Innovation?

It's no secret that pharmaceutical companies spend a large amount of money on promotion and marketing of their products, but the amount going into research and development is not insignificant (2004 US estimate of over $24 billion in R&D expenditures). But how much of that R&D money translates into innovative new products or improvements on current therapeutics?

The French publication Prescrire (link to English site) provides an annual report on new drugs released in France and rates them based on therapeutic advance and risk-benefit balance. In 2010, they reviewed 97 new drugs and indications, but first the rating system:

Bravo: The product is a major therapeutic advance in an area where previously no treatment was available.

A Real Advance: The product is an important therapeutic innovation but has certain limitations.

Offers an Advantage: The product has some value but does not fundamentally change the present therapeutic practice.

Possibly Helpful: The product has minimal additional value, and should not change prescribing habits except in rare circumstances.

Nothing New: The product may be a new substance but is superfluous because it does not add to the clinical possibilties offered by previous products available. In most cases it concerns a me-too product.

Judgement Reserved: The editors postpone their rating until better data and a more thorough evaluation of the drug are available.

Not Acceptable: Product without evident benefit but with potential or real disadvantages.

The review includes new products (other than generics copies) and new indications proposed by drug companies as well as new dose strengths and new form/presentations of existing drugs. Results from the past 10 years can be found here including the 2010 data reproduced below:


In 2010, over half the new products or indications added nothing new to existing clinical possibilities and almost 20% had potential or real disadvantages over current practice. The lone real advance was imatinib (Gleevec) reassessed in inoperable or metastatic gastrointestinal stromal tumours.

While breakthrough drugs might be expected to be relatively rare (only 2 in the last 10 years by Prescrire's account), the fact that 70% of new drugs or indications - in France, at least - represented no change or a step backwards from currently available interventions is not very encouraging. Where's the innovation? Sales techniques, it seems.

Carniverous Clock

h/t: Discoblog

Canadian Wait Times

One of the arguments often used against Canada's public health care system - and in support of privatized services - is the wait times. The Canadian Institute for Health Information has released a report [pdf] that claims that 8 out of 10 Canadians receive treatment within medically recommended wait times in provincially identified priority areas including cancer treatment, cardiac care, joint replacement, and vision restoration.

80% doesn't seem so terrible, unless of course you're in the 20% where wait times can be as much as three times the recommended benchmark. And if you're suffering with a hip fracture, 48 hours might seem like an eternity even if it is the evidence-based benchmark. Generally, although there is variation, Ontario, Quebec and British Columbia are your best bets for receiving timely care. Click the picture to enlarge or check out the full report for a more detailed look.

The study also looked at CT and MRI imaging, though there are currently no pan-Canadian benchmarks. In Ontario, where the provincial target for non-emergency, non-urgent CT scans is 4 weeks, the median wait time is under 10 days and the 90th percentile is about 35 days and trending downwards. MRIs on the other hand, with the same non-emergency, non-urgent target of four weeks have a median wait time of close to 40 days with the 90th percentile mark at 120. And these times have gotten longer over recent years.

Other items of note: If you need a knee replacement, avoid Nova Scotia (only 42% meet benchmark wait times). Ditto for cataract surgery in Alberta (48%). And PEI doesn't offer cardiac services? No wonder Matthew Cuthbert didn't make it.

Funny gene name browser

As you celebrate st-Patty's day, going for beers after a long day at the lab, here are a few gene names you can drop to impress your lab mates:

chadonnay. chablis, frascati, merlot, retsina, riesling, cabernet, grenache, chardonnay, chianti, pinotage, sauternes, weissherbst, zinfandel, freixenet and yquem: mutations in these loci cause defects in hematopoiesis (production of blood cells).

cheap date. Mutants are especially sensitive to alcohol (which, seriously speaking, might be a feature to avoid in a date). Interestingly, another name for the gene is amnesiac, as mutants also have a poor memory.

half pint. Cheryl Van Buskirk writes: "The mutant ovaries produce egg chambers that contain eight instead of sixteen cells. Since there are 16oz in a pint, we figured it was a pretty fitting name. Half pint is also an informal term for a very short person, and it so happens that the mutant eggs were indeed quite short. Sadly, the official gene name has since become Dmel/pUf68, based on its molecular weight and homology to poly-U binding splicing factors, and the name half pint is considered a synonym."

