Medsafe is a waste of time

Medsafe denied New Zealanders access to four drugs approved in comparable regulatory jurisdictions in the last three years. Medsafe rejected two other drugs in the last three years but these drugs were not approved in comparable jurisdictions. Doxorubicin Liposomal, chemotherapy drug, is not as yet actually refused, its application is pending. Medsafe is not involved in the funding of medicines; this is the responsibility of PHARMAC.

Source: data released 29 October 2015 pursuant to an Official Information Act request to the Ministry of Health.

What’s the point of this regulatory arm of the Ministry of Health? Is it a waste of space? Should not New Zealand automatically register any drug approved in the USA, UK, Canada, Australia or Germany? What can medical trials in New Zealand find out were not already found out overseas? Medsafe targets processing applications for the approval of new drugs in New Zealand to be done within 200 days. That’s 200 days too many.

It should be lawful under the Medicines Act 1981 to market any drug in New Zealand which any of Australia, UK, USA, Canada or Germany has approved for prescription to patients.

If economists have a bitter drinking song, a battle cry that unites the warring schools of economic thought all, it would be “how many people has the FDA killed today”. For example, drugs became available years after they were on the market outside the USA because of drug approval lags at the FDA. The dead are many. To quote David Friedman:

In 1981… the FDA published a press release confessing to mass murder. That was not, of course, the way in which the release was worded; it was simply an announcement that the FDA had approved the use of timolol, a ß-blocker, to prevent recurrences of heart attacks. At the time timolol was approved, ß-blockers had been widely used outside the U.S. for over ten years. It was estimated that the use of timolol would save from seven thousand to ten thousand lives a year in the U.S. So the FDA, by forbidding the use of ß-blockers before 1981, was responsible for something close to a hundred thousand unnecessary deaths.

In 1962, an amended law gave the FDA authority to judge if a new drug produced the results for which it had been developed. Formerly, the FDA monitored only drug safety. It previously had only sixty days to decide this. Drug trials can now take up to 10 years.

Sam Peltzman showed in a famous paper in 1973 that these 1962 amendments reduced the introduction of new drugs in the USA from an average of forty-three annually in the decade before the 1962 amendments to sixteen annually in the ten years afterwards. No increase in drug safety was identified.

Medsafe is a cost with no benefits to the New Zealand public. Medsafe has around 60 staff operating out of two offices, with centralised administrative functions, product approval and standard setting at the head office in Wellington.

How much of this budget of several million for Medsafe could be redirected to funding more life-saving and life changing drugs for use in New Zealand? This is rather than wasted on duplicating clinical trials already completed overseas or at the minimum duplicating regulatory approval processes, paperwork already completed overseas but not requiring a duplicate clinical trial in New Zealand.

At a minimum, the net benefits of the entire drug approval framework over the past three years in New Zealand is riding out on rejecting for approval half a dozen drugs, four of which are approved as safe in other comparable jurisdictions. That’s a pretty thin reed on which to hang a large budget that could be used by PHARMAC to fund life-saving drugs.

There should be a post box at the Ministry of Health to receive the certifications from overseas drug regulation agencies. Anything more is a deadly waste of taxpayers’ money.

My next round of Official Information Act requests will ask whether the minister and associate ministers of health were briefed on refusals of new medicines approved in other jurisdictions. Next I will ask:

  1. for any evidence that a separate regulatory authority for drug approvals in New Zealand has any benefits, and
  2. whether the Medsafe regime has ever been subject to a cost benefit analysis.

I have previously asked for information on drug approval lags. That was refused on the grounds I can look it up for myself on a rather complicated public database that requires knowledge of the names of medicines submitted for approval. Still mulling over what to do about that.

@BernieSanders @HillaryClinton drug price controls will shorten lives

Eroom’s Law in pharmaceutical R&D

via Figure 1 : Diagnosing the decline in pharmaceutical R&D efficiency : Nature Reviews Drug Discovery.

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@JosephEStiglitz talks sense on flaws of the #TPPA @ItsOurFutureNZ @greencatherine @RusselNorman

Joe Stiglitz occasionally gets it right such as this week when he spoke about the downside of the Trans-Pacific Partnership Agreement. As he said:

The reality is that this is an agreement to manage its members’ trade and investment relations – and to do so on behalf of each country’s most powerful business lobbies.

Make no mistake: It is evident from the main outstanding issues, over which negotiators are still haggling, that the TPP is not about “free” trade.

Because of all the haggling over the trade-offs where you do something stupid in return for the other side doing something sensible in terms of liberalisation or something equally stupid in additional regulation, the gains in the agreement can be quite small. Again as Joe Stiglitz explains:

New Zealand has threatened to walk away from the agreement over the way Canada and the US manage trade in dairy products. Australia is not happy with how the US and Mexico manage trade in sugar.

And the US is not happy with how Japan manages trade in rice. These industries are backed by significant voting blocs in their respective countries. And they represent just the tip of the iceberg in terms of how the TPP would advance an agenda that actually runs counter to free trade.

The case for intellectual property rights over drugs is complicated but no one seems to be suggesting that patents should be lengthened.

Far more can be gained in terms of drug availability through regulatory reforms that streamline the drug safety approval process which is currently costing many people their lives.

Sam Peltzman showed in a famous paper in 1973 that the 1962 amendments to US Federal drug approval laws reduced the introduction of effective new drugs in the USA from an average of forty-three annually in the decade before the 1962 amendments to sixteen annually in the ten years afterwards. No increase in drug safety was identified.

The most bizarre part of drug approval processes is they go beyond the checking whether the new drug is safe. What is even more bizarre in New Zealand is the New Zealand drug safety agency duplicates safety processes already performed overseas. This is instead of automatically approving any drug or medical device approved in the USA, UK, Canada or Australia.

