Excessive Heat Can Harm Medications, Expert Says
SATURDAY, Aug. 20 (HealthDay News) — Medications can be harmed by high temperatures, say pharmacists.
Although just a handful of drugs have been tested at temperatures above 86F, all medications could be altered by extreme heat, they warn.
According to Dr. Amy Peak, clinical pharmacist and director of Drug Information Services at Butler University, several medications have been tested at high temperatures. She outlined some of the changes the researchers found:
- Albuterol inhalers: The container could burst at temperatures above 120F. Moreover, when stored at high temperatures, there may be a decrease in the amount of medication inhaled.
- Concentrated epinephrine: Cyclical heating could reduce 64 percent of the medication’s potency.
- Diazepam: Concentration of this drug dropped 25 percent when stored at 98.6F.
- Formoterol (capsules that are placed in inhalers): Following four hours of exposure to 158F heat, the amount released from the capsules was less than half the normal amount.
- Lorazepam: When stored at 98F, concentration decreased 75 percent.
- Mometasone (formoterol inhalers): Temperatures above 120F may cause the container to burst.
Peak says several more medications may be susceptible to excessive heat, including:
- Insulin: Excessive heat could make the insulin less effective. It could also cause the insulin vials to explode.
- Thyroid hormones: Thyroid hormones could be altered by excessively high temperatures, resulting in inconsistent doses.
- Any medications in aerosolized canisters could burst when exposed to temperatures above 120F.
Although the United States Pharmacopeia Convention Inc. recommends that medications be protected from excessive heat, only a few drugs are actually tested at temperatures above 86F, Peak pointed out.
Nevertheless, she noted there are a number of steps people can take to ensure the quality of their medications during heat waves, including:
- Be aware that temperatures inside cars can top 160 F. When driving, be sure to keep medications out of the trunk and in the climate-controlled passenger compartment.
- Never leave medications in a parked car.
- During heat waves, have medications shipped overnight in special cooled containers.
- Request a one-time replacement from your insurance company or drug manufacturer for any medication that may have been affected by excessive heat.
SOURCE: Butler University, news release, August 2011
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Drug Shortages?
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From a 21 June 2011 Capital Area District Library Blog item
Maybe you’ve seen a little item in the news lately about shortages of important “medically necessary” medicines. You probably dismissed it as something that doesn’t affect you, however, you might be interested to know that the shortages include cancer drugs, anesthetics used for patients having surgery, injectibles used in emergency treatment, electrolytes, and medicines that many Americans take daily for chronic conditions. Curious now?
Fortunately, monitoring production supplies and shortages and working closely with U.S. drug makers is one of the important jobs of the U.S. Food and Drug Administration (FDA). They report that “…the number of drug shortages has tripled over the last six years – jumping from 61 drug products in 2005 to 178 in 2010 – …” So, as a consumer and patient what can you do? First of all, be in touch with your medical care provider to assess your individual situation and needs. Second, take a look at the list of Current Drug Shortages. If you believe a drug you’re taking is in short supply and isn’t on the list, you can contact the FDA’s Center for Drug Evaluation and Research at drugshortages [at] fda.hhs.gov.
You can find this and other Consumer Updates atwww.fda.gov/ForConsumers/ConsumerUpdates. Also, you can sign up for free email subscriptions to FDA news at https://public.govdelivery.com/accounts/USFDA/subscriber/new?topic_id=USFDA_9
Eunice B., CADL Reference Librarian
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More Being Prescribed Psychiatric Medications With No Diagnosis
From the 4 August Medical News Today article
59.5% of antidepressant prescriptions were made with no diagnosis in 1996, in 2007 the figure rose to 72.7%, researchers reported in Health Affairs. Antidepressant drugs are today the third most commonly prescribed class of drugs in the USA.
Nearly 8.9% of the American population had at least one antidepressant prescription during any given month during the period 2005-2008.
A good proportion of this growth in antidepressant prescription has been by non-specialist providers whose patients were not diagnosed by a psychiatrist.
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Environmental Pollutants Lurk Long After They ‘Disappear’
From a 20 July 2011 Science Daily article
The health implications of polluting the environment weigh increasingly on our public consciousness, and pharmaceutical wastes continue to be a main culprit. Now a Tel Aviv University researcher says that current testing for these dangerous contaminants isn’t going far enough.
Dr. Dror Avisar, head of the Hydro-Chemistry Laboratory at TAU’s Department of Geography and the Human Environment, says that, when our environment doesn’t test positive for the presence of a specific drug, we assume it’s not there. But through biological or chemical processes such as sun exposure or oxidization, drugs break down, or degrade, into different forms — and could still be lurking in our water or soil….
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New Report Shows 85% of Fake Online Drug Outlets Don’t Require Valid Prescription, Fuel Prescription Drug Abuse
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From the 28 July 2011 Drug Information Forum article by Marvin C Pankaskie
The National Association of Boards of Pharmacy® (NABP®) today issued a public health alert to warn Americans about the serious dangers associated with medicines purchased through fake online pharmacies. A report NABP released today on Internet drug outlets found that 96% of 8,000 rogue Web sites analyzed continue to operate out of compliance with United States pharmacy laws, fuel prescription drug abuse and misuse, and provide an outlet for counterfeit medicines to enter the US drug supply – all of which significantly endanger the health and safety of Americans.
“The fake online pharmacy crisis has reached an epidemic level – they prey on prescription drug abusers and the most vulnerable members of society who rely on medicine every day for their health,” said NABP President Malcolm J. Broussard, RPh. “They offer easy access to potent medicines without a prescription and indiscriminately push dangerous counterfeit drugs. This problem poses a clear danger to Americans’ health and safety and weakens the essential relationships between pharmacists and patients. By issuing a public health alert, we are calling on pharmacists, physicians, and other health professionals to educate their patients about the growing public health threat posed by these illegal online enterprises.”
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- Online Pharmacies Certified by PharmacyChecker.com are Guaranteed to Provide Safe and Authentic Prescription Medications (prweb.com)
- 3rd Annual National Prescription Drug Take-Back Day Slated for October 29, 2011 (forum.thenewalchemist.com)
- FDA ‘Bad Ad’ Program Raises Awareness of Provider Role in Ensuring Truthful Prescription Drug Promotion (forum.thenewalchemist.com)
- Protecting Consumers from Rogue Online Pharmacies (eset.com)
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- PharmacyChecker.com Begins Blog About Americans’ Access to Affordable Medication (prweb.com)
Celebrity endorsements of prescription drugs
From the 7 July 2011 KevinMD column by Richard Meyer
Boniva continues to use Sally Field as a celebrity spokesperson for their product but as John Mack pointed out, should any prescription drugs be paying celebrities to endorse their products? Well, according to an Ace Metrix study the answer to that is “probably no.”
The Ace Metrix study found of more than 2,600 ads that celebrity ads do not perform any better than non-celebrity ads and in some case perform much worse. In their study whether or not a celebrity endorses a product was unimportant in determining whether an ad resonated with viewers. In fact compared with industry norms relatively few celebrity ads were able to earn performance marks above the industry averages…
Studies Evaluate Criteria For Detecting Potentially Inappropriate Medications In Older Hospitalized Patients
From the 13 June 2011 Medical News Today article
Using the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria was associated with identification of adverse drug events in older patients, according to a report in the June issue of Archives of Internal Medicine, one of the JAMA/Archives journals. The article is part of the journal’s Less Is More series.
According to information in the article, adverse drug events (ADEs) are a significant issue in the older population, and are thought to represent an important cause of hospitalization and account for substantial health care expenditures. Some ADEs are associated with potentially inappropriate medications (PIMs): agents that may cause problems in older patients “because of the higher risk of intolerance related to adverse pharmacodynamics or pharmacokinetics or drug-disease interactions.” During the last two decades, the Beers criteria for judging whether a medication is appropriate for use in an older patient have become the leading standard. Nevertheless, the authors write, research into whether the Beers criteria are associated with avoidable ADEs has not generated consistent results….
…According to the authors, the results suggest that STOPP criteria were more likely than Beers criteria to reveal ADEs in general, avoidable or potentially avoidable ADEs, and ADEs that may have factored into the patient’s hospitalization. “We believe that this finding strengthens the argument for the use of STOPP criteria in everyday clinical practice as a means of reducing the risk of ADEs in older patient,” they write. …
For suggestions on how to get this article for free or at low cost, click here
Article Outlines Principles For A Conservative Approach To Prescribing Medication
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From the 14 June 2011 Medical News Today article
shift toward more conservative medication-prescribing practices would serve patients better, according to a review article published Online First today by Archives of Internal Medicine, one of the JAMA/Archives journals***. The article is part of the journal’s Less Is More series.
