Health and Medical News and Resources

General interest items edited by Janice Flahiff

[News release] Most Information in Drug Development Is Lost

From the 9 March 2015 Newswise article

Lots of potentially useful medical information is getting lost. McGill researchers discovered this when they looked into the lack of reporting of information from “stalled drug” trials in cancer, cardiovascular and neurological diseases.

“Stalled drugs” are drugs that fail to make it to the market either because they prove to be ineffective or unsafe or both. Because only one in ten of the drugs that goes into human testing actually gets licensed, most of the information collected in developing new drugs is currently being lost. This is despite the fact that this information is critical for effective care, protecting patients, and discovering better drugs.

….

Findings from trials of stalled drugs:

1. Allow drug developers to discover what didn’t work, and then adjust the compound or method of delivery so that it might work for other conditions. For example, the drug Viagra failed initially as a drug for treatment of angina. We now know it to be a very effective drug for erectile dysfunction.

2. Help us learn about the safety of other approved drugs. Often, trials of experimental drugs generate valuable evidence about the safety of approved drugs – especially if the approved drugs are in the same chemical family.

3. Help drug discoverers learn about the limits of animal models and other experimental techniques. “When a drug works in animal models but not in patients, we have an opportunity to study why our model fell short and to improve it,” says Amanda Hakala, a Master’s student who is first author on the study.

4. Contain safety and efficacy information that might be useful in other parts of the world. Often, drugs that are considered unsafe and ineffective in one part of the world are approved in another. “Failure to publish these trials deprives patients in those other jurisdictions of state of the art evidence of safety and efficacy,” says Kimmelman.

March 10, 2015 Posted by | Medical and Health Research News | , , , | Leave a comment

[News item] Only half of patients take their medications as prescribed: Are there interventions that will help them? — ScienceDaily

Only half of patients take their medications as prescribed: Are there interventions that will help them? — ScienceDaily.

From the news article

Date:November 20, 2014
Source:Wiley
Summary:The cost of patients not taking their medications as prescribed can be substantial in terms of their health. Although a large amount of research evidence has tried to address this problem, there are no well-established approaches to help them.

The cost of patients not taking their medications as prescribed can be substantial in terms of their health. Although a large amount of research evidence has tried to address this problem, there are no well-established approaches to help them, according to a new systematic review published in The Cochrane Library. The authors of the review examined data from 182 trials testing different approaches to increasing medication adherence and patient health. Even though the review included a significant number of the best studies to date, in most cases, trials had important problems in design, which made it hard to determine which approaches actually worked.

Only about half of all patients who are prescribed medication that they must administer themselves actually take their medication as prescribed. Many stop taking medication all together and others do not follow the instructions for taking it properly. This has been the case in many different diseases for at least the last half a century. In conditions where effective drug treatments are available, patients who take their medications as per their provider’s instructions can see a real difference to their health. However, when researchers in the field have tried to draw together evidence on this, they have found it unreliable and inconsistent.

November 28, 2014 Posted by | Medical and Health Research News | , , , , , | Leave a comment

Does taking multiple medicines increase risk of being admitted to hospital? Yes and no

Does taking multiple medicines increase risk of being admitted to hospital? Yes and no.

From the 14 January 2014 article

Patients with a single illness who take many drugs have an increased risk of being admitted to hospital, but for patients with multiple conditions, taking many medicines is now associated with a near-normal risk of admission. This is the key finding of work published in the British Journal of Clinical Pharmacology. Doctors call the situation where people take many drugs ‘polypharmacy’, a state of affairs that is becoming increasingly common in part because we have more elderly people and also a rising number of people are being diagnosed with multiple health conditions.

Dr Payne says that previous studies have missed the different effect that polypharmacy has in different people because they used overly simplistic approaches when looking at the effect of taking many drugs at once. He points out that their new work demonstrates the need for more sophisticated and nuanced approaches when measuring the impact of polypharmacy in future clinical research.

Medicine drugs

Medicine drugs (Photo credit: Wikipedia)

Dr Payne says that previous studies have missed the different effect that polypharmacy has in different people because they used overly simplistic approaches when looking at the effect of taking many drugs at once. He points out that their new work demonstrates the need for more sophisticated and nuanced approaches when measuring the impact of polypharmacy in future clinical research.

