Here, we discuss some possible solutions to the problems posed by DTCA and marketing of healthcare, outside of the obvious solution of banning DTCA, which we don't have much faith will happen anytime soon in the United States.
Ethan: What do you think if each of these big pharmaceutical companies were required to pay a subsidy to a 3rd-party independent research company that then utilized those funds to run after the fact studies on the medications to determine independently if they're efficacious or not, like a collaboration group.
Michael: My problem again, just cynical, is how do you prevent the outside influence on that thing? Because you look at, for example, a state formulary committee; there have been accusations in the state of Texas about how they derived the medications on their formulary and whether or not certain [00:01:00] brand name products were given preferential treatment. And so, any state formulary, any facility that designs a formulary about which drugs you include or exclude, there's been a lot of concerns about influence from the companies. And I'm just still cynical that there still wouldn't be an influence on that company. Who watches the watchman kind of approach. How do you shield them? The FDA already has a thing where, if you pay us more money, we'll fast track a drug. Certain people trying to come up with companies that will do research on generics, I think is one. There was one I tried looking at called Cure Accelerator, the idea of repurposing existing drugs. They're dirt cheap, let's study them. Trying to get it so it's not just incumbent on a drug company as well as now you get people to maybe take a risk on an existing medication and then give that a shot. But again, we're not there yet.
Ethan: I guess you could have some sort of like public research platform, which would definitely take away from the scientific nature of it and the kind of strict nature that we should have with research, but it would also allow [00:02:00] anybody and everybody to participate in that research process. We've got to change the way that research is done and there's got to be some sort of incentivization for the companies to actually come up with medicines that make us a healthier society. But that's got to be incentivized or else they're gonna look to next quarter or next year's profit margins and not to whether or not we've found more meds that are more beneficial for treating specific conditions.
Michael: I'm looking at my Twitter account to find, I liked a tweet from (J Clin?) Psych, Nassir Ghaemi wrote, I haven't read the full article...
Ethan: Oh, Ghaemi.
Michael: Yeah. Great writer.
Ethan: He's got a great podcast too.
Michael: He had a point-counterpoint in J Clin Psych, the quote of his commentary was the need for nonprofits, psychiatric drug discovery and development. And again, haven't read the whole thing, but that concept, I'm on board. As I said, Cure Accelerator is another one that's done this overseas. There's a few of these other ones where they're trying to balance it out so that there's maybe not as much of a profit. [00:03:00] But again, it's a benefit for the consumers. It's a benefit for the payers as well, because if you have a drug that's very cheap and we can repurpose it and use it effectively, Prazosin, and again, we have decades upon decades of data about the long term safety. We know it because it's been on the market for a very long time. So there's less concern about what's gonna happen when you're on it long term? We already know that, so we're repurposing existing drugs. That's something that I'm very big believer in, my goodness, people talk about Luvox, Fluvoxamine, we learned about it may have a role in COVID. So, there's pros and cons, but the idea is that we've got existing medications that we approved not knowing what they actually did, and then we learn what they can actually do. Minocycline, an antibiotic, for a while was the sexy new augmentation strategy for clozapine. We have tons of years of data showing that they're safe, but now let's use that and get lots more data about do they work? But again, you need more than just a couple schools to do that. And that's where having a big nonprofit, again, if it too would still be [00:04:00] free of that undue influence.
Ethan: You got any other ideas on, how to, besides just overhaul the FDA, create more separation between pharmaceutical companies and the FDA?
Michael: For those listening, sign up to be a reviewer of journal articles. If you notice something seems off, you know, for example, if you say, all right, 45% dropout rate, that's something you note, because anytime you say the drug is effective the percentage of efficacy is only based upon those who didn't drop out. And so that negatively affects the applicability to a given population. Do those things. State your concerns when you do peer reviews, writing editorials, being involved with local organizations or national organizations for physicians or pharmacists, whomever, and talk about these things, as well as providing education for coworkers. Every now and then, even the FDA looks for individual stakeholders. And so I've had chance once [00:05:00] to talk to the FDA about concerns about a medication. Just also then try to, again, maintain that objectivity through your career and be consistent about that, acknowledge to your patients that there are gonna be concerns about treatments and as best as we can, we're going to find a treatment that can apply to you. When we're interpreting studies, we're making sure that, if I'm gonna say I'm gonna use this medication for this patient, or recommend it, that ideally it's been studied in that type of person. If your patient is in a minority population that was underrepresented in those studies, you have to keep that in mind. Are there unintended consequences to this thing? Do I feel like there's been enough information and enough time out there to really understand the medication? Those are all things you can do.
Ethan: And on the flip side, as a patient, ask your doctor about these things, try to educate yourself, recognizing that you may not have the educational background or the experience with being able to comb [00:06:00] through data, but it is your life, it is your health outcomes, and you can ask your doctor, your physician, your provider, whatever you want. You are the one that is spending money on your healthcare. You are the one that is impacted by these things. So ask them about it. And one thing that I want to point out on the solution front, when we talk to patients about these issues, there may be a desire for patients to seek alternative forms of medicine. The same things that impact negative outcomes in our American healthcare system are happening in the supplement market. Businesspersons, people looking for profits, are preying on the uncertainty that comes with your health. They are preying on the fact that a lot of us realize some of the drugs that are touted as [00:07:00] effective are not effective, that we are being sold snake oil. And that does not mean that the supplement market should be trusted without question. And the reality with supplements and alternative medicines is that they are rarely studied, against the standard of care. So again there just needs to be a healthy amount of skepticism with anything that you are being sold. And it is important to your health to get help, to get education, but you also need to be assertive about asking where the information's coming from. Michael said whether or not it applies to you and what are the potential downsides or negative effects of this medication or this treatment?
Michael: Something you just said, an easy jumping off point, is maybe even ask, is this treatment of being recommended against the standard of care? Because sometimes, there's been a medication that's been around for decades and [00:08:00] decades, and then yes, somebody may recommend a newer medication, but you can ask are we doing this now because it's in the front of our minds, or is this the new standard of care? Lithium is the example, it's been around for ages, it's dirt cheap, are we choosing something new just because it's new or is it that much better? If they say that, ‘No, this isn't the standard of care yet,’ then maybe the question is, what does it offer better, and at what cost of side effects? So I think that simple question there could be a wonderful jumping off point.