College Freshmen See Rx Drug Misuse More Risky Than Alcohol, Pot

Freshman college students think the occasional use of prescription drugs for non-medicinal purposes poses a greater risk to their health than smoking pot or knocking back five drinks every weekend, a new study indicates. Read more

Doctors' Guide to Cancer Drugs May Need Revising

(HealthDay News) -- Doctors may not always have complete or clear information when they prescribe cancer medications for uses beyond what the drugs have been approved for, a new study finds.

According to the report, published in the Feb. 17 online issue of Annals of Internal Medicine, the online and hard-copy resource used by oncologists and pharmacists, known as the compendia, does not always contain clear or updated information on using medications for "off-label" purposes, such as treating diseases other than those approved by the U.S. Food and Drug Administration.

Doctors and pharmacists often rely on the compendia for off-label dosage information, making it an authoritative source, in some instances, when a question arises about whether insurance will cover a drug for off-label use.

But the researchers found a lack of systematic methods to ensure the compendia information is regularly reviewed or updated.

"Oncologists and pharmacists use the compendia to guide choice of drugs for cancer patients that are not FDA-approved for use in that patient's disease -- an example would be bevacizumab, or Avastin, for brain cancer," the study's lead investigator, Dr. Amy Abernethy, an oncologist at Duke University, said in a news release issued by the school. "Bevacizumab is approved for use in diseases such as colorectal and lung cancer; it is not FDA-approved for brain tumors. But we have evidence that suggests it could be effective in this population, including peer-reviewed studies."

Abernethy's team, from the Duke Comprehensive Cancer Center, also found inconsistencies and confusion in how some commonly used compendia presented information and updated it. Some entries, for example, were more detailed than others, and information was presented in different ways for different drugs.

"Our study found that there are some limitations in the way the compendia are currently presented, and there are opportunities to improve the system," Abernethy said. "Determining how to improve it will be the next step for policymakers."

More information
The U.S. Food and Drug Administration has more about prescription drugs.

Little Good About America Spending Twice as Much on Diabetes Drugs

By Sean Kelley
Getty Images
A few months back, I wrote a bit mockingly about the power that 24 million diabetics and 57 million Americans with prediabetes might wield if they united under a common banner.
What I didn’t say was what those numbers could mean for our health-care system if everyone in the prediabetes group eventually developed diabetes. Can you imagine the medical resources 71 million diabetics could consume in a country of 300 million? Good luck getting a parking space at your local hospital! Read More

Doctors Often Prescribe Placebo Treatments

(HealthDay News) -- American doctors regularly prescribe placebo pills that are intended to have a psychological effect, a new survey finds.

However, the placebos reported by the 679 physicians in the survey often aren't the inactive substances used in controlled clinical trials, said Dr. Farr A. Curlin, an assistant professor of medicine at the University of Chicago, and a member of the team reporting the finding in the Oct. 24 issue of the BMJ.

"Most people when they say 'placebo' think of something like a sugar pill," Curlin said. "But doctors can use a treatment that may have some effects but that they think will not have a direct effect on the patient except by the placebo effect."

The placebo effect, well-established in countless studies, is a benefit produced by assuring someone that whatever is being given will benefit whatever the problem happens to be -- "optimism or confidence that something is being done," as Curlin phrased it.

Only 3 percent of the doctors responding in the survey reported prescribing sugar pills. But 41 percent said they used over-the-counter painkillers as placebos, 38 percent used vitamins, 13 percent used antibiotics, and 13 percent used sedatives.

The survey also found that only 5 percent of the doctors who prescribe a placebo treatment describe it as such. The great majority, 68 percent, describe it as a potentially beneficial medicine or treatment not typically used for the condition.

And almost two-thirds of the doctors in the survey said they believed the practice to be ethically permissible.

"It's a gray zone," Curlin said. "It is not ethical to actively deceive patients. But when doctors give something which they think will help but don't think it helpful to explain the full reasoning about why it will help, that's a gray zone."

Placebo treatment "is pretty common in the practice of medicine," said Curlin, who acknowledged using it. "I give people the information I think a reasonable person would want to know, trying to be as candid as possible," he said. "There are times when I have said, 'Yes, I think it might be helpful, why don't you give it a try,' when I don't have confidence it will help their condition."

What matters is that the treatment can help, Curlin added. "The placebo effect is a real effect," he said. "People do feel better. To the extent that it can be mobilized in a way that is restful and not actively deceiving patients, I think it is acceptable."

Placebo treatment "is part of an old but good medical tradition," said Dr. David Spiegel, an assistant chair of psychiatry and behavioral sciences at Stanford University. "The basic rule is: First, do no harm. If there is no toxicity, and it does some good, evidence supports its use," Spiegel said.

But straightforward lying about a prescription is wrong, said Dr. Andrew Leuchter, associate dean of the school of medicine at the University of California, Los Angeles.

