Praise then darkness, and creation unfinished

Biogen has agreed to a $900 million settlement of a drug kickback lawsuit. This was specifically about kickbacks to doctors to get them to prescribe specific MS drugs. Three drugs, all of which I've taken for MS in the past. (Avonex, Tysabri, and Tecfidera.)

As usual with these things, Biogen isn't admitting wrongdoing--but they thought the case against them was strong enough that they agreed to pay $900 million rather than go to trial.

The lawsuit was filed in 2012 under the False Claims Act, which allows whistleblowers to sue companies on the government's behalf to recover taxpayer money paid out based on fraudulent claims.

The Justice Department may intervene in such cases following an investigation, though in 2015 it opted against doing so in [ex-employee Michael] Bawduniak's case. Under the law, he is entitled to 25% to 30% of any money Biogen pays.

My current MS drug, Ocrevus, is made by a different company, Genentech, which at the moment feels somewhat reassuring.

My neurologist in New York, Brian Apatoff, prescribed the Avonex and then the Tysabri. My Washington neurologist continued the Tysabri for a few months, and then switched me to Tecfidera, because it wasn't safe for me to stay on the Tysabri for more than 18 months, for cumulative safety reasons (which I knew about when I started taking Tysabri). My first neurologist here in Massachusetts continued the Tecfidera; I don't remember whether he or Dr. Katz looked at an MRI and advised me to switch to Ocrevus instead. Nor do I know whether any of the doctors who advised me to take the Biogen drugs got the kickbacks; it seems unlikely that none of them did.

[via RetractionWatch]

Before I forget: yes, the Ocrevus interferes with other vaccines. What this means in practice is that if I ever have the sort of injury where they ask when you last had a tetanus vaccine, my answer will be "I'd better have one now."

Also, after talking to my neurologist this afternoon, I decided I do want the Evushield preventive monoclonal antibodies, so he has placed that order and the hospital will call me when I can come in. (That will be in the area the hospital calls the walk-in clinic, even though I need an appointment for this.) They're supposed to be good for six months. He thinks that whether a second dose will be approved depends on whether the FDA thinks this is a reasonable thing for the government to be spending money on, and that depends on vaccination rates and whether there's another variant like delta or omicron driving up case rates.

The Evushield is two intramuscular injections, one in each buttock; having been on Avonex for several years, my reaction was "that's easy" because I won't have to self-inject.

In addition to the disappointing test for covid antibodies, last fall my neurologist ordered a bunch of liver-related blood tests. Those came back that my liver enzymes were fine, but also told us that I had no antibodies against hepatitis B, despite having had three doses of that vaccine eight or nine years earlier.

I asked my primary doctor for a referral to get another dose of the hepatitis B vaccine, because maybe it would help, but I suspect that I'm not immune to anything I was vaccinated against in the last 22 years, since I started on the various anti-MS drugs. That's covid, hepatitis A and B, shingles, pneumonia, and the last couple of decades of flu vaccines.

I should probably keep wearing at least medical masks during flu season, if not year-round, for however many more years I'm taking any of the MS disease-modifying agents (as distinct from the things I'm taking to deal with the symptoms).

(I don't specifically expect to be exposed to any of those things except the respiratory viruses, i.e., influenza and the pneumonia they vaccinate older people for.)