Most people believe that we need to spend more money in research and development to cure all the diseases, viruses, and health problems of our population. This is an interesting belief however I’d like to point out a little bit of the hypocrisy that goes on when it comes to pharmaceutical research. First, do you know what to the very largest selling drugs ever produced by the pharmaceutical companies have been? Viagra and Prozac. So I ask you, what’s really wrong with America and our pharmaceutical technological advances?

Is it really important that we give drugs to people who have ADHD, so they can sit in a classroom, without misbehaving? Do we really need to create a drug to help us with this? And is America’s biggest problem really the fact that some men can’t get it up? I mean that’s ridiculous when you think about it, in fact, if they would just do a little bit of exercise, perhaps go to the gym and work out a little bit, their blood would be flowing and they would never have this problem.

Nevertheless, they can solve all of their impotence issues by taking a little pill. What a major breakthrough in science? It’s utterly ridiculous if you ask me.

Some would say that this is an unfair assessment of the pharmaceutical companies and their incredible research, because they have produced lots of drugs which have actually allowed people to live with diseases, ailments, and issues which might have killed them. Nevertheless most of the drugs created do not cure anybody, they wouldn’t want to do that, they only help treat them.

Indeed, I hope someday we get real serious, and start curing some of these diseases, and overcoming things like old age which kills everybody, who doesn’t die of something else someday. Please consider all this.

A new research has suggested that more patients are ready to follow their medicine when mailed to their door. Doctors do not have to fret about their patients’ disease worsening from non-adherence if the medicines are bought online. The UCLA and Kaiser Permanente’s Division of Research has concluded this from a study of patients undergoing high blood pressure, high cholesterol levels, and diabetes. These patients had obtained their medicines in a delivery. They showed a greater likelihood in obeying their prescribed drugs than those who bought medications from a nearby pharmacy.

This study is the first to be done, with no other research linking the pharmacy type to patient adherence. As more individuals prefer the convenience of sent buys, the trade of web drug stores definitely has big potential. It may be the moment for doctors to look into the trusted and popular pharmaceuticals and advise these to their stubborn patients.

The study shows significant results, with a majority of the patients following medications when received through a delivery. This could be from the convenience of having the medicines on hand. Unlike local drug stores, buying in a large amount is cheaper when ordered from internet pharmaceuticals. If the week’s supply of medications run out, the patient can simply go to the storage cabinet or the rest of the stock to replenish. This is certainly easier than bringing out your car, paying for gas, or waiting for the bus to buy an extra stock. Financial factors have a significant role, considering that health care’s price persists to rise.

The study adds that the link between delivery drug stores and medication adherence is regular for patients with high blood pressure, high level cholesterol, and diabetes. Individuals who experience the same difficulties and don’t take their medications must consider buying from a delivery drug store. If costs are the issue, the physician will readily have a less expensive, generic counterpart as treatment. You can spend a smaller sum of money buying the pills on the internet and economize other relevant costs. Attaining the financial security enables an individual to be more habitual with their medication treatment.

The conclusions of this study may be startling but patient adherence is a serious issue. The WHO reports that a mere 50 percent of US patients really follow their prescribed medicines. The National Community Pharmacists Association relates that around 3 out of 4 American consumers say they do not usually consume their medicines as prescribed. The report of the NCPA continues to say that 1/2 have do not remember to take their medications and 31% did not fill the recommended prescription. 24% state they take smaller than the recommended amount while 29% stopped consuming medicines when their supply ran out.

Individuals who are guilty for refusing to take their medicines should consider that over $177 billion was spent for healthcare costs. Economical buyers concerned about their wallet can stop fretting over money by ordering from online pharmacies.

Product Registration

Getting marketing authorisation for medicinal products in more than one Member State in the EU is done by using one of three procedures:

“Centralised Procedure” - Regulation (EC) No 726/2004

“Mutual Recognition Procedure” and

“Decentralised Procedure” - Directive 2001/83/EC.

As well as these, national authorisations still allow products to be marketed in individual countries in the EU. Products could be authorised separately in several Member States by a number of national authorisations, alternatively one of these authorisations could be used to apply for authorization using the Mutual Recognition Procedure. Where products have national authorisation, the regulatory agency of the country concerned has to monitor and assess the safety of any products that have national authorisation.

Centralised Procedure

The EMEA administers the centralized procedure, where a single application, if approved, grants marketing authorisation for all the countries in the European Union (and the European Economic Area, that’s the EU countries plus Iceland, Norway and Liechtenstein). The European Commission becomes the responsible authority for products which come to market through the centralised procedure. This procedure is available to all new or innovative pharmaceuticals and is the only way to authorise biotechnology medicines. Where products contain new substances for treating serious diseases, they would use the centralised procedure.

The regulatory agency of one Member State is then appointed as the Rapporteur and they will then carry out initial assessments of the application for Marketing Authorisation; a second agency is appointed as Co-Rapporteur. These countries will then be responsible for leading the monitoring and assessment of safety of the product when it is subsequently marketed.

