Health and Medical News and Resources

General interest items edited by Janice Flahiff

Ending medical reversal [New book]

Guest post by Vinayak K. Prasad, MD, MPH, and Adam S. Cifu, MD For doctors, it is common to have some doubt about a new medical test, procedure or drug—even one which is widely hailed as remarkable…

For doctors, it is common to have some doubt about a new medical test, procedure or drug—even one which is widely hailed as remarkable or a game changer. It is not cynicism but a healthy skepticism towards marketing over substance. Doctors want to see the evidence that a drug actually works rather than just a good story about why it should work.

Often, however, this skepticism does not last. After a few months, still without any evidence, the doctor finds herself buying in, just a little, to the hype. OK, let me just see what everyone is talking about, she thinks. She begins recommending the drug herself. She still thinks of herself as cautious and conservative—while her colleagues use the treatment widely, she thinks it has a more narrow and defined role. Probably the pill does not work for everyone, but in a select group of people.

A few more years go by, and she gets comfortable with the once-hyped treatment. She now knows how to manage its complications; she thinks she has a good sense of who it benefits; and she considers it a part of her practice.”

Source: Ending medical reversal

March 4, 2016 Posted by | health care | , , | Leave a comment

Ending medical reversal

Source: Ending medical reversal

From the book review

Guest post by Vinayak K. Prasad, MD, MPH, and Adam S. Cifu, MD

prasadFor doctors, it is common to have some doubt about a new medical test, procedure or drug—even one which is widely hailed as remarkable or a game changer. It is not cynicism but a healthy skepticism towards marketing over substance. Doctors want to see the evidence that a drug actually works rather than just a good story about why it should work.

Often, however, this skepticism does not last. After a few months, still without any evidence, the doctor finds herself buying in, just a little, to the hype. OK, let me just see what everyone is talking about, she thinks. She begins recommending the drug herself. She still thinks of herself as cautious and conservative—while her colleagues use the treatment widely, she thinks it has a more narrow and defined role. Probably the pill does not work for everyone, but in a select group of people.

A few more years go by, and she gets comfortable with the once-hyped treatment. She now knows how to manage its complications; she thinks she has a good sense of who it benefits; and she considers it a part of her practice.

Then, one day, she opens one of the nation’s top medical journals and discovers that the treatment she was once skeptical of, but slowly grew to accept, simply does not work. A well-done clinical trial, probably the one which should have been done before the treatment even came to market, compared the treatment to the prior therapy, and found no benefit.”

September 18, 2015 Posted by | Uncategorized | , , | Leave a comment

[News release] How to get smarter on pills for senior

From the ScienceDaily article

Date:March 23, 2015
Source:Thomas Jefferson University
Summary:Cancer patients over the age of 65 often take multiple drugs, which can interfere with cancer treatment. A new study shows that currently used tools to prevent over-medicating senior cancer patients need improvement.

March 25, 2015 Posted by | health care | | Leave a comment

[Press release] More women now using compounded hormones without understanding the risks — ScienceDaily

More women now using compounded hormones without understanding the risks — North America Menopause Society

From the 28 February 2015 press release

From 28% to 68% of women using hormones at menopause take compounded, so-called “bioidentical” hormones, but women don’t understand the risks of these unapproved, untested treatments, shows an analysis of two large surveys, which was published online in Menopause, the journal of The North American Menopause Society.

Prescriptions of compounded hormones aren’t systematically tracked the way those for FDA-approved drugs are, so the analysts used two large internet surveys of middle-aged and older US women to gauge how commonly they use approved hormone therapy and compounded hormone therapy at menopause. Nearly 3,000 women completed the Harris Interactive Inc and Rose Research LLC surveys, and the researchers used their feedback and US Census data to estimate national use.

They calculated that each year 57 to 75 million prescriptions for all menopausal hormone therapies are filled. Thirty-six million prescriptions are written for FDA-approved hormone therapy, so the remaining 28 to 39 million prescriptions are likely for compounded hormones.

But it seems that women who take them don’t know what they’re getting into. One survey asked women “Do you believe that bioidentical hormone therapies compounded at a specialty pharmacy are FDA-approved?” Only 14% correctly answered “no.” Most–76%–weren’t sure, and 10% incorrectly answered “yes

March 3, 2015 Posted by | health care | , , | Leave a comment

[News] New regulations proposed for off-label uses of drugs, devices — ScienceDaily

New regulations proposed for off-label uses of drugs, devices — ScienceDaily.

Excerpts

Date:January 22, 2015
Source:University of California, Los Angeles (UCLA), Health Sciences
Summary:Researchers have proposed a system for off-label drug prescriptions combining reporting, testing and enforcement regulations, and allowing interim periods of off-label use. This would give patients more treatment options while providing regulators with evidence of the drugs’ safety and efficacy.

 

Medicine drugs

Medicine drugs (Photo credit: Wikipedia)

Off-label use of drugs and medical devices — using approved remedies in unapproved ways — has long been a part of medicine. The practice provides public health benefits but also presents some risks.

For the most part, the U.S. Food and Drug Administration allows physicians to prescribe drugs and devices off-label in the same way they are prescribed for their approved uses. The FDA couldn’t require approval for each off-label use because the burden for approval would be so high that few off-label uses would be approved, which would deprive patients of effective treatments for which the drugs weren’t originally intended.

As a result, health care providers have had to make their own decisions about using drugs off-label, often in the face of uncertain evidence.

To address that issue, researchers from the David Geffen School of Medicine at UCLA have proposed a system combining reporting, testing and enforcement regulations, and allowing interim periods of off-label drug prescription. Their recommendations, published in the Duke Law Journal, would give patients more treatment options while providing regulators with evidence of the drugs’ safety and efficacy.

….

The authors’ proposal comprises three elements:

• Improved reporting of off-label use through disclosure of diagnostic codes in reports to the FDA, in detailing data that pharmaceutical companies obtain on physicians’ prescribing habits, and in reports to the FDA and Medicare/Medicaid reimbursement requests. This information, which would omit details that could identify individual patients, could then be shared with academics and pharmaceutical companies for use in research. • Expansion of post-market testing requirements for off-label use of drugs and medical devices. • A tiered labeling system for drugs consisting of “red box” warnings that prohibit certain off-label uses; informed consent from patients receiving prescriptions for off-label use of some drugs that currently carry “black box” warnings, which identify drugs that pose a significant risk of serious or life-threatening adverse effects; and the creation of a new “grey box” warning that blocks Medicare Part D and Medicaid reimbursements by the Centers for Medicare and Medicaid Services.

“The improved reporting, testing and enforcement regulation would work together to produce a more layered range of regulatory responses,” the authors write. “The FDA, armed with better information about the extent of off-label use and adverse effects, would be in a better position to require post-market testing and to discourage off-label use with new types of warnings if manufacturers fail to provide sufficient, timely evidence of safety and efficacy in that particular extrapolation.”