"The cornerstone of what treatment is acceptable is full disclosure for the patient," Leuchter said. "If you explain to the patient what you are doing, and why you are doing it, that is right. If you mislead a patient, there is a serious problem with that."

The appropriate way to explain a placebo treatment, Leuchter added, is to say, "There is no reasonable medical evidence that this pill is effective for your condition, but some people who take this pill say it makes them feel better."

It is important to note that "deception is not a necessary part of the placebo effect," Spiegel said. "You can tell people that the treatment might benefit them, and that is not a lie."

And the placebo effect is often at work in medical practice, Spiegel noted. "A lot of factors go into the effect of therapy, some of which are specifically pharmaceutical, and some are not. You might feel better, because you feel you are doing something actively to treat the problem."

The argument about the ethics of placebo treatment can also be turned around, he added. "There are ways to present placebo treatment that do not involve deception," he said. "You are doing it because it can help a patient, and a certain percentage of patients will respond. Especially in conditions where we do not have a lot of treatments, is it ethical to withhold it?"

More information
The history of placebo treatments is described in the Skeptics Dictionary.

New MS Therapies Show Promise

(HealthDay News) -- Two medications may prove to be advances in the treatment of multiple sclerosis, researchers say.

In one study, an experimental drug called oral fumarate (BG00012) substantially reduced symptoms in patients with relapsing-remitting multiple sclerosis, according to a phase II clinical trial by European and North American researchers.

And in a second trial, researchers found that the leukemia drug alemtuzumab (Campath) was about 70 percent more effective than another drug already widely used to treat MS. However, alemtuzumab also had significant side effects, including bleeding disorders, a greater risk of thyroid disease, and infections. This prompted experts to say that much more research is needed before alemtuzumab can be prescribed to treat multiple sclerosis.

Multiple sclerosis is a nervous system disease that affects the brain and spinal cord. It damages the myelin sheath, the material that surrounds and protects nerve cells. This damage slows or blocks messages between the brain and the body, according to the U.S. National Library of Medicine.

Symptoms of the disease can include visual disturbances; muscle weakness; trouble with coordination and balance; sensations such as numbness, prickling, or "pins and needles;" and thinking and memory problems.

It's not known what causes multiple sclerosis. It may be an autoimmune disease, which happens when the body attacks itself. MS affects women more than men, and it often begins between the ages of 20 and 40. An estimated 400,000 Americans have the disease. Usually, the disease is mild, but some people lose the ability to write, speak or walk. There's no cure for MS, but medicines may slow it down and help control symptoms, according to the National Library of Medicine.

The 24-week study of BG00012 included 257 patients, ages 18 to 55, who were randomly assigned to receive either 120 milligrams of BG00012 once a day (64 patients), 120 milligrams three times a day (64 patients), 240 milligrams three times a day (64 patients), or a placebo (65 patients). The patients were assessed at weeks 12, 16, 20 and 24.

MRI brain scans showed that patients treated with 240 milligrams of BG00012 three times a day had 69 percent fewer new gadolinium enhancing (GdE) lesions -- a marker of MS-related inflammatory activity -- from week 12 to 24 than those who received the placebo. They also had fewer new or enlarging T2-hyperintense and T1-hypointense lesions at week 24.

The study also found that BG00012 reduced the annual relapse rate by 32 percent, but this finding wasn't statistically significant. Patients who received the drug were more likely than those in the placebo group to suffer adverse events such as abdominal pain and hot flush. Dose-related adverse events in patients taking the drug included headache, fatigue and feeling hot, the researchers said.

"Longer-term (phase III) studies of BG00012 in larger patient populations are underway to define its place in the future of relapsing-remitting multiple sclerosis treatment. If these studies show similar relapse rate reductions with BG00012, interferon beta, and glatiramer acetate, BG00012 could be a suitable initial treatment for relapsing-remitting multiple sclerosis," wrote Professor Ludwig Kappos, of University Hospital Basel, in Switzerland, and colleagues.

The study was published in the Oct. 24 issue of the The Lancet.

In an accompanying comment in the journal, Professor Per Soelberg Sorensen and Dr. Finn Sellebjerg of the Danish Multiple Sclerosis Research Center, noted that "BG00012 might have a favorable benefit-to-risk ratio profile compared with its oral competitors and the currently available first-line injectable drugs. However, we will have to await the results from the ongoing large phase III trials to establish the place of BG00012 and of other oral drugs in the treatment of relapsing-remitting multiple sclerosis."

The study of the leukemia drug alemtuzumab, which temporarily depletes white blood cells and is part of a class of drugs called monoclonal antibodies, included 334 patients. Patients were randomly assigned to get either alemtuzumab or interferon beta, a standard MS therapy, for three years.

