Rheumination

Breaking News From The Vatican

It is widely known that Catholic nuns suffer an increased risk of developing osteoporosis, related to their wearing of a habit which restricts sun derived vitamin D.  Widely known maybe, but I haven't actually been able to dig up the actual study that proves this point.   I did find one article who's abstract restates this finding but also attributes the increased risk to the advanced age of this cohort. (And I ain't going to fork over $31.50 to get the original article)

In any case, there is evidence that simply acting like a nun can lead to osteoporosis.

Sally Field has been found to have osteoporosis and is now shilling for an osteoporosis pharmaceutical.  It appears to  have something to do with weightlessness, a similar mechanism affecting astronauts on the space station.

Now news has arrived that the Pope has suffered a wrist fracture after falling in the bath.  This low impact type fracture could well suggest that the Pope suffers from osteoporosis which often leads to this kind of fracture.  Could this be related to the wearing of long, neck to toe garb, restricting access to sunlight in the same manner as the nuns? Should being a man of the cloth be considered a risk factor for male osteoporosis? More importantly, which pharmaceutical company will get to claim that it's product is the 'preferred choice of holy men worldwide.'

Darvon, Really?

The FDA has decided after fifty years it's time to get tough with Darvon.  Surprisingly the drug is apparently still popular in the States, if only amongst drug abusers.  Here, I have only a single patient who still uses this mild narcotic.  The patient is in her eighties and has apparently used the drug forever, twice a day.  She lost her family doc recently and so I've had to prescribe her Darvon for her.  I was rather uncomfortable at first, this drug having been out of fashion before I even graduated from med school, so many  years ago. I kind of worried what the pharmacist might think.    I eventually got over the weirdness and now, in fact, I kind of like playing Dr. Marcus Welby  whenever I see her.  

"So, do you think you might need your librium topped up as well?"

A Billion Here, A Billion There...

Last week Johnson and Johnson/Centocor won it's patent law suit against Abbott concerning Humira.  The jury trial concluded that adalimumab (Humira) inpinged on J&J's patent for infliximab, and awarded them 1.7 billion dollars.  Apparently they felt that the fully human antibody was not adequately different from infliximab.  Hard to believe that a jury is left to ponder these kind of decisions.  In any case, Abbott would continue to sell their drug but would owe royalties.  Given that sales of Humira in 2008 were in the order of 4.5 billion dollars, we're talking about serious cash.  Not that Abbott is caving though.  They're appealing the decision and counter suing J&J over Symponi, J&J's own fully human anti-TNF that is just now coming out.  Could be amusing.

Comparative Effectiveness in Rheumatology

Interesting times ahead I think.

  The Obama administration's new Comparative Effectiveness Research initiative seems to have rheumatological biologics in their sites.  That may or may not be a good thing. In one respect this is clearly welcomed.  There are now four anti-TNF drugs available in Canada with a fifth not far away.  Orencia, Rituximab and soon Actemra are the other biologics in the rheumatologist's arsenal. Weirdly, almost every biologic has clinical studies with near identical results for ACR 20, 50 and 70.  Side effect profiles are hard to compare because the important ones, infection and cancer, don't seem to be very high in these studies.  Large databases are starting to tease out some results but not much, and not quickly. Getting to that information isn't so easy either.  Each pharma company brings over the European database researcher that seems to best support their drug, or at least some tiny advantage that they may have tumbled upon.  So it would be nice to have a third party, a party with a little oomph and a little cash,  try to look at all the data and try to sort things out. Head to head trials would be great but I don't think there will be enough cash in the till to do an adequate job with the biologics.

On the down side, and a worry for everybody, is whether the information gleaned will be used to limit choice.  It's a little less a concern here in Canada as in Britain, only because we are already acclimatized to government interference.  In Britain, for example, Orencia will not be covered for RA.  It is in Quebec, but with numerous criteria.  The criteria established are not horribly onerous but the paperwork is.  And it could get worse after the Comparative Effectiveness Research gets rolling.

So there could be some bad with the good, but overall, I think I'm ready for a non-pharmaceutical company based appraisal of the biologics.