As background, the article notes that the majority of patients under age 65 years receive at least one prescription drug annually. However, according to the authors, not every patient visit needs to result in a prescription. They point to “the recent spate of revelations of undisclosed and unexpected adverse effects of drugs in multiple therapeutic categories” as just one reason to take a more measured approach to medication usage…
…Among the steps they recommend for conservative prescribing:
- Think beyond drugs. Would other interventions help? Would a medication simply mask symptoms without treating the problem? Can a condition be prevented instead of treated? Would waiting to see if the symptoms self-resolve be wise?
- Practice more strategic prescribing. Do you have a solid understanding of medication choices? Is there a valid reason to switch to a new drug? Is it the right drug for your patient? Can you avoid using multiple medications?
- Maintain heightened vigilance regarding adverse effects. Do you check with patients about potential drug reactions? Do you teach them the warning signs? Are the drugs you’re choosing prone to withdrawal symptoms or relapse?
- Approach new drugs and new indications cautiously and skeptically. Where do you get your information about new treatments? Can you wait until a new drug has had a longer track record? Does the drug actually help resolve the core problem? Is it actually indicated for this problem? Does it deliver what it promises? Do studies tell the whole story on a drug?
- Work with patients for a more deliberative shared agenda. Can you persuade patients not to demand drugs they have seen or heard advertised? Is a patient’s noncompliance with therapy the source of the problem? Has the patient already tried this drug without success? Can you encourage healthy skepticism in your patients?
- Consider longer-term, broader effects. Would a different therapy be less likely to cause future harm? Can you find a way to make the prescribing system better?
***For suggestions on how to get this article for free or at low cost, click here
Information Overload in Drug Side Effect Labeling
ScienceDaily (May 24, 2011) — The lists of potential side effects that accompany prescription drugs have ballooned in size, averaging 70 reactions per drug, a number that can overwhelm physicians trying to select suitable treatments for their patients, according to a new study of drug labels.
In the study, appearing in the May 23, 2011 issue of the Archives of Internal Medicine, the researchers found that the average label contains 70 different side effects, with more commonly prescribed drugs averaging around 100 side effects. The upper range was remarkably high, with a single label containing as many as 525 reactions. The study involved analysis of more than 5,600 drug labels and more than half a million labeled effects.
“Having a high number of side effects on a drug’s label should not suggest that the drug is unsafe. In fact, much of this labeling has less to do with true toxicity than with protecting manufacturers from potential lawsuits,” said lead author Jon Duke, M.D., Regenstrief Institute investigator and assistant professor of medicine at the IU School of Medicine.
“But having all these labeled side effects can overwhelm doctors who must weigh the risks and benefits when prescribing a medication. The Food and Drug Administration has taken steps to discourage such ‘overwarning,’ but at present information overload is the rule rather than the exception,” Dr. Duke said….
Journal Reference:
- J. Duke, J. Friedlin, P. Ryan. A Quantitative Analysis of Adverse Events and ‘Overwarning’ in Drug Labeling.Archives of Internal Medicine, 2011; 171 (10): 944 DOI:10.1001/archinternmed.2011.182
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AHRQ Releases Tool to Help Consumers Reduce Medication Errors
From the press release
Three out of four Americans are not following their doctor’s advice when it comes to taking prescription medication, according to U.S. Surgeon General Dr. Regina Benjamin. AHRQ and the National Council on Patient Information and Education have released a revised guide to help patients learn more about how to take medicines safely. “Your Medicines: Be Smart. Be Safe” is a booklet that includes a detachable, wallet-sized card that can be personalized to help patients keep track of all medicines they are taking, including vitamins and herbal and other dietary supplements. Available in English and Spanish, the guide includes questions that patients can ask their doctors about their medications. Select to access a copy of the guide. Print copies are available by sending an e-mail to ahrqpubs@ahrq.hhs.gov.
Easy Online Availability Of Controlled Drugs May Contribute To Soaring Abuse Levels
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From a 12 May Medical News Today article
Increasing access to rogue online pharmacies – those which dispense medications without a doctor’s prescription – may be an important factor behind the rapid increase in the abuse of prescription drugs. In a report that was released today, 12th May, online by the journal Health Affairs and will also appear in its June edition, investigators from Massachusetts General Hospital (MGH) and the University of Southern California (USC) find that states with the greatest expansion in high-speed Internet access from 2000 to 2007 also had the largest increase in admissions for treatment of prescription drug abuse….
….The analysis indicated that each 10 percent increase in the availability of high-speed Internet service in a state was accompanied by an approximately 1 percent increase in admissions for prescription drug abuse. The increases were strongest for narcotic painkillers, followed by anti-anxiety drugs, stimulants and sedatives. During the same period admissions to treat abuse of alcohol, heroin or cocaine, substances not available online, showed minimal growth or actually decreased. …
The abstract and full text of the Health Affairs article Growing Internet Use May Help Explain The Rise In Prescription Drug Abuse In The United States may be found here.
Doctor’s Office Is Usually First Stop In Medication Mishaps
From the 6 May 2011 Medical News Today article
Harmful effects of medication bring an estimated 4.5 million patients to doctors’ offices and emergency rooms yearly, according to a new study, and people who take multiple medications are particularly vulnerable to unpleasant or dangerous side effects, allergic reactions and toxicity.
Such medication mishaps are a widely recognized problem in health care, but until now, most research has focused on their incidence in the hospital.
“The outpatient setting is where 80 percent of medical care takes place-where we would expect the real burden of the problem to be,” said Urmimala Sarkar, M.D., lead study author, at the University of California, San Francisco.
Analyzing data from 2005 to 2007 from the National Center for Health Statistics, the researchers found that 13.5 million outpatient visits during this three-year period had links to negative effects from prescription medications, in the study appearing online in the journal Health Services Research. …
…While some unwanted effects are inevitable with drug treatment, “many are preventable,” Sarkar said. To reduce their incidence, she said, “medical counseling in doctors’ offices and pharmacies has to be better. Patients need to know what medications they’re on and their possible side effects, and to understand what they’re allergic to.”
Steps to alleviate drug-related problems ultimately should include changes in the health care system, such as coordinated electronic medical records to facilitate information sharing between clinicians, Sarkar said.
Sarkar U, et al. Adverse drug events in U.S. adult ambulatory medical care. Health Services Research online, 2011.
Related Articles
- Prevent Medical Errors With Health Records (everydayhealth.com)
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Ten Tips to Prevent an Accidental Overdose
Always use the cup, syringe, or other dosage device that comes with a medicine. A different device, or a kitchen spoon, could hold the wrong amount.
Get Consumer Updates by E-mail
For a medicine to work for you—and not against you—you’ve got to take the right dose.
Many over-the-counter liquid medicines—such as pain relievers, cold medicine, cough syrups, and digestion aids—come with spoons, cups, oral droppers, or syringes designed to help consumers measure the proper dose. These “dosage delivery devices” usually have measurement markings on them—such as teaspoons (tsp), tablespoons (tbsp), or milliliters (mL).
But the markings aren’t always clear or consistent with the directions on the medicine’s package. The Food and Drug Administration (FDA) has received numerous reports of accidental overdoses—especially in young children—that were attributed, in part, to the use of dosage delivery devices that were unclear or incompatible with the medicine’s labeled directions for use.
On May 4, 2011, FDA issued a guidance to firms that manufacture, market, or distribute over-the-counter liquid medicines. The guidance calls for them to provide dosage delivery devices with markings that are easy to use and understand.
Parents and caregivers can do their part, too, to avoid giving too much or too little of an over-the-counter medicine. Here are 10 tips:
1.Always follow the directions on the Drug Facts label of your medicine. Read the label every time before you give the medicine.
2.Know the “active ingredient” in the medicine. This is what makes the medicine work and it is always listed at the top of the Drug Facts label. Many medicines used to treat different symptoms have the same active ingredient. So if you’re treating a cold and a headache with two different medicines but both have the same active ingredient, you could be giving two times the normal dose. If you’re confused, check with a doctor, nurse, or pharmacist.
3.Give the right medicine, in the right amount. Medicines with the same brand name can be sold in different strengths, such as infant, children, and adult formulas. The dose and directions also vary for children of different ages or weights. Always use the right strength and follow the directions exactly. Never use more medicine than directed unless your doctor tells you to do so.
4.Talk to your doctor, pharmacist, or nurse to find out what mixes well and what doesn’t. Medicines, vitamins, supplements, foods, and beverages aren’t always compatible.
5.Use the dosage delivery device that comes with the medicine, such as a dropper or a dosing cup. A different device, or a kitchen spoon, could hold the wrong amount of medicine. And never drink liquid medicine from the bottle.
6.Know the difference between a tablespoon (tbsp) and a teaspoon (tsp). A tablespoon holds three times as much medicine as a teaspoon. On measuring tools, a teaspoon (tsp) is equal to “5 mL.”
