Skip header and navigation

Refine By

27 records – page 1 of 3.

Assessing the quality of drug detailing.

https://arctichealth.org/en/permalink/ahliterature188127
Source
J Clin Epidemiol. 2002 Aug;55(8):825-32
Publication Type
Article
Date
Aug-2002
Author
William Molloy
David Strang
Gordon Guyatt
Joel Lexchin
Michel Bédard
Sacha Dubois
Rosalie Russo
Author Affiliation
Geriatric Research Group, McMaster University, Hamilton Health Sciences, Henderson Site, 711 Concession Street, Ontario, Canada. molloy@mcmaster.ca
Source
J Clin Epidemiol. 2002 Aug;55(8):825-32
Date
Aug-2002
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Attitude of Health Personnel
Canada
Chi-Square Distribution
Drug Industry - standards
Drug Information Services - standards
Drug Prescriptions - standards
Family Practice - standards
Female
Humans
Male
Physicians - psychology
Professional Competence
Quality of Health Care
Abstract
This study measured the validity of a new instrument, the Assessment Instrument for Drug Detailing (AIDD), used by doctors to score the quality of drug detailing provided by pharmaceutical representatives in their offices. Five pharmaceutical representatives provided "good, medium, and poor" details to 135 family doctors in their offices, who were blinded to the quality of the details. A "reference standard group" constructed the details and trained the representatives. An "assessment group" trained family physicians to use the AIDD to score the details. Physicians discriminated between different quality details in all but one domain, nomenclature (P
PubMed ID
12384198 View in PubMed
Less detail

CJEM and pharmaceutical advertisements: it's time for an end.

https://arctichealth.org/en/permalink/ahliterature149712
Source
CJEM. 2009 Jul;11(4):375-84
Publication Type
Article
Date
Jul-2009
Author
Joel Lexchin
Source
CJEM. 2009 Jul;11(4):375-84
Date
Jul-2009
Language
English
French
Publication Type
Article
Keywords
Advertising as Topic
Drug Industry
Humans
Information Dissemination - methods
Ontario
Periodicals as Topic
Risk factors
Notes
Comment In: CJEM. 2010 Jan;12(1):520480984
PubMed ID
19594978 View in PubMed
Less detail

Clinical trials in Canada: whose interests are paramount?

https://arctichealth.org/en/permalink/ahliterature155515
Source
Int J Health Serv. 2008;38(3):525-42
Publication Type
Article
Date
2008
Author
Joel Lexchin
Author Affiliation
School of Health Policy and Management, York University, Toronto, ON, Canada. jlexchin@yorku.ca
Source
Int J Health Serv. 2008;38(3):525-42
Date
2008
Language
English
Publication Type
Article
Keywords
Canada
Clinical Trials as Topic - ethics
Conflict of Interest
Drug Approval
Drug Industry - ethics
Ethics, Research
Humans
Patient Selection - ethics
Research Support as Topic - ethics
Abstract
More than 80 percent of clinical drug trials in Canada are funded by the pharmaceutical industry. This article evaluates the overall state of clinical trials in Canada and looks at the interplay between public and private interests. Health Canada has adopted standards developed by the International Conference on Harmonization, a body that is heavily influenced by industry. Commercial interests are increasingly involved in recruiting patients into clinical trials and in running these trials. It is in industry's interests to conduct drug tests on people for which it is easiest to see benefits. These interests are not fundamentally challenged by Health Canada's policy of issuing nonmandatory guidelines on who should and should not be included in clinical trials. The outcome of clinical trials is heavily influenced by commercial sponsorship, with the result that trials may favor corporate interests rather than the interests of the public. How Health Canada deals with that possibility is not known, because of its strict policy of treating clinical trial data as private property. If clinical trials are to serve the purpose for which they are designed, developing reliable and objective information about new drugs, then commercial interests cannot be allowed to take precedence over health interests.
PubMed ID
18724580 View in PubMed
Less detail

The danger of imperfect regulation: OxyContin use in the United States and Canada.

