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.

New HIV drug

More HIV news: The FDA, just last week, approved a new drug, etravirine or Intelence. Here's the press release. A quick high point though: This non-nucleoside reverse transcriptase inhibitor is effective when other NNRTI's have established resistance and is the first drug in this class that accomplishes this.

Shopping for Health Care

This past weekend, I attended the MPhA Winter Clinical Conference-some meetings not great, some really good. One of the better ones highlighted a project that Drs. Schommer and Schondelmeyer (and others) have been working on for the past few months.

Drug companies, due to direct-to-consumer ads and other marketing (where they spent, just on direct-to-consumer ads, nearly $6 Billion in 2005!) have been great on getting their name out and information...on their new brand name drugs. To attempt to improve the information on non-marketed drugs, the U of M PRIME Institute began to develop information on drugs that were almost as effective as the brand name, but generic. More information on this project can be found at crbestbuydrugs.org. I encourage you to direct your patients to this website, and ask Drs. Schommer and Schondelmeyer for more information if you are interested.

In addition, a new website just started as well. You likely have heard the advertisements or seen the billboards on https://www.carol.com/ a new website that allows you to shop and compare health care. It will be interesting to see where this leads, and if this "shopping" for healthcare allows greater effectiveness in the use of health care flex spending accounts.

An option to an HIV vaccine

Hey, third years, do you remember your HIV drugs? Yeah, me neither. But maraviroc/Selzentry prevents the virus from binding to the cell, and then enter into it. According this WSJ article (which, by the way, I realize I need to pay much more attention to since it seems they have the most up-to-date information regardless of the fact that they are owned by Rupert Murdoch now) Pfizer is taking a different approach to preventing AIDS. If you remember back to last fall, Merck halted their research into the HIV/AIDS vaccine realm due to findings that more people were contracting HIV after the vaccine than those in the control group....yeah. But this takes a different route, namely, the vaginal route. Pfizer is even working with a non-profit to develop this, and hopefully release it to women in areas of high occurence. A very interesting approach to prevention....

Perceptions of drugs and Big Pharma

First off, I recently found out that "Big Pharma" is actually an organization, cleverly called PhRMA. Just an interesting factoid. Anyways, there was a recent study released by the New York Institute of Technology looked at the perceptions of people aged 18-26 and what they thought about medications, advertising and Big Pharma. Here's the link to the article on the study, as well as some actually pics. It's encouraging to see that most surveyed realized the importance of drugs, as well as the possibility of side effects. People also requested more information (see the top question on the second chart) And, who is better than drug information than us. Obviously, an opportunity to step in and offer information, and be a resource. I think we can also realize that advertising, thought totally biased, can stimulate conversation with patients.

Just for the taste of it!

A University of Minnesota study, published in Circulation, found that fast foods-including diet soda-were correlated with a higher risk of developing metabolic disease, which is strongly correlated with later development of diabetes. Here's the MPR article. This supports a study out of the University of Boston from last July that had similar findings. It is important to note that both studies acknowledged that the diet soda may just be indicative of other behaviors that are contributing to the higher risk, fast food likely being at the top of this list. Here's another good summary from the trusty ol' Star Trib as well.

Adults don't like shots either...

Or at least that is what this study says, well the CNN article says so. I couldn't find the actual CDC report-but I'll work on it. Anyways, opportunity for education by pharmacists, perhaps? I think, yes. Especially when you think about how cost-effective vaccines are in the long run.