Four stent makers and 4 drug companies have agreed to fund a $100 million study to determine how long vigorous but risky anti-platelet therapy should be continued in patients who receive stents following balloon angioplasty.

Anti-platelet therapy with aspirin and Plavix helps prevent blood clot formation around the stent (pictured), an event which can be serious, even fatal. The downside of anti-platelet therapy is an increased risk of bleeding and stroke. 

In patients receiving stents, physicians typically prescribe aggressive anti-platelet therapy for about one year, but many patients have developed clots after that time. The study will randomize patients to receive one year versus 2 ½ years of aggressive anti-platelet therapy.

The global market for stents, particularly the more profitable drug-eluting variety, has diminished to about $5 billion per year primarily due to concerns about blood clots and bleeding from anti-platelet therapy.

Four of the study’s funding companies are stent-makers: Johnson & Johnson, Boston Scientific Corp. Abbott Laboratories, Inc. and Medtronic, Inc.

The other four are drug companies. They include Sanofi-Aventis and Bristol-Meyers Squibb, which co-market Plavix, and Eli Lilly & Co. and Daiichi Sankyo, which co-developed prasugrel, a Plavix competitor that is edging toward FDA approval.

Plavix by the way, is the world’s second largest selling drug with $5.9 billion in annual sales. It has patent protection until November, 2011. It is anticipated that the current study will take 4 years to complete.

The Great Economic Crisis of 2008 has darkened the mood of Silicon Valley venture capitalists, according to a study published this week by Mark Cannice, director of the Entrepreneurship Program at University of San Francisco.

Each quarter since 2004, Mr. Cannice has asked VCs to assess on a five-point scale their own confidence about start-ups and entrepreneurialism generally for the ensuing 6-18 months. His just completed Q3 2008 survey revealed the VC’s confidence level to be 2.89 (with 5 being the most confident), the lowest ever recorded and the fourth new low in a row.

The VCs cited, what else, the impact of the Crisis on their business models and in particular their ability to cash in their investments. There have been only six IPOs this year for example. That’s the lowest number in 30 years. The prognosis for acquisitions is also gloomy since companies are cash-strapped and can’t secure loans easily.

Beyond this, it’s probably just a matter of time before institutional investors decide to allocate less money towards risky VC-type investments.

Mr. Cannice did note that some unperturbed VCs actually scored the current period a 5, the most optimistic rating possible. These people see high-tech entrepreneurs flooding their inboxes with superb ideas and plans, and point out that in the past, many successful start-ups began during economic downturns. 

What’s in their Kool-Aid?

Physicians know the dangers of smoking, but they don’t have time to counsel patients. Toll free tobacco quit lines are a proven, cost-effective alternative, but physicians rarely refer patients to such services.

A study published in this week’s Archives of Internal Medicine has shown that paying physicians to refer cigarette-smoking patients to quit lines increases their referral rates by 250%.

The study was a randomized trial of a program offering physicians $5,000 for 50 referrals to a quit line vs. usual care (no pay for performance). Only patients who intended to quit within 30 days were eligible for referral. Physicians in the incentive program referred 11.4% of eligible smokers while those in the usual care cohort referred 4.2%.

The marginal cost per quit line enrollee was $300, a pittance given that in the US, tobacco use causes 440,000 premature deaths and $75 billion in extra medical costs per year.

The study’s authors commented that health plan collaboration was essential to program success. It streamlined referrals and allowed physicians to refer patients regardless of their insurer. Thus physicians could target all smokers rather than just those from certain health plans.

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