US drug sales will fall 1-2% in 2009, according to IMS Health, a record drop. The market research firm expects growth to rebound in the following years, but that overall compound annual growth over the next 5 years will be flat.

The problem, according to IMS, has been inopportune pharmaceutical cost shifts to patients who are being hammered by the Great Economic Crisis, as well as patent expirations for several blockbusters in the upcoming years.

Global sales are not immune to these developments. IMS now predicts that worldwide sales will rise only 2.5- 3.5% this year, which is 2 percentage points less than it forecast before the Feds played Russian Roulette with Lehman Brothers and the chamber turned out to be loaded.

The new forecast translates to about $750 billion in 2009 revenues for Big Pharma.

In October, IMS had pegged that number at a cool $820 billion. 

“To the now-familiar factors impeding market growth such as patent expirations, a slowdown in innovative product launches, and hurdles imposed by payers on market access and acceptance, we can now overlay the economic downturn,” said Murray Aitken, a senior VP at IMS.

“There is a clear correlation between demand for medicines and key macroeconomic variables such as GDP, consumer spending and government expenditures. The pharmaceutical industry is not recession-proof.”

Despite the near term hit to global pharmaceutical sales, IMS predicts that the global compound annual growth rate for pharmaceutical sales will run between 3-6% through 2013.

Countries in which patients largely pay out-of pocket for drugs, such as China and Brazil will impact these figures negatively.

Despite this, IMS expects that China will rise from its current position as the world’s sixth-largest pharmaceutical market to 3rd place by 2011.

Law enforcement officials have begun a determined effort to expand DNA databases by obtaining specimens from citizens that have been arrested or detained for crimes but not yet convicted.

The FBI’s DNA database currently includes 6.7 million profiles.

It had been growing by 80,000 entries per year, but the new initiative will increase this annual growth rate 15-fold, to 1.2 million per year by 2012.

Cops say genetic surveillance solves crimes more accurately than other physical evidence. “I’ve watched women go from mug-book to mug-book looking for the man who raped her,” Denver DA Mitch Morrissey told the New York Times. “It saves lives.”

DNA evidence has also exonerated at least 200 wrongfully convicted people.

Courts typically support compulsory DNA collection from convicts on grounds they are not entitled to full privacy rights, but the new initiatives appear to trample those precedents.

Currently, minors in 35 states must provide DNA samples if convicted, and in some states they must submit specimens upon arrest. In 16 states, authorities can obtain samples from certain people after being found guilty of a misdemeanor.

Some believe the new initiatives threaten Fourth Amendment privacy rights. “The Constitution prohibits…indiscriminate taking of DNA for things like writing an insufficient funds check, shoplifting, drug convictions,” ACLU lawyer Michael Risher told the Times.

In the UK, which has fewer privacy protections than here, authorities have DNA samples for 4.5 million of its 61 million citizens including children as young as 10. About 20% of them have no criminal record.

Rock Harmon, a former prosecutor for Alameda County, Calif., told the Times there was no cause for concern. “If you haven’t done anything wrong, you have nothing to fear,” he said.

Hospitalized Medicare beneficiaries are far less likely to be seen in house by their PCP than they were 10 years ago, according to Gulshan Sharma and his team at the University of Texas medical Branch of Galveston.

The findings raise concern about continuity of care as various payment reforms and the hospitalist movement change longstanding routines.

The scientists reported that in 1996, 51% of hospitalized Medicare patients were seen by at least one physician that had seen them as an outpatient in the preceding year.

In 2006, that number had dropped to 40%.

To reach these conclusions, the scientists utilized a retrospective cohort trial design involving 3,020,770 hospital admissions from over a 2 year period, representing a 5% national sample of Medicare beneficiaries.

The write-up is in JAMA.

Using multivariable, multilevel models, the scientists ascribed about a third of the lost continuity to the hospitalist movement. Medicare payment formulas discourage PCPs from visiting their hospitalized patients when hospitalists are on the case.

Patients admitted on weekends, or who lived in large metropolitan areas or in New England experienced greater losses in contact with their outpatient physicians during the study period.

For its study, Sharma’s team posited that continuity of care included 3 dimensions: continuity in information, continuity in management, and continuity in the patient-physician relationship.
 
The team recommends further study to determine whether the reduced continuity of care has detrimental effects on patient outcomes, and that interventions be developed which would mitigate any such untoward effects.