Brief Note...

A patient came into the office today with severe arthritis of both knees. After some discussion, we both decided that she was not a candidate for surgery despite not being fully controlled with medications. Arthritis pain is a very frustrating symptom to treat. In this I envy my colleagues in Cardiology and Primary Care. If someone has high blood pressure, they rarely even know it. You tell them they have it. The patient believes you. You give them a diet and a pill and the pressure gets to normal. You are a hero. The medical treatment of joint pain is painfully incomplete.

Dr. K.


Related Topics: Stem Cells May Mend Arthritis Damage, Is Chronic Knee Pain Limiting Your Life?

Technorati Tags: arthritis, kneepain

Money for Nothing and Cures Ain't Free

Reading the newspaper is always a good thing. It is not to learn about news. It is to learn about what trends are happening next which generally are not good for the average person. I make sure I read a variety of sources since the news is really the opinions of those writing it. Sort of like this blog except here on WebMD Blogs we at least admit they are opinions while the NY Times, Washington Post, etc. actually believe they are reporting something objectively.

Just before Christmas, I read an interesting article in the New York Times business section. Let's call it an early Christmas present for people with rheumatoid arthritis...from the Devil himself.


"Rivals Laying Siege to Amgen's Near Monopoly in Anemia Drugs," by Andrew Pollack

"...Amgen's critics say that while its anemia drugs have truly helped people, its near monopoly is lasting much longer than patent law was meant to allow." Further in the story, Pollack quotes Gary Peterson, of Renalweb, a website about dialysis..."Simply put, this is a monopoly within Medicare that is now working against the patients it was intended to help and is costing U.S. tax payers billions of dollars."

Together, both of these statements represent classic examples of the depths of brain depth in logic. While one can always argue that pharmaceutical companies make a lot of money frequently, both authors need to be reminded of a few facts.

First, considering Amgen has won every patent challenge it has faced in every US court, how is it possible that its patent has lasted longer than it was meant to? Patents and other inventions are not "meant" to last any length of time. They last, by definition for as long as the law allows. Currently, biologic patents last twenty years from the time of application. When Amgen obtained its patents, the law stated that patents last 20 years from the time of their granting. Amgen, by moving their patent applications in at carefully timed moments did what any good business would do: they protected their intellectual property for as long as it could.

As it turns out, Amgen's flagship product Epogen, was so successful that the company was able to and had the incentive to develop Enbrel (etanercept). Embrel is a most recent biologic agent for the treatment of rheumatoid arthritis.

To quote from the respected Harrison's Textbook of Medicine (online version): "Clinical trials [of etanercept] have been shown to be remarkably effective at controlling signs and symptoms of rheumatoid arthritis...Repetitive therapy with these agents is effective with or without...methotrexate...[T]hey have also been shown to slow the rate of joint damage assessed radiographically and to improve disability...[S]ide effects are uncommon."

It is interesting that in the music and entertainment industry, protection of intellectual property is for 28 years, and then renewable for another 28 years but these drugs, which cost investors millions to produce get twenty years.

This is often the double standard in business and medical business. While the US taxpayers spend billions on missiles and other tools of mass destruction, it seems that when a drug helps millions of US taxpayers without question, someone thinks that is "working against the patients." I don't know, but where I come from, things that save lives are a bargain. Things that kill people are a waste of money.

According to the New York Times article, for renal dialysis patients, Epogen costs $7,000-$10,000/year and for chemotherapy patients, about $1,200/month. All told, the entire nation - Medicare and private insurance spends about 2 billion dollars on Epogen and 1.2 billion dollars on Embrel. Put in perspective, President Bush's defense budget is at over $400 billion.

Medicine is an amazing bargain. In addition, if the success of Epogen stimulated capitalism to work its magic and get Amgen to invest in Embrel which seriously helps the over 2.1 million American with definite Rheumatoid arthritis and potentially the 59.4 million Americans projected to get some form of arthritis by 2020 (Source: NIH, also see Future Approaches to Arthritis Treatment), I would strongly disagree with Mr. Peterson's assessment that extended patents are working against the taxpayers and Mr. Pollack's assessment that the patent was intended to last that long.

In fact, if I was one of those millions of Americans I would simply say thank you to Amgen and its researchers. I would sell off 300-400 Tomahawk missiles to the highest bidder and buy more of this stuff. I would close some more unnecessary bases and invest in more biologics. I would pull out say...130,000 or so troops in Iraq and freakin' buy Amgen and give out the drugs it sells for free.

When will we stop treating healthcare like it is a resource that is rationed out and defense spending as an unlimited money pit? If all the roads the federal government built, all the prisons it maintains, and all the social programs it supports worked half as well as Epogen, we would all live in a better world.

Cures cost money but they are sure worth every penny if you are the one who needs one.

Dr. K.

(Disclaimer: Dr. Kirschenbaum is NOT a consultant to Amgen, has never been a consultant to Amgen and in fact has never even met a sales representative or any employee of the Amgen company. Further, he does not even own Amgen stock. So there.)

Related Topics: Use of Enbrel in Psoriasis, New Rheumatoid Drugs Work Well, Fast Diagnosis and Treatment Key to Managing Rheumatoid Arthritis

Tags: healthcare,Enbrel,Epogen,Amgen,webmd