The report can be found at: http://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=3785&context=dlj

 

January 26, 2015 Posted by | Uncategorized | , , , , , , , , , | Leave a comment

[Press release] Drugs in the environment affect plant growth

From the 3 December 2014 University of Exeter press release

The drugs we release into the environment are likely to have a significant impact on plant growth, finds a new study nled by the University of Exeter Medical School and Plymouth University.

By assessing the impacts of a range of non-steroidal anti-inflammatory drugs, the research has shown that the growth of edible crops can be affected by these chemicals – even at the very low concentrations found in the environment.

Published in the Journal of Ecotoxicology and Environmental Safety, the research focused its analysis on lettuce and radish plants and tested the effects of several commonly prescribed drugs, including diclofenac and ibuprofen. These drugs are among the most common and widely used group of pharmaceuticals, with more than 30 million prescribed across the world every day.

The potential for these chemicals to influence plants is becoming increasingly relevant, particularly as waste management systems are unable to remove many compounds from our sewage. Drugs for human use make their way into soil through a number of routes, including the use of sewage sludge as fertiliser and waste water for irrigation.

Crop_research_main

Crop image via Shutterstock.

This study looked for a number of changes in edible plants, assessing factors such as water content, root and shoot length, overall size and how effectively the plants photosynthesised.

Each drug was shown to affect the plants in very specific ways, with marked differences between drugs that are closely related. For example, drugs from the fenamic acid class affected the growth of radish roots, whilst ibuprofen had a significant influence on the early root development of lettuce plants.

Dr Clare Redshaw, one of the scientists leading the project at the Medical School’s European Centre for Environment & Human Health, said: “The huge amounts of pharmaceuticals we use ultimately end up in the environment, yet we know very little about their effects on flora and fauna. As populations age and generic medicines become readily available, pharmaceutical use will rise dramatically and it’s essential we take steps towards limiting environmental contamination. We haven’t considered the impact on human health in this study, but we need to improve our understanding quickly so that appropriate testing and controls can be put in place.”

There have been growing concerns about the presence of pharmaceuticals in the environment, particularly as evidence emerges of the effects they can have on the development of animals and antibiotic resistance in bacteria. Yet their ability to affect plant growth is poorly understood.

December 9, 2014 Posted by | environmental health, Medical and Health Research News | , , , , | Leave a comment

[News item] Finding new ways to make drugs — ScienceDaily

Finding new ways to make drugs — ScienceDaily

Excerpt

Date:November 18, 2014
Source:Australian National University
Summary:Chemists have developed a revolutionary new way to manufacture natural chemicals by clipping smaller molecules together like Lego. They have used the new method to assemble a scarce anti-inflammatory drug

November 25, 2014 Posted by | Medical and Health Research News | , | Leave a comment

[Repost] Medical Cost Offsets from Prescription Drug Utilization Among Medicare Beneficiaries

Medical Cost Offsets from Prescription Drug Utilization Among Medicare Beneficiaries

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Excerpt from the commentary by M. Christopher Roebuck, PhD, MBA

SUMMARY
This brief commentary extends earlier work on the value of adherence to derive medical cost offset estimates from prescription drug utilization. Among seniors with chronic vascular disease, 1% increases in condition-specific medication use were associated with significant (P<0.001) reductions in gross nonpharmacy medical costs in the amounts of 0.63% fordyslipidemia, 0.77% for congestive heart failure, 0.83% for diabetes, and1.17% for hypertension.
J Manag Care Pharm.
2014;20(10):994-95
Excerpts:
With about half of patients not taking their medications as directed, avoidable adverse health events and use of medical services are estimated to add up to $290 billion in U.S.health care expenditures annually. Improvements in clinical and economic outcomes from medication adherence have been demonstrated across a variety of conditions and patientcohorts. As an example, in 2011 my colleagues and I (Roebuck et al.) determined that adherence to medication for chronic vascular disease was associated with fewer inpatient hospital days and emergency department visits and lower overal health care costs. Specifically, annual net savings in healtcare expenditures for an adherent (compared to nonadherent) elderly beneficiary were estimated to be $7,893 for congestive
heart failure, $5,824 for hypertension, $5,170 for diabetes, and $1,847 for dyslipidemia—or approximately 9% to 28% of total
health care costs. This research employed a rigorous observational study design that addressed a key concern and limitation
ofprior analyses—the potentialendogeneity (confounding) of adherence. More plainly, results reported in earlier publications mayhave been biased if patients who took medications as directed also engaged in other unmeasured healthy behaviors

(i.e., the “healthy adherer effect”)
..
Figure 1 presents the new findings and includes the CBO estimate for reference. Specifically, 1% increases in condition-specific prescription drug utilization were significantly (P<0.001) associated with reductions in seniors’ gross nonpharmacy medical costs in the amounts of 0.63% for dyslipidemia, 0.77% for congestive heart failure, 0.83% for diabetes, and 1.17% for hypertension. These results demonstrate that medical cost offsets from prescription drug utilization likely vary bychronic condition and that impacts for therapeutic classes used to treat these 4 conditions—which represent 40% of Medicare Part D utilization—may be between 3 and 6 times greater than the CBO’s assumption. In dollar terms, these relative impacts are not trivial. For example, 53% of Medicare (fee-for-service) beneficiaries have the comorbidity combination of hyperten sion plus high cholesterol—with average annual medical costs of $13,825. The current findings suggest that a 5% increase in the use of antihypertensive medication by patients with those conditions may prompt reductions in medical (Parts A and B) costs of more than $800 annually per beneficiary.
….
The present analysis examined retirees with employer-sponsored insurance in addition to Medicare. To the extent that these individuals differed from the broader Medicare population, the generalizability of study findings may be limited.

November 3, 2014 Posted by | health care | , , , , , , , | Leave a comment

Recent additions to the NLM Drug Information Portal include clinical experience with drugs and dietary supplements

 

 

NLMDrug

 

 

 

 

From the NLM-TOX-ENVIRO-HEALTH-L Digest – 2 Oct 2014 to 7 Oct 2014 (#2014-19)

The National Library of Medicine (NLM) Drug Information Portal (http://druginfo.nlm.nih.gov) is a free web resource that provides an informative, user–friendly gateway to current drug information for over 53,000 substances. The Portal links to sources from the NLM, the National Institutes of Health (NIH), and other government agencies such as the U.S. FDA.

Current information regarding consumer health, clinical trials, AIDS–related drug information, MeSH® pharmacological actions, PubMed® biomedical literature, and physical properties and structure is easily retrieved by searching a drug name. A varied selection of focused topics in medicine and drug–related information is also available from displayed subject headings.