Read the entire article here

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January 22, 2014 Posted by | Consumer Health, health care | , , , , | Leave a comment

[Brookings Conference] Exploring Implications of the Nonprescription Drug Safe Use Regulatory Expansion (NSURE) Initiative on Reimbursement and Access

 

Check back after the conference, audio and/or video of the conference should then “be up”

From the Brookings Institute Web page

On November 4, the Engelberg Center for Health Care Reform convened an expert workshop “Exploring Implications of the Nonprescription Drug Safe Use Regulatory Expansion (NSURE) Initiative on Reimbursement and Access.”

In an effort to address the undertreatment of common diseases and conditions, the U.S. Food and Drug Administration is exploring how a regulatory expansion of the nonprescription drug class might increase access to medications. This initiative, known as the Nonprescription Safe Use Regulatory Expansion (NSURE), is exploring how health care professionals and innovative technologies can serve as a condition to the safe use of drugs in a nonprescription setting.

Understanding the impact of NSURE on reimbursement and patient access to medication will be critical to the initiative’s success in addressing medical undertreatment. At this expert workshop, a wide range of experts and stakeholders explored previous effects from prescription-to-nonprescription medication switches, identified potential incentives for coverage of nonprescription drugs with Conditions of Safe Use, and investigated potential mechanisms for reimbursement.

This expert workshop was the third in a series of meetings that explored the NSURE initiative. To explore previous discussions regarding the potential role of health care professionals as a Condition of Safe Use within the NSURE initiative, please visit our expert workshop, “Nonprescription Medications with Conditions of Safe Use as a Novel Solution for Undertreated Diseases or Conditions”. To explore previous discussion regarding the role of technology in supporting the safe and effective use of nonprescription products, please visit our expert workshop, “Innovative Technologies and Nonprescription Medications: Addressing Undertreated Diseases and Conditions through Technology Enabled Self-Care”.

 

November 7, 2013 Posted by | Consumer Health, health care | , , , | Leave a comment

[Partial Reblog] What Should NOT Be in Your Medicine Cabinet

 

Screen Shot 2013-10-12 at 5.57.07 AM

From the 4 October 2013 post at Straight, No Chaser by Dr. Sterling

Ever notice that people run straight to the medicine cabinet to do harm to themselves or others? I want you to know the harder the effort is to obtain items to hurt oneself, the less likely one is to follow through on the notion. On another related note, here’s a quick not-so-fun-but-interesting fact. One of the differences between America and say, certain European countries is the oversized influence of corporations in the States. Why am I talking about that on a medical blog? Read on. If you can’t tell where I’m going with this, you’ll get it pretty quickly.

Here’s my top five items I want you to take out your medicine cabinets and lock up.

1. Any jumbo sized container of any medication. Think about two of the most common over the counter (OTC) medications used for suicide attempts: acetaminophen (Tylenol) and salicylate (aspirin). One thing they have in common is you can buy what amounts to a tub-full of it at your local superstore in the United States. They should call these things ‘suicide quantities’, because often those in the midst of a suicide attempt will grab and swallow whatever is convenient. Many different medications will hurt you if you take enough; Tylenol and aspirin certainly fit that bill. Observing that (and additional considerations after the deaths due to the lacing of Tylenol with cyanide back in 1983), the Brits decided to not only pass a law limiting quantities, but certain medications that are high-frequency and high-risk for suicide use are now mandatorily dispensed in those annoying containers that you have to pop through the plastic container. Needless to say, observed suicide rates by medication rates plummeted as a result. Wonder why that hasn’t been implemented in the good ol’ USA?

2. Have teens in your house? Lock up the Robitussin and NyQuil.

Read the entire article here

October 12, 2013 Posted by | Consumer Health, Consumer Safety | , , , , , | Leave a comment

Aspirin to Zoloft: Ways Medicines Work

From the 8 August 2013  US National Library of Medicine article

Most medicines work by binding to and modifying the actions of proteins, tiny molecular machines that perform important cellular tasks. Details about protein structure and function help scientists develop medicines that block proteins or otherwise interact with them. But even when a drug is designed to target a specific protein, it can sometimes impact others, causing side effects. The way medicines work also can be influenced by how a person’s body absorbs and processes them.