https://arctichealth.org/en/permalink/ahliterature128945
Source
Int J Risk Saf Med. 2011;23(4):233-40
Publication Type
Article
Date
2011
Author
Joel Lexchin
Jillian Clare Kohler
Author Affiliation
School of Health Policy and Management, York University and Emergency Physician, University Health Network, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario. jlexchin@yorku.ca
Source
Int J Risk Saf Med. 2011;23(4):233-40
Date
2011
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Drug Industry - legislation & jurisprudence
Drug and Narcotic Control - legislation & jurisprudence - organization & administration
Humans
Marketing - legislation & jurisprudence
Oxycodone - therapeutic use
Substance-Related Disorders - epidemiology
United States - epidemiology
United States Food and Drug Administration
Abstract
Drug companies aggressively market their products to increase sales and economic rewards. Different countries have different regulatory regimes for controlling promotion. In the United States control rests directly with the Food and Drug Administration whereas Canada relies on a mixture of voluntary self-regulation and an autonomous agency. Each method has significant weaknesses. We examine these weaknesses by analyzing the promotion of OxyContin (the time release version of the opioid oxycodone) by Purdue in Canada and the United States. We then look at the association between promotion and the misuse and abuse of OxyContin in both countries. Finally, we advance specific recommendations for regulating promotion for drugs that may have a high abuse potential.
PubMed ID
22156088 View in PubMed
Less detail

Different conclusions about memantine.

https://arctichealth.org/en/permalink/ahliterature161328
Source
Can Fam Physician. 2007 Mar;53(3):403-4; author reply 404
Publication Type
Article
Date
Mar-2007
Author
Joel Lexchin
Source
Can Fam Physician. 2007 Mar;53(3):403-4; author reply 404
Date
Mar-2007
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - diagnosis - drug therapy
Canada
Dose-Response Relationship, Drug
Drug Administration Schedule
Excitatory Amino Acid Antagonists - adverse effects - therapeutic use
Female
Humans
Male
Memantine - adverse effects - therapeutic use
Randomized Controlled Trials as Topic
Risk assessment
Sensitivity and specificity
Severity of Illness Index
Treatment Outcome
United States
Notes
Cites: N Engl J Med. 2003 Apr 3;348(14):1333-4112672860
Cites: Int J Geriatr Psychiatry. 1999 Feb;14(2):135-4610885864
Cites: Stroke. 2002 Jul;33(7):1834-912105362
Cites: Int Clin Psychopharmacol. 2002 Nov;17(6):297-30512409683
Cites: Can Fam Physician. 2007 Jan;53(1):50-417872609
Cites: Med Lett Drugs Ther. 2003 Sep 15;45(1165):73-412968123
Cites: Drug Ther Bull. 2003 Oct;41(10):73-614593973
Cites: JAMA. 2004 Jan 21;291(3):317-2414734594
Cites: Prescrire Int. 2003 Dec;12(68):203-514986682
Comment On: Can Fam Physician. 2007 Jan;53(1):50-417872609
PubMed ID
17872671 View in PubMed
Less detail

Do higher drug costs lead to better health?

https://arctichealth.org/en/permalink/ahliterature173554
Source
Can J Clin Pharmacol. 2005;12(1):e22-7
Publication Type
Article
Date
2005
Author
Barbara Mintzes
Joel Lexchin
Source
Can J Clin Pharmacol. 2005;12(1):e22-7
Date
2005
Language
English
Publication Type
Article
Keywords
Canada
Drug Approval - legislation & jurisprudence
Drug Costs - trends
Drug Prescriptions - economics
Drug Utilization - economics
Health Expenditures - trends
Humans
Product Surveillance, Postmarketing
Quality of Health Care - trends
Abstract
Prescription drugs are the fastest growing healthcare cost in Canada. Increased spending is mainly due to use of newer, more expensive medicines and a higher overall volume of prescription drug use. In the large majority of cases, empirical studies fail to support claims of a net benefit to health. Newer high-priced drugs are neither consistently safer nor more effective than older alternatives. Over 2000 new drugs and indications introduced in France from 1981-2000 were compared to existing treatments: 81% offered little to no added value and 3% were less safe or effective. In Canada, only 5% of drugs introduced from 1996-2000 offered substantial improvement to therapy. Claims linking use of newer drugs to reduced hospitalization and mortality fail to distinguish between underlying differences in disease severity and treatment outcomes. For "newer" to truly mean "better", fundamental changes are needed to the regulations governing market approval and post-approval surveillance. Such changes are possible, but would require strong political will.
Notes
Comment On: Can J Clin Pharmacol. 2005 Winter;12(1):e10-2116055940
PubMed ID
16055941 View in PubMed
Less detail

