Joint replacements are the #1 expenditure of Medicare. The process of approving these medical devices is flawed according to the Institute of Medicine. It is time for patients' voices to be heard as stakeholders and for public support for increased medical device industry accountability and heightened protections for patients. Post-market registry. Product warranty. Patient/consumer stakeholder equity. Rescind industry pre-emptions/entitlements. All clinical trials must report all data.
Please share what you have learned!
Twitter: @JjrkCh

Wednesday, July 11, 2012

Selling Sickness 2013 - People Before Profits

LINK
February 20-22, 2012 at the Hyatt Regency on Capitol Hill, Washington, DC
http://sellingsickness.com/
 2006 Inaugural Congress on Disease Mongering in Australia  marked a watershed in networking among health care reformers and drug industry critics.
 2010 Selling Sickness conference in Amsterdam expanded the network and updated the work.
About
Selling Sickness 2013 will bring together academic scholars, healthcare reformers, consumer advocates and progressive health journalists to examine the global tide of disease mongering.
Conference will include topics pertaining to disease-mongering such as: misleading marketing; ethics in professional education; journalistic standards; social media; over-treatment; new models for drug development and testing; whistleblowers; new conflict of interest areas; health screening policies; impact on public health and pocketbook.
The conference is designed to encourage audience participation and increase collaboration among the conference attendees.
Kim Witczak 


Kim Witczak became involved in pharmaceutical drug safety issues after the death of her husband, Tim “Woody” Witczak in 2003 as a result of an undisclosed drug side effect. She has taken her personal experience and turned it into advocacy/public awareness campaign on drug safety which included the SSRI/suicide risk (which resulted in black box warnings being added to antidepressants), DTC advertising, undue Pharma influence, COI, PDUFA, and FDA reform. Kim has testified before US Senate on PDUFA/FDA reform as well as numerous FDA Advisory Committees. In 2008 she was appointed to the FDA’s Psychopharmacologic Drugs Advisory Committee as a Patient Representative. In 2004, Kim launched www.woodymatters.com in memory of Woody’s life and death as a resource for others that live every day with the consequences of a flawed drug safety system.


Tuesday, July 10, 2012

Mayo Social Media Summit

LINK

Voting for the scholarship is July 16-August 3, 2012.  http://socialmedia.mayoclinic.org/2012/07/16/joleen-c-scholarship-contest-essay/  I will win if you- DAILY - push the 'Like' button for FaceBook, Twitter, and leave a positive comment. Thank you!

My essay:

Login, “Like” Twitter & Post:  When the Medical Device Safety Act is passed by Congress and the Charter of the FDA is amended to include voting Patient Representatives on the medical device panel (as in pharmaceuticals), social media will be able to claim a large part of the victory.

Four years ago I began handling phone, mail and other correspondence for a family member who experienced early failure of a joint replacement implant.  Internet research revealed the medical and legal purgatory of thousands of joint replacement implant patients.  Navigating the medical system (for a disabled person prescribed maximum dose painkiller and living 1,000 miles apart) is challenging but not uncommon situation for many caregivers, I learned.  Because the root of the problem was intractable (poor federal public policy) my role transitioned to unpaid full-time advocate. I applied and was selected in September 2010 to attend the FDA Patient Representative workshop, which expanded my advocacy to all patients with failed implanted medical devices.   

My stated goal is to help patients with failed devices access the medical care that they require and to work toward the conclusions of the Institute of Medicine’s 7/29/2011 report. It advised the FDA to restrict the use of FDA 510(k) approvals for implanted devices and provide a post-market UDI national registry that would be accessible to patients and their medical providers.

This quest prompted me to join with a number of effective advocacy organizations such as The Society for Preventative Medicine, Consumers Union and SpeakerLink.  I created a blog (http://fida-advocate.blogspot.com) and regularly participate on FaceBook, Twitter (@JjrkCh) and LinkedIn.  I have testified twice at FDA/CDRH Town Hall meetings and have traveled from my home in Dallas, TX to Minnesota, Washington, DC -4 times-, San Francisco, CA, Irving & San Antonio & Austin, TX in my role as advocate.  Recently, financial limitations prevented me from attending Regina Holliday’s The Walking Gallery and the HDI Forum in Washington, D.C. (both with registration complete) so I participated virtually on a webinar. 

