Promotion of New Diabetes Products in the District of Columbia

Background: Growth in pharmaceutical expenditures for diabetes outpaced growth in diabetes prevalence. Prescribers accepting gifts and meals from pharmaceutical companies have been linked with higher prescription rates and costs[1]. Pharmaceutical marketing to these prescribers and patients often promotes newer, more expensive drugs, such as the GLP-1 analogues and SGL-2 inhibitors. These two drug classes are more expensive but no more effective than metformin,[2] the recommended first-line treatment for diabetes, and the oldest and cheapest available treatment. We investigated how cost of diabetes treatment was affected by marketing practices in the District of Columbia. Methods: The AccessRx program in DC requires pharmaceutical companies to report gifts given to healthcare providers, drug advertising expenses, and the salaries for staff engaged in promotional activities (“detailing expenses”). We combined data from AccessRx and the federal Open Payments system to estimate promotional payments. We used Medicaid drug utilization data to examine spending for diabetes treatment. Results: In 2014, DC Medicaid spent more than $17.1 million on pharmaceutical treatments for diabetes. We estimated that ten companies spent$3.8 million in detailing expenses to market diabetes drugs in 2014. SGLT-2 inhibitors and GLP-1 analogues had the highest estimated detailing expenses, each totaling more than $1.2 million. From 2014 to 2015, DC Medicaid spending for Victoza (liraglutide), a GLP-1 analogue, increased 51$183,873 to $362,230) and Invokana (canaglifozin), a SGLT-2 inhibitor, increased 213$8,933 to $27,958). Conclusions: Pharmaceutical promotion drives unnecessary use of newer, more expensive medications. The District of Columbia should provide education on rational prescribing for diabetes treatment (including diet and exercise). [1] Perlis RH, Perlis CS. Physician payments from industry are associated with greater Medicare Part D prescribing costs. PLoS One. 2016;11(5):e0155474. DeJong C, Aguilar T, Tseng CW, et al. Pharmaceutical industry-sponsored meals and physician prescribing patterns for Medicare beneficiaries. JAMA Intern Med. 2016;176(8):1114-10. [2] Prescrire International. Hypoglycaemic therapy in type 2 diabetics. Prescrire Int. 2015 Apr;24(159):103- 106. Prescrire International. Glucose-lowering treatment of type 2 diabetics. Prescrire Int. 2015 May;23(160):130-135

Treatment of Men for “Low Testosterone”: A Systematic Review

Testosterone products are recommended by some prescribers in response to a diagnosis or presumption of “low testosterone” (low-T) for cardiovascular health, sexual function, muscle weakness or wasting, mood and behavior, and cognition. We performed a systematic review of 156 eligible randomized controlled trials in which testosterone was compared to placebo for one or more of these conditions. We included studies in bibliographic databases between January 1, 1950 and April 9, 2016, and excluded studies involving bodybuilding, contraceptive effectiveness, or treatment of any condition in women or children. Studies with multiple relevant endpoints were included in all relevant tables. Testosterone supplementation did not show consistent benefit for cardiovascular risk, sexual function, mood and behavior, or cognition. Studies that examined clinical cardiovascular endpoints have not favored testosterone therapy over placebo. Testosterone is ineffective in treating erectile dysfunction and controlled trials did not show a consistent effect on libido. Testosterone supplementation consistently increased muscle strength but did not have beneficial effects on physical function. Most studies on mood-related endpoints found no beneficial effect of testosterone treatment on personality, psychological well-being, or mood. The prescription of testosterone supplementation for low-T for cardiovascular health, sexual function, physical function, mood, or cognitive function is without support from randomized clinical trials

Overcoming: A Concept Analysis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86851/1/j.1744-6198.2011.00227.x.pd

Comparison of glucosamine sulfate and a polyherbal supplement for the relief of osteoarthritis of the knee: a randomized controlled trial [ISRCTN25438351]

