E-prescribing

Thanks to Adele Reichel and Rachel Root, "Guest Bloggers" for submitting some info on e-prescribing:

E-prescribing is definitely something we will all hear more about. Here are some questions for thought:
• How will this impact your practice?
• What would you say to a physician in order to convince her/him of the important role e-prescribing can play in healthcare?
• Do you think this method would work for controlled substances?
• What will you do with the time you were formerly using to process prescription claims?
• The Fox News article states, “Doctors received an annual bonus for prescribing more generics.”Are pharmacists rewarded for dispensing generics, why/why not?

For further consideration, here's the letter from APhA to President Bush. Also, for further information on some examples of e-prescribing companies, check out RxHub and SureScript (p.s. checkout the RxHub ePrescribing 101 Overview as well.)

Scratch your trip to Azerbaijan...

Bummer, I know. According to the WHO, the incidence of Multi-drug resistant TB is at the highest level, and is also at it's highest level ever. What is MDR-TB? Well, I would tell you, but I haven't started studying for my therapy test. As always, Wikipedia has the answer (from now on, I'm going to abbreviate that statement as AAWHTA) The WHO also has a great site on tuberculosis as well. MDR-TB is also highest, oddly enough, in eastern Europe and the countries of the former Soviet Union. Why? Poor funding for TB drugs, slow diagnoses of MDR-TB and stopping treatment before cure. However, Africa only provided info on 6 countries which may skew the results. Now, geography wasn't my strong point, but I'm pretty sure there's at least 8 countries in Africa, possibly as many as 10 (no really, look at a map. Also, they also have the highest incidence of TB, so take the info in the report with a grain of salt. If you really want to get into the report-go to the actual report. But, you better have some serious spare time.

Easing prostate cancer

There's been a few prostate cancer pieces brewing, so I'll combine the two topics into an enlarged (prostate) posting. Okay, that was uncalled for, especially for such a serious disease, but I couldn't resist.

A venture capital company, Dendreon, that develops biotech drugs that target cancer, is currently conducting Phase III trials into a vaccine for the disease. As this article details, an advisory panel to the FDA recommended approval, but afterwards two panel members suggested a go slow approach. Here's where it gets interesting: These two panel members then came under fire for possible conflicts of interest. Congress was asked to investigate, they refused, and now there is a bit of a storm-Read the bottom of the Pharmalot blog for the comments from organizations that say that 20,000 people have died due to a few doctors that have financial interests in competitor companies.

A couple of weeks ago, Dendreon had a press release that they hope will change the FDA's mind and fasttrack the vaccine-again a report from Pharmalot (gotta love that blog.)

Another development in prostate cancer care looks to reverse the side effects to androgen-deprivation therapy that is used to treat prostate cancer (One good thing about writing this blog-it makes me really interested to learn more about what I write about-I guess it's a good thing that "Learner" is one of my strengths according to this book.) The drug, toremifene, has previously been marketed and used under the brand name Fareston. However, according to a Phase III trial from the company, GTx, there is a possibility that it can also be used to lower the incidence of fractures. More info is also on the WSJ blog.

More bad news for Vytorin

I think this news shows you need to make sure your studies are a) well designed b) you don't make suspicious moves to secondary endpoints and bring in new investigators during the study and c) if you do all of those bad things-don't try and hide it. Though the study didn't show that Vytorin was superior or inferior-one always has to ask "What are they hiding?" and the effects of that decision are starting play out. The American College of Cardiology is meeting in March, and will release a statement on the trial then. But, will it be too late?

