Claire was about to start at college when her counsellor recommended that she should not tell anyone that she was being treated for drug dependence. So she spent months leaving class early and making up excuses to sneak to the chemist to collect her methadone prescription: lying to teachers, administrators and her friends. Eventually, the pressure of the constant evasions became too much and she dropped out of the course, rather than reveal her secret.
Claire’s story is far from unusual. As her treatment counsellor had recognised, suspicion, fear and distrust of people struggling with drug problems are widespread. The result is that people with drug dependence, and their families, are suffering in silence, missing opportunities for treatment, and prolonging the process of recovery.
Research by the
UK Drug Policy Commission(UKDPC found these attitudes to be widespread, affecting those with drug problems throughout their lives. We encountered people who felt trapped in their homes because of the hostility they faced from neighbours. Being stuck indoors, without social contacts or the opportunity to find work, may be one of the hardest settings imaginable in which to fight drug dependence.
Everyday prejudice creates a host of obstacles for recovering drug users. Offers of work or housing are commonly withdrawn when it becomes known that the recipient has had a serious drug problem, even if they have stopped using. Yet employment and stable accommodation are two of the most important factors for helping people overcome dependence and stay off drugs. Anything that makes these harder to access will worsen drug problems.
Public hostility can even make it harder for people with dependence problems to get the treatment they need to help rebuild their lives. The fear of being exposed as someone with a drug problem can deter them from going to a pharmacy to collect prescriptions for methadone, for example, which could provide the stability they need to stop using street drugs.
These attitudes are not just those of an uneducated general public. Our
researchfound that many people with drug problems experience similar barriers in their dealings with the professionals who should be helping them. Some find it impossible to convince doctors or nurses that they need help, even when they are in agonising pain or suffering from long-term conditions like Hepatitis C. The suspicion of the medics is often that their patient is just looking for drugs to relieve their cravings.
Others are made to wait at pharmacies for as long as it takes to serve every other customer in the store, including those who arrive after them. For recovering drug users, treatment can mean daily visits to pharmacies. Such long waits can make it impossible for them to be reliable in keeping other appointments, such as work obligations or job interviews.
Disapproval
Such problems are not just faced by those still using drugs. Even after they have managed to overcome drug dependence, former drug users can face similar hostility and distrust. The negative attitudes they face go beyond simple disapproval. Disapproval is usually linked to a person’s behaviour, and so disappears when that behaviour changes. Social disapproval of drug use even has a useful role in dissuading some from engaging in potentially risky behaviour.
But perceptions of people with drug problems go far beyond this. They are seen as bearing a stigma, an enduring mark that defines them and which cannot be removed by their stopping using street drugs. For many people with serious drug problems, suffering not only from a debilitating health condition, but also from social exclusion, the prospect of never being able to move past the label of drug user or addict can be one more barrier to overcoming their dependence.
The families of those with drug problems are also affected by this stigma. Such is the fear of being associated with the shame of addiction, that family members may avoid situations that could lead to their being identified as the relative of a drug user, even at risk to their own well-being.
In our research, we met Patricia, a mother who avoids contact with her old friends because she is afraid they will mention her son’s drug dependence. We also spoke to Tom, the brother of someone with a drug problem, who will not seek the support he needs himself because he is worried others will find out and would think less of him and his family.
Public opinion on dependence and recovery suggests that this worry is not misplaced. In one survey of public attitudes that UKDPC carried out, we found that, while people want top-quality help to be made available to those recovering from dependence, they are nevertheless suspicious and afraid of those who have had drug problems.
More than four in five agreed that people recovering from drug dependence should be part of the normal community. But the public still wants to keep its distance, with 43 per cent of those asked saying they would not want to live next door to someone who had been dependent on drugs. More than a third felt it would be foolish to get into a serious relationship with someone who had suffered from drug dependence, even if they appeared to be fully recovered.
Beating stigma
To a certain extent, these attitudes reflect how dependence is portrayed in the media. People with drug addictions tend to labelled as “junkies” not as people with a health problem that can be addressed. The term “addict” has itself become pejorative and frames the issue in a particularly negative way.
If a media story about a drug user is not about a celebrity, it is most likely to be about a criminal, who, for example, has mugged someone or broken into a house in order to pay for drugs. And if an article features someone who used to be dependent on drugs but is now drug free or on medication, their previous addiction is invariably mentioned, even when it has no relevance to the story. The implication is that no one can truly move on from dependence.
But if television and newspapers can perpetuate attitudes that make recovery more difficult, changes in how they report such stories could be similarly effective in making recovery more achievable. A forthcoming guide for journalists and editors, produced by the Society of Editors and UKDPC, will suggest ways to reframe news stories to avoid the assumption that drug dependence is a life sentence.
But media coverage cannot stray too far from where the public is. The stigma of drug dependence will only be overcome if it is acknowledged and confronted directly.