Drug Reps: The Telemarketer Script

A large amount of pharmaceutical company promotional dollars goes towards convincing physicians to prescribe their drugs. It's not all in the freebies either. Drug sales reps are often taught to follow a paricular script or adopt certain tactics depending on who they're dealing with. This 2007 PLoS Medicine paper has some of the details based on a former rep's experience and expert testimony.(Click to enlarge)

The full text is freely available at the above link.

A Study on Beer Taste? Sign Me Up!

I saw this item from the Journal of Food Science posted by a friend on Facebook.

This study aimed to test the much-pronounced but poorly supported theory that “Guinness does not travel well.” A total of 4 researchers from 4 different countries of origin traveled around the world for 12 mo to collect data on the enjoyment of Guinness and related factors. The main outcome was measured on a Visual Analogue Scale (VAS) from 0 (enjoyed it not at all) to 100 (enjoyed it very much). A total of 103 tastings were recorded (42 in Ireland, 61 elsewhere) in 71 different pubs spread over 33 cities and 14 countries. The enjoyment of Guinness consumed in Ireland was rated higher (74 mm VAS) than outside Ireland (57 mm; P < 0.001). This difference remained statistically significant after adjusting for researcher, pub ambience, Guinness appearance, and the sensory measures mouthfeel, flavor, and aftertaste. This study is the first to provide scientific evidence that Guinness does not travel well and that the enjoyment of Guinness (for our group of nonexpert tasters) was higher when in Ireland. Results, however, are subject to further verification because of limitations in the study design.

This is a pretty fun bit of research though, as the authors point out, very limited. For example, there is no reporting on a "control" beer to see if their findings are Guinness specific. Strangely, the authors attempted to adjust for pub ambience (which was ranked higher in pubs in Ireland) but seemed to ignore the fact that while in Ireland they consumed more alcohol before testing than in other countries (2.5 versus 1.4, P = 0.035), a factor that can undoubtedly affect perception and overall enjoyment. The authors point out the fact that Guinness is brewed in nearly 50 countries around the world, so the question "Does Guinness travel well?" may not be appropriate. And of course expectations and blinding issues run rampant in a study like this. Clearly the authors should recruit my beer-drinking expertise the next time they embark on this type of research.

Other items of note: The price of a pint of Guinness was not significantly different in Ireland compared to the other countries visited (£3.66 versus £3.83) and none of the pints served in Ireland had the head stamped with a shamrock or other design, compared to 13.1% of non-Irish pours (P = 0.015)

I have to say that while journals often do publish short "fun" pieces, I was a bit surprised to see this study appear in a peer-reviewed journal instead of a blog post. I just hope the editors are as kind when I submit my upcoming study of the best local beers here in Ottawa.

Undergrads Will Believe Anything. If it's Well Written

Scientific American is reporting on a study examining the credibility of pseudonymous bloggers.

Chesney and Su gave 269 undergraduate students – 182 in the UK, 87 in Malaysia - a fake story chronicling a blogger's discovery of, and subsequent battle with, nail fungus (ew?). The posts were identical except for the blogger's biographical information running along the top. Here, the researchers had three types of bio: 1) a pseudonym only 2) a pseudonym, age, and sex, or 3) the blogger's “real” name, age, sex, email address and photograph.

Each blogger was graded by the students on criteria such as trustworthiness and credibility. The authors of the study found that fully-identifiable bloggers were rated no better than their pseudonymous counterparts. Of course, as the SciAm piece points out, it could just be that bloggers in general have such low credibility that adding a real name and a photo just doesn't help. And while the results seem to support the idea that pseudonymous bloggers have just as much (perceived) credibility as RealName bloggers, it says nothing of other potential anti-pseud arguments - like the ease with which one can be an unbridled asshole when there is no fear of repercussion. We're fine with that though, since what's the point of being a pseudonymous asshole when nobody believes you?