"Imagine there's no drug ads, it isn't hard to do"

Could it be possible? According to a blog post from the magazine DTC Perspectives (yes, there actually is a magazine dedicated to DTC, but it looks like the only perspective they take is their own. They even have a national DTC convention. It's in April if you want to go, but I don't think MPSA will be reimbursing for it.) Here's some articles from WSJ and Pharmalot on it too. I would take some time and check out the DTC Perspectives website too and just look a bit more at the market that has emerged for drug marketers. Though I imagine most pharmacy students are against DTCA, I think it's interesting to look at what they consider when they market, trends they watch, and, of course, how much they spend (one study put it at more than what they spend on R&D, but it wasn't the best study.) One thought-get some DTC out there about MTM and pharmacists. We just need a mascot as cute as the Nasonex bee or Rozerem beaver.

Another napping article? Really?

Apparently sleeping during the day is big for the Brits, because this is the second article on the topic in as many days. (See below for the other note.) Now, I'm all for napping, but I guess I need to make sure it's on my schedule. I also don't know if this study accounted for students in a pharmacology lecture or not...

Mirror, mirror, on the wall...

...which flu bug will we see this fall... Sounds like choosing the bugs for next year's flu season is going to be pretty tough-they will be changing all three strains for the first time ever this year. It's kind of shocking that they have to develop it this far off. I suppose I'll forgive them for missing on it a bit this year.

And now for something completely different

So, I saw a couple of things that weren't exactly drug related, but still pertinent, so I'll just throw them all into one post.

Cat-naps=good according to this article. Of course, I'll still take a longer nap whenever I wants to. Something to remember when you are cramming late at night for those dang therapy exams. Just remember to wake up after 6 minutes.

Your patients won't care how much you know until they know how much you care. Sometimes overused, but still an important idea. This article from CNN/Oprah.com was passed on to me by someone who doesn't think I am empathetic enough-I won't say who. Anways, a lot of what it talks about is very pertinent to think about when we talk with our patients and being more empathetic and better caregivers.

Google: The saviour of EMR? So this topic raises so many questions and concerns that I won't even get into, but Google is looking at storing health records online. Good? Bad? To be decided...

Drug prices rising

It's not really news that drug costs are raising, but more that the rate that they are increasing is increasing. I think this is called something in calculus, but due to my pump and dump studying strategies, I don't remember what it's called. Anyways, here's the WSJ article on it.

Pharmacy's "Dirty little secret"

Last night (Feb 18) Henri R. Manasse spoke about "Leadership with Integrity" and how pharmacy needs to continue to push the profession forward, admit its mistakes and understand how to improve them. One thing he mentioned, that others have also noted is the area of errors in pharmacy. For third years, this is especially noted as many of our lectures lately have dwelled on this topic, and Dr. Hadsall sent out similar articles (we'll get to them below.)

The way that Dr. Manasse brought up the issue was in the context of technicians who are not adequately trained, both in the community and in hospitals and health-systems, calling this the profession's "dirty little secret." Obviously, errors can not be blamed on a particular person-we are all to blame. But well trained technicians and certified technicians can greatly help minimize errors. Also, the Pharmacy Technician Certification Board conducted a survey and found that the general public overwhelmingly supports technician certification, and most thought that training and certification was done anyways.

Media coverage on errors, like what recently was posted on USA Today in an ongoing series called "Rx for errors." (Check out the graphic on how prescriptions are filled as well.) The series also has suggestions on how to safeguard against errors like consulting with your pharmacist as well (Brilliant!)

Dr. Manasse said that errors will still occur, but taking a defensive stance on the issue helps no one-realizing that the system isn't perfect and looking to improve it is what will help things. The USP also issued a statement on the most commonly confused drugs, and technology can help as well. Understanding that errors occur is one step to move the profession forward, and lead with integrity.

Flu shot a little bit off....

So...this kind of sucks. According to the CDC, their prediction of which B virus was going to be popular this flu season was a bit off. Confused by that report, me too-Here's a better one from CIDRAP-the Center for Infectious Disease-Research and Policy that is at the University of Minnesota and an article on it from the Wall Street Journal blog.

Also, here's a little FAQ on how they select the viruses they put into the vaccine, and some other info as well in case you need a refresher...like me.

