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Drug company access to patient records?
Drug company access to
ess and less profitable. According to Merck the merger will create America’s
patient
First "coordinated
power to negotiate favourable drug prices from manufacturers. Medco handles about 95 million prescriptions a year, worth about records? $4 billion, distributing them through mailorder services and a network of retail world’s the & Merck largest drug pharmacies. But what is perhaps most Co, on 28 that it important to Merck is Medco’s database, announced July manufacturer, would purchase the largest distributor of which has the prescription histories of the discount drugs in the United States, Medco 33 million Americans who get their drugs Containment Services, Inc. The$6 billion through Medco-administered plans. Merck decided to purchase Medco after a deal allows Merck to buy its way into the business of managed care and gain access to year-long strategy evaluation. It was beMedco’s formidable marketing machine. coming increasingly clear that managedMedco, which is based in Montvale, New care buyers were going to dominate the Jersey, manages drug-benefit plans for prescription market. It has been projected more than 100 Fortune 500 companies, 132 that by 1995 two-thirds of drug purchases union groups, 34 state and federal plans, would be made through some form of : and 58 Blue Cross and Blue Shield and managed-care plan, said company spokesinsurance companies. The company works . man Kevin Colgan. Meanwhile, drug with the plans to establish low-cost fordevelopment and manufacturing has been mularies and wields its considerable buying, becoming more and more competitive and
NO good and bad
Educated wallet
through the
Excessive production of nitric oxide has The restriction on prescribing in the new been associated with several disease states. ’ German Health Structure Law is being felt In the nervous system, however, NO seems 1 painfully by pharmaceutical manufacturers to have both neurotoxic and neuroprotecI (except generics producers) and even more tive effects. To unravel the mechanism for these paradoxical effects, Lipton andby the pharmacists. The number of pharmacies grew after the Supreme Court colleagues1 examined the effect of redox states of nitric oxide on rat cerebrocortical decision in 1956 to end the restrictions on cultures. They found that neurotoxicity their numbers. Nevertheless annual inoccurs when NO is present in the reduced creases in prescription costs of around 10 form (as NO.), the effect being mediated, at assured golden days for all except those in ’
pharmaceutical
care
:ompany". Colgan said that, using Med:o’s database, Merck will be able to analyse doctors’ drug choices and recommend other regimens if warranted, to monitor patients’ compliance and remind them to refill their prescriptions, and to collect outcome data to help develop cost-effective medical therapies. But there are sceptics. Some Medco customers say they will wait and see whether Medco remains an independent purchaser of prescription drugs or merely a purveyor of Merck products. And consumer activists say they find any plan that gives corporations access to patient records worrying. Mark
McCarthy
cutting down on prescriptions "for the devil’s sake" at the expense of pharmacists and the pharmaceutical industry, to protect their own financial situation, and that the patient’s position was no longer being taken into account in many therapeutic decisions. In some areas pharmacists’ associations have been encouraged to collect complaints of customers who felt that they were not being prescribed all the drugs they needed. The Sick Fund physicians, however, have been selective in what they have cut down on-they obviously know the weak spots in their prescribing. Compared with prescriptions in March, 1992, those for lipid-lowering agents had fallen by 42-8% in March, 1993, those for varicose vein remedies by 34-2%, those for "blood flow enhancing preparations" by 26-5%, those for vitamins by 25-4%, and those for mineral supplements by 22-6%. Prescriptions for medicines of definite value dropped initially but have returned to former levels.