The study also looked at the effect of presentation on perceived credibility.

This time respondents were shown one of two blog posts which conveyed exactly the same information and revealed exactly the same information about the blogger. One post introduced a number of spelling/grammar/punctuation errors.

In this case, the well-written posts were graded higher than those riddled with spelling and grammatical errors. So if you're going to be posting BS online, make sure it's well-written if you want people to believe it. (That's been my secret all along)

Of course, the real moral of the story is that undergrads will believe anything, as long as you run it through spell check.

One thing to note, though, is that the study seemed to use personal blog-type entries, like those you might find in an online diary. Science or medical blog posts, where credentials could add certain weight to delivered information, may be graded differently when it comes to pseudonymous credibility. That would be an interesting study to see, but one that wouldn't affect the Bayblab since our posts are so well-written they've got to be true.

Cancer Carnival #43

Welcome to the 43rd edition of the Cancer Research Blog Carnival. The Carnival relies on posts and hosts, so be sure to submit your posts for next month or drop us a line to sign up as a future host.

Kicking things off is Biotunes who writes about the PSA screening test for prostate cancer and how it falls short.

Our overzealous “war” on prostate cancer in particular has been devastating to the quality of life of millions of men: it has been estimated that 48 men are treated to save one life from prostate cancer.

Issues with screening techniques (such as false positive rates) have been discussed before on this blog and last month's Cancer Research Blog Carnival contained a post about genetic determinants of baseline PSA levels - a subject that really underscores one of the issues raised in the Biotunes post.

Dwarfism seems to be a big topic this month with two posts discussing dwarfism in Ecuador and a link between diabetes and cancer.

Can a gene that causes dwarfism also confer major health benefits? Perhaps, according to a new study showing that a group of extremely short people in Ecuador get no diabetes, even though they are unusually obese.

The 22-year study of people living in villages on the slopes of the Andes mountains also found just one case of cancer in the 99 patients it tracked, many fewer than among non-dwarf relatives.

The absence of two of the worst diseases of aging was strong evidence that the mutation that causes what’s called “Laron syndrome” has an upside.

This study was also sent to us in a different post at Genome Engineering.

Genome Engineering also sends us a news brief about a study looking at the genetics of inflammatory bowel disease, which can increase the risk of bowel cancer.

Our friends at Highlight HEALTH have a post up about the drug Crizotinib and a movement towards personalized cancer care.

Unfortunately, though perhaps not surprisingly, drugs like crizotinib and Gleevec cannot be the last line of defense. Once they are administered, the kinases they target can mutate to resistant them. The third research study published in the NEJM, by Choi et al., enumerates the mutations in EML4-ALK that confer such resistance to crizotinib [5]. Additional kinase inhibitors are being developed to act as backup therapies for both crizotinib and Gleevec once drug resistance has occurred.

The post points out the importance of tumor gene expression profiling to determine which drugs are best suited for individual treatment.

Finally, a guest post at Hematopoiesis discusses the role of cancer stem cells in mesothelioma, a cancer typically traced back to asbestos exposure.

Recent research has explored the idea that cancer stem cells (CSC) play a role in the metastasis of mesothelioma tumors. Researchers at the University of Tokyo’s Division of Clinical Immunology transferred malignant mesothelioma cells into mice and studied the cell lines as they developed. They found that many of the cells displayed markers for CSC such as SP, CD9, CD24, and CD26. The cells with those markers were also found to generate larger tumors.

That's it for this month's Cancer Research Blog Carnival. For older editions, visit the Carnival Homepage. Don't forget, the CRBC has subscription options; you can follow by email or RSS feed. An aggregated feed of credible, rotating health and medicine blog carnivals is also available. For a broader collection of science-related blog carnivals, sign up for the Science, Medicine, Environment and Nature Blog Carnival Twitter Feed.