Findings from research funded by the National Institutes of Health have shed light on how some common medicines work.

HIV protease with saquinavir.

HIV protease with saquinavir.
View larger image.

Antibiotics, Antivirals

Antibiotics and antiviral drugs attack proteins that are only found in the targeted bacterium or virus and that are crucial for the pathogen’s survival or multiplication. In many cases, the targets are enzymes, which are proteins that speed up chemical reactions. The antibiotic penicillin, for example, hones in on an enzyme that builds bacterial cell walls, causing infecting bacteria to burst and die. Protease inhibitors like saquinavir shut down an enzyme that would otherwise help HIV spread in the body.

Anticancer Agents

Tubulin with taxol.

Tubulin with taxol.
View larger image.

Many anticancer drugs act by killing cells that divide rapidly, but they can also affect healthy dividing cells. For example, paclitaxel (Taxol), which is prescribed for breast, ovarian and other cancers, works by binding to the tubulin protein, inhibiting the formation of structures called microtubules that are needed for cell division. Newer anticancer drugs are more discriminating, often targeting important proteins that are abnormally active in certain cancers. One such drug, imatinib mesylate (Gleevec), halts a cell-communication pathway that is always “on” in a cancer of the blood called chronic myelogenous leukemia. Gleevec’s target is a protein called a kinase, and the drug’s design is based on years of experiments on the basic biology of how cancer cells grow.

Antihistamines, Antidepressants, Aspirin

Adrenergic receptor with carazolol, a beta-blocker.

Adrenergic receptor with carazolol, a beta-blocker. View larger image.

Some of the most widely prescribed drugs function by blocking proteins called G protein-coupled receptors, which play key roles in transmitting the signals that allow a cell to respond to its environment. The drug loratadine (Claritin) relieves allergies by blocking the histamine receptor; antidepressant medications (such as Prozac, Paxil and Zoloft) affect the serotonin receptor; and beta-blockers treat heart disease by interfering with the adrenergic receptor. Signaling can also be stopped by targeting the enzymes that create a molecule involved in the process. This is how aspirin works—it inhibits the enzyme cyclooxygenase, which makes pain-signaling molecules called prostaglandins.

Weight Loss, Cholesterol Blockers

Pancreatic lipase with an inhibitor similar to orlistat.

Pancreatic lipase with an inhibitor similar to orlistat.
View larger image.

Medicines taken to control weight or cholesterol also work by interacting with specific proteins. The weight-loss drug orlistat (Xenical or Alli) blocks the action of pancreatic lipase, reducing the amount of fat that is absorbed from food. Cholesterol-lowering medications, such as atorvastatin (Lipitor) and simvastatin (Zocor), block the action of HMG-CoA reductase, an enzyme involved in making cholesterol.

Future Directions

With a better understanding of the specific relationships between a drug and its target (and off-target) proteins, researchers are using a variety of existing data to identify and test FDA-approved drugs for new uses and to predict potential side effects. This could reduce the time and cost of bringing drugs to market. Scientists are also learning more about how a person’s genes may influence the effectiveness and safety of certain drugs. Another area of active research involves developing new ways to deliver drugs to specific organs or disease sites, also improving therapeutic benefits and reducing side effects.

Content adapted from the poster “How Do Drugs Work?” available from the RCSB Protein Data Bank. Images courtesy of David S. Goodsell, The Scripps Research Institute.

Learn more:

Also in this series:

This Inside Life Science article also appears on LiveScience Link to external Web site.

 

August 25, 2013 Posted by | Educational Resources (High School/Early College(, Health Education (General Public) | , , , , , , , , , , , , | Leave a comment

Why clinical decision making in psychiatry is difficult

English: medications

English: medications (Photo credit: Wikipedia)

 

From the post by JULIA FRANK, MD on October 17th, 2012 at KevinMD.com

 

All psychiatrists do is push drugs!”

I have heard this repeatedly, from students, wary patients, even family members who don’t pick up on a carefully worded hint that they just might benefit from getting help.  For some reason, no one makes the same complaint about infectious disease specialists, or oncologists, though I wager that the success rates of our drug treatments are roughly equivalent.