7.Know your child’s weight. Dosage amounts for some medicines are based on weight. Never guess how much to give your child or try to figure it out from the adult dose instructions. If a dose is not listed for your child’s weight, call your health care professional.
8.Prevent a poison emergency by always using a child-resistant cap. Relock the cap after each use. Be especially careful with any medicines that contain iron; they are the leading cause of poisoning deaths in young children.
9.Store all medicines in a safe place. Some are tasty, colorful, and many can be chewed. Kids may think they’re candy. Store all medicines and vitamins out of your child’s (and your pet’s) sight and reach. If your child takes too much, call the Poison Center Hotline at 800-222-1222 (open 24 hours a day, 7 days a week) or call 9-1-1.
10.Check the medicine three times before using. For any medicine, it is always good practice to first, check the outside packaging for such things as cuts, slices, or tears. Second, once you’re at home, check the label on the inside package to be sure you have the right medicine and that the lid and seal are not broken. Third, check the color, shape, size, and smell. If you notice anything unusual, talk to a pharmacist or other health care professional before using.
This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.
Related Resources (from the University of Toledo Consumer Health Library Guide)
- Familydoctor.org -health information for the whole family
Web pages include Conditions A-Z, Health Information for Seniors, Men, and Women, Healthy Living Topics, pages geared to Parents & Kids, and videos. Numerous health tools in the left column (as health trackers, health assessments, and a Search by Symptom page. Written and reviewed by physicians and patient education professionals at the American Academy of Family Physicians. - Mayo Clinic
Trusted information on diseases and conditions (including a symptom checker), drugs and supplements, tests and procedures, and healthy lifestyle information. By a team of Mayo physicians, scientists, writers, and educators.
- Drugs, Supplements, and Herbal Information (from a MedlinePlus page)
Prescription and over-the-counter medication information contains answers to many general questions including topics as what a drug is used for, precautions, side effects, dietary instructions, and overdoses. From the American Society of Health System Pharmacists - Drug Information Portal
A good central source of drug information by the US government (the National Institutes of Health). It links you to information on over 12,000 drugs from trusted consumer drug information sources, the US Food and Drug Information, and LactMed (summary of effects on breastfeeding), It also gives any summaries from medical and toxicological articles (however, the whole article may not be for free on the Internet)
Related Articles
- Over-the-Counter Medicine: Kids Aren’t Just Small Adults (education.com)
- FDA 101: Medication Errors (everydayhealth.com)
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- Drugmakers Eliminate Infant Drops of Key Medicine (foxnews.com)
- Overdose Risk for Young Children on Prescription Pain Drugs (webmd.com)
- Opioid prescription overdose and abuse – Staying safe while reducing pain (psychologytoday.com)
- High Dose Painkillers Up Risk of OD Deaths (abcnews.go.com)
- Parents – Dosing Tips for Kids and Cough and Cold Remedies (education.com)
AARP Health Tools
- Medicare with a search box and clickable general and specific topids
- Medicare Part D and prescription coverage
- Drug Savings Tool for finding cheaper alternatives
- Drugs A-Z to find information on prescription and over the counter medications
- Drug Compare to earn the differences and similarities between any two prescription or over-the-counter medications
- Pill Identifier to Avoid a medication mix-up. Use our tool to identify pills by color, shape and markings
- Symptom Checker – Enter your health symptoms to find out possible causes and treatments
Related Resources (from the University of Toledo Consumer Health Library Guide)
- Familydoctor.org -health information for the whole family
Web pages include Conditions A-Z, Health Information for Seniors, Men, and Women, Healthy Living Topics, pages geared to Parents & Kids, and videos. Numerous health tools in the left column (as health trackers, health assessments, and a Search by Symptom page. Written and reviewed by physicians and patient education professionals at the American Academy of Family Physicians. - Mayo Clinic
Trusted information on diseases and conditions (including a symptom checker), drugs and supplements, tests and procedures, and healthy lifestyle information. By a team of Mayo physicians, scientists, writers, and educators.
- Drugs, Supplements, and Herbal Information (from a MedlinePlus page)
Prescription and over-the-counter medication information contains answers to many general questions including topics as what a drug is used for, precautions, side effects, dietary instructions, and overdoses. From the American Society of Health System Pharmacists - Drug Information Portal
A good central source of drug information by the US government (the National Institutes of Health). It links you to information on over 12,000 drugs from trusted consumer drug information sources, the US Food and Drug Information, and LactMed (summary of effects on breastfeeding), It also gives any summaries from medical and toxicological articles (however, the whole article may not be for free on the Internet)
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Rising reports of bad reactions to drugs
Rising reports of bad reactions to drugs
From the March 28 2011 Health Day news item By Alison McCook
NEW YORK (Reuters Health) – Official reports of negative reactions to prescription drugs have increased dramatically over the last decade, according to a new study.
In a U.S. Food and Drug Administration (FDA) database launched in 1969, researchers found that over half the reports of “adverse events” suspected to be caused by a particular drug or device date from just the past 10 years.
The FDA currently receives about half-a-million such reports of health problems, and even deaths, associated with medical products each year. In 2000, they came in at a rate of nearly five for every 10,000 office visits in which at least one prescription was written. By 2005, that rate had risen to nearly seven per 10,000 visits, according to the new analysis published in the Archives of Internal Medicine.
Between 2000 and 2010, the number of reports coming in grew steadily by more than 11 percent every year. By 2010, they added up to 2.2 million reports — 55 percent of the entire database total.
Study author Dr. Sheila Weiss-Smith of the University of Maryland in Baltimore cautioned that the number of reports does not equal the true number of negative reactions to drugs.
Manufacturers are required to report to the FDA any health problem they suspect stems from one of their products, but for doctors, patients, lawyers, and anyone else who reports these reactions, it’s entirely voluntary, she told Reuters Health.
It’s hard to estimate how many negative reactions to drugs actually occur, Weiss-Smith noted. Some experts suggest official reports represent one-tenth of the number of actual negative reactions, but she said she doesn’t trust that figure. “We just don’t know. We don’t know what percentage of events actually gets reported.”…
…More people are taking drugs, and for longer times, which increases the potential for bad reactions, and negative interactions between drugs, she said….…Negative reactions can occur from a variety of drugs, and patients need to take steps to protect themselves, Weiss-Smith urged. “Drugs are chemicals. And you’re putting something in your body. You need to know what it is.” [Editor Flahiff’s emphasis]She recommended that everyone tell their doctors what they are taking, and try to go to one pharmacy, “so someone can keep track of all the different things,” preventing negative interactions.
If you keep adding drugs to your daily routine, talk to your doctor about whether you can cut back on others, so that you are only taking the minimum necessary amount, she said. Read all the material that comes with medicines, and tell someone immediately if you start to feel unwell. “If something doesn’t feel right, talk to your doctor, talk to your pharmacist.” [Flahiff’s emphasis]
Are you looking for information about a drug? to use for consultations with your health care provider?
Please use reputable resources that strive to provide unbiased information.
Pharmacists are great sources of information. Practicing pharmacists are college graduates (many with Master’s degrees) that are state licensed. Many give free information at their place of business, they seldom ask if you are one of their customers!!
Also, don’t forget librarians as your personal, professional guides to information in print and online resources.
Contact your local public, academic, or medical library. Many medical and academic libraries, especially those state funded, give at least some assistance to the public. Call ahead. You may be pleasantly surprised!
And, as always, contact me( jmflahiff who virtually resides at yahoo.com)
Some examples of good drug information Web sites
Drugs, Supplements, and Herbal Information (from a MedlinePlus page)
Prescription and over-the-counter medication information contains answers to many general questions including topics as what a drug is used for, precautions, side effects, dietary instructions, and overdoses. From the American Society of Health System Pharmacists
Herb and supplement information includes information on uses based on scientific evidence as well as safety and potential interactions with drugs, herbs, and supplements. From Natural Standard, an independent group of researchers and clinicians.
Drugs and Supplements (sponsored by the Mayo Clinic)
Somewhat lengthy drug and over-the-counter medicationinformation with these sections: description, before using, proper use, precautions and side effects. From Micromedex, a trusted source of healthcare information for health professionals.
Herb and supplement information includes information on uses based on scientific evidence as well as safety and potential interactions with drugs, herbs, and supplements. From Natural Standard, an independent group of researchers and clinicians.
A good central source of drug information by the US government (the National Institutes of Health). It links you to information on over 12,000 drugs from trusted consumer drug information sources, the US Food and Drug Information, and LactMed (summary of effects on breastfeeding), It also gives any summaries from medical and toxicological articles (however, some whole articles may not be for free on the Internet).