The Drug Portal retrieves by the generic or trade name of a drug or its category of usage.  Records provide a description of how the drug is used, its chemical structure and nomenclature, and include up to 20 Resource Locators which link to more information in other selected resources.   Recent additions to these Locators include clinical experience with drugs in PubMed Health (http://www.ncbi.nlm.nih.gov/pubmedhealth), substances reviewed in NLM LiverTox (http://livertox.nih.gov/), information from the Dietary Supplement Label Database (http://dsld.nlm.nih.gov/dsld/), and drug images in the Pillbox beta (http://pillbox.nlm.nih.gov/) database.

Data in the Drug Information Portal is updated daily, and is also available on mobile devices.

More information can be found at http://www.nlm.nih.gov/pubs/factsheets/druginfoportalfs.html

October 11, 2014 Posted by | Consumer Health, Educational Resources (Health Professionals), Educational Resources (High School/Early College(, Health Education (General Public) | , , , , , , , | Leave a comment

[Press release] Health, United States, 2013 includes special section on prescription drugs

From the 14 May 2014 press release

Most common prescription drugs among adults are those for cardiovascular disease and high cholesterol

Photo: Spilled bottle of pills.

About half of all Americans reported taking one or more prescription drugs in the past 30 days during 2007-2010, and 1 in 10 took five or more, according to Health, United States, 2013, the government’s annual, comprehensive report on the nation’s health.

This is the 37th annual report prepared for the Secretary of the Department of Health and Human Services by the Centers for Disease Control and Prevention’s National Center for Health Statistics.  The report includes a compilation of health data from state and federal health agencies and the private sector.

This year’s report includes a special section on prescription drugs.  Key findings include:

  • About half of all Americans in 2007-2010 reported taking one or more prescription drugs in the past 30 days.  Use increased with age; 1 in 4 children took one or more prescription drugs in the past 30 days compared to 9 in 10 adults aged 65 and over.
  • Cardiovascular agents (used to treat high blood pressure, heart disease or kidney disease) and cholesterol-lowering drugs were two of the most commonly used classes of prescription drugs among adults aged 18-64 years and 65 and over in 2007-2010.  Nearly 18 percent (17.7) of adults aged 18-64 took at least one cardiovascular agent in the past 30 days.
  • The use of cholesterol-lowering drugs among those aged 18-64 has increased more than six-fold since 1988-1994, due in part to the introduction and acceptance of statin drugs to lower cholesterol.
  • Other commonly used prescription drugs among adults aged 18-64 years were analgesics to relieve pain and antidepressants.
  • The prescribing of antibiotics during medical visits for cold symptoms declined 39 percent between 1995-1996 and 2009-2010.
  • Among adults aged 65 and over, 70.2 percent took at least one cardiovascular agent and 46.7 percent took a cholesterol-lowering drug in the past 30 days in 2007-2010.  The use of cholesterol-lowering drugs in this age group has increased more than seven-fold since 1988-1994.
  • Other commonly used prescription drugs among those aged 65 and older included analgesics, blood thinners and diabetes medications.
  • In 2012, adults aged 18-64 years who were uninsured for all or part of the past year were more than four times as likely to report not getting needed prescription drugs due to cost as adults who were insured for the whole year (22.4 percent compared to 5.0 percent).
  • The use of antidepressants among adults aged 18 and over increased more than four-fold, from 2.4 percent to 10.8 percent between 1988-1994 and 2007-2010.
  • Drug poisoning deaths involving opioid analgesics among those aged 15 and over more than tripled in the past decade, from 1.9 deaths per 100,000 population in 1999-2000 to 6.6 in 2009-2010.
  • The annual growth in spending on retail prescription drugs slowed from 14.7 percent in 2001 to 2.9 percent in 2011.

Health, United States, 2013 features 135 tables on key health measures through 2012 from a number of sources within the federal government and in the private sector.  The tables cover a range of topics, including birth rates and reproductive health, life expectancy and leading causes of death, health risk behaviors, health care utilization, and insurance coverage and health expenditures.
The full report is available at www.cdc.gov/nchs

 

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May 17, 2014 Posted by | health care, Health Statistics | , , | 1 Comment

[Reblog] The illegal ways patients buy drugs

The illegal ways patients buy drugs.

From the 27 March 2014 KevinMD article by Pamela Wible, MD

Tom is diabetic, asthmatic, and broke. He’s back for a checkup.

“I take my metformin every morning with my grits,” he says, “but I don’t need no refill. I just got me some metformin XR.”

“How did you get extended release? They’re super expensive.”

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“Well, my neighbor runs a tattoo shop. We live behind her store. Her doc switched her up to insulin, so she gave me her old meds—a big sackful in the alley. That’s gonna last me another year.”

Prescriptions dispensed behind a tattoo parlor? Wow. I’m constantly impressed by my patients’ ingenuity. One gal this week told me she’s on her deceased grandfather’s antidepressants. Another gets his pharmaceuticals from the farm supply store. I’m just glad to know he doesn’t have fleas.

“Are you good on your inhalers?” I ask.

“Well, the cheapest inhaler is 52 bucks. So I basically can’t afford to breathe. On Craigslist, I found some for ten bucks. I contacted the guy, and he met me at the Walmart gas station in a black Jaguar. I went to the door. He asked if I was Tom. Then he said, ‘You know this is illegal.’”

…….

And from one of the comments

Considering the high prices that pharmaceutical companies are allowed to legally charge in the US, this kind of thriving illegal underground market does not surprise me at all. It may be wrong and potentially dangerous, but it’s also wrong for Big Pharma to price millions of Americans out of being able to buy the drugs they need legally. Think of that huge segment of the population as “what the market can’t bear.”

Read the entire article here

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May 13, 2014 Posted by | health care | , | Leave a comment

Drugs For Life; Subcultural Identity

The Kente Weaver

Watch: http://www.bbc.co.uk/programmes/b01r0h4r

BY: BBC Video Documentary, Think Aloud.

Here’s a short video interview with anthropologist Joseph Dummit, author of the book “Drugs For Life” in which he tackles  the pervasiveness of America’s pharmaceutical market in its economy and society. Dummit explores in detail, America’s increasing medicalization and the emergence of the ‘expert patient’ who shifts the dynamic of the patient-doctor relationship because this ‘expert patient’ is now equipped with ‘knowledge’ about his own health, what kind of lifestyle is healthy and to some extent the ‘medical know-how’ of how to treat certain conditions ‘off-the-counter’.

Dummit argues that Pharmaceutical companies have come to occupy a predominant role in American society, changing the discourse about what is “healthy” and what isn’t through their huge marketing campaigns and their capitalistic drive. What I find most interesting in his argument is the fact that he shows how these direct-to-consumer advertising mechanisms not only affect patients…

View original post 390 more words

March 13, 2014 Posted by | health care | , , | Leave a comment

Pill Nation

Pill Nation.