In my work toward the goal of safer and more effective implant devices I would value and benefit from discussions with trained social media professionals and other advocates.  I wish to elevate my advocacy skills and clarity of purpose so that I capably represent the patients who have been harmed and are often unable to travel or spare time/money for this endeavor.  Exposure to new ideas/attitudes would refresh and enhance my implementation of more targeted social media communications.  My advocacy includes educating the public, the device industry, administrators and legislators about federal public policy and legislative changes that would strengthen patient safety and reduce patient harm. 

I appreciate that Mayo Social Media has many qualified applicants for these three scholarships.  Thank you for your consideration and this valued opportunity to communicate via social media! 

Partnership WITH Patients Summit


http://partnershipwithpatients.com/
http://partnershipwithpatients.com/blog/

Partnership With Patients Summit
Friday, Sept 21, 2012 at 6 PM - Sunday, Sept 23, 2012 at 4 PM
Kansas City, MO
Event Details
This conference is two-fold in its mission. We will be working on strategies for a grass roots support the Partnership for Patients campaign. We will also help enable patients by providing a place to network, learn and grow as patient advocates that focus on health policy. You can read more about this on our website 

The funding model for this event is the STONE SOUP method.  Please give what you can and take from this event the energy you need. 

We have no federal funding and no grants.  Cerner has graciously agreed to provide the space for our event in their educational building.  The Society for Participatory medicine is our non-profit partner.  They have agreed to create a Patient Travel Scholarship Fund.  They will accept donations for this purpose and will issue grants.  The hope being that this fund will grow beyond this one event and help patients attend other conferences in the future. 

We are looking for sponsors to help defray overall costs as well as providing scholarships to patients for travel and lodging.  This summit will be a moment of true cooperation with venders, organizations, providers and patients all coming together to advocate for positive change.  If you purchase a ticket here it covers attendance at this conference on Friday night, Saturday and Sunday.  You will need to make travel and lodging arrangement in addition.  A block of rooms have been reserved at 
The Marriott Downtown Kansas City
200 West 12th Street. Kansas City, Missouri 64105 
Please call 1 (816) 421-6800 to book your room at the conference rate.

Agenda:
 Attendees must attend at least one session in all three tracks
September 21, Friday night would be a meet and greet with a few speeches. Gathering of #TheWalkingGallery  Light refreshments.
September 22, Saturday begins with breakfast in exhibition space, Opening Keynote, Panel Presentation from the Society for Participatory Medicine, 4x4 presentations from our sponsors,  break outs in multiple tracks with different levels of information :ie 101 level, 102 level…
Attendees must attend at least one session in all three tracks
Track 1: HIT/Health Policy
Meaningful Use/ Cerner Experience Theatre/ ACO/HIE/ Blue Button/ Patient Portals 
Track 2: Patient Quality/Safety
Paticipatory Medicine, e-Patients, End of Life Care, Palliative Care, Healthcare-Associated Infection, Types of Medical Harm, Adverse Events, Safety Concerns About the Electronic Medical Record, History of Patient Advocacy, Partnership for Patients, Quantified Self, Gamification
Track 3: Media and the Message
Social Media/Activism through the Arts/ Public Speaking/
Evening: Ignite format speeches 

September 23, Sunday: Two tracks
Healthcamp unconference
Honing your message: for the patient speaker who needs more experience and for mentors who wish to help them!