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Sunlight can influence the breakdown of medicines in the body
Sunlight can influence the breakdown of medicines in the body
The body’s ability to break down medicines may be closely related to exposure to sunlight, new research suggests. (Credit: iStockphoto/Michiel De Boer)
From the March 9 Science Daily item
ScienceDaily (Mar. 9, 2011) — A study from the Swedish medical university Karolinska Institutet has shown that the body’s ability to break down medicines may be closely related to exposure to sunlight, and thus may vary with the seasons. The findings offer a completely new model to explain individual differences in the effects of drugs, and how the surroundings can influence the body’s ability to deal with toxins.
The study will be published in the scientific journal Drug Metabolism & Disposition and is based on nearly 70,000 analyses from patients who have undergone regular monitoring of the levels of drugs in their blood.
Older patients confused about multiple drug dosing
Older patients confused about multiple drug dosing
From the March 4 2011 Science Daily news item
Many older patients, who take an average of seven medicines a day, are so confused by the vague instructions on prescription bottles they don’t realize they can combine their medications to take them more efficiently. A new study shows patients thought they had to take seven medicines at least seven and up to 14 separate times a day. Researchers recommend a standardized universal medication drug schedule at morning, noon, evening and bedtime.
A complex and confusing regimen means people are less likely to take their drugs properly, and that means they are not getting the full benefits of their medicine,” said Michael Wolf, associate professor of medicine and of learning sciences at Northwestern University Feinberg School of Medicine. He is lead author of the study, funded by the National Institute on Aging, that will be published February 28 in Archives of Internal Medicine.***
***For suggestions on how to get this article for free or at low cost, click here
Paid Caregivers Struggle to Follow Doctor’s Orders
Struggling to follow doctor’s orders
Paid caregivers may lack the skills to take on health-related tasks in senior’s homes
From a February 22, 2011 Eureka news alert
CHICAGO — Paid caregivers make it possible for seniors to remain living in their homes. The problem, according to a new Northwestern Medicine study, is that more than one-third of caregivers had difficulty reading and understanding health-related information and directions. Sixty percent made errors when sorting medications into pillboxes.
The study will be published in the Journal of General Internal Medicine. It has been published online.***
In a first-of-its-kind study, nearly 100 paid, non-family caregivers were recruited in the Chicago area and their health literacy levels and the health-related responsibilities were assessed, said Lee Lindquist, M.D., assistant professor of geriatrics at Northwestern University Feinberg School of Medicine and physician at Northwestern Memorial Hospital.
“We found that nearly 86 percent of the caregivers perform health-related tasks,” said Lindquist, lead author of the study. “Most of the caregivers are women, about 50 years old. Many are foreign born or have a limited education. The jobs typically pay just under $9.00 per hour, but nearly one-third of the caregivers earn less than minimum wage.”
Lindquist found that despite pay, country of birth or education level, 60 percent of all the caregivers made errors when doling medication into a pillbox. This is an alarming statistic, because patients who don’t take certain medications as prescribed could end up in the hospital, Lindquist said.
“Many of these caregivers are good people who don’t want to disappoint and don’t want to lose their jobs,” Lindquist said. “So they take on health-related responsibilities, such as giving out medications and accompanying clients to the doctor for appointments. Most physicians and family members do not realize that while the caregiver is nodding and saying ‘yes’, she might not really understand what is being said.”
Right now there isn’t a standard test family members or employment agencies can use to gauge a caregiver’s ability to understand and follow health-related information, Lindquist said.
“Currently we are developing tests consumers can use to evaluate caregiver skills as well as studying the screening processes caregiver agencies use,” Lindquist said. “But, if you really want to know if the caregiver is doing a good job and is taking care of the health needs of your senior, start by going into the home, observing them doing the tasks, and asking more questions.”
###The title of the study is “Inadequate Health Literacy Among Paid Caregivers of Seniors.”***
For suggestions on how to get this article for free or at low cost click here.
Related Articles
- Managing Medications: Tips for Family Caregivers (homecareminneapolis.wordpress.com)
- How to Create a Pill Card to Keep Track of Meds
How to Create a Pill Card to Keep Track of Meds
AHRQ (Agency for Healthcare Research and Quality) has a one page guide on how to create a pill card.
The guide includes a template, clip art from Microsoft Word, and what information to include.
An excerpt
Table 1: Organize Information for the Pill Card
| Medicine | Important Information in Simple Terms | Incorporating This Information into a Pill Card | Possible Graphics Used |
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 Simvastatin20mg |
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 Furosemide20mg |
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What Is Comparative Effectiveness Research?
What Is Comparative Effectiveness Research?
From the US AHRQ (Agency for Healthcare Research and Quality) Web page
Comparative effectiveness research is designed to inform health-care decisions by providing evidence on the effectiveness, benefits, and harms of different treatment options. The evidence is generated from research studies that compare drugs, medical devices, tests, surgeries, or ways to deliver health care.
There are two ways that this evidence is found:
- Researchers look at all of the available evidence about the benefits and harms of each choice for different groups of people from existing clinical trials, clinical studies, and other research. These are called research reviews, because they are systematic reviews of existing evidence.
- Researchers conduct studies that generate new evidence of effectiveness or comparative effectiveness of a test, treatment, procedure, or health-care service.
Comparative effectiveness research requires the development, expansion, and use of a variety of data sources and methods to conduct timely and relevant research and disseminate the results in a form that is quickly usable by clinicians, patients, policymakers, and health plans and other payers. Seven steps are involved in conducting this research and in ensuring continued development of the research infrastructure to sustain and advance these efforts:
- Identify new and emerging clinical interventions.
- Review and synthesize current medical research.
- Identify gaps between existing medical research and the needs of clinical practice.
- Promote and generate new scientific evidence and analytic tools.
- Train and develop clinical researchers.
- Translate and disseminate research findings to diverse stakeholders.
- Reach out to stakeholders via a citizens forum.
Common questions about comparative effectiveness research
Q: Why is comparative effectiveness research needed? What problem is it trying to solve?
- If you don’t get the best possible information about your treatment choices, you might not make an informed decision on what treatment is best for you.
- When you shop for a new car, phone or camera, you have lots of information about your choices. But when it comes to choosing the right medicine or the best health-care treatment, clear and dependable information can be very hard to find.
- It’s true that some treatments may not work for everyone, and that some treatments may work better for some people than others. This research can help identify the treatments that may work best for you.
Q: What are the practical benefits of comparative effectiveness research?
- You deserve the best and most objective information about treating your sickness or condition. With this research in hand, you and your doctor can work together to make the best possible treatment choices.
- For example, someone with high blood pressure might have more than a dozen medicines to choose from. Someone with heart disease might need to choose between having heart surgery or taking medicine to open a clogged artery. Reports on these topics and others include the pros and cons of all the options so that you and your doctor can make the best possible treatment decision for you or someone in your family.
- Every patient is different — different circumstances, different medical history, different values. These reports don’t tell you and your doctor which treatment to choose. Instead, they offer an important tool to help you and your doctor understand the facts about different treatments.
- …and AHRQ Effective Health Care Program Links
- Guides for Patients and Consumers include research reviews, research reports, and summary guides
- Glossary of Terms
- Personalization and Social Media Tools – These tools (as an email list)allow you to personalize your experience with the EHC Program Web site and share it with colleagues, family, and friends.
Related Articles
- Many new drugs did not have comparative effectiveness information available at time of FDA approval (eurekalert.org)
- The differences between comparative and clinical effectiveness (kevinmd.com)
- The Role of Data Mining in Cost Effectiveness Research (medicineandtechnology.com)
- The Newspeak of comparative effectiveness research (CER) (doctorrw.blogspot.com)
- CDISC Standards at Core of FDA Cross-study Clinical Trial Repository Project (prweb.com)
- National Library of Medicine Updates (aa47.wordpress.com)
- Shall I compare thee to another drug? (blogs.nature.com)
Online Medical Advice Can Be a Prescription for Fear
Online Medical Advice Can Be a Prescription for Fear
From the Resource Shelf news item of February 7, 2011 17:04
Online Medical Advice Can Be a Prescription for Fear
If you’re looking for the name of a new pill to “ask your doctor about,” as the ads say, the Mayo Clinic Health Information site is not the place for you. If you’re shopping for a newly branded disorder that might account for your general feeling of unease, Mayo is not for you either. But if you want workaday, can-do health information in a nonprofit environment, plug your symptoms into Mayo’s Symptom Checker. What you’ll get is: No hysteria. No drug peddling. Good medicine. Good ideas.
This is very, very rare on the medical Web, which is dominated by an enormous and powerful site whose name — oh, what the hay, it’s WebMD — has become a panicky byword among laysurfers for “hypochondria time suck.” In more whistle-blowing quarters, WebMD is synonymous with Big Pharma Shilling. A February 2010 investigation into WebMD’s relationship with drug maker Eli Lilly by Senator Chuck Grassley of Iowa confirmed the suspicions of longtime WebMD users. With the site’s (admitted) connections to pharmaceutical and other companies, WebMD has become permeated with pseudomedicine and subtle misinformation.
