FT Weekend columnist. She started writing for the Life and Arts section in 2005 and moved to the magazine in 2008. She also has her own blog: www.margaretmccartney.com/blog

Clive Cookson has been a science journalist for the whole of his working life. He joined the FT in 1987. Clive, the FT's science editor, picks out the research that everyone should know about. He also discusses key policy issues, from R&D funding to science education.

Andrew Jack is pharmaceuticals correspondent, covering the industry and public health issues. He has been a journalist with the FT for 19 years, based in London, Paris and Moscow

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