Dealing with Drug Reps - Dead or Alive

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Several years ago, long before promotional lectures, I traveled for a series of lectures. I flew north for 4 days and 4 lectures, 2 at major university programs and 2 dinner lectures to local rheumatologists.

The first lecture went well but the weather turned bad, with a snow storm in the overnight forecast.  Hence my host, a local drug rep, suggested we drive at night to beat the snow and get to the next city for the 10 am University lecture the following morning.

The one-hour drive felt like a week in Cleveland. 

Forced, Rational or Glitch-Ridden Prescribing Practices

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A recent analysis of 3 groups of treatment-naïve, early rheumatoid arthritis (ERA) patients looked at the factors that influenced the choice of therapy.

The IL-6 Wars

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In the years to come, the availability of numerous new IL-6 inhibitors it will either complicate treatment decisions, alter existing treatment paradigms, or result in an all-out war against TNF inhibitor dominance. Data, differences and time will tell.

The Pain of Funerals and Suicides

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My Take on New Ocular Screening Guidelines for Plaquenil

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A recent article published by the American Academy of Ophthalmology presented new recommendations for screening of patients being managed with hydroxychloroquine that changed the previous monitoring paradigm. More importantly, it has repositioned hydroxychloroquine from one of the safest medications that rheumatologists use to a drug that can have potentially significant ocular morbidity (if used in doses greater than 5 mg per kilogram and or for prolonged periods of time).

It's the engine that kills ya’, not the caboose

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This past weekend I was fortunate to lecture at the Harvard Advances in Rheumatology Course, where I reviewed the safety issues surrounding the use of biologic therapies. In discussing infections, cancer, cardiovascular events, etc., it became very clear to me that these problems, while worrisome, are often escalated in their importance – all at the expense of what is most dangerous: RA itself.

MONEYBALL

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The movie Moneyball is a David versus Goliath tale with the A’s (David) struggling to compete with Goliath teams like the Yankees. The movie pits hunch-driven “expertise” (convention) against a mathematic approach to decision making (Moneyball). Would you trust a big Whopper computer printout of next best drug(s) to give to Mrs. Hawking who has psoriatic arthritis and needs to start a DMARD? I believe most of you would huff and scoff at a formulaic or number-driven approach.

Guiding Patients Considering Biologics

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What are the questions patients should ask their doctors about biologics? Are there rules for starting and stopping biologics?

The Errors that Underlie 'Medical Errors' in the News

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Upon reading the title of a recent news item - 'Medical error is the third leading cause of death in the US' - a feeling of apprehension and dread arose. Very quickly, my worst fears were realized.

Biologic Prescribing and Patient Education

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Biologics are big. Their popularity is reflected in their growing use since being introduced in 1998. Biologics have been used by more than 3 million patients worldwide. In 2013, Enbrel, Remicade and Humira accounted for nearly $30 billion in worldwide sales. In the USA, it is estimated that we will spend $220 billion on biologics by 2017. 

What It’s Like to Work with a KOL (Key Opinion Leader)

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Rheumatology is fortunate to have many "key opinion leaders" (KOLs) to teach, study, synthesize and pave the advances in our discipline.  Who are these KOLs and how can we tell them apart? 

Why Not Just Kick the TNFi Habit?

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Why do we use TNF inhibitors as our first biologic choice?  Is it the evidence of efficacy, access, safety, and drug retention, or is it a prescriber habit that merits critique?