Articles

NAPC News 24 August 2012

Novartis Takes India To Court Over Loss Of Drug Patent

One of the world’s biggest drug companies, Novartis, has this week taken the Indian government to the nation’s Supreme Court in a landmark case that could affect the prices of life-saving medicine for hundreds of millions of people.

The Indian government denied Novartis a patent for Glivec.  Ranjit Shahani, managing director of Novartis, India, has characterised the litigation as an attempt to ‘advance the practice of medicine’, but opponents of the company have claimed that a government defeat would result in thousands being unable to afford the drug.

Greek Austerity Leads To Speculation In Medicine

GlobalData has reported that competitive lowering of drug prices in Europe has created a host of speculators buying medicines cheaply in one country to sell in another at a much higher price.

The practice is credited with pharmaceutical shortages.

Sir Andrew Witty, CEO of GlaxoSmithKline, and President of the European Federation of Pharmaceutical Industries and Associations, wrote to European leaders in June noting that through price cuts and discounts the pharmaceutical industry had contributedPh more than E7bn to Greece, Ireland, Italy, Spain and Portugal in 2010 and 2011.

Nicholson Orders Trusts To Offer Approved Drugs

All NHS organisations have been ordered to publish details of which drugs they will routinely fund in a bid to make sure that patients get medicines to which they are legally entitled.

NHS chief executive, Sir David Nicholson, has given trusts and clinical commissioning groups until next April to reveal which drugs approved by the National Institute for Health and Clinical Excellence are included in their formularies.

By law the health service is required to automatically fund all drugs recommended by NICE.  However, this does not always happen in practice.

In a letter to primary care trust and strategic health authority chief executives, as well as CCG leaders informing them of the new requirement, Sir David said local formularies should not duplicate NICE assessments or challenge an appraisal recommendation.  He added that once on formularies, there should be no further barrier to the use or prescription of technologies or medicines.

Sir Michael Rawlins, Chair of NICE, commented that Sir David’s letter should lead to a very positive result.  He did not think that trusts would dare leave out any NICE approved drugs; it would be too glaringly obvious that they were breaking the law.  There would be lots of people checking, including patient organisations and pharmaceutical companies.

Asked about the criticism that NICE technology appraisals did not take into account the financial situation within the NHA, Sir Michael said that was not an issue for NICE.  It was the law the NHS provided these drugs.  Until that law is changed they have to obey the law.    

NHS Urged To Think Long Term To Save

NHS organisations need to think more long term to innovate and release more savings, NHS South of England chief executive, Sir Ian Carruthers, has said.

By 2013/14, trusts will have to introduce high-impact innovations identified by last year’s Department of Health Innovation, Health and Wealth review or risk losing up to 2.5 per cent of their income.  Sir Ian, who led the review, said their rollout would improve the quality of care, add social value and reduce mortality.  The patient outcome was the priority, followed by taxpayer value.  To achieve these, you need to take a view that is greater than one year.

He went on to say: ‘Quite often people make short-sighted decisions where saving tuppence today is more important than saving three times as much in a few years’ time.  We have to look at some decisions in different ways.’  He continued that this could not mean that trusts ran deficits in the early years of change plans.

The review’s six work stream were chosen to demonstrate different sorts of innovation.  The ‘child in a wheelchair in a day’ programme aims to facilitate a consumer responsive service redesign, while the rollout of telehealth to three million people intends to change care delivery settings.  The move to ‘digital by default’, where fact to face consultations between patients and clinicians happen only where necessary, requires a culture change.

Sir Ian said it would be for commissioners to agree which of the innovation would be relevant for individual organisations to introduce or release 2.5 per cent commissioning for quality and innovation payment.

He said the CQUIN, along with the introduction of academic health science networks and the ‘thirst’ to move to best practice due to the economic imperative, would see the NHS get over its traditional slowness at adopting innovation.

Sir Ian said Innovation, Health and Wealth had attracted interest from pharmaceutical and medical technology industries in China, Australia, Singapore, the US and New Zealand.

Is There A Cholesterol Cover Up

(From Monday’s Daily Telegraph)

Statins are currently recommended for those who have a 20 per cent risk of heart attack.

We all know the mantra: high cholesterol causes heart attacks, so foods high in saturated fats which raise cholesterol should be avoided.  We also know that by the age of 40 as many as one in three of us will be taking cholesterol-lowering drugs called statins, to reduce our risk of coronary heart disease.

Now a controversial new documentary has questioned this received wisdom.  It asked whether the link between saturated fat (found in foods like butter and cream), high cholesterol and coronary heart disease is as straightforward as believed – and it warned that we mess with cholesterol levels at our peril.  Statin Nation: The Great Cholesterol Cover-Up, made by Justin Smith, a former personal trainer at the BBC turned film director, includes interview with cardiologists and other specialists, yet it has been widely attacked by others in the medical establishment as ‘simplistic’ and a ‘travesty’.

Smith’s film will be released as video on demand next month and was ‘crowd funded’ – made with money he raised from the general public.  In it, he asks why it is that, if high cholesterol causes heart disease, cholesterol levels for men in Britain are the 15th lowest among 45 countries in Europe, yet Britain still has one of the highest levels of heart attacks.  He also queries why both men and women in the lowest social economic group die of heart disease at far higher rates than their richer peers, yet do not have higher cholesterol levels.

While the ‘bad’ low-density lipoprotein (LDL) cholesterol is widely blamed for clogging up the arteries and causing heart attacks, doctors in the documentary argue that it is wrong to see cholesterol (or saturated fats) as the villain of the piece.  They suggest the key to heart disease is initial damage to the artery wall, and that cholesterol is one of the substances used to effectively form a scab over the rupture, before the artery wall grows over this again.  ‘Essentially, cholesterol is there to help repair the damage,’ said Dr Malcolm Kendrick, as Scottish GP and author of The Great Cholesterol Con.  ‘It’s a bit like blaming firemen for causing fires, because they are there when fires break out.

The film also claimed a US study form 2009 showed that patients with heart disease had lower levels of LDL cholesterol than the general population, as did studies in Hawaii and Austria.

London’s Cardiac Arrest Survival Rate ‘Best In England’

London’s survival rate following an out-of-hospital cardiac arrest is the best in England, new figures show.

A total of 362 people in the capital were successfully resuscitated and discharged from hospital after their heart stopped beating in 2011/12.  This means that 32 per cent of out of hospital cardiac arrest patients survived, compared with just five per cent ten years ago.

The report also revealed that a greater number of members of the public are attempting cardiopulmonary resuscitation (CPR), which doubles a patient’s chance of survival while they are awaiting the arrival of ambulance staff.

Cot Death Rates At Record Low

The number of babies dying from unexplained causes has fallen to an all-time low, new figures show.Data published by the Office for National Statistics revealed that there were 254 unexplained infant deaths in 2010, compared with 440 in 1996.

The rate of unexplained infant deaths, including cot death, is at its lowest level since records began.  It fell to 0.35 per cent per 1,000 live births in 2010, down from more than 0.6 per 1,000 live births in 1995, when figures were first compiled.  

The figures also show that babies born in London are much less likely to die from unexplained causes than those born in the north west of England.

Frances Bates, chief executive of the Foundation for the Study of Infant Deaths, welcomed the overall reduction in the number of deaths, but said the figure for the north west was ‘extremely concerning.

‘The region has had the highest rate for the last seven years.  We know that smoking is a major risk factor of sudden, unexplained infant death and the smoking rate in London is the lowest in the UK, but the rate of the north west is above the national average.’