Alemtuzumab reduced by 74 percent the risk of MS relapse, the researchers reported in the Oct. 23 issue of the New England Journal of Medicine.

"The ability of an MS drug to promote brain repair is unprecedented," Alasdair Coles, of Cambridge University in England, and one of the study's leaders, told the AFP news service. "We are witnessing a drug which, if given early enough, might effectively stop the advancement of the disease and also restore lost function by promoting repair of the damaged brain tissue."

However, in an accompanying journal editorial, Dr. Stephen L. Hauser, a neurologist at the University of California, San Francisco, said the "toxic effects associated with alemtuzumab considerably dampen any enthusiasm for its routine use in patients with multiple sclerosis until more is known about its long-term safety and sustained efficacy."

More information
The U.S. National Institute of Neurological Disorders and Stroke has more about multiple sclerosis.

Getting buff without the sweat is cheating

By Mark Leyner and Dr. Billy Goldberg
What if you could simply swallow a pill and become a buff, shredded, aerobic dynamo all without having to spend one sweaty second in the gym? Wouldn’t an instant fitness drug be great? Maybe not.

We were both mighty intrigued to learn that scientists had developed not one, but two “Mighty Mouse Drugs” that endow mice with all the benefits of having worked out furiously, without the effort of actual exercise. Researchers at the Salk Institute in San Diego reported that a drug called Aicar increased mice’s endurance on a treadmill by 44 percent after just four weeks of treatment and helped them burn more calories and have less fat than untreated mice. A second drug with the catchy name “GW1516,” when combined with exercise, boosted the mice’s endurance by a whopping 75 percent!

Both drugs activate PPAR-delta protein which produces more high-endurance Type 1 muscle fibers in the body. Aicar actually mimics the effects of exercise, convincing cells that they’ve burned off energy and need to generate more. As one of the researchers said: “It’s pretty much pharmacological exercise.” The researchers contend that it’s reasonable to assume that these results will apply to people.



Continue Reading >>

Fears Cloud Medical Marijuana Legalization - Daily Bulletin

As a registered nurse, I am growing increasingly weary of the insulting attacks which brand me as a miscreant and criminal. Even though a person would never consider going to a police station to obtain an opinion on the use of a medication, pronouncements by law enforcement such on the efficacy of medicinal marijuana are accepted as fact. read more digg story

Life Without Email? Wassup, Doc?

So a diabetic walks into an endo's office and says, "Hey Doc, can I get your email address in case I have any follow-up questions?" And the doctor replies, "Sorry, we do medicine, not email."
I made that up myself. No, really... I did.

But don't laugh too hard. There is actual proof now that doctors who are willing to email with their patients are a rare breed indeed. I'm very lucky to have found one -- well, a few actually -- here in the tech-savvy SF Bay Area who were willing to take the plunge. Why isn't email contact with your healthcare provider more common across the country, what with it being so darn convenient, and let's face it, pretty much the lifeblood of the business world these days? In many ways, email functions as our portal to the world, no?

What's standing in the way is primarily fear, apparently. Fear of being overwhelmed by yet one more responsibility, of not being reimbursed for time spent answering emails, of patient privacy concerns, and of course, of legal liability if patients are unhappy with email interaction, or if anything said there should result in negative health consequences. Fair enough. Those are legitimate concerns.

But electronic communication is now a fact of life. It's used for virtually ever other aspect of commerce in this country. "People are able to file their taxes online, buy and sell household goods, and manage their financial accounts," says Susannah Fox of the Pew Internet & American Life Project. "The health care industry seems to be lagging behind other industries." Ya think?
But doctors will continue to resist as long as they have no support on the concerns mentioned above. So once again, all arrows seem to point back to the need to reform our healthcare system, in this case to address and support the way people interact in this century.

Oddly enough, the pharma industry hasn't wasted too much time finding ways to use email to reach out to doctors -- bombarding them with "ePromotions," and more recently, electronic drug alerts. Meanwhile experts have been touting the benefits of email to the physician-patient relationship since the year 2000 at least. But doctors are still holding back, for all the practical reasons mentioned (read the comments on that post).

According to this story ("It's no LOL"): "It's not the first time the medical field has been slow to embrace technology. When the first telephones became widely available in the late 1800s, doctors were concerned about being swamped with calls." But the medical establishment is expected to come around on the email issue eventually. Hmm, I wonder how many more decades before they embrace Social Media?

So, how many of you actually exchange emails with your doctors? I can't tell you how happy it makes me to receive my lab slips as an email attachment in two minutes, rather than waiting for them to arrive via Snail Mail, and then misplacing the envelope. Even my daughters' pediatrician sends me quick replies, usually with a nice side query as to how we're all doing. How lucky are we?

New Psoriasis Pill Appears Effective

(HealthDay News) -- A new drug for patients with moderate to severe psoriasis appears to be safe and effective, a Canadian trial shows.