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February 13, 2014 Posted by | health care | | 4 Comments

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

[Reblog] The Really Bad Math Behind the Social Security Cuts

As a volunteer Area Office on Aging counselor, I  help folks apply for Extra Help with their prescription drugs and a state program for Medicare Part B financial assistance.  In the past year I have been astounded at the prescription drug costs for quite a  few clients, as well as saddened by those who are falling through the cracks. Have heard folks tell me how they are choosing between eating well and buying prescribed drugs.

This blog item covers what I have heard first hand, and more

From the 8 December 2013 item at The Health Care Blog

Among the sacrifices Congressional representatives placed on the altar of deficit negotiations is an “inflation adjustment” that will shave “only” a few hundred dollars from an average, newly retired Social Security beneficiary’s income each year. But the cruel hoax is that the reduction will amount to as much as $1600 when the beneficiary is older, poorer, and sicker.  Many seniors already have a tough time paying for food, rent, and medical care.

Even worse,  reductions in beneficiaries’ incomes may well cost government more for potentially preventable hospital and long-term care.  Senator Elizabeth Warren and other New England lawmakers should be lauded for splitting from Democratic representatives and the Administration regarding this ill-conceived proposal.

Many senior citizens are already vulnerable to economic hardship.  A recent US Census analysis that counts rising medical expenses found that over 1 in 6 elderly people live in poverty, unable to meet basic living expenses, and almost 20% more are living just above the poverty line. Social Security is the only or largest source of income for about 70% of seniors; the average monthly check is only about $1200.

The typical retirement savings of seniors is a paltry $50,000 — barely enough to get through several years’ living expenses, let alone 20-30 years of retirement.  This is not the result of cavalier actions by the older generation; these are the Americans whose home values have plummeted, whose defined-benefit pension plans have been decimated or disappeared, and whose retirement accounts were eviscerated by the Wall Street meltdown of the last decade. Yet the current proposal punishes these Americans as if they were at fault for their poverty.

What are the consequences of having to rely on Social Security alone?  High out-of-pocket health care costs can be “catastrophic” because they cause people to go without essential medical care. Our studies published in the New England Journal of Medicine show that a 50% reduction in drug benefits in New Hampshire for low income, chronically ill seniors backfired.

The NH policy reduced the use of essential medicines (e.g., for diabetes and heart disease), worsened chronic illness, increased acute care, and doubled the rate of permanent institutionalization in expensive nursing homes. These increased admissions raised government costs several times more than the drug “savings,” not even counting increased pain and suffering of patients and their families.

Dr. Nicole Lurie, the current US Assistant Secretary for Preparedness and Response, showed that about 15% of people (many seniors) who are admitted to hospital emergency departments experience significant hunger before admission.  Frequently, seniors skimp on medicines to pay for food, and this leads to illness and further hospital care.

Similarly, our studies show that almost 30% of disabled Medicare recipients in poor health skip or split pills to make them last longer because they can’t afford their prescription drugs, even in the era of the Part D drug benefit. One study indicates that splitting pills increases hospitalization of heart disease patients by 21%.

The current debate in Washington encapsulates the growing political and ideological divide as to how the costs of deficit reduction should be allocated across various parts of the population.  No single proposal more starkly embodies that issue than efforts to trim and chip away from recipients of an earned, contributory entitlement at precisely that time in their lives when they can least afford reduced incomes, and have the least capacity to compensate for them.

Read the entire blog item here

 

December 9, 2013 Posted by | health care | , , | 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

The wacky world of prescription prior authorizations

English: National Naval Medical Center, Bethes...

English: National Naval Medical Center, Bethesda, Md., (Aug. 19, 2003) — Pharmacist Randal Heller, right, verifies the dosage and medication of a prescription at the National Naval Medical Center in Bethesda, Maryland. Heller checks all prescriptions dispensed at the pharmacy before they are handed over the counter to the patient. Heller is retired as a Commander from the Navy Medical Service Corps. U.S. Navy photo by Chief Warrant Officer 4 Seth Rossman. (RELEASED) (Photo credit: Wikipedia)

Pharmacists are among my favorite professionals.
I’ve always been able to get expert prescription drug related information (as side effects) and OTC advice for free! Even when I wasn’t their customer.

But even they are human and have their customer service pet peeves.
Don’t we all who work with clients, customer, and “the public”.
(Just hope I’m not one of those wacky customers!).

 

From the 26 July 2013 KevinMD article

 | MEDS | JULY 26, 2013

It’s happened at last: the epitome of ridiculousness in the already pretty ridiculous world of drug prior authorizations. I wish I could say that I made this up.

I got a fax from a pharmacy requesting a prior authorization for a brand name drug called Protonix, one of a family of medications used to treat ulcers, acid reflux, and other forms of tummy ache. This happens. Because there are five different drugs in this class (not counting generics), there is no way I can keep straight which plans prefer which drug. Sadly, switching patients from one medication to another, even if it’s working just fine, purely because of which drug maker is in bed with which insurance plan, is an everyday event. No big deal.

Here’s the thing: the patient was already doing well on pantoprazole, which happens to be generic Protonix. What?

The fax from the pharmacy has more information: “The patient wants a prescription for brand name Protonix because she has a coupon that will allow her to pay only $4.00 for it.”

It just so happens that pantoprazole is already on the list of $4.00 generics!

But, says the pharmacy, that’s what the patient wants.

Read the entire article here

July 26, 2013 Posted by | health care | , , , , , , , , , | Leave a comment

Internet search data and unreported side effects of drugs

Public Health--Research & Library News

A very interesting use of crowdsourcing for medical research.

Using data drawn from queries entered into Google, Microsoft and Yahoo search engines, scientists at Microsoft, Stanford and Columbia University have for the first time been able to detect evidence of unreported prescription drug side effects before they were found by the Food and Drug Administration’s warning system.

Using automated software tools to examine queries by six million Internet users taken from Web search logs in 2010, the researchers looked for searches relating to an antidepressant, paroxetine, and a cholesterol lowering drug, pravastatin. They were able to find evidence that the combination of the two drugs caused high blood sugar.

The study, which was reported in the Journal of the American Medical Informatics Association [White, R.W. et al. Web-scale pharmacovigilance: listening to signals from the crowd. J Am Med Inform Assoc doi:10.1136/amiajnl-2012-001482] on Wednesday, is based on data-mining techniques similar to those…

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March 22, 2013 Posted by | Consumer Health | , , , , , , | Leave a comment

Study Questions Drug Expiration Policy

 

From the 8 October 2012 article at MedPage Today

By Charles Bankhead, Staff Writer, MedPage Today

Published: October 08, 2012

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Prescription drugs retained their potency for as long as 40 years after expiration date, an analysis of 14 different compounds showed.

Overall 12 (86%) of the compounds tested at concentrations at least 90% of the labeled amount. Three compounds had concentrations that exceeded labeled amounts, and in two cases laboratory tests showed the compounds had less than 90% of the labeled concentration.