Mutual Recognition Procedure

In the Mutual Recognition Procedure the marketing authorisation of one member State is recognised and copied by the other member states. In this procedure, the ‘Reference Member State’, is “mutually recognised” by other ‘Concerned Member States’. Once the application for mutual recognition has gone in, there is a 90 day assessment period. After the assessment period the Member States grant a marketing authorisation with an identical summary of product characteristics to the one in the Reference Member State as long as they accept the original assessment of the product. If a Member State raises objections and does not recognise the original marketing authorisation then the matter may be referred to the EMEA for discussion among the parties: if this fails, binding arbitration is imposed.

Decentralised Procedure

The decentralised procedure can apply where there is no authorisation yet in any of the Member States. The same dossier is submitted to all Member States where a marketing authorisation is needed. The applicant selects a Reference Member State and prepares a preliminary assessment report within 120 days and sends it to the other states, the Concerned Member States. They then approve the assessment or the application will continue into a facilitation or, if this fails, a binding arbitration procedure applies.

Laws and guidelines

Laws

In the EU there are EU laws which are directives and regulations, and national laws. Once an EU regulation comes into effect it is in force in all the Member States of the European Union. However EU directives are different, once an EU directive comes into force it must first be enacted in national law in each EU Member State within a specified time-frame. As well as the national laws that put EU directives into action, there may also be national laws governing pharmacovigilance practice.

The principal EU laws concerning pharmacovigilance are:

Directive 2001/83, amended by Directive 2004/27. This concerns all medicinal products, although for pharmacovigilance it is most relevant to products authorised by the national, mutual recognition and decentralised procedures. The Member States are the licensing authorities in these procedures.

Regulation 726/2004. This concerns centrally authorised products. The European Commission is the licensing authority for these products.

Directive 2001/20. This is the Clinical Trials Directive and includes extensive coverage of pharmacovigilance for interventional clinical trials pre- and post-authorisation.

Guidelines

A word to the wise here. The guidelines tends to be suggestions or recommended methods. When it comes to EU pharmacovigilance law the guidelines are considered to be compulsory as far as pharmaceutical companies are concerned.

The European Commission guidelines provide detail and interpretation as to how the directives and regulations should be followed.The guidelines are also aimed at regulatory authorities and provide detailed requirements for the way that they must carry out pharmacovigilance as well. The guidelines are:

Volume 9A of the Rules Governing Medicinal Products in the European Community - for post-authorisation pharmacovigilance

Volume 10 of the Rules Governing Medicinal Products in the European Community. This applies to clinical trials pre- and post-authorisation and incorporates the guideline Detailed guidance on the collection, verification and presentation of adverse reaction reports arising from clinical trials on medicinal products for human use

As well as these laws and regulatory guidelines there are also various voluntary guidelines, generated for the most part by two organizations:

The Council for International Organizations of Medical Sciences (CIOMS)

The International Conference on Harmonization of Technical Requirements for the Registration of Pharmaceuticals (ICH).

CIOMS is a body set up under the World Health Organization and UNESCO. It has developed a series of guidelines on pharmacovigilance, drawn up by a committee of volunteers from Industry, regulatory authorities, WHO and others. The main guidelines concern the international reporting form (CIOMS I); periodic safety update reports (CIOMS II); core data sheets (CIOMS III); benefit-risk assessments (CIOMS IV); practical issues in pharmacovigilance (CIOMS V); clinical trial safety data (CIOMS VI); and development safety update reports (CIOMS VII).

Whilst CIOMS guidelines are very influential they are not “official” regulatory guidelines, they have no legal force and are generally there just to provide a consensus on good practices and new methodologies.

ICH consists of representatives of the regulatory authorities from the EU, Japan and US, with representatives of the corresponding industry regional organizations and Health Canada and WHO as observers. ICH establishes guidelines applicable to the EU, US and Japan through a series of expert working groups. There is a stepwise development of the guidelines. At Step 4, there is consensus internationally and at Step 5, an agreement by the regulators that they will introduce the guidelines into legislation, although there may be some divergence when these are actually put into effect in the different regions.

The three areas covered by ICH guidelines are Efficacy, Safety and Multidisciplinary. Paradoxically, the “Efficacy” guidelines include clinical (human) safety, whereas the “Safety” guidelines concern only pre-clinical (animal toxicology) safety.

The main guidelines concerning pharmacovigilance are:

E1: populations to be studied for safety and efficacy

E2A: reporting on safety in clinical trials

E2B: electronic reporting of adverse events

E2C: periodic safety update reports

E2D: reporting on safety post-marketing

E2E: pharmacovigilance planning

E2F: development safety update reports

M1: Medical Dictionary for Regulatory Activities

M4: the Common Technical Document (i.e. the international registration dossier)