Funding/Tickets:
Sponsorship levels:

Diamond Cinder Block 5,000 level
Regina Holliday will create a 24x36 canvas during 2012/2013 Partnership for Patients campaign year for this sponsor
Recognized from the stage during opening keynote
4x4 Presentation
Limited edition print of conference painting
Admission for 1
Table in exhibition hall
Logo on our website
Logo on thank you signage

Golden Cinder Block: $3,000 level
Regina Holliday will create a 18x24 canvas during the 2012/2013 Partnership for Patients campaign year for this sponsor
Recognized from the stage during opening keynote
4x4 Presentation
Limited edition print of conference painting
Admission for 1
Table in exhibition hall
Logo on our website
Logo on thank you signage

Cinder Block Level: $1,000
Recognized from the stage during opening keynote
Limited edition print of conference painting
Admission for 1
Table in exhibition hall
Logo on our website
Logo on thank you signage

4x4 Level $500
Admission for 1
Table in exhibition hall
Logo on our website
Logo on our thank you signage

2x4 Level: $250
Admission for 1
Logo on our website
Logo on our thank- you signage

Partner Level:  $100.00
Attendee who does not self-define as patient

Patient Level: $50.00
Attendee who does self-define as patient


Friday, July 6, 2012

Criminal prosecutions more effective deterrent.


http://huff.to/MOjbYI
How Not to Get Big Pharma to Change Its Ways
Robert Reich

Chancellor's Professor of Public Policy, University of California at Berkeley; Author, 'Beyond Outrage'
Posted: 07/06/2012 8:23 am  (FiDA blog bold.)
Earlier this week the Justice Department announced a $3 billion settlement of criminal and civil charges against pharma giant GlaxoSmithKline -- the largest pharmaceutical settlement in history -- for improper marketing prescription drugs in the late 1990s to the mid-2000s.
The charges are deadly serious. Among other things, Glaxo was charged with promoting to kids under 18 an antidepressant approved only for adults; pushing two other antidepressants for unapproved purposes, including remedying sexual dysfunction; and, to further boost sales of prescription drugs, showering doctors with gifts, consulting contracts, speaking fees, even tickets to sporting events.
$3 billion may sound like a lot of money, but during these years Glaxo made $27.5 billion on these three antidepressants alone, according to IMS Health, a data research firm -- so the penalty could almost be considered a cost of doing business.
Besides, to the extent the penalty affects Glaxo's profits and its share price, the wrong people will be feeling the financial pain. Most of today's Glaxo shareholders bought into the company after the illegal profits were already built into the prices they paid for their shares.
Not a single executive has been charged -- even though some charges against the company are criminal. Glaxo's current CEO came on board after all this happened. Glaxo has agreed to reclaim the bonuses of any executives who engaged in or supervised illegal behavior, but the company hasn't officially admitted to any wrongdoing - and without legal charges against any of executive it's impossible to know whether Glaxo will follow through.
The Glaxo case is the latest and biggest in a series of Justice Department prosecutions of Big Pharma for illegal marketing prescription drugs. In May, Abbott Laboratories settled for $1.6 billion over its wrongful marketing of an antipsychotic. And an agreement with Johnson & Johnson is said to be imminent over its marketing of another antipsychotic, which could result in a fine of as much as $2 billion.
The Department says the prosecutions are well worth the effort. By one estimate it's recovered more than $15 for every $1 it's spent.
But what's the point if the fines are small relative to the profits, if the wrong people are feeling the financial pinch, and if no executive is held accountable?
The only way to get big companies like these to change their behavior is to make the individuals responsible feel the heat.
An even more basic issue is why the advertising and marketing of prescription drugs is allowed at all, when consumers can't buy them and shouldn't be influencing doctor's decisions anyway. Before 1997, the Food and Drug Administration banned such advertising on TV and radio. That ban should be resurrected.
Finally, there's no good reason why doctors should be allowed to accept any perks at all from companies whose drugs they write prescriptions for. It's an inherent conflict of interest. Codes of ethics that are supposed to limit such gifts obviously don't work. All perks should be banned, and doctors that accept them should be subject to potential loss of their license to practice.
ROBERT B. REICH, Chancellor's Professor of Public Policy at the University of California at Berkeley, was Secretary of Labor in the Clinton administration. Time Magazine named him one of the ten most effective cabinet secretaries of the last century. He has written thirteen books, including the best sellers "Aftershock" and "The Work of Nations." His latest is an e-book, "Beyond Outrage." He is also a founding editor of the American Prospect magazine and chairman of Common Cause.

