Paul Kim

[polekim]

Hi!

I'm Paul, currently a 2nd Year in the Bachelor of Science / Doctor of Medicine at USYD. I am a mentor in this Dalyell project. I hope to learn much about essential medicines and how various factors affect their accessibility.

:)

[kym834]

Hi Paul - Great to have you on the project :)

[SerriMat]

Looking forward to being a mentor and leader!

[polekim]

Drug: Amlodipine

Challenge 1:

Amlodipine is a calcium channel blocker commonly used to relieve hypertension. I learnt of Amlodipine in pharmacology class this semester. In my own research, found that it was the 5th most prescribed medication in the US. This is the reason that I chose amlodipine as the drug to research.

I couldn't find any recent news on amlodipine. However, I did find a study that compared amlodipine and nifedipine (a similar calcium blocker). Nifedipine actually increased chances of out-of-hospital cardiac arrest while amlodipine does not. This was only discovered now as out-of-hospital cardiac arrest is very hard to track. Given that Nifedipine is the 121st most prescribed medication in the US, many negative health outcomes could have been associated with this phenomenon prior to its discovery. I expect that this will increase demand for Amlodipine in the future.

Source: https://www.sciencedaily.com/releases/2019/03/190317150427.htm

[polekim]

Challenge 2:

In the UK, amlodipine's price had been increased from 60p to 3.75 pounds in 2017. This is a part of a broader pattern of drug price increases which cost the NHS 300 million pounds in 2017. This was not due to the action of a single pharmaceutical company. Rather, it was a combination of factors such as the falling value of the pound, various international supply shortages and increases in prices by various wholesalers. Thankfully, the increase in price was mostly absorbed by the NHS so patients were not impacted as much. However, given that amlodipine is such an important and widely used drug to treat hypertension, if this price hike was to happen in a country without robust healthcare, it would have a large impact on patients.

Reflecting on my learning, I think that my prior knowledge of how important amlodipine is, along with the prevalence of CV diseases which necessitates its use, really motivated my learning. If I was researching a drug which I knew nothing about (e.g. carbetocin), I wouldn't be able to imagine the impact or the importance of this price hike. I think a possible modification to the project could be a short description of what each drug does (e.g. "treats hypertension") along with a description of the prevalence of its use (e.g. "5th most prescribed medication in the US").

Source: https://www.express.co.uk/news/uk/971132/nhs-price-hikes-medicine-nhs-england-national-audit-office

[polekim]

Challenge 3

Finding information about amlodipine was hard, which is very surprising considering it is a multibillion-dollar drug. Eventually, I found that the drug was initially patented by Pfizer, and then possibly acquired by Upjohn. Upjohn, after a series of mergers, was merged with Pfizer. I also found a good database (linked below) which listed a satisfactory summary of events for this drug. I think that a possible addition to the project would be linking databases like these to be a quick 'go-to'. This would allow people to quickly gain an understanding of the general flow of events, and then they can research more about the specifics on other websites.

http://cdek.wustl.edu/api/35180/

Another thing I learnt is how obscurely documented drug lifecycles are. If the 5th most sold drug in the US only has a few vague references to its history, then what about other drugs? I guess that this is one of the lessons we are meant to learn from this project and why we should be advocating for a more clear, standardised documentation of drug history.