There is a parallel with attitudes to mental health. Public perceptions of those suffering with mental illness have shifted over recent years. Nonetheless, it is still less than a decade since the
Sun
newspaper
ran a front-page storyabout boxer Frank Bruno being taken to a psychiatric hospital under the headline “Bonkers Bruno locked up”. The editor belatedly realised this was out of step with British attitudes and later editions carried the headline “Sad Bruno in mental home”. Even today, the
Time to Change campaign “Get Talking”, which aims to encourage debate about mental health, demonstrates that shifting these views takes a lot of work over a long period.
Attitudes to those who suffer from drug dependence may lag behind perceptions of other stigmatised groups. But the process has begun. Earlier this year, the Duchess of Cambridge became a patron of the charity
Action on Addiction and said specifically that she wanted to
break the stigma associated with addiction, as Princess Diana had done with Aids.
UKDPC, along with other organisations, is working on a project to determine practical measures, such as the media guide, that can make recovery and inclusion achievable for everyone.
* Names have been changed
The Food and Drug Administration (FDA has had to face dealing with a growing number of prescription drug shortages caused by various reasons. The health regulating agency issued a
consumer update on its website stating that possible reasons for the shortages may be caused by manufacturing or quality problems, delays, or discontinuations of the drug. When there is a drug shortage, the FDA works with the drug manufacturer to work out the issue and often asks generic drug makers to increase productions.
A
letter of concern was issued to manufacturers in short supply of prescription drugs. The letter was issued on October 31, 2011 and stated that the number of drug shortages has nearly tripled within 5 years. In 2005, there were 61 drug shortages and that number increased to 178 in 2010. About 54% of these drugs shortages were caused by manufacturing problems and the FDA warns that these issues should be taken care of immediately so as to not jeopardize the patient’s health.
There are multiple reasons for drug shortages such as the following:
Interruptions or other adjustments in manufacturing
Delays in obtaining dire raw materials
Manufacturing complications causing supply disruptions
Import suspensions
Unforeseen rises in demand
Many of the drugs in short supply are used to treat life threating conditions such as cancer and anesthesia and are typically the only type on the market. This has raised much attention causing the Obama administration to get involved. An
executive order by the Obama administration was also issued on October 31, 2011.The FDA has taken multiple approaches to dealing with the increase in drug shortages including issuing a letter of concern to the manufacturers of these critical drugs in short supply, increasing staff resources to avoid drug shortages, supporting legislation which will require manufacturers to report drug shortages, and much more.
Take Heart: Men's Health Week 2012, 11-17 June
To celebrate the tenth birthday of Men’s Health Week, the Men’s Health Forum is launching a new interactive campaign. YoLo - You Only Live Once - will encourage men to make the choices that will enable them to live better, live healthier and live longer. Because you only live once.
Put your heart into the Week
Heart disease is the single biggest killer of men. That’s why we’ve chosen heart health as the theme for for Men’s Health Week 2012, 11-17 June and to kick off the YoLo campaign. Three times as many men as women die from heart disease before their 75th birthday. This year’s Men’s Health Week message is clear: you only live once - so you need a tip-top ticker.
We are keen to support men to do all they can to prevent heart disease by encouraging them to exercise, eat right and to get help if they are concerned about their health.
This year’s campaign will put more emphasis on promoting the local campaign events and activities which are run across the country which is what partners have asked us to do. We are broadening our target audience to include women and children who play a key role in influencing the men in their lives lifestyle choices. We will use Father’s Day holiday (Sunday, 17 June 2012 to promote our messages to the general public.
You can
register your organisation free of charge for updates on events and resources for the week.
Active hearts, healthy hearts
Activities for the Week include:
- A social media driven advertising campaign in print and online media promoting Men’s Health and engaging members of public to support Men’s Health Week in varied and fun ways
- A customisable and downloadable Father’s Day e-card incorporating men’s health messaging linked to the campaign’s website
- A dedicated National Men’s Health Week website with all resources available for registrants and partner organisations featuring a navigatable listing of all local events and activities taking place across the country during the week
- A high-profile National Launch Event at Arsenal Stadium on Tuesday, 12 June 2012, 4-6pm. (by invitation only
- Our award-winning Haynes mini-manuals on Heart Health – a proven and succefful, fun resource for men – available to purchase
- National/local media activity
- The week will be followed by an expert symposium on men’s heart health which will aim to develop further policy in this area
We want to hear from you - especially if you've a dickie ticker
If you are planning any event or have anything else you want to tell us or suggest or have any questions about the Week
contact us.
We are also looking for
heart health case studies. So if you've experienced something that would help others - heart-warming, heart-breaking - we'd love to hear from you.
Thank you your support of Men’s Health Week.
EARLY diagnosis has become one of the most fundamental precepts of modern medicine. It goes something like this: The best way to keep people healthy is to find out if they have (pick one heart disease, autism, glaucoma, diabetes, vascular problems, osteoporosis or, of course, cancer — early. And the way to find these conditions early is through screening.
It is a precept that resonates with the intuition of the general public: obviously it’s better to catch and deal with problems as soon as possible. A study published with much fanfare in The New England Journal of Medicine last week contained what researchers called the best evidence yet that colonoscopies reduce deaths from colon cancer.