Drugs in the news: an analysis of Canadian newspaper coverage of new prescription drugs.

https://arctichealth.org/en/permalink/ahliterature185620
Source
CMAJ. 2003 Apr 29;168(9):1133-7
Publication Type
Article
Date
Apr-29-2003
Author
Alan Cassels
Merrilee A Hughes
Carol Cole
Barbara Mintzes
Joel Lexchin
James P McCormack
Author Affiliation
School of Health Information Science, University of Victoria, Victoria, BC. jmccorma@interchange.ubc.ca
Source
CMAJ. 2003 Apr 29;168(9):1133-7
Date
Apr-29-2003
Language
English
Publication Type
Article
Keywords
Acetamides - adverse effects
Advertising as Topic
Anti-Inflammatory Agents, Non-Steroidal - adverse effects
Anticholesteremic Agents - adverse effects
Antiviral Agents - adverse effects
Bibliometrics
Canada
Cholinesterase Inhibitors - adverse effects
Consumer Product Safety
Disclosure
Drug Industry
Drug Prescriptions
Drug-Related Side Effects and Adverse Reactions
Estrogen Antagonists - adverse effects
Heptanoic Acids - adverse effects
Humans
Indans - adverse effects
Newspapers
Oseltamivir
Patient Education as Topic
Piperidines - adverse effects
Pyrazoles
Pyrroles - adverse effects
Raloxifene - adverse effects
Sulfonamides - adverse effects
Abstract
Patients routinely cite the media, after physicians and pharmacists, as a key source of information on new drugs, but there has been little research on the quality of drug information presented. We assessed newspaper descriptions of drug benefits and harms, the nature of the effects described and the presence or absence of other important information that can add context and balance to a report about a new drug.
We looked at newspaper coverage in the year 2000 of 5 prescription drugs launched in Canada between 1996 and 2001 that received a high degree of media attention: atorvastatin, celecoxib, donepezil, oseltamivir and raloxifene. We searched 24 of Canada's largest daily newspapers for articles reporting at least one benefit or harm of any of these 5 drugs. We recorded the benefits and harms reported and analyzed how such information was presented; we also determined whether clinical or surrogate outcomes were mentioned; if and how drug effects were quantified; whether contraindications, other treatment options and costs were mentioned; and whether any information on affiliations of quoted interviewees and potential conflicts of interest was presented.
Our search yielded 193 articles reporting at least one benefit or harm for 1 of the 5 drugs. All of the articles mentioned at least one benefit, but 68% (132/193) made no mention of possible side effects or harms. Only 24% (120/510) of mentions of drug benefits and harms presented quantitative information. In 26% (31/120) of cases in which drug benefits and harms were quantified, the magnitude was presented only in relative terms, which can be misleading. Overall, 62% (119/193) of the articles gave no quantification of the benefits or harms. Thirty-seven (19%) of the 193 articles reported only surrogate benefits. Other information needed for informed drug-related decisions was often lacking: only 7 (4%) of the articles mentioned contraindications, 61 (32%) mentioned drug costs, 89 (46%) mentioned drug alternatives, and 30 (16%) mentioned nondrug treatment options (such as exercise or diet). Sixty-two percent (120/193) of the articles quoted at least one interviewee. After exclusion of industry and government spokespeople, for only 3% (5/164) of interviewees was there any mention of potential financial conflicts of interest. Twenty-six percent (15/57) of the articles discussing a study included information on study funding.
Our results raise concerns about the completeness and quality of media reporting about new medications.
Notes
Cites: N Engl J Med. 2000 Jun 1;342(22):1645-5010833211
Cites: Can Fam Physician. 2002 Jan;48:104-1011852597
Cites: N Engl J Med. 1991 Oct 17;325(16):1180-31891034
Cites: Lancet. 1998 Sep 19;352(9132):943-89752816
Cites: Ann Intern Med. 1992 Dec 1;117(11):916-211443954
Cites: Lancet. 1994 May 14;343(8907):1209-117909875
Cites: BMJ. 1994 Sep 24;309(6957):761-47950558
Cites: JAMA. 1992 Aug 26;268(8):999-10031501326
PubMed ID
12719316 View in PubMed
Less detail