Because of the way WebMD frames health information commercially, using the meretricious voice of a pharmaceutical rep, I now recommend that anyone except advertising executives whose job entails monitoring product placement actually block WebMD. It’s not only a waste of time, but it’s also a disorder in and of itself — one that preys on the fear and vulnerability of its users to sell them half-truths and, eventually, pills.
Source: New York Times
Shirl’s note: You can’t go wrong with MedlinePlus, from the National Library of Medicine. Every site linked there has been vetted by a reliable professional.
Editor Flahiff’s note: You also cannot go wrong with these resources (via a Consumer Health Library Guide
Dietary Supplements Labels Database
Information about ingredients in more than three thousand selected brands of dietary supplements. It enables users to determine what ingredients are in specific brands and to compare ingredients in different brands. Information is also provided on the health benefits claimed by manufacturers. These claims by manufacturers have not been evaluated by the Food and Drug Administration. Check out the Help section for tips on how to browse and search this site.
This noncommercial consumer health and drug information site provides information about drugs and treatment options to be discussed with your primary health care provider or a pharmacist. Information about over 1,500 drugs as well as common herbs and supplements. The check interactions tab (potential interactions between drugs) and conditions/treatments area provide easy-to-read overviews. Information provided by Drawing pharmacy experts, licensed doctors of pharmacy, and physicians. From ExpressScripts.
Drugs and Supplements (sponsored by the Mayo Clinic)
Somewhat lengthy drug and over-the-counter medicationinformation with these sections: description, before using, proper use, precautions and side effects. From Micromedex, a trusted source of healthcare information for health professionals.
Herb and supplement information includes information on uses based on scientific evidence as well as safety and potential interactions with drugs, herbs, and supplements. From Natural Standard, an independent group of researchers and clinicians.
A good central source of drug information by the US government (the National Institutes of Health). It links you to information on over 12,000 drugs from trusted consumer drug information sources, the US Food and Drug Information, and LactMed ***(summary of effects on breastfeeding), It also gives any summaries from medical and toxicological articles (however, some whole articles may not be for free on the Internet).
For information on how to obtain medical and scientific articles for free or at low cost, click here
***As of July 2011
The National Library of Medicine Drugs and Lactation Database (LactMed)
has added complementary and alternative medicine (CAM) products. CAM
products generally consist of dietary supplements derived from botanicals
(herbals), “nutraceuticals” (natural and synthetic nonherbals, such as
coenzyme Q10), and related products.
http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
How do data exclusivity periods affect pharmaceutical innovation?
How do data exclusivity periods affect pharmaceutical innovation?
Study is first to estimate financial and social impact of extending exclusive access to clinical trial data for conventional drugs
From a January 6, 2011 Eureka news alert
LOS ANGELES, Calif. — January 6, 2011 — Pharmaceutical companies and generic drug manufacturers have long been at odds over regulations about “data exclusivity,” the period of time before generic manufacturers can make use of valuable clinical trial data.
A new study in the January 2011 issue of Health Affairs *** is the first to calculate the financial and social costs of limiting access to trial data — and finds that extending the term of exclusive access will lead to higher drug costs in the short term but also to more than 200 extra drug approvals and to greater life expectancy in the next several decades.
“Elected officials are unlikely to embrace legislation that would result in higher drug prices, but our research suggests that legislation to extend data exclusivity would spur innovation that would benefit future generations,” explained Dana Goldman, lead author, director of the Schaeffer Center for Health Policy and Economics at USC and Norman Topping Chair in Medicine and Public Policy at USC.
The pharmaceutical companies that introduce new drugs are currently granted five years of exclusive access to the clinical trial data they submit during the approval process. An extension of three years is available if new applications arise and a six month extension is granted if the drug is approved for use in pediatric populations.
In 2007, the National Academies Committee on Science, Engineering and Public Policy called for extending this “data exclusivity” term to the longer period used in Europe, ten to 11 years. But generic manufacturers have argued for shorter limits so that they can bring less expensive versions of drugs to patients sooner.
“Unfortunately, the health policy literature contains no information about the effects such a policy would have on innovation, population longevity and social welfare,” said Darius Lakdawalla, research director at the Schaeffer Center at USC and associate professor in the USC School of Policy, Planning and Development.
In the first study to directly address these issues, the researchers estimate that extending the term of data exclusivity to 12 years would increase the lifetime revenue of a drug by 5 percent, on average.
With empirical evidence that profits drive drug innovation, this longer term would lead to an additional 228 drug approvals over the next fifty years and an increase of 1.7 months in average life expectancy, according to the study.
John Romley, an economist with the Schaeffer Center at USC and research assistant professor at the USC School of Policy, Planning and Development, acknowledged the trade-off between current and future generations: “Americans in the early 2020’s would bear the cost of increasing drug spending. However, people turning 55 in 2060 could expect increased life expectancy as a result of innovation in the interceding years — that is, new drugs brought to market because of lengthier data exclusivity.”
***Click here for suggestions on how to get this article for free or at low cost
Drug Overdoses on the Rise in Most Age Groups
Image via Wikipedia
Image taken from English Wikipedia, originally uploaded by Thoric.
An arrangement of pyschoactive drugs including (counter-clockwise from top left): cocaine, crack, methylphenidate (Ritalin), ephedrine, MDMA (Ecstasy – lavender pill with smile),mescaline (green dried cactus flesh), LSD (2×2 blotter in tiny baggie), psilocybin (dried Psilocybe cubensis mushroom), Salvia divinorum (10X extract in small baggie), diphenhydramine(Benadryl – pink pill), Amanita muscaria (red dried mushroom cap piece), Tylenol #3 (contains codeine), codeine containing muscle relaxant, pipe tobacco (top), bupropion (Zyban – brownish-purple pill), cannabis (green bud center), hashish (brown rectangle)
From the December 23, 2010 Reuters health news item
NEW YORK (Reuters Health) — More and more people are dying from abusing or misusing drugs, including both prescription and illegal drugs, new research suggests.
In some groups, deaths from “accidental poisonings” — most the result of drug overdoses — are more than ten times higher than they were in the late 1960s, the study found.
While the notoriously drug-loving baby boomers account for part of the recent increase as they age and embrace prescription medications, death from accidental poisoning is higher across almost all age groups than it was a few decades ago, especially among white Americans. And the upward trend doesn’t appear to be leveling off.
“I went in expecting to see a blip (in increased accidental poisonings) with the baby boomer(s),” Dr. Richard Miech, the study’s lead author and head of Health and Behavioral Sciences at the University of Colorado Denver, told Reuters Health. After all, he said, “you’ve seen pictures of Woodstock.”
Miech was surprised that the boomer generation’s impact on the death rates was overshadowed by a “huge increase” in accidental poisoning deaths overall — an increase he attributes to the growing number of prescription drugs being taken in the United States by all age groups.
Miech and his colleagues analyzed data from the U.S. Census, which counts all people in the country, as well a register that tracks the number of deaths from different causes every year. Putting them together, the researchers could calculate the percentage of people of different ages and races dying from accidental poisonings annually.
Overall, white men and women were more than nine times as likely to die from an accidental poisoning in 2005 through 2007 than they were in 1968 and 1969 according to the analysis, which is published in the journal Addiction. Black men and women were about three times more likely to die from the same cause in recent years than they were 40 years ago.
Because of changes in the body or changes in drug use, the greatest proportion of overdoses happen in people in their 40’s and 50’s — and that age group, which currently includes the tail-end of the baby boom generation, is where some of the biggest changes in poisoning rates over time showed up.
In 1968, for example, about one in every 100,000 white women in their early 50’s died from accidental poisoning. In 2007, 15 out of 100,000 did so. Among black women of the same age, accidental poisoning deaths during the same timeframes increased from about two people in 100,000 to almost 17 in 100,000. Both white and black men had even larger jumps.
While the increases weren’t quite as striking in younger adults, the study found that deaths from accidental poisonings are significantly higher for almost every age group. That trend that was particularly clear among white Americans.
Although the authors couldn’t tell what drugs were responsible for the most accidental poisonings, the majority of prescription drug abuse involves painkillers, according to the Drug Enforcement Administration, and Vicodin (containing acetaminophen and the opiate drug hydrocodone) is the most commonly abused prescription drug in the U.S.
Such medications having become so common is likely one of the major drivers behind the increasing deaths, Miech said. According to a 2004 government report, almost half of all Americans take a prescription drug. With more prescriptions come more opportunities for people to get addicted, to take drugs that aren’t theirs, or to use drugs for non-medical purposes, all of which can have dangerous consequences.