Another recall....

Note to self-Don't have surgery this week. In addition to half of the heparin across the country being pulled, Duragesic patches made by Johnson and Johnson are also being recalled as well due to accidental overdose when the patches fail.

This article had a lot of interesting points (how much Johnson and Johnson grossed on the patches even though it's generic, new drug-Ionsys-that's having problems) but there was a statistic that really jumped out at me: They estimate that 2 patches per million have failed-around 64 total. But one patch failing could kill someone-so at what point did they decide to recall the patches? Perhaps a case for an Ethics case analysis....

More trouble for Baxter

You may recall that Baxter was sued earlier by Dennis Quaid over confusing packaging-there is a post earlier on this. Well, looks like Baxter is in a bit more trouble now as well due to allergic reactions to their meds. Here's a link to FiercePharma with an article on it.

Retail Clinics the next step?

A bit of a follow-up to the discussion on healthcare from the WSJ blog. Is it possible that Wal-Mart (and other similar models) could save healthcare? Important notes: Average cost-$50, and over half of the customers are uninsured. I think this indicates two things: A normal doctor's visit or ER is too expensive or takes too long and that people are willing to pay for health care...as long as it's affordable.

New clopidogrel study

A new clopidogrel study was just released in JAMA that found that patient's risk of heart attack after ceasing use of clopidogrel doubled when they stopped using Plavix nine to twelve months after a stent was placed. (Bloomberg article here) The study was carried out in VA's around the country (120 or so) and wasn't funded by the drug company. It also raises the question of where the benefit of stents was coming from-from the stent itself, which has come under scrutiny as of late due to build-up of clots around the metal tubes.

For your edification and reminder, as well as a chance for me to showcase the hyperlinking capability of blogs, here are links to previous clopidogrel studies that show the possible benefit of this highly touted (and prescribed) drug, here are a couple of commentaries and dissection of the trial that set the standard of prescribing for clopidogrel prior to this study, the CURE trial. Here's one in the ol' favorite JAMA and one from respected heart hospital Cleveland Clinic's journal.

Debate on National Health Care

Universal health care. Generally, that phrase is used as rhetoric to guide voters to support that particular candidate. Michael Moore used his documentary Sicko to play with the idea, and also pointed out the many flaws in our current system. Our own Quynh Nguyen commented on this movie and topic as well in Student Pharmacist.

This past month, the New England Journal of Medicine had a great commentary on our broken system, or non-system. It also brings up the safety-net, part of which our HRSA-PSCC grant helps to support. This commentary points out that any major shift in policy has to come from our leadership responding to public opinion as it did with the FDR's New Deal in 1932 and with LBJ's Great Society in 1964. Recently, the Clinton health care reform proposal was brought forth by then First Lady Hilary Clinton. (I like Wikipedia.)

There is no end of commentary, research, opinions and examples from other countries of the pros and cons of universal health care. It's a tough concept for us to imagine here since we our current system has essentially lasted for the past two generations. Whether it's right or wrong to pursue universal health care, I think we can all agree that something must change. What that change will look like, will, for better or worse, come from our elected officials. The more we make our voices heard, the better chance we have of having an influence.

And one more study from JAMA looking at the approval ratings of health care in seven countries. Moral: I'm moving to the Netherlands.

Medicated creams and lotions

Laura Behm forwarded this CNN article on to me, and it's a good reminder that OTC meds can be dangerous as well. The story of Arielle Newman is especially notable for me-I remember hearing about it last year and warning the high school kids I was coaching to be aware that excess use of even OTC meds can be extremely dangerous.

I also received this article from Tom Welch. It reminds us of the importance of counseling patients and the effect meds can have. It has an 8-step reminder system for patients. With the untimely, and apparently drug-related, death of Heath Ledger, hopefully it will serve as yet another wake-up call for the importance of pharmacists. Here's the latest on Heath at WSJ.