were
Now many pharmacies face uncertain future. : Under the new law (see Lancet Feb 13, p 427), if the Sick Fund drug expenditure exceeds a certain sum, doctors will have to pay part of the excess. At first the pharmacists criticised the Health Minister, but they have turned their anger against the medical profession because doctors are now epilepsy, trauma, neuropathic pain, and spending well below budget. In an editorial various neurodegenerative diseases (such (Pharm Ztg 1993; 138: 1981), the president as Parkinson’s disease) are thought to be of the Assembly of German Phamacists mediated in part by excessive stimulation of Association (ABDA) alleged that doctors Karl H Kimbel NMDA receptors, manipulation of the redox chemistry of NO to lessen NMDAabout the number of cases where a funeral receptor-mediated neurotoxicity could v for the dead have therapeutic implications. Another company has known about a patient’s death even before the relatives have been notified. approach would be to limit peroxynitrite formation with scavengers of superoxide or The Portuguese authorities are particularly Some Portuguese hospitals have come concerned that this nitvic oxide synthase inhibitors, for excompetitiveness does ample. The ideal drug, says Snyder in an under criticism for their involvement in the not reach the scale found in some Italian accompanying article,would be one that fierce competition for business amongcities. In June a male nurse in Milan was prevents the formation of NO. while funeral directors. Relatives and friends of sentenced to 28 years in jail for killing a the deceased are pestered and pressurised enhancing the formation of NO +. patient for the commission fee offered by by funeral directors, who work openly inthe undertakers. More recently a hospital Vivien Choo hospitals. To try to keep matters underorderly has been arrested for allegedly control, some hospitals operate a rota sys- killing 20 patients by adding lethal drugs to tem of which funeral services to notify their intravenous drips in order to claim 1 Lipton SA, Choi Y-B, Pan Z-H, et al. A when a death occurs. However, evidence commission from the undertakers. In parts redox-based mechanism for the has emerged of undertakers bribing hospiof undertakers Italy patrol the streets lookneuroprotective and neurodestructive effects tal workers to notify them of deaths, and for fatal accidents. of nitric oxide and related nitrosoing even to provide early warnings of likely compounds. Nature 1993; 364: 626-32. death. The Policia Judiciaria is investigat2 Snyder SH. Janus faces of nitric oxide. Nature 1993; 364: 577. ing this practice and has indicated concern Peter Kandela
least in part, by peroxynitrite (ONOO-), formed by reaction with superoxide anion. Neuroprotection occurred when NO in the oxidised form (NO+, or nitrosonium ion) reacted with the thiol group of the Nmethyl-D-aspartate (NMDA) receptor to : down-regulate neurotransmission. : Lipton and colleagues point out that since neurological disorders such as stroke, :
remote areas. an
Fighting
427
ess and less profitable. According to Merck the merger will create America’s
patient
First "coordinated
power to negotiate favourable drug prices from manufacturers. Medco handles about 95 million prescriptions a year, worth about records? $4 billion, distributing them through mailorder services and a network of retail world’s the & Merck largest drug pharmacies. But what is perhaps most Co, on 28 that it important to Merck is Medco’s database, announced July manufacturer, would purchase the largest distributor of which has the prescription histories of the discount drugs in the United States, Medco 33 million Americans who get their drugs Containment Services, Inc. The$6 billion through Medco-administered plans. Merck decided to purchase Medco after a deal allows Merck to buy its way into the business of managed care and gain access to year-long strategy evaluation. It was beMedco’s formidable marketing machine. coming increasingly clear that managedMedco, which is based in Montvale, New care buyers were going to dominate the Jersey, manages drug-benefit plans for prescription market. It has been projected more than 100 Fortune 500 companies, 132 that by 1995 two-thirds of drug purchases union groups, 34 state and federal plans, would be made through some form of : and 58 Blue Cross and Blue Shield and managed-care plan, said company spokesinsurance companies. The company works . man Kevin Colgan. Meanwhile, drug with the plans to establish low-cost fordevelopment and manufacturing has been mularies and wields its considerable buying, becoming more and more competitive and
NO good and bad
Educated wallet
through the
