Fascinating story of how Lipitor almost didn’t make it; but eventually became world’s biggest blockbuster drug
Lipitor has been the biggest blockbuster drug till date with sales of over $120 Billion over the past 14 years. It recently came off patent.
I came across this great article by Linda A. Johnson in Associated Press – “Against odds, Lipitor became world’s top seller”, that chronicles the story of how this drug almost didn’t make it. It was not the first statin on the market. However, early trials showed results that were significantly better than the existing peers. The article also discusses the extensive use of marketing (targeted to the consumers and doctors). To quote a line from the article: “The Lipitor promotion team set new standards for a marketing campaign.”
One wonders if the pharma industry would ever again see such a massive success. Do read the full article, click here.
Why Doctors Hate Electronic Medical Records (EMRs)
Having studied the Electronic Medical Records (EMRs) space for a few years now, it’s clear to me that EMR adoption is a huge challenge. Even in developed markets like the US, successful implementation rates are pretty low (especially in small clinics). In spite of a huge Federal Government Incentive Program, the progress is gradual (at best).
In India the picture is a lot worse. My assessment is that EMR adoption here is in low single digits.
There are many theories and observations about why doctors dislike Electronic Medical Records (EMRs). One often discussed observation is that doctors are ‘technophobes’. I personally don’t think that’s true. On the contrary many doctors, whether in US or in India are ‘gadget freaks’ (when it comes to devices like new smartphones, laptops, cameras, etc.).
The primary issue is that of software usability. Many traditional EMR systems are quite complicated and difficult to use. These systems at times resemble heavy duty ERPs (Enterprise Resource Planning IT Systems) that run the operations of large multi-million dollar corporations. A small clinic doesn’t need all this complexity. These EMRs may actually end up hurting the efficiency of a clinic, rather than improve it. Also many of these systems do not enable interactions with patients for chronic disease management, e-consultation, telemedicine, etc. Doctors are looking for simple systems that can improve their productivity, as well as support better patient care. In absence of these, they are perfectly ok going back to their old paper notes based methods.
I recently came across an excellent article in ‘The Journal of Surgical Radiology’ by Shahid Shah, “Column: Why MDs Dread EMRs”. The author has done a great job of summarizing the major reasons that are hurdles to effective adoption. I encourage the readers to go through this article for a detailed insight into the real issues.
‘What do you do for living?’ – A psychiatrist’s personal viewpoint
Healthcare & Medicine are topics of interest for me, and I occasionally blog about these topics. Recently, my friend Dr. Bhooshan Shukla, who is a Child & Adolescent Psychiatrist here in Pune, started a new blog: http://docbhooshan.wordpress.com/ His first article is quite interesting: “What do you do for living?”. I am reproducing it here on my blog. You can also visit Dr. Bhooshan’s blog for his other upcoming articles.
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What do you do for living?
by Dr. Bhooshan Shukla
It has become my favorite past time to watch peoples’ reactions to my answer to the question – “what do you do?” I am a Child and Adolescent Psychiatrist and most people react to this fact in an interesting way -
1.“ you mean kids go crazy and require a psychiatrist? That must happen in western countries with drugs and broken families and all that stuff! Do you actually finds work in India?”
2.“ we read about student suicides all the time. If parents behaved properly and nicely with their kids, professionals like you would not be needed at all”
3.“ oh, so you are the doctor looking after genetically deformed, retarded kids!”
There are many other reactions but these three are most representative. It just goes on to show that we as a society are still quite naive about concept of mental health and illness.
Adult psychiatry has just started emerging from the closet in India and depression/ anxiety/ phobias have become “okay” illnesses. Still more severe mental health issues like schizophrenia and addictions are struggling for the attention and acceptance they deserve. It is a long way, but at least we have started.
Child psychiatry is a funny thing. We see adverts selling foods and games that claim to make your child smarter, faster, etc. There are parenting discussions in media involving famous personalities, gurus, teachers,etc. So we are aware of importance of a good, healthy childhood and are willing to put our money where our child is….but are we really aware about mental health issues in childhood?
Some people ask me what kind of kids are my patients? Now that is a question that I can answer. More than 90% of my child patients are brought by their parents for just one of two complaints – poor academic performance and discipline/behavior problems.
There are hundreds of reasons why school performance or behavior deteriorates, but most important thing is that unless one of these parameters takes a hit, there is no acknowledgement of a problem that needs professional help.
Children are like the ozone layer around the earth or tigers in our jungles. Their happiness is a sensitive indicator of society’s attitude towards life ! Following is an easy to understand classification of why things go wrong with children -
1.Problems related to brain development and physical health – like attention and concentration problems, reading and writing difficulties ( dyslexia made famous by “Taare Zameen Par”), speech and language difficulties, etc.
2.Problems perceived due to misunderstanding of normal development – certain things appear in development of a child like bedwetting, restlessness, fear of staying alone or dark places, food fads, defiance, etc. If parents are unaware of this “ normal phase” they may try to find solution to a problem that is going to go away anyway.
3.Problems in relationships – Children’s relations with family members, schools, or even friends may sometime become strained and reflect in behavior or academics or emerge as discipline issues.
4.Problems with social expectations transmitted to child by parents and school system.
5.Problematic emotions like anger, sadness, fear, excess competitiveness, etc.
All of the above issues can be assessed and helped by mental health professionals with the help of family and if necessary, schools.
One more commonly asked question is how to identify a child needing help -
there are some clear indicators –
disturbance in usual sleep, eating, interaction pattern lasting for more than one to two weeks.
Sudden and severe change in emotions like – sadness, anger, fear.