The findings add to existing evidence that prescription drugs retain their potency long after the expiration date, according to a research letter published online in Archives of Internal Medicine.

“The most important implication of our study involves the potential cost savings resulting from lengthier product expiration dating,” Lee Cantrell, PharmD, of the California Poison Control System in San Diego, and co-authors wrote. “Each dollar spent on SLEP [the Shelf-Life Extension Program] to demonstrate longer-than-labeled drug stability results in $13 to $94 saved on reacquisition costs…

The study involved eight medications comprising 15 different active ingredients, all in original, unopened containers. The medications were methaqualone, codeine, meprobamate, amphetamine, pentobarbital, secobarbital, and hydrocodone.

In addition to the primary ingredient, one or more of the eight medications included butalbital, aspirin, phenacetin, caffeine, phenobarbital, homatropine, chlorpheniramine, acetaminophen, and caffeine.

Ultimately, the authors evaluated medications representing 14 drug compounds. For each of the eight medications, the authors dissolved the contents of tablets/capsules, sonicated in methanol, reconstituted in analysis buffer, and analyzed with liquid chromatography time-of-flight mass spectrometry. Homatropine was the only drug not included in testing.

Of the 14 compounds analyzed, 12 retained the generally recognized minimum acceptable potency of 90% of labeled amount. The only two that did not meet the 90% minimum standard were aspirin (200 mg labeled, 2.28 mg by analysis; 226.8 mg labeled, 1.53 by analysis) and amphetamine (5.0 mg labeled, 2.2 mg by analysis; 15.0 mg labeled, 8.1 mg by analysis).

 

 

October 10, 2012 Posted by | Medical and Health Research News | , , , , , | Leave a comment

States Crack Down on Mental Health Prescriptions

 

From the 14 August 2012 edition of Stateline

n the past two years, Illinois has done just about everything it could to reduce the amount it spends on prescription drugs for mental health. It has placed restrictions on the availability of 17 medications used to treat depression, psychosis and attention-deficit disorder. Doctors now have to explain to Medicaid why the drugs are necessary before a patient can get access to them. Then in July, as part of an effort to cut overall Medicaid spending by $1.6 billion, the state capped the number of prescriptions for Medicaid recipients to four a month, even if they previously were taking a broader cocktail of behavioral medications.

In financial terms, there is no question that it has worked. Last year, the state’s Medicaid mental health drug spending budget was reduced by $112 million. The new cap on prescription drugs is expected to save another $180 million.

Up until 2011, behavioral health drug spending made up about a quarter of Illinois’ Medicaid prescription drug costs. The state spent about $392 million that year on drugs for treating mental health patients. In fiscal 2012, the state spent $280 million on mental health drugs.

But what are the implications for quality of care? Some physicians argue that they are disastrous. “It’s a mess,” says Dr. Daniel Yohanna, a psychiatrist at the University of Chicago Medical Center.  “People who were stable on some drugs have been unable to get them. It has created a significant problem.”

Michael Claffey, of the Illinois Department of Healthcare and Family Services, says the state is aware of the complaints from the mental health community, but adds, “we don’t have unlimited funds. We need doctors to work with us…If a patient needs a drug, they will get approval.”..

..

About half of Medicaid mental health patients had difficulty accessing at least one medication, and about a quarter of them then stopped taking their medications, according to a Psychiatric Services report in 2009 on physicians’ experiences in 10 state Medicaid programs. Physicians reported that many patients experienced an adverse event, such as hospitalization, homelessness or even suicide because they couldn’t get their drugs.  Another study, reported in the May 2008 issue of Health Affairs, showed that between 2003 and 2004, Maine’s prior authorization program for atypical antipsychotics (drugs that treat serious psychoses) resulted in a 29 percent greater risk that patients suffering from schizophrenia would fail to follow their treatment protocol.

Competing studies, on the other hand, suggest that mental health drugs aren’t being properly prescribed, particularly to those under 18, and that imposing restrictions can improve quality of care by requiring physicians to reconsider why they are writing a prescription. I..

In Illinois, Yohanna says he has seen examples of inappropriate prescribing of psychotropic drugs and agrees that “prior approval can help with that.” But he thinks that requiring all doctors to get approval for drugs “is just throwing a blanket on things without really dealing with the worst offenders.” He says a policy like Washington State’s second opinion program would be a good idea, as well as setting up a system where there are fewer restrictions on doctors who had responsible prescribing patterns. Currently Yohanna says, it can take two to three days to get a drug approved.

 

August 15, 2012 Posted by | Public Health | , , , | Leave a comment

Off-Label Drug Use Common, but Patients May Not Know They’re Taking Them

 

From the 6 August 2012 article at Science News Daily

Many people have probably heard of off-label drug use, but they may not know when that applies to prescriptions they are taking, a Mayo Clinic analysis found. Off-label drug use occurs when a physician prescribes medication to treat a condition before that use has been approved by the Food and Drug Administration.

In a newly published article in Mayo Clinic Proceedings, researchers pose and answer 10 questions about off-label drug use.

“Since the Food and Drug Administration does not regulate the practice of medicine, off-label drug use has become very common,” says lead author Christopher Wittich, M.D., internal medicine physician at Mayo Clinic. “Health care providers and patients should educate themselves about off-label drugs to weigh the risks and benefits before a physician prescribes one or a patient takes one.”

Some highlights from the article:

* Off-label drug use is common. Within a group of commonly used medications, roughly 1 in 5 prescriptions were for an off-label use, a 2006 report found. Another study found that about 79 percent of children discharged from pediatric hospitals were taking at least one off-label medication.

* Patients may not know when drugs they have been prescribed are being used off-label. No court decision has required that physicians must disclose, through informed consent, the off-label use of a drug, the authors say. The FDA makes clear that it doesn’t regulate the practice of medicine and that the federal Food, Drug, and Cosmetic Act of 1938 doesn’t make physicians liable for off-label drug use, they note.

* Off-label drug use can become the predominant treatment for a condition. For example, some antidepressants are not approved by the FDA as a treatment for neuropathic pain, yet some drugs in this class are considered a first-line treatment option.

* Examples of widely practiced off-label drug use include morphine, used extensively to treat pain in hospitalized pediatric patients. Many inhaled bronchodilators, antimicrobials, anticonvulsants, and proton pump inhibitors also are used in children without formal FDA approval.

* Obtaining new FDA approval for a medication can be costly and time-consuming. To add additional indications for an already approved medication requires a supplemental drug application; if eventually approved, revenue from it may not offset the expense and effort for obtaining approval.

* Generic medications may not have the requisite funding resources needed to pursue FDA-approval studies. For these financial reasons, drug proprietors may never seek FDA approval for a new drug indication.