The results indicate higher doses of ISA247, which is a calcineurin inhibitor, significantly improve symptoms of psoriasis. Calcineurin is a protein that helps regulate inflammation.

"This is the first oral medication in 20 years to show promise for the treatment of moderate to severe plaque psoriasis," said lead researcher Dr. Kim Papp, from Probity Medical Research in Waterloo, Ontario.

The new drug is safer and easier to use than current treatments for psoriasis, the researchers said.

Psoriasis is an autoimmune skin disease. The most common form, plaque psoriasis, appears as raised, red patches or lesions covered with a silvery white buildup of dead skin cells. As many as 7.5 million Americans have psoriasis, according to the U.S. National Institutes of Health.

Currently, one of the most effective treatments for psoriasis is the calcineurin inhibitor drug ciclosporin. However, the drug's toxic effects on the kidneys prevent it from being used for long-term treatment, which is often needed because psoriasis tends to reappear once treatment is stopped.

Other drugs such as infliximab (Remicade) are safe and effective but are expensive and inconvenient to use. In addition, the long-term safety of the drug isn't known.

The report is published in the April 19 issue of The Lancet.

In the study, Papp's team randomly selected 451 patients with plaque psoriasis that affected at least 10 percent of the body, to receive the new drug or placebo. There were three groups of patients who received ISA247, but at different doses.

The researchers looked for a 75 percent reduction in what is called the psoriasis area and severity index score (PASI 75).

Papp's group found that after 12 weeks of treatment, 47 percent of patients who received the highest dose of ISA247 achieved PASI 75. Patients receiving lower doses achieved a 25 percent or a 16 percent improvement in their PASI score. Among patients in the placebo group, only four of 115 achieved PASI 75, the researchers reported.

"ISA247 is a reasonable oral medication for the treatment of psoriasis," Papp said. "It is reasonable because of reasonable efficacy, high tolerability and minimal metabolic effects."

In addition, because the effect of the drug correlates with its dose, it "can be titrated to suit patients response and tolerance without undue risk of adverse effects," Papp said.

One expert thinks the result of this trial needs to be duplicated in longer-term studies, and it needs to put in a head-to-head comparison with other psoriasis drugs.

"ISA247 may offer advantages compared with ciclosporin," said Dr. Luigi Naldi, from the Unit of Dermatology and GISED Study Centre at Ospedali Riuniti di Bergamo, Italy, and author of an accompanying editorial. "However, its efficacy and safety profile needs to be further evaluated in the context of longer-term comparative studies."

Naldi noted that these trials need to be done in real-life situations. In addition, the trial done by Papp is too short to really tell whether or not the drug is safe, since most patients taking the drug would have to use it for a long time to control their psoriasis, he said.

"The risk of chronic kidney toxicity induced by calcineurin inhibitors increases with treatment duration and cannot be reliably predicted with short-term data," Naldi said." An obvious comparator in the ISA247 trial would have been ciclosporin. Without such an internal comparison, the claim that ISA247 is safer than ciclosporin should be viewed cautiously, because it is based on external comparisons," he said.

More information
For more on psoriasis, visit the U.S. National Library of Medicine.

Trial: Popular cholesterol drug fails to improve heart disease

Story Highlights

• Trial: Vytorin failed to improve heart disease though it reduces key risk factors


• Millions of Americans already take the drug or one of its components, Zetia


• Yale University cardiologist: People need to return to statins, like Lipitor


• Zetia, Vytorin have racked up $5 billion in sales despite limited proof of benefit

CHICAGO, Illinois (AP) -- Leading doctors urged a return to older, tried-and-true treatments for high cholesterol after hearing full results Sunday of a failed trial of Vytorin.

Millions of Americans already take the drug or one of its components, Zetia. But doctors were stunned to learn that Vytorin failed to improve heart disease even though it worked as intended to reduce three key risk factors.

"People need to turn back to statins," said Yale University cardiologist Dr. Harlan Krumholz, referring to Lipitor, Crestor and other widely used brands. "We know that statins are good drugs. We know that they reduce risks."

The study was closely watched because Zetia and Vytorin have racked up $5 billion in sales despite limited proof of benefit. Two Congressional panels launched probes into why it took drugmakers nearly two years after the study's completion to release results.

Results were presented at an American College of Cardiology conference in Chicago Sunday and published on the Internet by the New England Journal of Medicine.

Doctors have long focused on lowering LDL or bad cholesterol as a way to prevent heart disease. Statins like Merck & Co.'s Zocor, which recently came out in generic form, do this, as do niacin, fibrates and other medicines.

Vytorin, which came out in 2004, combines Zocor with Schering-Plough Corp.'s Zetia, which went on sale in 2002 and attacks cholesterol in a different way. Read the full story>>