The effect of generic competition on the price of brand-name drugs.

https://arctichealth.org/en/permalink/ahliterature181006
Source
Health Policy. 2004 Apr;68(1):47-54
Publication Type
Article
Date
Apr-2004
Author
Joel Lexchin
Author Affiliation
Emergency Department, University Health Network, Toronto, Ont., Canada. joel.lexchin@utoronto.ca
Source
Health Policy. 2004 Apr;68(1):47-54
Date
Apr-2004
Language
English
Publication Type
Article
Keywords
Drug Costs - standards - statistics & numerical data
Drug Industry - economics
Drug Prescriptions - classification - economics
Drugs, Generic - economics
Economic Competition
Formularies as Topic
Government Programs - economics
Health Services Research
Humans
Insurance, Pharmaceutical Services - economics
Ontario
Patents as Topic
Private Sector - economics
Public Sector - economics
Abstract
Literature from the US has shown that brand-name manufacturers do not compete on price once generic competitors become available. This study was undertaken to investigate if this is also true in Canada.
Editions of the Ontario Drug Benefit Formulary were used to identify brand-name drugs that lacked generic competition in July 1990 but had acquired one or more generic competitors by December 1998. Prices of the brand-name drugs were compared before generic competition, at the point when generic competition started and subsequent to the initiation of competition.
Price changes for 81 different products in 144 separate presentations were analysed. There was no statistically significant change in brand-name prices when generic competition started. The movement of brand-name prices was not influenced by whether the generic was made by the company producing the brand-name product or price freezes imposed by the Ontario government. When generics first became available having four or more generics was associated with a rise in the price of the brand-name drugs compared to having one, two or three generic competitor(s).
The lack of price competition may lead to increased costs in the private market. Private insurance companies generally do not require generic substitution and some provinces do not require generic substitution for cash-paying customers. Maintaining higher prices on brand-name drugs impacts on the prices of new patented medications coming onto the Canadian market under the current pricing guidelines of the Patented Medicine Prices Review Board.
PubMed ID
15033552 View in PubMed
Less detail

Effects of restrictive formularies in the ambulatory care setting.

https://arctichealth.org/en/permalink/ahliterature191772
Source
Am J Manag Care. 2002 Jan;8(1):69-76
Publication Type
Article
Date
Jan-2002
Author
Joel Lexchin
Author Affiliation
School of Health Policy and Management, York University, Toronto, Canada. joel.lexchin@utoronto.ca
Source
Am J Manag Care. 2002 Jan;8(1):69-76
Date
Jan-2002
Language
English
Publication Type
Article
Keywords
Ambulatory Care - economics - standards
Canada
Developed Countries
Drug Costs
Drug Utilization
Formularies as Topic - standards
Health Expenditures
Health Services Research
Humans
Medicaid
Quality of Health Care
Treatment Outcome
United States
Abstract
To determine the consequences of restrictive formularies in the ambulatory care setting in 4 areas: overall drug expenditures, overall healthcare spending, changes in the quality of prescribing, and health outcomes.
A MEDLINE search was conducted for English and French language articles, published between 1977-1999, that presented results in quantitative terms. Only articles from industrialized countries were used.
Information was extracted from each article in the following areas: time period of the study, geographic location and group of patients involved, outcome measurement(s), intervention, study design, and results.
Poor methodologic quality made definitive conclusions difficult to draw in most areas. Prior authorization may be effective in controlling drug costs without increasing costs in other areas. Both desirable and undesirable therapeutic substitutions may take place when drugs are delisted from formularies.
The use of restrictive formularies in the ambulatory care setting requires more rigorous research. Before changes are made in formularies, money needs to be set aside for research into short-term and long-term consequences of using restrictive formularies.
PubMed ID
11814174 View in PubMed
Less detail

How does direct-to-consumer advertising (DTCA) affect prescribing? A survey in primary care environments with and without legal DTCA.