* Pharmaceutical manufacturers are not allowed to promote off-label uses of medications. However, they can respond to unsolicited questions from health care providers and distribute peer-reviewed publications about off-label use. Just this year, GlaxoSmithKline agreed to pay a record $3 billion to settle a Justice Department case involving alleged off-label drug use marketing, and Merck Sharp & Dohme was fined $322 million over its alleged promotion of the painkiller Vioxx for an off-label use.

 

 

August 8, 2012 Posted by | health care | , , | Leave a comment

[Reblog] The Doctor Is In: The arithmetic of children’s medicine

[Reblog]

The Doctor Is In: The arithmetic of children’s medicine

The Doctor Is In is an occasional series where JHU Press authors discuss the latest developments and news in health and medicine.

Guest post by Edward A. Bell, Pharm.D., BCPS

Do you know how to properly measure and administer medicine to your child? Arecent study presented at the Pediatric Academic Societies annual meetingsuggests that parents with low reading and math skills may not.

This study is similar to others in that it describes how common and easy it is for parents to err when determining and measuring liquid medication doses for their children. A multitude of factors contribute to the potential for these errors, including misinterpretation of medications and their strengths and miscalculation of a child’s specific dose by his or her weight. What is interesting about this study is that it evaluated a unique aspect of how parents determine medication doses for their children—the parents’ reading and math skills. Nearly one-half of the parents (41%) made a dosing error, demonstrating that the process of giving a dose of liquid medication to an infant or child can be somewhat complicated and that errors can be easy to make. According to anarticle on ScienceDaily, “parents’ math scores, in particular, were associated with measuring mistakes, with parents who scored below the third grade level on the math test having almost a five times increased odds of making a dosing error.”

Health care providers—including physicians, pharmacists, and nurses—should not assume that all parents can accurately administer medicine to their child, and should adequately educate parents on how to do so.

Edward A. Bell is a pediatric pharmacist and a professor of clinical sciences at Drake University College of Pharmacy and Health Sciences and the Blank Children’s Hospital and Clinics, Des Moines, Iowa. His book A Parent’s Guide to Children’s Medicines, is forthcoming this summer.

The information provided in this blog post is not meant to substitute for medical advice or care provided by a physician, and testing and treatment should not be based solely on its contents. Instead, treatment must be developed in a dialogue between the individual and his or her physician. This post has been written to help with that dialogue. The services of a competent medical professional should be obtained whenever medical advice is needed.

Related resources

July 23, 2012 Posted by | Consumer Health | , , | Leave a comment

Drug Side Effects Successfully Predicted By Computer Model (with Fast Stats on Drug Failure Rates)

Cost efficient way to develop safer compounds

 From the 13 June 2012 Medical News Today article

A new set of computer models has successfully predicted negative side effects in hundreds of current drugs, based on the similarity between their chemical structures and those molecules known to cause side effects, according to a paper appearing online this week in the journal Nature. …

Drugs frequently interact with more than one target, with hundreds of these targets linked to the side effects of clinically used therapeutics. Focusing on 656 drugs that are currently prescribed, with known safety records or side effects, the team was able to predict such undesirable targets – and thus potential side effects – half of the time.

That’s a significant leap forward from previous work, which has never tackled hundreds of compounds at once, according to Brian Shoichet, PhD, a UCSF professor of pharmaceutical chemistry who was the joint advisor on the project alongside Laszlo Urban, MD, PhD, at Novartis.

As a result, it offers a possible new way for researchers to focus their efforts on developing the compounds that will be safest for patients, while potentially saving billions of dollars each year that goes into studying and developing drugs that fail. …

Drug Failure Rates

  • Estimated cost of bringing a drug to market: $1.2 billion
  • Only one in 5,000 drug candidates that enter preclinical testing ever reaches the market
  • For every five drugs that start clinical trials, only one succeeds
  • Of the 4,300 companies engaged in drug innovation, only 6% (261) have registered a new drug since 1950.
  • Worldwide, the pharmaceutical industry spends $50 Billion per year on R&D, but produces only 21 new drugs per year (2008)

    A Side Effect of Vicodin

    A Side Effect of Vicodin (Photo credit: thehoneybunny)

July 9, 2012 Posted by | Medical and Health Research News | , , , , | Leave a comment

Your care is fragmented, here’s how to fix it

From the 4 April 2011 post by BARBARA BRONSON GRAY, RN at KevinMD.com

…The more complicated your problems, the more fragmented your care will be. The average Medicare patient sees two physicians and five specialists a year, (according to The Fragmentation of American Health Care: Cases and Solutions, edited by Einer Elhage). Those with a chronic illness see an average of 13 physicians a year. A Medicare patient with coronary artery disease sees ten physicians in six distinct practices annually. Indeed, the more physicians following someone after a heart attack, the lower the survival rates.

It’s important you know that there is no little Tinkerbell picking up your medical records and automatically delivering them to the physicians in your life who should know what’s happening with you. Consider yourself the the person most responsible to collect written updates, copies of test results and lists of new and changed medications and get them to all your other healthcare providers.

What can you do?

When you get a test result, procedure or have surgery, get the summary in writing, keep a copy, and send or bring copies to all your other healthcare providers. Attach a simple note: “Wanted to keep you up- to-date on my health status. Please put this in my chart.” If it’s an important healthcare issue, be sure to bring up the data or  problem at your next visit and mention that you sent a written summary for inclusion in your medical record.
Keep a list of all your medications and update it any time a healthcare provider adds or deletes a drug or changes a dosage. Bring a copy of that list to your medical appointments and to the emergency room if you end up there.
Don’t leave your dentist or your optometrist/ophthalmologist out of the loop. They need to know the details of your general health status. It will help them diagnose and treat any issues they may identify with you. Be sure they know if you have any infections, immune issues, heart problems, chronic conditions or are taking blood thinners or antibiotics, as well as other medications.
If you have a test or procedure and you do not hear the results soon afterwards, do not assume the results were normal. Call the healthcare provider who ordered the test and ask the office staff to email or send you a written copy of the test summary. Keep a copy in your own “medical updates” file. If the test was indeed OK, you still should have copy for reference at a later time, if needed.

If you or someone you love ends up in the hospital, your role of communicator will be even more vital. Often multiple consulting physicians — specialists — are called by the admitting physician to weigh in on issues and questions that develop while you’re in the hospital. They don’t always talk to each other or even realize who has changed or added a medication, who has ordered a test, or what results are in. The more you communicate the better. If you are being asked to go back for a test you already had or if you have questions about what is happening, don’t assume someone at the “nurses’ station” has it all managed. Ask questions and be sure you understand what tests you’re getting and why. If you are being discharged from the hospital ask for the results of any tests or procedures you had in the hospital.