Drug safety regulators in the USA also check to see if the drug works – that the drug has its predicted effects. Drug safety is a health policy concern but whether the investors developed a useful drug is something between them and those interested in buying it. Drugs became available years after they were on the market outside the USA because of drug lags at the FDA. To quote David Friedman:

In 1981… the FDA published a press release confessing to mass murder. That was not, of course, the way in which the release was worded; it was simply an announcement that the FDA had approved the use of timolol, a ß-blocker, to prevent recurrences of heart attacks.

At the time timolol was approved, ß-blockers had been widely used outside the U.S. for over ten years. It was estimated that the use of timolol would save from seven thousand to ten thousand lives a year in the U.S.

So the FDA, by forbidding the use of ß-blockers before 1981, was responsible for something close to a hundred thousand unnecessary deaths.

It is a pity that the far left movement ranted against the TPP focused on conspiratorial theories about investor state dispute settlement rather than the risks of this trade deal to the cost of drugs to the health sector. Only late in the game did the far left start talking about drug availability and the costs of drugs to the health budget of the government if patent lives were extended under the TPPA.

A campaign against the TPPA on the basis of its impact on drug availability because of longer patent terms running up against the limited budgets of pharmaceutical purchasing agencies would have appealed across the entire political spectrum. As Joe Stiglitz explains:

The TPP would manage trade in pharmaceuticals through a variety of seemingly arcane rule changes on issues such as “patent linkage,” “data exclusivity,” and “biologics.”

The upshot is that pharmaceutical companies would effectively be allowed to extend – sometimes almost indefinitely – their monopolies on patented medicines, keep cheaper generics off the market, and block “biosimilar” competitors from introducing new medicines for years. That is how the TPP will manage trade for the pharmaceutical industry if the US gets its way.

The health sector can only so much to buy drugs. If drug patents last longer, there is less money to go around because the generics become available later than otherwise.

The most dangerous monopoly: When caution kills

Killer drug approval lags

New drug lags versus laboratory federalism

The rising cost of bringing new drugs to the market

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Pharmaceutical Regulation: A Matter of Life and Death | Sam Peltzman

Incentives facing the FDA on drug approval

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How many people has the FDA killed today?

Beta blockers regulate hypertension and heart problems. The FDA held up approval of beta blockers for eight years because it believed they caused cancer. Dr. Louis Lasagna of the Tufts University Center for the Study of Drug Development estimated that 119,000 people died who might have been helped by that medication.

Clozaril was first approved and used in 1970 in Europe to treat schizophrenics who did not respond to other medicines. The drug was not approved in the United States until 1990 because companies believed the FDA would reject it on the grounds that 1 per cent of all patients who take the drug contract a blood disease. Clozaril has a beneficial effect on 30 to 50 per cent of patients. FDA delay meant nearly 250,000 people with schizophrenia suffered needlessly.

cat

Mevacor is a cholesterol-lowering drug that became available in Europe in 1989 but did not in the United States until 1992. Taking the drug reduced death due to heart disease by about 55 per cent. During that three-year period as many as a thousand people a year died from heart disease because of this FDA delay.

From 1938 until 1962, the FDA had sixty days to disapprove the application of a new drug. If it did not, the drug could be marketed. The system worked without significant incident.

The dead are many but who did the FDA save from unsafe drugs. There is an infallible test. That test is based on the FDA not being infallible.

The FDA must have made some errors and let some unsafe drugs slip through which caused the hundreds of thousands of deaths needed to make up for the deaths  – the premature deaths –  that were the result of drug delays. What were those drugs that slipped through the net?

via Unpleasant Economists : The Freeman : Foundation for Economic Education.

Learn Liberty | The most dangerous monopoly: When caution kills

The economics of the Dallas Buyers Club

Deciding if a new drug is safe is a serious issue. Separate to this is whether the drug is better than existing drugs.

In 1962, an amended law gave the FDA authority to judge if a new drug produced the results for which it had been developed. Formerly, the FDA monitored only drug safety. It previously had only sixty days to decide this. Drug trials can now take up to 10 years.

Who cares if a safe drug works or not? If a new drug does not work or is no better than the existing drugs on the market, the investors in the development of the new drug bear the (unrecoverable) development costs. Capitalism is a profit AND loss system. Losses are a signal that you should try something else.

Sam Peltzman showed in a famous paper in 1973 that these 1962 amendments reduced the introduction of effective new drugs in the USA from an average of forty-three annually in the decade before the 1962 amendments to sixteen annually in the ten years afterwards. No increase in drug safety was identified.

Drugs became available years after they were on the market outside the USA. To quote David Friedman:

“In 1981… the FDA published a press release confessing to mass murder. That was not, of course, the way in which the release was worded; it was simply an announcement that the FDA had approved the use of timolol, a ß-blocker, to prevent recurrences of heart attacks.

At the time timolol was approved, ß-blockers had been widely used outside the U.S. for over ten years.

It was estimated that the use of timolol would save from seven thousand to ten thousand lives a year in the U.S. So the FDA, by forbidding the use of ß-blockers before 1981, was responsible for something close to a hundred thousand unnecessary deaths.”

AZT double-blind trials collapsed in the mid-1980s in the USA because participants sold the drug in the black market.

If memory serves right, Australian drug regulators planned to duplicate these double-blind trials in Australia before approving the drug. Last time I checked, the physiology of Australians was the same as any other human being. What did they plan to find that justified the delay in approving AZT?

The duplicate double-blind AZT trials in Australia were abandoned not because they were mad and evil, but because again the participants sold the drug in the black market. That was to be expected too so the duplicate double-blind AZT trials in Australia in the 1980s were a double evil.

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