FDA Tracking Implantable Devices Soon!


http://bit.ly/R4LAZS
FDA PROPOSES Unique Device Identification Regulations for Medical Device
Unique Device Identification System Will Provide FDA
With a Critical Tool For Protecting Patients
 07/03/12 at 12:13 pm  Consumers Union Safe Patient Project
WASHINGTON, D.C. – The Food and Drug Administration (FDA) issued a proposed regulation today to establish a unique device identification (UDI) system for medical devices marketed in the U.S. A UDI system was mandated by Congress in 2007 but still is not in place.  Legislation passed by Congress in June requires the FDA to implement the UDI system for high risk, life sustaining and implantable medical devices within two years of finalizing the regulations.
Consumers Union, the policy and advocacy division of Consumer Reports, applauded the FDA for issuing the proposed regulations, while noting that it was still reviewing the specifics of the draft rule.  Consumers Union will file formal comments to the proposed regulations later this year.
“These regulations are long overdue and are critical for protecting patients from faulty and dangerous medical devices,” said Lisa Swirsky, senior policy analyst for Consumers Union, the policy and advocacy division of Consumer Reports.  “Effective post-market surveillance of medical devices depends on having UDI in place.  Once it is fully implemented, this system will enhance the FDA’s ability to identify problem medical devices more quickly and inform patients when their safety is at risk.”
For most medical devices, the UDI will include a device identifier, which is a unique code tied to a specific device model, and a production identifier, which includes production information for the device.  The FDA has proposed phasing in the implementation of the UDI system beginning with the highest risk medical devices first.  Low risk devices will be exempt from some or all of the regulations.  The FDA is seeking public comment on the proposed regulations for 120 days.
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm310505.htm

FDA NEWS RELEASE
For Immediate Release: July 3, 2012
Media Inquiries: Karen Riley, 301-796-4674, karen.riley@fda.hhs.govConsumer Inquiries: 888-INFO-FDA
FDA proposes unique device identification system for medical devices
Today, in response to requirements in legislation that passed Congress with broad bipartisan support, the U.S. Food and Drug Administration proposed that most medical devices distributed in the United States carry a unique device identifier, or UDI.
A UDI system has the potential to improve the quality of information in medical device adverse events reports, which will help the FDA identify product problems more quickly, better target recalls, and improve patient safety. The FDA has worked closely with industry, the clinical community and patient and consumer groups and conducted four pilot studies in the development of this proposed rule. The FDA is seeking comment on the proposal for 120 days.
"The safety of medical devices is a top priority for the FDA, Congress, industry, and patients," said FDA Commissioner Margaret A. Hamburg, M.D. "The unique identification system will enhance the flow of information about medical devices, especially adverse events and, as a result, will advance our ability to improve patient safety." 
With certain exceptions, under the proposed rule, a UDI would include:
                a device identifier, which is a unique numeric or alphanumeric code specific to a device model; and
                a production identifier, which includes the current production information for a device.
The FDA is proposing a risk-based, phased-in approach to implementation, focusing on the highest-risk medical devices first and exempting low-risk devices from some or all of the requirements. The FDA is proposing to exempt over-the-counter devices sold at retail; these devices generally have UPC codes in place.
A UDI is a unique numeric or alphanumeric code that acts as a key to certain basic identifying information about a device, such as the name of the manufacturer and the type of device, and may represent certain other information about the device, such as its expiration date and batch or lot number. This information will be contained in a publicly available UDI database, and no identifying patient information will be stored in this device information center.
The proposed rule reflects the considerable input the FDA received from the medical device industry, the clinical community, patients and consumers, and industry experts. To minimize industry costs and expedite implementation, the proposed rule builds upon current standards and systems already in use by some companies.
A UDI system can provide multiple benefits, including:
                Allow more accurate reporting, reviewing and analyzing of adverse event reports so that problem devices can be identified and corrected more quickly.
                Reduce medical errors by enabling health care professionals and others to more rapidly and precisely identify a device and obtain important information concerning the characteristics of the device.
                Provide a consistent way to enter information about devices in electronic health records and clinical information systems.
                Provide a standardized identifier that will allow manufacturers, distributors and healthcare facilities to more effectively manage medical device recalls.
                Provide a foundation for a global, secure distribution chain, helping to address counterfeiting and diversion and prepare for medical emergencies.
For more information:
                  Proposed Rule: Unique Device Identification System
The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Friday, June 29, 2012