Related Resources

April 7, 2012 Posted by | health care | , , , , , , | Leave a comment

Legal Drug-Pushing: How Disease Mongers Keep Us All Doped Up – John-Manuel Andriote – Health – The Atlantic

daily dose

daily dose (Photo credit: nirbhao)

By manipulating our fear of suffering and death, big pharmaceutical companies are able to keep us coming back for expensive medications

Legal Drug-Pushing: How Disease Mongers Keep Us All Doped Up – John-Manuel Andriote – Health – The Atlantic

Excerpts from this article from the 3 April 2012online edition of The Atlantic

.Pharmaceutical giants, like small-town pizza parlors, have two options for making more money: convince regulars to buy more of what they obviously like, or find ways to persuade more people that they will be happier with this drug or that thin crust with extra cheese.In the case of the drug companies, it’s not our taste buds they’re appealing to. Instead, they market prescription drugs directly to consumers — a practice legal only in the United States and New Zealand — by, basically, manipulating our fear of suffering and death.These “disease mongers” — as science writer Lynne Payer in her 1992 book of that name called the drug industry and the doctors, insurers, and others who comprise its unofficial sales force — spin and toil “to convince essentially well people that they are sick, or slightly sick people that they are very ill.”Changing the metrics for diagnosing a disease is one reliable technique. Dr. Adriane Fugh-Berman, associate professor of pharmacology and director of the industry watchdog group PharmedOut.org at Georgetown University School of Medicine, pointed to how the numbers used to diagnose diabetes and high cholesterol have been lowered over time. “The very numbers we use have been reduced to the point of absurdity,” she said. “120/80 was considered normal blood pressure; now it’s considered ‘pre-hypertension.'”Entirely new diseases can be, and have been, invented to extend a manufacturer’s patent on a highly profitable drug. Fugh-Berman said Eli Lilly stood to lose a lot of profits once the patent expired on its hugely popular antidepressant Prozac. “So they positioned this new condition, PMDD (Pre-Menstrual Dysphoric Disorder), and then went to physicians and the FDA with their highly paid experts who said PMDD is a tragic disease, and they got approved for Sarafem, the same drug. It’s an on-label use for a repackaged drug; they created the disease and then got a drug re-approved that was going off patent.”..

The article goes on to outline one feature of the “medical industrial complex” –  the expansion of disease categories to include precursor conditions as psychosis risk syndrome. These categories are included in professional manuals, making it easier for drug companies to develop and market new drugs associated with conditions recognized by medical associations.

The authors also asks if Americans are being overdiagnosed through an overly medicalized drug culture partly created through aggressive prescription drug advertisements.  Responsibility for addressing this issue is in the hands of consumers, professional health care providers, government regulators, and all who contribute to our culture (as artistis, writers, and journalists).

Read the entire article here.

Related Resources

  • ClinicalTrials.gov -up-to-date information for locating federally  and privately supported clinical trials for a wide range of diseases and  conditions. A clinical trial (also clinical research) is a research study in  human volunteers to answer specific health questions. Interventional trials  determine whether experimental treatments or new ways of using known therapies  are safe and effective under controlled environments.

A growing number of clinical trials publish at least some of their results at ClinicalTrials.gov
Use the Advanced Search and use the Search Results to limit to Studies with Results

  • Cochrane Systematic Reviews
    (Click here for the free summary version)Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognised as the highest standard in evidence-based health care. They investigate the effects of interventions for prevention, treatment and rehabilitation. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting. They are published online in The Cochrane Library.Each systematic review addresses a clearly formulated question; for example: Can antibiotics help in alleviating the symptoms of a sore throat? All the existing primary research on a topic that meets certain criteria is searched for and collated, and then assessed using stringent guidelines, to establish whether or not there is conclusive evidence about a specific treatment. The reviews are updated regularly, ensuring that treatment decisions can be based on the most up-to-date and reliable evidence
  • Drug Information Portal
    A gateway to selected drug information from the US government. It links you to information on over 12,000 drugs from trusted consumer drug information sources (as MedlinePlus Drug Information), the US Food and Drug Information (as Drugs @FDA), LactMed (summary of effects on breastfeeding), and more.
  • Clinically important safety information and reporting serious problems with human medical products.
    Safety information includes drug information, recalls & alerts, drug shortage information, and medication guides.
  • Adverse Reaction Online Database contains information about suspected adverse reactions (also known as side effects) to health products, recalls, advisories, and warnings from the Canadian government
  • Learn about your prescription drugs and over-the-counter medicines. Includes side effects, dosage, special precautions, and more.
    Browse dietary supplements and herbal remedies to learn about their effectiveness, usual dosage, and drug interactions.
  • We should treat diseases not create diseases to treat (medrants.com)
  • Pop. Snort. Parachute.(New York Magazine, 2005))

    To many New York teenagers, all the world’s a pharmacy. There is a vanishing distinction between pills for medication and for recreation, and the much-touted risk of suicide misses the point.By David Amsden Published May 21, 2005

    “….Drug companies, though, have plenty of incentives to market their drugs to kids. Adolescents represent a relatively untapped (but rapidly growing) market for drugmakers, something any successful business looks to exploit. And they’re generally encouraged to do so by the government. A federal law passed in 1997 allows a drug company to keep its patent an extra six months by performing clinical trials on children, which translates into enormous profits. Zoloft, for instance, grossed about $3.1 billon in sales last year, so that additional time is hugely lucrative.

    Meanwhile, the shame associated with psychotropic meds continues to dissipate as doctors write more prescriptions and the diagnosed “disorders” become less severe-sounding. First there was depression, then social-anxiety disorder; now we have general-anxiety disorder, which Xanax’s Website defines as having “vague feelings that something bad is going to happen,” an apt description of what it’s like to be an adolescent. Zoloft’s Website describes social-anxiety disorder as often starting in the “mid-teen” years, and yet the drug’s television ad campaign, with its cartoon powder puffs, looks like a Sesame Streetouttake. And while Pfizer denies targeting kids, teenagers themselves aren’t so sure. “That’s so geared toward children,” Timothy told me. “It’s like, ‘You’re not happy anymore? Here, take some pills and you’ll be appreciating butterflies left and right!’ ”

    “What’s really changed is that now they market medical conditions,” says Marcia Angell, a member of Harvard Medical School’s Department of Social Medicine and author of The Truth About the Drug Companies, the just-published indictment of big pharmaceutical firms. “It’s simple—there will always be more healthy people than sick people, so they need to make more people think they’re sick. Teens are naturally going through an intense period of ups and downs. The marketing makes them think the downs are unacceptable, that they’re a disorder.”

    What such marketing cannot take into account is that kids are cynical, reluctant to take the word of adults at face value. When this attitude mixes with prescription drugs, it turns into a desire to reinvent their intended uses in a manner that’s not necessarily ill-intentioned. Because the taboo truth is that illicit use can be legitimately helpful, which makes the dangers that much easier to overlook….