Theodore Cicero, who studies drug abuse at Washington University in St. Louis, agrees. In general, he said, a certain percentage of the prescription drugs that are given to patients will be used for non-medical purposes. “Even if it’s a very small percentage, when the number of people (getting prescriptions) grows, obviously you’re going to have more drugs in the illicit market,” he told Reuters Health.
But it’s hard to tell someone with chronic pain, for example, that the risk of abuse or misuse isn’t worth a drug’s benefit, Miech said. And that leaves researchers and policy makers stuck.
What’s needed is for people to be more aware of the dangers these drugs pose, Miech said. Yet even with the deaths of celebrities like Heath Ledger and Michael Jackson, he pointed out, the public still hasn’t stopped to take a closer look at how prescription drug use can go wrong.
“You can, in fact, overdose on prescription meds just as easily as you can overdose on illegal drugs,” Cicero said. “Addiction is addiction no matter what the drug source is. That message has not yet come across.”
Death from prescription painkiller overdose has “been an epidemic in the last ten years,” Dr. Wilson Compton, director of the Division of Epidemiology, Services and Prevention Research at the National Institute on Drug Abuse, told Reuters Health.
But figuring out how to stop prescription drugs from ending up in the wrong hands is harder than it looks. The government, Compton said, can’t encourage people to flush their extra drugs down the toilet — that could harm the environment — and pharmacies aren’t set up to take them back.
Miech has the same fears. “Ultimately, I don’t have any silver bullets to come up with a way to reduce this huge increase” in deaths from accidental poisoning, he said.
Related MedlinePlus Pages
Related Articles
- Overdose Risk for Young Children on Prescription Pain Drugs (webmd.com)
- Prescription Narcotics Overdoses Kill More Than Heroin and Cocaine Combined (livescience.com)
- Narcotic pain relief drug overdose deaths a national epidemic (scienceblog.com)
- Prescription Drug Abuse Growth Linked To Increase In Internet Access (Medical News Today, May 2011)
- Patients on Higher Doses of Prescription Painkillers More Apt to Overdose (cherished79.wordpress.com)
Generic Drug Roundup: December 2010
From the US Food and Drug Administration Web Page
Each year, the Food and Drug Administration (FDA) approves many generic drugs that treat a wide variety of conditions and help consumers save money.
Significant FDA approvals of generic medications are listed below.
Be aware that the notes included with the description of each drug listed below do not include all warnings, side effects, or use instructions associated with these products. You should read the medication guide, when available, and speak with a health care professional regarding any medication you are taking, have been prescribed, or are considering taking
- Anastrozole Tablets
- Venlafaxine Hydrochloride extended-release capsules
- Aztreonam (for Injection)
- Enoxaparin Sodium Injection
- Losartan Potassium Tablets
- Generic Drugs: Vital Facts
- Generic drugs are identical to their brand-name equivalents in dosage, safety, strength, quality, performance characteristics, intended use, and the way they’re administered to patients.
- On average, the cost of a generic drug is 80 to 85 percent lower than the brand-name product.
- New drugs are patented to protect the investments of the manufacturers that develop them. As patents or other periods of exclusivity on new drugs expire, manufacturers—including firms that did not develop the drugs—can seek FDA approval to sell generic versions.
This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-
regulated products.For More Information
Studies detail triumphs, troubles of African innovators creating products for local health needs
From a December 12, 2010 Eureka news item
Africans strengthen ability to meet health needs in sub-Sahara with homegrown science solutions, but many products stagnate in labs for want of commercialization know-how, support
IMAGE: Invented by Moses Musaazi of Makerere University, Uganda, this easy‑to‑use, inexpensive, WHO‑approved portable medical‑waste incinerator could help solve the problem of hospital waste management in rural areas, especially during mass…
Global health experts today published a landmark collection of papers that together provide a unique microscope on the experience of countries, companies and organizations in sub-Saharan Africa addressing neglected health problems with homegrown drugs, vaccines, diagnostics and other creative scientific and business solutions.
The first-of-its kind study chronicles the triumphs and troubles of entrepreneurs, institutes and firms in Africa creating innovative, affordable technologies that bring hope to many sufferers of local diseases. While some have yet to succeed, several organizations cleared major hurdles to finance and create products, some of which may expand into global markets one day.
It is the first research offering a broad range of evidence and concrete examples of African innovation to address local health concerns. The papers draw on the experiences of authorities, researchers and entrepreneurs in Ghana, Kenya, Madagascar, Nigeria, Rwanda, South Africa, Tanzania, and Uganda. In addition to efforts involving health products, the experiences of health venture capital funds in African and other developed countries are profiled.
The papers were produced by Canada’s McLaughlin-Rotman Center for Global Health (MRC), at the University Health Network and University of Toronto, and published as a special supplement in the UK-based open-access journal publisher BioMed Central Dec. 12 (with full public access atwww.biomedcentral.com/bmcinthealthhumrights/10?issue=S1). One of the papers was published earlier in the journal Science….
……
Since it began in 2004, the MRC has focused extensively on how low-income countries themselves can remedy diseases of poverty. With relatively little profit incentive, firms in rich, developed countries largely neglect such diseases. The MRC has documented the benefits of the homegrown science approach to health problems, which include, beyond affordable products, less dependency on international donor programs and much-needed new economic opportunities and job creation. This collection represents the MRC’s largest contribution to date on product commercialization for improving health in Africa.
Examples of African innovation:
- In Tanzania, local funding, economies of scale, technology transfer, and partnerships all helped the A to Z Textile Company become one of the world’s largest producers of long-lasting insecticide treated bed nets, cost-effectively producing tens of millions of nets in an area where malaria is a critical problem. The company succeeded despite regulatory issues, procurement rules, and other barriers.
- In Madagascar, The Malagasy Institute of Applied Research (IMRA) has created Madeglucyl, a treatment for diabetes management based on a traditional remedy;
- In Nigeria, the National Institute for Pharmaceutical Research and Development has a plant-based drug for sickle-cell anemia – one of the few low-toxicity drugs available anywhere to treat the debilitating chronic blood disorder – but has yet to overcome barriers to its commercialization;………
AIDSinfo Drug Database
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From the US Dept of Health and Human Services page
The AIDSinfo Drug Database provides fact sheets on HIV/AIDS related drugs. The fact sheets describe the drug’s use, pharmacology, side effects, and other information. The database includes:
- Approved and investigational HIV/AIDS related drugs
- Three versions of each fact sheet: patient, health professional, and Spanish.
One may search by drug name, drug class, or select drug names from an alphabetical list.
Adding pharmacists to docs’ offices helps patient outcomes, study shows
From a November 15, 2010 Eureka news alert
Adding pharmacists to the primary care team right in doctors’ offices may help patients with chronic diseases such as diabetes better manage associated risks, a new University of Alberta study had found. The blood pressure of patients with Type 2 diabetes dropped significantly when pharmacists were included in the on-site clinical examination and consulting process, the U of A study showed. Among 153 patients whose hypertension was inadequately controlled at the beginning of the study, the 82 who had advice from a pharmacist were more likely to reach blood pressure treatment targets recommended by the Canadian Diabetes Association. As well, the study showed that with input from pharmacists, the predicted 10-year risk of cardiovascular disease for patients with Type 2 diabetes will drop by three per cent. The results were reported online by Diabetes Care, and are scheduled to appear in the January 2011 issue of the journal. The study can currently be found online at http://diabetes.org/diabetescare. “Pharmacists can play a more active role in primary care and community clinics,” said Scot Simpson, lead author of the study. “We’ve already been actively collaborating on health care teams for years in hospitals.” Placing pharmacists in the doctor’s office instead of in a more traditional role at the neighbourhood pharmacy allows for a more collaborative frontline approach to medication management in primary care, Simpson said. “The doctors, nurses and pharmacists can directly discuss issues specific to any one patient, and by doing so, have the best outcome for the patient.” High blood pressure and other cardiovascular risk factors are common in people with diabetes, so effective management of medications is key to helping reduce the risk of heart attacks and stroke, Simpson added. ### For more information on the study contact: Scot Simpson, associate professor Faculty of Pharmacy and Pharmaceutical Sciences University of Alberta 780-492-7538 ssimpson@pharmacy.ualberta.ca
/blockquote>
Pricey Drugs May Not Mean Better Care
Study finds wide variations in drug spending, risky prescriptions for Medicare patients
From a November 3,2010 Health Day news item
By Robert Preidt
WEDNESDAY, Nov. 3 (HealthDay News) — Higher levels of drug spending don’t necessarily translate into better quality care for Medicare patients, a new study has found.
The analysis of the U.S. Healthcare Effectiveness Data and Information Set revealed wide variation across the United States in both Medicare drug spending and the rate of inappropriate prescriptions for the elderly, said the researchers at the University of Pittsburgh Graduate School of Public Health….