<p>Abstract</p> <p>Background</p> <p>The efficacy and safety of a dietary supplement derived from South American botanicals was compared to glucosamine sulfate in osteoarthritis subjects in a Mumbai-based multi-center, randomized, double-blind study.</p> <p>Methods</p> <p>Subjects (n = 95) were screened and randomized to receive glucosamine sulfate (n = 47, 1500 mg/day) or reparagen (n = 48, 1800 mg/day), a polyherbal consisting of 300 mg of vincaria (<it>Uncaria guianensis</it>) and 1500 mg of RNI 249 (<it>Lepidium meyenii</it>) administered orally, twice daily. Primary efficacy variable was response rate based on a 20% improvement in WOMAC pain scores. Additional outcomes were WOMAC scores for pain, stiffness and function, visual analog score (VAS) for pain, with assessments at 1, 2, 4, 6 and 8 weeks. Tolerability, investigator and subject global assessments and rescue medication consumption (paracetamol) were measured together with safety assessments including vital signs and laboratory based assays.</p> <p>Results</p> <p>Subject randomization was effective: age, gender and disease status distribution was similar in both groups. The response rates (20% reduction in WOMAC pain) were substantial for both glucosamine (89%) and reparagen (94%) and supported by investigator and subject assessments. Using related criteria response rates to reparagen were favorable when compared to glucosamine. Compared to baseline both treatments showed significant benefits in WOMAC and VAS outcomes within one week (P < 0.05), with a similar, progressive improvement over the course of the 8 week treatment protocol (45–62% reduction in WOMAC or VAS scores). Tolerability was excellent, no serious adverse events were noted and safety parameters were unchanged. Rescue medication use was significantly lower in the reparagen group (p < 0.01) at each assessment period. Serum IGF-1 levels were unaltered by treatments.</p> <p>Conclusion</p> <p>Both reparagen and glucosamine sulfate produced substantial improvements in pain, stiffness and function in subjects with osteoarthritis. Response rates were high and the safety profile was excellent, with significantly less rescue medication use with reparagen. Reparagen represents a new natural productive alternative in the management of joint health.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN25438351.</p

Utilization of award fee contracts at Naval Regional Contracting Centers

The use of the award fee contract is an unique incentive structure that provides the Government's method of subjective, after the fact evaluation of contractor performance and affords the Government additional flexibility to reward and motivate the contractor for above average performance. Use of cost-plus-award-fee and fixed-price-award-fee has many applications at the Field Contracting Activity level. The use of award fee contracts has many benefits and costs not associated with other types of incentives contracts. To better facilitate its use, barriers will need to be recognized that are preventing more applications at the field level and what can be done to overcome these barriers.http://archive.org/details/utilizationofawa00hogeLieutenant, United States NavyApproved for public release; distribution is unlimited

Red Bull Marketing Techniques

The differences in marketing techniques using the product Red Bull Energy Drink was investigated in this research project. Three techniques were used: the participant was read aloud information, the participant read information from a pamphlet, and the participant was shown a power point presentation. These techniques were tested to discover whether the marketing technique influenced the consumer purchase of the product. 64 participants were tested, but only 31 participants’ data was used. Many participants’ data had to be excluded due to factors of affiliation and missing data. After conducting a one-way ANOVA, we did find statistical significance between the presentation of different marketing techniques and a change in consumption. The power point method of marketing was the most effective

An update on osteoarthritis therapeutics

This review addresses recent major developments in symptomatic therapy and the principles of disease modification in osteoarthritis. It emphasizes issues that are of importance to the practicing clinician at a time when researchers in the field are trying to improve ways not only to provide symptomatic relief but also to slow disease progression. The past year has led to a reassessment of the role of cyclo-oxygenase-2 inhibitors in osteoarthritis therapy and has yielded new information on nutriceuticals such as glucosamine. The relative efficacy of intra-articular injections of agents such as corticosteroid and hyaluronic acid preparations has been assessed. In addition, reports on trials of potentially disease-modifying agents for osteoarthritis have been published. Because the therapeutic options have been reduced over the past year and the role of nutritional supplements remains unclear, the clinician is faced with a need to reassess osteoarthritis therapy. Although no practical disease-modifying agent for osteoarthritis has been identified, reports such as the recent doxycycline trial reviewed herein provide hope that continued research will soon yield a therapeutic model similar to that used in rheumatoid arthritis, for which some therapeutic agents achieve disease modification and other agents can be added as needed for symptomatic relief