Doctors' Lunch

A small group gathered for Thursday lunch, chatting about their concerns relating to "Health Reform," whether they anticipated difficulty in maintaining their incomes and whether they should be thinking about other career opportunities.  Questions were directed to the drug company representative who provided lunch about opportunities to work for the drug company he represented,  as experienced,  well-trained, competent doctors articulated serious thoughts about leaving practice.

The drug company representative talked about his product, a monoclonal antibody given by injection, for treatment of arthritis targeted, at this time, for patients who fail on other drugs, even those of the same class. A kidney doctor asked about use of the drug in his field because of the high levels of inflammatory substances which might be susceptible to its effects and a similar question was asked by a pulmonary doctor who mentioned that for certain severe lung diseases there were very few treatments available. The representative was asked about the cost of the drug,  eliciting a response of $1,000 - $2,000 a month, depending on dose. One doctor asked why many of the drugs of the general class seemed to be priced about the same and whether there was an agreement among the various manufacturers about target pricing.  The drug representative said that he wasn't aware of any such agreement and that this wasn't an area where he had any  information. Several of the doctors agreed that their patients who receive samples or low-cost initial ("come-on") supplies of this class of drugs can't afford to buy the drugs when their initial supplies are exhausted and leave their treatment programs. The analogy was made to illicit drug-dealers luring new customers for marijuana with low cost introductory deals.

Considering the high cost, and significant risk of serious side-effects, of the drug, the representative was asked whether there were any tests, such as genetic markers, which would predict which patient would benefit from the drug and which would not. He indicated that this was a subject of intense interest for his company, but there were no genetic tests available, to his knowledge.

If there were predictive genetic tests, they would probably reduce the number of prescriptions for the expensive monoclonal antibody since rheumatoid arthritis patients currently being considered for treatment  first receive a prescription and then are removed from the medicine if they do not respond (rather than never get it). It would pose an interesting dilemma for health insurance companies which can now say that they won't approve the expensive drug without evidence of effectiveness of specific therapeutic benefit, and if there were genetic markers indicating a high likelihood of success, would have difficulty maintaining that position.