…
The findings contradict “the idea that high spending leads to better prescription practices,” lead investigator Yuting Zhang, an assistant professor of health economics, said in a University of Pittsburgh news release.
“Higher spending can be justified if it’s for drugs that are necessary and appropriate and improve patients’ health,” she said in the news release. “But if certain drugs are being incorrectly prescribed to seniors, then that can lead to complications and expensive interventions, such as hospitalization. As we try to reform health care to get costs under control, we need a better understanding of how spending differs regionally to make a positive impact.”
The study was published in the Nov. 3 online edition of the New England Journal of Medicine.
SOURCE: University of Pittsburgh Schools of the Health Sciences, news release, Nov. 3, 2010
Related Articles
- America’s 10 Most Popular Prescription Drugs (healthland.time.com)
- New Study: Generics Account For 78% Of All Retail Prescriptions
- “US govt will negotiate Medicare drug prices, says Obama” and related posts (pharmagossip.blogspot.com)
International variation in the usage of medicines
A review of the literature
From a Rand Corporation item by Ellen Nolte, Jennifer Newbould, Annalijn Conklin
The report reviews the published and grey literature on international variation in the use of medicines in six areas (osteoporosis, atypical anti-psychotics, dementia, rheumatoid arthritis, cardiovascular disease/lipid-regulating drugs (statins), and hepatitis C).
We identify three broad groups of determinants of international variation in medicines use:
(1) Macro- or system level factors: Differences in reimbursement policies, and the role of health technology assessment, were highlighted as a likely driving force of international variation in almost all areas of medicines use reviewed. A related aspect is patient co-payment, which is likely to play an important role in the United States in particular. The extent to which cost-sharing policies impact on overall use of medicines in international comparison remains unclear.
(2) Service organisation and delivery: Differences in access to specialists are a likely driver of international variation in areas such as atypical anti-psychotics, dementia, and rheumatic arthritis, with for example access to and availability of relevant specialists identified as acting as a crucial bottleneck for accessing treatment for dementia and rheumatoid arthritis.
(3) Clinical practice: Studies highlighted the role of variation in the use and ascertainment methods for mental disorders; differences in the use of clinical or practice guidelines; differences in prescribing patterns; and reluctance among clinicians in some countries to take up newer medicines.
Each of these factors is likely to play a role in explaining international variation in medicines use, but their relative importance will vary depending on the disease area in question and the system context.
Free, downloadable PDF file(s) are available below.
Full Document(File size 0.4 MB, < 1 minute modem, < 1 minute broadband)
RAND makes an electronic version of this document available for free as a public service.
Use Adobe Acrobat Reader version 7.0 or higher for the best experience.
Comparative effectiveness research needs to be taught to doctors and patients
An August 18, 2010 blog post by David Williams (posted in Kevin MD.com)
Oncology is the area where the health care cost conundrum is coming into sharpest focus. Theoretically, who wouldn’t spend whatever it takes to cure a life-threatening disease? And yet practically the costs of new treatments are so high, and the improvements usually modest enough, that when it comes right down to it costs are becoming a real issue for patients and doctors.
An interesting article in the Journal of Clinical Oncology explores the attitudes of US and Canadian oncologists. From a survey of hundreds of oncologists they conclude that views of the two countries’ oncologists are similar, despite the fact that Canadians practice in a system where some chemotherapy drugs are not covered due to their cost, while in US society as a whole it is taboo to even talk about cost effectiveness or “rationing.”
A few highlights from the article:
On cost-effectiveness:
- 84% of US and 80% of Canadian oncologists agree that,”Patient ‘out of pocket’ costs currently influence my decisions regarding which cancer treatments to recommend for my patients.” (Note that while there is little out-of-pocket spend in Canadian health care in general, patients do have to pay for certain drugs that aren’t covered)
- 67% of US and 52% of Canadian oncologists say, “Every patient should have access to effective cancer treatments regardless of their cost.” Note that even in the US this means one-third of physicians think costs should be a deciding factor
- 58% of US and 75% of Canadian oncologists agree that, “Every patient should have access to effective cancer treatments only if the treatments provide ‘good value for money’ or are cost effective.” And yet only 42% of US and 49% of Canadian oncologists said they were well prepared to interpret and use cost-effectiveness information for treatment decisions
On policy issues:
- 57% of US and 68% of Canadian oncologists favored price controls for cancer drugs by Medicare
- 80% of US and 69% of Canadian oncologists thought there should be more use of cost-effectiveness data in coverage and payment decisions. (The lower number for Canadians is probably due to the fact that cost-effectiveness information is already used for this purpose)
- 79% of US and 85% of Canadian oncologists want more government research on comparative effectiveness of cancer drugs
Many ideological foes of health reform and comparative effectiveness research think that all would be well if decisions were left up to doctors and their patients. But oncologists already take costs into account and favor cost-effectiveness research, so life (and death) might not actually change much.
In my opinion, we should support more and higher quality comparative effectiveness research, then train doctors and patients to interpret and act on it.
David E. Williams is co-founder of MedPharma Partners and blogs at the Health Business Blog.
Communication in Cancer Care
Communication in Cancer Care is a PDQ (Physician Data Query) summary** which outlines good communication skills among patients, family members, and health care providers. Good communication in all phases of cancer care contributes to the well being of the patient and improves quality of life.
The Communication in Cancer Care Web site has a patient version, a health professional version, and a Spanish language version.
The patient version addresses issues as the roles of family givers and parents, how to talk with the health care team (including the importance of checklists and record keeping)
and where to find more information on communicating effectively in cancer care settings.The health professional version outlines factors and outcomes related to communicating effectively, how to communicate effectively in cancer care settings, and information on training programs and clinical trials.
On a related note, this is an example of why good communication is important in cancer care…
The Perils of Taking Experimental Cancer Drugs [Reuters Health, Oct 26,2010, by Frederik Joelving]
[Excerpt]
NEW YORK (Reuters Health) – Trying a new, experimental cancer drug may offer a glimpse of hope for very sick patients, but often does more harm than good, a new study shows.
Researchers said cancer doctors regularly resort to drugs still undergoing testing, as long as they have been approved for other diseases or in different combinations or doses.
But because the science is still up in the air, nobody really knows what the consequences of taking such drugs are.
“Many of these drugs end up not being the tremendous improvement that we hoped they would be,” said Dr. Otis Brawley, chief medical officer of the American Cancer Society, who was not involved in the new study.
“People need to realize that because the trials have not been completed there is a great deal that is not known about the treatments,” he told Reuters Health. “There are people who get these treatments and get hurt.”
The new study, published in the Journal of Clinical Oncology, looked at 172 clinical trials published over two years. [Editor Flahiff’s note : Ask a reference librarian at a local public, academic, or medical library for availability and if any fee is involved]
Less than a third of the clinical trials showed the experimental drugs improved patient survival, and less than half found the drugs helped other clinical outcomes…..
……
Sometimes, of course, new drugs do work, and no one argues that doctors shouldn’t be allowed to prescribe medications they think will help patients.
But doctors should be very clear about the high risks involved. One way to do that, said Peppercorn, would be to require that cancer doctors get informed consent from patients before they start them on experimental drugs.
In the end, Brawley said, the decision to use such treatment should be left to the patient and his or her doctor.
“There are times when it can be justified,” he noted, “but it is done far more often than it should be.”
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**PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI’s Web site athttp://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.
Hospitalizations for Medication and Illicit Drug-related Conditions on the Rise among Americans Ages 45 and Older
From an October 25, 2010 Agency for Healthcare Research and Quality (AHRQ) news release
The number of hospital admissions among Americans ages 45 and older for medication and drug-related conditions doubled between 1997 and 2008, according to a new report released today by the Department of Health and Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ). Medication and drug-related conditions include effects of both prescription and over-the-counter medications as well as illicit drugs.
Hospital admissions among those 45 years and older were driven by growth in discharges for three types of medication and drug-related conditions—drug-induced delirium; “poisoning” or overdose by codeine, meperidine and other opiate-based pain medicines; and withdrawal from narcotic or non-narcotic drugs.
Admissions for all medication and drug-related conditions grew by 117 percent—from 30,100 to 65,400—for 45- to 64-year-olds between 1997 and 2008. The rate of admissions for people ages 65 to 84 closely followed, growing by 96 percent, and for people ages 85 and older, the rate grew by 87 percent. By comparison, the number of hospital admissions for these conditions among adults ages 18 to 44 declined slightly by 11 percent.
“This report reveals a disturbing trend, and we need to find out more about why these admissions are increasing,” said AHRQ Director Carolyn M. Clancy, M.D. “As the average age of hospital patients continues to increase, so does the need for close monitoring of the types and dosages of drugs given to them.”