 

As a psychiatrist, I try to treat people with diseases, not diseases that happen to occur in people, but combining drugs with other modes of therapy requires a daily, even hourly balancing act. Add the effects of pharmaceutical marketing, especially direct to consumer advertising (followed by direct potential litigant recruitment)–some days I don’t want to get out of bed.

Beyond a general temptation to rely on drugs as the primary mode of treatment, psychiatrists feel particularly pressed to use the newest, most expensive drug. Many psychiatric patients receive their care in publicly funded clinics, under excruciatingly tight budgets. Having free samples to distribute allows us to provide a few patients with high end drugs. Clinical decision making in psychiatry is difficult because of our lack of objective measures of response. Newer psychotropic medicines do sometimes work where older ones have failed. The side effects of newer medications typically differ from those of older ones, though the overall burden of adverse consequences is arguably the same. These background forces are invisible. In the clinical moment, the selection of a particular remedy is often based more on nonmedical influences—the patient’s response to advertising, the clinic’s necessary concern with costs—than upon the prescribing professional’s careful assessment and detailed discussion with a patient.

Aggressive pharmaceutical marketing has exacerbated the problem of responsible prescribing…

..

Although radical reform is still a long way off, section 6002 of the Patient Protection Affordable Care Act requires manufacturers of drugs, devices, supplies and biological materials that are covered under various federal health programs to disclose on an annual basis the payments (of various kinds) they have made to physicians and teaching hospitals.

 

 

October 18, 2012 Posted by | health care, Psychiatry | , | Leave a comment

American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

Tablets and Patches of Clonidine, Comprimés et...

Tablets and Patches of Clonidine, Comprimés et patch transdermique de clonidine (Photo credit: Wikipedia)

From the  April 2012 Full Text Report summary (with link to report)

Potentially inappropriate medications (PIMs) continue to be prescribed and used as first-line treatment for the most vulnerable of older adults, despite evidence of poor outcomes from the use of PIMs in older adults. PIMs now form an integral part of policy and practice and are incorporated into several quality measures. The specific aim of this project was to update the previous Beers Criteria using a comprehensive, systematic review and grading of the evidence on drug-related problems and adverse drug events (ADEs) in older adults. This was accomplished through the support of The American Geriatrics Society (AGS) and the work of an interdisciplinary panel of 11 experts in geriatric care and pharmacotherapy who applied a modi- fied Delphi method to the systematic review and grading to reach consensus on the updated 2012 AGS Beers Criteria. Fifty-three medications or medication classes encompass the final updated Criteria, which are divided into three categories: potentially inappropriate medications and classes to avoid in older adults, potentially inappropriate medications and classes to avoid in older adults with certain diseases and syndromes that the drugs listed can exacerbate, and finally medications to be used with caution in older adults. This update has much strength, including the use of an evidence-based approach using the Institute of Medicine standards and the development of a partnership to regularly update the Criteria. Thoughtful application of the Criteria will allow for (a) closer monitoring of drug use, (b) application of real-time e-prescribing and interventions to decrease ADEs in older adults, and (c) better patient outcomes.

April 20, 2012 Posted by | Consumer Health | , , , , , , | Leave a comment

Medication Safety Booklet in Spanish and English | Health Information Literacy – for health and well being

Medication Safety Booklet in Spanish and English | Health Information Literacy – for health and well being.

 

The following was posted on the BHIC Blog; August 30, 2011.

by Siobhan Champ-Blackwell

Spanish http://1.usa.gov/niu45x
English http://1.usa.gov/jClN3h
AHRQ has released a revised Spanish-language medication safety booklet, “Su medicamento: Infórmese. Evite riesgos” (“Your Medicine: Be Smart. Be Safe.”) to help Spanish-speaking patients learn more about how to take medicines safely. The booklet includes a detachable, wallet-size card that can help patients keep track of medicines they are taking, including vitamins and herbal and other dietary supplements. Print copies are available by sending an e-mail to AHRQPubs@ahrq.hhs.gov.

November 22, 2011 Posted by | Consumer Health, Consumer Safety, Health Education (General Public) | , , , | Leave a comment

   

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