  • Many NIH-funded clinical trials go unpublished over two years after completion (with ClinicalTrials.gov link for many trial study results) (jflahiff.wordpress.com)
  • Pharmaceutical Companies Turn to Checklists to Sell More Drugs (labsoftnews.typepad.com)
  • Painkiller sales soar across U.S., spread to new areas (usatoday.com)
  • Tony Bennet Says Legalizing Drugs Could Prevent Deaths Like Whitney Houston’s; Prescription Drugs Aren’t Safer (blisstree.com)
  • The billion-dollar battle over premenstrual disorder (salon.com)

April 5, 2012 Posted by | Uncategorized | , , , | Leave a comment

Bioorthogonal Chemistry – Making Drugs Inside Patients – And More

From the 27 March 2012 article at Medical News Today

The traditional way of making medicines from ingredients mixed together in a factory may be joined by a new approach in which doctors administer the ingredients for a medicine separately to patients, and the ingredients combine to produce the medicine inside patients’ bodies.

That’s one promise from an emerging new field of chemistry, according to the scientist who founded it barely a decade ago. Carolyn Bertozzi, Ph.D., spoke on the topic – bioorthogonal chemistry – delivering the latest Kavli Foundation Innovations in Chemistry Lecture at the 243rd National Meeting & Exposition of the American Chemical Society (ACS).

Bertozzi explained that the techniques of bioorthogonal chemistry may fundamentally change the nature of drug development and diagnosis of disease, so that the active ingredients for medicines and substances to image diseased tissue are produced inside patients.

“Suppose a drug doesn’t reach diseased tissue in concentrations high enough to work,” Bertozzi said, citing one example of the potential of the new chemistry. “Maybe it is an oral drug that doesn’t get absorbed very well into the blood through the stomach. You can imagine a scenario in which doctors administer two parts of the molecule that makes up the drug. …

March 28, 2012 Posted by | Medical and Health Research News | , | Leave a comment

Drugs: ‘New’ does not always mean ‘better’

Drugs: ‘New’ does not always mean ‘better’

From the 2 March Science Daily article

Cases in which a newly approved drug is more effective than the cheaper alternatives already available are the exceptions rather than the rule.

This is the conclusion reached in a study by Mariam Ujeyl et al. in the current issue of Deutsches Ärzteblatt International.

Research into 39 proprietary medicinal products (PMPs) launched on the German market in 2009 and 2010 shows that there were frequently insufficient data available on efficacy when approval was granted. The legal requirements of the licensing procedure have never yet required direct data comparing a new drug to a commercially available drug.

The researchers’ evaluations also show that for around half of approvals the only trials presented compared the new drug with a placebo, not an effective comparator drug.

This can give rise to room for interpretation regarding pricing when new drugs are marketed. The authors do not even rule out the possibility that these more expensive PMPs may actually be inferior to the alternatives already on the market.

March 4, 2012 Posted by | health care | , , | Leave a comment

Fake drug sales are increasing on the Internet and turning up in legitimate supply chains

Counterfeit drugs

Counterfeit Drugs

 

From the 22 February 2012 Eureka News Alert

Major review contains wealth of international facts and figures

Criminal gangs are increasingly using the internet to market life-threatening counterfeit medicines and some have even turned up in legitimate outlets such as pharmacies, according to a review led by Dr Graham Jackson, editor of IJCP, the International Journal of Clinical Practice, and published in the March edition.

Latest estimates suggest that global sales of counterfeit medicines are worth more than $75 billion, having doubled in just five years between 2005 and 2010. Numerous studies have also reported large numbers of websites supplying prescription only drugs without a prescription and people buying internet drugs despite being aware of the dangers.

“Counterfeit medicines pose an every-increasing threat to public health, including death and inadequate healthcare as a result of self medication” says Dr Jackson. “Particularly worrying examples include counterfeit cancer and heart drugs and fake vaccines sold during the bird and swine flu scares.

“The majority of medicines people buy from unverified internet sites are counterfeit and often lack the active ingredients they claim. Others have variable concentrations of active ingredients or even contain dangerous toxins, such as arsenic, boric acid, leaded road paint, floor and shoe polish, talcum powder, chalk and brick dust and nickel.

Counterfeit medicines are a major concern to the authorities and significant European Union legislation is being developed, including stronger penalties. As outgoing European Commissioner for Enterprise and Industry Gunter Verheugen said in 2010: “Every faked drug is a potential massacre. Even when a medicine only contains an ineffective substance, this can lead to people dying because they think they are fighting their illness with a real drug.”

Facts and figures highlighted in Dr Jackson’s review include:…..

 

February 23, 2012 Posted by | Consumer Health, Consumer Safety | , , , | Leave a comment

Mayo Clinic plans to sequence patients’ genomes to personalise care

 

Mayo Clinic

Image via Wikipedia

Mayo Clinic plans to sequence patients’ genomes to personalise care [The Guardian]

Project will give doctors the genetic information they need to choose drugs that work best and minimise side effects

Excerpt from the 27 December article

Doctors have drawn up plans to sequence the full genetic code of thousands of people in a landmark project to personalise their medical care.

Volunteers will have all six billion letters of their genome read, stored and linked to their medical records to help doctors prescribe more effective drugs and other therapies.

The prestigious Mayo Clinic in the US will launch the pilot study early next year as part of an ambitious move towards an era of “proactive genomics” that puts modern genetics at the centre of patient care.

The trial reflects a growing trend in medicine to use genetic information to identify those patients who will benefit most from a drug and those who will respond better to an alternative.

Other medical centres around the world that are thinking of introducing their own whole genome tests will be watching the trial with interest.

The wealth of information locked up in the human genome can help doctors advise patients on lifestyle changes to stave off diseases they are at risk of developing, but in many cases that advice is familiar and generic – for example focusing on healthy eating, regular exercise, drinking in moderation and not smoking.

The Mayo Clinic trial goes further by giving doctors all the genetic information they need to choose drugs that will work best for a particular patient while minimising side effects.

 Read the entire article

 

 

January 9, 2012 Posted by | health care | , , , , , | Leave a comment

MedWatch: The FDA Safety Information and Adverse Event Reporting Program

Concerned about the safety of your drugs or medical advices? Wish to report a serious medical product problem online?
The US Food and Drug Agency (FDA) can help.

MedWatch logo

Medwatch is the FDA gateway for clinically important safety information and reporting serious problems with human medical products.

Safety Information includes

Medwatch also encourages anyone to report serious problems with human medical products

Want to stay informed with MedWatch updates? Here are some options…

Stay Informed

Track medication safety from your iPhone

Now available for free in the iTunes store!

Stay up to date with the latest news and government safety alerts for the prescription medicines you take. Submit any side effects you experience to the US Food and Drug Administration (FDA) to make drugs safer for everyone.

MedWatcher is a mobile tool for both healthcare professionals and the general public.

December 29, 2011 Posted by | Consumer Health, Consumer Safety, Finding Aids/Directories | , , , , , , , , , , | Leave a comment

   

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