Threat to prescribed pain relief for failed device?

http://bit.ly/LzyYVT

How to intelligently prevent opioid abuse

Acute and chronic pain is bad. Proper pain management is essential and has been strongly emphasized by the American medical establishment for the past nearly two decades.
Simultaneously, during these years, both the quantity of opioids prescribed by physicians and dentists has increased dramatically and prescription opioid abuse has escalated at an alarming rate among chronic pain patients and the general population. Opioid analgesics now result in more American overdose deaths than cocaine and heroin combined.
What should physicians do? For treatment of chronic pain, non-opioid analgesics should be the first-line agents.
Physicians and nurses must discuss with patients common opioid side effects such as constipation and sedation, other risks such as addiction and overdose, and potential long-term risks such as hyperalgesia and sexual dysfunction.
Short-acting opioids such as Dilaudid (hydromorphone) and Vicodin (hydrocodone/paracetamol) may be helpful for initial pain relief, but longer-term dosing can lead to breakthrough pain and withdrawal, and these agents carry a relatively high abuse potential.
Oxycontin (oxycodone CR) is also widely abused, especially in rural areas; its elevated dosage means it is highly addictable, and coverage by insurance makes it cheaper than heroin.
Longer-acting opioid analgesics such as Suboxone (buprenorphine), methadone, and fentanyl have a much lower abuse liability. However, methadone is found in more overdose deaths than any other prescription opioid and should not be prescribed for opioid-naive patients. Because analgesic effects of methadone are of shorter duration (6 to 9 hours) than its half-life (36 hours), levels may accumulate, leading to respiratory suppression or cardiac events.
Patients should be instructed to keep controlled substances safe in a locked location to prevent use or sale by others.
If a physician intends to prescribe opioids for chronic pain, a narcotic protocol – medication contract, psychological evaluation, and urine toxicology – should be considered. Monitoring both urine toxicology and aberrant behaviors will detect more opioid abuse than either strategy alone.
Combining a clinical interview and the SOAPP (Screening and Opioid Assessment for Patients with Pain) yields the highest sensitivity (.90) for abuse detection.
A “universal precautions” approach to minimizing risk includes asking patients about history of substance abuse, written informed consent, and ongoing reassessment of the benefits of opioid therapy. Clinicians can thus triage patients to low-, medium-, and high-risk addiction potential. Treatment agreements should delineate rules such as having no early refills and requiring urine toxicology.
For patients who develop opioid addiction, substitution with buprenorphine or another abuse-deterrent formulation and adherence monitoring can be implemented.
The medical establishment should develop and use effective analgesics with lower abuse potential. Current research efforts to identify better methods to detect patients at heightened risk for developing addiction should be supported.
All prescribers of opioids must actively manage pain control while aggressively and intelligently attempting to prevent opioid abuse.
George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association. Maria A. Sullivan is an Associate Professor of Clinical Psychiatry in the Division on Substance Abuse at Columbia University and the New York State Psychiatric Institute.
 Comment by Joleen Chambers (FiDA blog)
So . . . those innocent patients who received prescription pain medication (e.g. long-term maximum dose hydrocodone) will be side railed into a "new" medical plan to EVALUATE their pain/addiction level (eliminate the current prescription).  How is this new program customized to a victim of a failed implanted medical device (FDA MedWatch #5009052)? The cascading damage of failed device, pharma evasion of untreated serious dry mouth side-effect on dental health,  medical abandonment, insurance abandonment, inaccessible justice, and now potential coercion into withdrawal or alternate medication so that the medical community can move on.  How is this patient-centered? The prescribing doctors need to experience this kind of treatment:  they have no concept.    