Excessive production of nitric oxide has The restriction on prescribing in the new been associated with several disease states. ’ German Health Structure Law is being felt In the nervous system, however, NO seems 1 painfully by pharmaceutical manufacturers to have both neurotoxic and neuroprotecI (except generics producers) and even more tive effects. To unravel the mechanism for these paradoxical effects, Lipton andby the pharmacists. The number of pharmacies grew after the Supreme Court colleagues1 examined the effect of redox states of nitric oxide on rat cerebrocortical decision in 1956 to end the restrictions on cultures. They found that neurotoxicity their numbers. Nevertheless annual inoccurs when NO is present in the reduced creases in prescription costs of around 10 form (as NO.), the effect being mediated, at assured golden days for all except those in ’
pharmaceutical
care
:ompany". Colgan said that, using Med:o’s database, Merck will be able to analyse doctors’ drug choices and recommend other regimens if warranted, to monitor patients’ compliance and remind them to refill their prescriptions, and to collect outcome data to help develop cost-effective medical therapies. But there are sceptics. Some Medco customers say they will wait and see whether Medco remains an independent purchaser of prescription drugs or merely a purveyor of Merck products. And consumer activists say they find any plan that gives corporations access to patient records worrying. Mark
McCarthy
cutting down on prescriptions "for the devil’s sake" at the expense of pharmacists and the pharmaceutical industry, to protect their own financial situation, and that the patient’s position was no longer being taken into account in many therapeutic decisions. In some areas pharmacists’ associations have been encouraged to collect complaints of customers who felt that they were not being prescribed all the drugs they needed. The Sick Fund physicians, however, have been selective in what they have cut down on-they obviously know the weak spots in their prescribing. Compared with prescriptions in March, 1992, those for lipid-lowering agents had fallen by 42-8% in March, 1993, those for varicose vein remedies by 34-2%, those for "blood flow enhancing preparations" by 26-5%, those for vitamins by 25-4%, and those for mineral supplements by 22-6%. Prescriptions for medicines of definite value dropped initially but have returned to former levels.
were
Now many pharmacies face uncertain future. : Under the new law (see Lancet Feb 13, p 427), if the Sick Fund drug expenditure exceeds a certain sum, doctors will have to pay part of the excess. At first the pharmacists criticised the Health Minister, but they have turned their anger against the medical profession because doctors are now epilepsy, trauma, neuropathic pain, and spending well below budget. In an editorial various neurodegenerative diseases (such (Pharm Ztg 1993; 138: 1981), the president as Parkinson’s disease) are thought to be of the Assembly of German Phamacists mediated in part by excessive stimulation of Association (ABDA) alleged that doctors Karl H Kimbel NMDA receptors, manipulation of the redox chemistry of NO to lessen NMDAabout the number of cases where a funeral receptor-mediated neurotoxicity could v for the dead have therapeutic implications. Another company has known about a patient’s death even before the relatives have been notified. approach would be to limit peroxynitrite formation with scavengers of superoxide or The Portuguese authorities are particularly Some Portuguese hospitals have come concerned that this nitvic oxide synthase inhibitors, for excompetitiveness does ample. The ideal drug, says Snyder in an under criticism for their involvement in the not reach the scale found in some Italian accompanying article,would be one that fierce competition for business amongcities. In June a male nurse in Milan was prevents the formation of NO. while funeral directors. Relatives and friends of sentenced to 28 years in jail for killing a the deceased are pestered and pressurised enhancing the formation of NO +. patient for the commission fee offered by by funeral directors, who work openly inthe undertakers. More recently a hospital Vivien Choo hospitals. To try to keep matters underorderly has been arrested for allegedly control, some hospitals operate a rota sys- killing 20 patients by adding lethal drugs to tem of which funeral services to notify their intravenous drips in order to claim 1 Lipton SA, Choi Y-B, Pan Z-H, et al. A when a death occurs. However, evidence commission from the undertakers. In parts redox-based mechanism for the has emerged of undertakers bribing hospiof undertakers Italy patrol the streets lookneuroprotective and neurodestructive effects tal workers to notify them of deaths, and for fatal accidents. of nitric oxide and related nitrosoing even to provide early warnings of likely compounds. Nature 1993; 364: 626-32. death. The Policia Judiciaria is investigat2 Snyder SH. Janus faces of nitric oxide. Nature 1993; 364: 577. ing this practice and has indicated concern Peter Kandela
least in part, by peroxynitrite (ONOO-), formed by reaction with superoxide anion. Neuroprotection occurred when NO in the oxidised form (NO+, or nitrosonium ion) reacted with the thiol group of the Nmethyl-D-aspartate (NMDA) receptor to : down-regulate neurotransmission. : Lipton and colleagues point out that since neurological disorders such as stroke, :
remote areas. an
Fighting
427