https://arctichealth.org/en/permalink/ahliterature183815
Source
CMAJ. 2003 Sep 2;169(5):405-12
Publication Type
Article
Date
Sep-2-2003
Author
Barbara Mintzes
Morris L Barer
Richard L Kravitz
Ken Bassett
Joel Lexchin
Arminée Kazanjian
Robert G Evans
Richard Pan
Stephen A Marion
Author Affiliation
Centre for Health Services and Policy Research, and the Department of Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC. bmintzes@chspr.ubc.ca
Source
CMAJ. 2003 Sep 2;169(5):405-12
Date
Sep-2-2003
Language
English
Publication Type
Article
Keywords
Adult
Advertising as Topic - methods
British Columbia
California
Consumer Participation
Drug Industry - trends
Drug Prescriptions
Female
Humans
Linear Models
Male
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Physician-Patient Relations
Questionnaires
Abstract
Direct-to-consumer advertising (DTCA) of prescription drugs has increased rapidly in the United States during the last decade, yet little is known about its effects on prescribing decisions in primary care. We compared prescribing decisions in a US setting with legal DTCA and a Canadian setting where DTCA of prescription drugs is illegal, but some cross-border exposure occurs.
We recruited primary care physicians working in Sacramento, California, and Vancouver, British Columbia, and their group practice partners to participate in the study. On pre- selected days, patients aged 18 years or more completed a questionnaire before seeing their physician. We asked these patients' physicians to complete a brief questionnaire immediately following the selected patient visit. By pairing individual patient and physician responses, we determined how many patients had been exposed to some form of DTCA, the frequency of patients' requests for prescriptions for advertised medicines and the frequency of prescriptions that were stimulated by the patients' requests. We measured physicians' confidence in treatment choice for each new prescription by asking them whether they would prescribe this drug to a patient with the same condition.
Seventy-eight physicians (Sacramento n = 38, Vancouver n = 40) and 1431 adult patients (Sacramento n = 683, Vancouver n = 748), or 61% of patients who consulted participating physicians on pre-set days, participated in the survey. Exposure to DTCA was higher in Sacramento, although 87.4% of Vancouver patients had seen prescription drug advertisements. Of the Sacramento patients, 7.2% requested advertised drugs as opposed to 3.3% in Vancouver (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.2-4.1). Patients with higher self- reported exposure to advertising, conditions that were potentially treatable by advertised drugs, and/or greater reliance on advertising requested more advertised medicines. Physicians fulfilled most requests for DTCA drugs (for 72% of patients in Vancouver and 78% in Sacramento); this difference was not statistically significant. Patients who requested DTCA drugs were much more likely to receive 1 or more new prescriptions (for requested drugs or alternatives) than those who did not request DTCA drugs (OR 16.9, 95% CI 7.5-38.2). Physicians judged 50.0% of new prescriptions for requested DTCA drugs to be only "possible" or "unlikely" choices for other similar patients, as compared with 12.4% of new prescriptions not requested by patients (p
Notes
Cites: West J Med. 2000 Oct;173(4):221-211017964
Cites: J Fam Pract. 2000 Dec;49(12):1092-811132058
Cites: CMAJ. 2001 May 15;164(10):1449-5111387918
Cites: CMAJ. 2001 Aug 21;165(4):46211531059
Cites: BMJ. 2002 Feb 2;324(7332):278-911823361
Cites: JAMA. 1999 Jan 27;281(4):380-29929095
Cites: JAMA. 2003 Feb 19;289(7):827-812588246
Cites: Adv Data. 2002 Jun 5;(328):1-3212661586
Cites: Health Aff (Millwood). 2003 Jan-Jun;Suppl Web Exclusives:W3-82-9514527237
Cites: Health Aff (Millwood). 2003 Jan-Jun;Suppl Web Exclusives:W3-112-514527241
Cites: J Health Serv Res Policy. 2003 Oct;8(4):237-4414596759
Cites: N Engl J Med. 2002 Feb 14;346(7):498-50511844852
Comment In: CMAJ. 2004 Mar 2;170(5):768-70; author reply 770-114993155
Comment In: CMAJ. 2004 Mar 2;170(5):768 ,770; author reply 770-114993157
PubMed ID
12952801 View in PubMed
Less detail

27 records – page 1 of 3.