Marketing patient harm: implanted medical devices.



AP News  Bloomberg Business Week
FDA panel sees little use for metal-on-metal hips
By Matthew Perrone on June 28, 2012  (FiDA blog bold)
           
WASHINGTON (AP) — Government health experts said Thursday there are few reasons to continue using metal-on-metal hip implants, amid growing evidence that the devices can break down early and expose patients to dangerous metallic particles.
The Food and Drug Administration asked its 18-member panel to recommend guidelines for monitoring more than a half-million U.S. patients with metal hip replacements. The devices were originally marketed as a longer-lasting alternative to older ceramic and plastic models. But recent data from the U.K. and other foreign countries suggests they are more likely to deteriorate, exposing patients to higher levels of cobalt, chromium and other metals.
While the FDA has not raised the possibility of removing the devices from the market, most panelists said there were few, if any, cases where they would recommend implanting the devices.
"I do not use metal-on-metal hips, and I can see no reason to do so," said Dr. William Rohr of Mendocino Coast District Hospital, who chaired the meeting.
For decades nearly all orthopedic implants were coated with plastic or ceramic. But in the last 10 years some surgeons began to favor all-metal implants, after laboratory tests suggested the devices would be more resistant to wear and reduce the chances of dislocation.
But recent data gathered from foreign registries shows the devices fail at a higher rate than older implants. That information comes on top of nearly 17,000 reports to the FDA of problems with the implants, which sometimes require invasive surgery to replace them.
The pain and inflammation reported by patients is usually caused by tiny metal particles that seep into the joint, damaging the surrounding tissue and bone. The long-term effects of elevated metal levels in the bloodstream are not clear, though some studies have suggested links to neurological and heart problems.
About 400,000 Americans get a hip replacement each year to relieve pain and restore motion affected by arthritis or injury. Metal hips accounted for about 27 percent of all hip implants in 2010, down from nearly 40 percent in 2008. Doctors have begun turning away from the implants amid several high-profile recalls, including J&J's recall of 93,000 metal hips in 2010.
FDA's experts said Thursday that patients complaining of pain and other symptoms should get regular X-rays and blood testing for metal levels. However, panelists pointed out the problems with the accuracy of blood tests and the difficulties of interpreting the results. There are no standard diagnostic kits for sale that test for chromium and other metals
For patients who are not experiencing pain, panelists said annual X-rays would be sufficient to monitor their implants.
If the FDA ultimately follows the group's advice, U.S. recommendations would be less involved than those already in place overseas.
Earlier this year U.K. regulators recommend that all people who have the implants get yearly blood tests to make sure no dangerous metals are seeping into their bodies.
FDA regulators have suggested they want to take more time to sort out the differences between various implants and patient groups before making recommendations.
"The truth is there are different types of hips and different types of patients," said Dr. William Maisel, FDA's chief scientist for devices, in an interview last week. "Understanding the characteristics of patients who experience adverse events is very important."
Women and overweight people are among the groups that are more likely to have an implant failure.
With little definitive data on U.S. hip implants, the agency has asked manufacturers like Johnson & Johnson, Zimmer Holdings Inc. and Biomet Inc. to conduct long-term, follow-up studies of more than 100 metal-on-metal hips on the U.S. market.
FDA scientists say the studies will help "fill in the blanks" on a number of scientific questions, including the long-term effects of metal particles.
But public health advocates say it could take a decade before that information is available.
"Keeping these metal-on-metal hips on the market for the next five to 10 years while research is conducted is not ethical," said Diana Zuckerman, president of the National Research Center for Women & Families, during a public comment session at the meeting. "If the companies want to sell metal-on-metal hips, they should be required to prove their safety first."