Drug-induced delirium or dementia can be caused by sleeping pills as well as drugs for urinary incontinence, nausea and other problems common in the elderly, but doctors sometimes cannot identify the cause. Poisoning by pain medicines or other drugs containing codeine, meperidine or other opiates can be caused by accidental overdosing or the failure to recognize the drug’s active ingredient. Drug withdrawal occurs when there is an abrupt withdrawal or significant reduction in the dosage of pain or other prescription medicines to which a person can become addicted, as well as of illicit drugs.
HHS’ Substance Abuse and Mental Health Services Administration helped support the analysis of the data in the report on hospital care for mental health and substance abuse disorders.”Substance abuse is rising, and drug abuse of all kinds is exploding as a major public health concern for our country,” said SAMHSA Administrator Pamela S. Hyde, J.D. “The challenge for our health care practitioners is to see that patients receive medications when there is medical need but also to help prevent the adverse health consequences from drug use.”
The new AHRQ report also shows that Medicare and Medicaid were responsible for 57 percent of the $1.1 billion cost to hospitals in 2008 for treating patients with medication and drug-related conditions, private insurance covered 24 percent, and the uninsured accounted for 14 percent. The remaining 5 percent of hospital costs for treating these conditions were borne by other sources such as TRICARE.
AHRQ’s report also includes data on other types of medical conditions treated in U.S. community hospitals, surgical and other procedures, and costs in 2008. For more information, go to HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2008 at http://www.hcup-us.ahrq.gov/reports/factsandfigures/2008/TOC_2008.jsp.
For more information, please contact AHRQ Public Affairs: (301) 427-1855 or (301) 427-1539.
Use Twitter to get AHRQ news updates: http://www.twitter.com/ahrqnews/
What Drug Companies are Paying Your Doctor – “DollarsForDocs”
From an October 21, 2010 Open Medicine blog item
The American broadcaster, National Public Radio (NPR), recently ran a story about doctors who get money from drug companies to promote their drugs. ProPublica has created a free database with the names of doctors and the amount they’ve received from pharmas.
http://projects.propublica.org/docdollars/
“Drug companies have long kept secret details of the payments they make to doctors for promoting their drugs. But seven companies have begun posting names and compensation on the Web, some as the result of legal settlements. ProPublica compiled these disclosures, totaling $258 million, into a single database that allows patients to search for their doctor. Receiving payments isn’t necessarily wrong, but it does raise ethical issues. “
Similarly, NPR posted a story that shows more of the disclosures. Note: pharmaceutical sales in the US in 2009? $300 billion dollars~!
http://www.npr.org/templates/story/story.php?storyId=130654426
NPR has links to health, business, science news, and much more at its home page. There are also options for podcasts and RSS feeds.
Purchasing Pet Drugs Online: Buyer Beware (video)
From the US Food and Drug Administration (FDA)
Consumers should be cautious when buying pet drugs online and should not let Internet pharmacies evaluate their pets. Watch this video to learn more and/or read this article.
Excerpt
“Discount pet drugs—no prescription required” may appeal to pet owners surfing the Web, but FDA experts say it can be risky to buy drugs online from sites that tout this message and others like it.
Some of the Internet sites that sell pet drugs represent legitimate, reputable pharmacies, says Martine Hartogensis, D.V.M., deputy director of the Office of Surveillance and Compliance in FDA’s Center for Veterinary Medicine (CVM). But others are fronts for unscrupulous businesses operating against the law.
FDA has found companies that sell unapproved pet drugs and counterfeit pet products, make fraudulent claims, dispense prescription drugs without requiring a prescription, and sell expired drugs.
Pet owners who purchase drugs from these companies may think they are saving money, says Hartogensis, but in reality, they may be short-changing their pet’s health and putting its life at risk.
FDA Asking Consumers to Weigh-In on Drug Information
Apologies for this late posting…
From a US Food and Drug Administration (FDA) item
Right now, consumers may get as many as three types of written information with prescription medications—a Consumer Medication Information sheet developed by the private sector and voluntarily given to patients; a Patient Package Insert, labeling that’s developed by the drug maker or private vendor; and a Medication Guide, required labeling for some drugs that FDA believes pose a “serious and significant” public health concern.
FDA is proposing that medication information leaflets be streamlined into a single, FDA-approved Patient Medication Information sheet that would be given to the patient the first time a prescription is filled and for subsequent refills.
But before anything happens, FDA is asking consumers for feedback at a Sept. 27-28 hearing at FDA offices in Silver Spring, Md. Complete details about the hearing are posted athttp://www.fda.gov/Drugs/NewsEvents/ucm219716.htm. At the hearing, consumers and organizations will be able to weigh-in on more than a dozen questions related to prescription drug information for consumers, including
- Should the medication information be given to patients if the medicine has been administered in a health facility?
- How can the process be monitored to ensure patients are receiving the information?
- What accommodations are needed for special populations, such as the elderly, vision impaired, low literacy, and limited or non-English proficient?
- Should there be a process for monitoring distribution of the information?
- What functions should FDA and drug makers perform?
To learn more about FDA’s effort to streamline prescription drug information, please see theFederal Register notice, which was posted Aug. 27.
Anyone interested in attending the hearing should see details posted athttp://www.fda.gov/Drugs/NewsEvents/ucm219716.htm
For those unable to attend, the meeting can be viewed on the Internet using Adobe Connect Pro from 8:30 a.m. to 4:30 p.m. Webcast participants will not be able to ask questions.
Join the meeting by using the following links:
https://collaboration.fda.gov/p15d109272010/ on September 27
https://collaboration.fda.gov/p15d209272010/ on September 28
If you have never attended an Adobe Connect Pro meeting before, test your
Prescription Pain Reliever Abuse on the Rise
Study Shows 111 Percent Increase in ER Visits Involving Nonmedical Use of Prescription Opioid Pain Relievers
From 2004 to 2008 the estimated number of emergency department visits linked to the nonmedical use of prescription pain relievers rose from 144,644 visits to 305,885 visits a year
The three prescription opioid pain relievers most frequently involved in hospital emergency department visits from 2004 to 2008 were:
- Oxycodone products – ED visits involving nonmedical use rose 152 percent, to 105,214.
- Hydrocodone products – emergency department visits involving nonmedical use rose 123 percent, to 89,051.
- Methadone products – emergency department visits involving nonmedical use rose 73 percent, to 63,629.
FDA releases risk summaries for newer drugs
[From a news item at http://www.nlm.nih.gov/medlineplus/news/fullstory_100014.html]
“U.S. health officials have started releasing summaries of safety reviews for recently approved medicines as part of their efforts to inform doctors and consumers about potential side effects.”
“A 2007 law required the FDA (US Food and Drug Administration) to prepare a safety summary for certain prescription drugs 18 months after approval or after they have been used by 10,000 people, whichever comes later. Those summaries will now be posted on the FDA website.
On Tuesday, the agency released summaries for 24 medicines and two vaccines for hypertension, allergies, HIV and other conditions. It included details on what action the agency was taking.”
These Postmarketing Drug Safety Evaluations are part of the Surveillance activities of the FDA.
About
This blog presents a sampling of health and medical news and resources for all. Selected articles and resources will hopefully be of general interest but will also encourage further reading through posted references and other links. Currently I am focusing on public health, basic and applied research and very broadly on disease and healthy lifestyle topics.
Several times a month I will post items on international and global health issues. My Peace Corps Liberia experience (1980-81) has formed me as a global citizen in many ways and has challenged me to think of health and other topics in a more holistic manner.
Do you have an informational question in the health/medical area?
Email me at jmflahiff@yahoo.com
I will reply within 48 hours.
This blog is a companion site to my Health and Medical News and Resources Web site with…
- Great places to start (locating health information)
- Links to help from others (as health care providers and support groups)
- Interactive tools (as health calculators and apps)
- Select related news sites and blogs
My professional work experience and education includes over 15 years experience as a medical librarian and a Master’s in Library Science. In my most recent position I enjoyed contributing to our library’s blog, performing in depth literature searches, and collaborating with faculty, staff, students, and the general public.
While I will never be be able to keep up with the universe of current health/medical news, I subscribe to the following to glean entries for this blog.
- Science Daily – Your source for the latest research news
- MedlinePlus email updates from the US National Institutes of Health
- Partners in Information Access for the Public Health Workforce – a collaboration of U.S. government agencies, public health organizations and health sciences libraries
- US Agency for Healthcare Research and Quality (AHRQ) news now with updates on the agency’s efforts to “improve the quality, safety, efficiency, and effectiveness of health care for all Americans”
- Research Buzz, “news about search engines, digital archives, online museums, databases, and other Internet information collections since 1998”
- Scout Report, a “weekly publication offering a selection of new and newly discovered Internet resources of interest to researchers and educators”
- KevinMD.com -“Social Media’s leading physician voice”
- EurekAlert-Medicine and Health
Health and Medical News and Resources 