Unpredictable and rapidly changing mood.
Return of habits of younger age like- clinging to parents, excessive fear, babytalk.
Sudden change or unstable pattern of friendships.
If you suspect anything, do check -
http://www.youthinmind.co.uk/sdqonline/Parent/StartParent.php
Most importantly – most problems can be solved with the help of family counseling, child counseling and some help from school ! Medications ( from any ‘-pathy’) are very rarely needed.
Dr. Bhooshan Shukla
MD, DNB, MRCPsych
Child and Adolescent Psychiatrist
America’s Top Prescription Drugs
Wondering what the top prescription drugs are in America/Globally? Cholesterol lowering drugs? Antibiotics? Blood Pressure Medications? Anti-Depressants? Pain-Killers?
The Forbes Magazine recently published an interesting article America’s Most Popular Drugs that lists the top 15 most prescribed drugs in America. While many from my expected list showed up, I thought that there were a few surprises (inclusions and omissions). For example, was surprised to not find a single anti-depressant in the top 15 list. Maybe because there are many different anti-depressants out there. I am sure that as a category, they will show up quite a high.
The top drug in the list is the pain-killer Vicodin. Cholesterol reducing drugs, blood pressure medications show up in a large number in the top 15 list. So do a few of common antibiotics.
In a sense, this list gives an indirect overview of the types of common ailments, as well as the state of the health of the population. I wonder what such a list would look like in India/other countries. I think, in India more antibiotics might show up in the top drugs list.
Is the paranoia around H1N1 in Pune / India justified? – A look at some factoids & information resources
Honestly, I don’t have the exact answer. Only time will tell whether we, the citizens of Pune (and India) over-reacted, or should have done a lot more. All we have right now are statistics, data-points, examples from other regions of the world, and expert advisories to look at and learn from.
In this article, I am listing out the various relevant factoids, observations and information resources that I have stumbled upon over the past few days. I will let the readers draw their own conclusions.
What is painfully clear though is that we don’t have enough data, and we often don’t rely on credible sources of information. In absence of data and facts, the common population is always swayed by ‘headlines’ and ‘sound bites’ – Sadly, this is true even in the 21st century. Thanks to the latest technology, data can be accessed easily; yet this same technology can also help in spreading rumors a lot faster as well.
Here are some factoids and observations:
1. According to WHO and other estimates, there are nearly 1 Billion cases of normal flu (influenza) each year. Around 3-5 Million of these are severe and 300,000 – 500,000 of these result in deaths.
Statistically speaking (based on a simple extrapolation that India’s population is apprx 1/5 of World Population) that translates to 200 M cases, 600,000 – 1 M severe cases, and 60,000 – 100,000 deaths.
For a city of Pune, that translates to 500 deaths/year or 10 deaths/week.
All these are huge numbers. And yet, until a few weeks back, we hardly even thought about ‘influenza’ as something serious!
2. On a related topic – Pollution levels in Pune and in all major Indian cities are at very dangerous levels. Yet very few perceived the need to wear masks over all these years. Do we know the statistics of upper respiratory problems in major Indian cities?
3. According to WHO (World Health Organization), the recommended mask to protect against H1N1 infections is the one that meets the N95 standard. Yet, these constitute a miniscule amount of the ones being worn around in Pune. The others don’t really offer any significant help. For a complete list of Do’s and Don’ts regarding masks – please refer to the next section.
4. Commonsense tells us that it is better to wear masks in crowded places; but they are not very critical when walking or driving on uncrowded, open roads. Yet, what we are seeing around in Pune is quite the opposite. It is also amazing to see so many people wearing masks that are covering their mouths, but not their noses?!
5. Last year, over 200 riders lost their lives in 2-Wheeler Accidents in Pune – many of these deaths could have been prevented had the riders been wearing helmets. Yet I see so many people on Pune roads today wearing masks but not helmets!
6. According to what I have read thus far, the H1N1 strain is not significantly more virulent than the traditional influenza virus. The prescribed treatments are also very similar to normal flu.
7. Most individuals who get infected with H1N1 will get back to normal in a few days (similar to the normal flu). This is not a virus like HIV that an individual will carry with him / her for the rest of their lives!
8. Apparently, a vast percentage (by some accounts, up to 90%) of the Indian population tests +ve on the skin test for TB (Tuberculosis). Majority of these tests yield a –ve result on a follow-up (and more reliable) X-Ray test. Disease causing germs (viruses and bacteria) are present everywhere – in most of the cases, the immune system should be able to take care of them! It is only when the immune system becomes weak (in case of old age, young children, patients suffering from certain chronic ailments, etc.) do these germs present any significant danger.
Here are some useful information sources:
1. Flu related statistics (from Roche Laboratories – makers of Tamiflu) http://www.flufacts.com/impact/statistics.aspx
2. Comprehensive Flue Related Information from US Dept of Health & Human Services and CDC (Center for Disease Control) www.flu.gov http://www.cdc.gov/h1n1flu/
3. Comprehensive Flue Related Information from WHO (World Health Organization) http://www.who.int/csr/disease/swineflu/en/
4. A map based depiction of Flu cases across the globe http://www.healthmap.org/en
5. WHO – FAQ about H1N1 http://www.who.int/csr/disease/swineflu/frequently_asked_questions/what/en/index.html
6. WHO – Document regarding use of masks http://www.who.int/csr/resources/publications/swineflu/masks_community/en/index.html
7. WHO – Document regarding cleaning hands as a key preventive measure http://www.who.int/csr/resources/publications/swineflu/AH1N1_clean_hands/en/index.html
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