Recently, however, there have been rumblings within the medical profession that suggest that the enthusiasm for early diagnosis may be waning. Most prominent are recommendations against prostate cancer screening for healthy men and for reducing the frequency of breast and cervical cancer screening. Some experts even cautioned against the recent colonoscopy results, pointing out that the study participants were probably much healthier than the general population, which would make them less likely to die of colon cancer. In addition there is a concern about too much detection and treatment of early diabetes, a growing appreciation that autism has been too broadly defined and skepticism toward new guidelines for universal cholesterol screening of children.
The basic strategy behind early diagnosis is to encourage the well to get examined — to determine if they are not, in fact, sick. But is looking hard for things to be wrong a good way to promote health? The truth is, the fastest way to get heart disease, autism, glaucoma, diabetes, vascular problems, osteoporosis or cancer ... is to be screened for it. In other words, the problem is overdiagnosis and overtreatment.
Screening the apparently healthy potentially saves a few lives (although the National Cancer Institute couldn’t find any evidence for this in its recent large studies of prostate and ovarian cancer screening . But it definitely drags many others into the system needlessly — into needless appointments, needless tests, needless drugs and needless operations (not to mention all the accompanying needless insurance forms .
This process doesn’t promote health; it promotes disease. People suffer from more anxiety about their health, from drug side effects, from complications of surgery. A few die. And remember: these people felt fine when they entered the health care system.
It wasn’t always like this. In the past, doctors made diagnoses and initiated therapy only in patients who were experiencing problems. Of course, we still do that today. But increasingly we also operate under the early diagnosis precept: seeking diagnosis and initiating therapy in people who are not experiencing problems. That’s a huge change in approach, from one that focused on the sick to one that focuses on the well.
Think about it this way: in the past, you went to the doctor because you had a problem and you wanted to learn what to do about it. Now you go to the doctor because you want to stay well and you learn instead that you have a problem.
How did we get here? Or perhaps, more to the point: Who is to blame? One answer is the health care industry: By turning people into patients, screening makes a lot of money for pharmaceutical companies, hospitals and doctors. The chief medical officer of the American Cancer Society once pointed out that his hospital could make around $5,000 from each free prostate cancer screening, thanks to the ensuing biopsies, treatments and follow-up care.
A more glib response to the question of blame is: Richard Nixon. It was Nixon who said, “we need to work out a system that includes a greater emphasis on preventive care.” Preventive care was central to his administration’s promotion of health maintenance organizations and the war on cancer. But because the promotion of genuine health — largely dependent upon a healthy diet, exercise and not smoking — did not fit well in the biomedical culture, preventive care was transformed into a high-tech search for early disease.
Some doctors have long recognized that the approach is a distraction for the medical community. It’s easier to transform people into new patients than it is to treat the truly sick. It’s easier to develop new ways of testing than it is to develop better treatments. And it’s a lot easier to measure how many healthy people get tested than it is to determine how well doctors manage the chronically ill.
But the precept of early diagnosis was too intuitive, too appealing, too hard to challenge and too easy to support. The rumblings show that that’s beginning to change.
Let me be clear: early diagnosis is not always wrong. Doctors would rather see patients early in the course of their heart attack than wait until they develop low blood pressure and an irregular heartbeat. And we’d rather see women with small breast lumps than wait until they develop large breast masses. The question is how often and how far we should get ahead of symptoms.
For years now, people have been encouraged to look to medical care as the way to make them healthy. But that’s your job — you can’t contract that out. Doctors might be able to help, but so might an author of a good cookbook, a personal trainer, a cleric or a good friend. We would all be better off if the medical system got a little closer to its original mission of helping sick patients, and let the healthy be.
H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, is an author of “Overdiagnosed: Making People Sick in the Pursuit of Health.”
“It could be possible to reverse the muscle damage seen in children with a form of motor neurone disease,” according to BBC News. The condition in question – spinal muscular atrophy (SMA – causes deterioration of specific nerves and muscles in the body, and is sometimes known as ‘floppy baby syndrome’ due to the weakness it creates in the limbs. The condition reportedly affects 1 in 6,000 babies, with around half of children with the most severe form of this disease dying before the age of two.
Research has already established that the condition affects the nerves, and it has previously been thought that the muscles waste mainly as a result of this nerve damage. However, this news is based on an experiment in mice that suggests the muscles start to undergo changes even before the nerves deteriorate. Crucially, some of these changes could be reversed using a drug called SAHA, which has also been found to increase lifespan in SMA mice in a previous study.
The drug SAHA is already approved by the US Food and Drug Administration for use in a very specific form of cancer. The fact that this drug has already been tried in humans for another condition may make it easier to test in people with SMA. Trials will still need to be carried out before we can say whether this drug is effective and safe in humans. Drug treatments for this condition would be valuable, as there is currently no cure.
Where did the story come from?
BBC News’ coverage referred to two related papers from the same group of researchers based primarily at the University of Edinburgh. One of these research papers looked at the effect of using drugs called HDAC inhibitors on a mouse model of SMA, while the other paper focused only on the biology of a mouse model of SMA, but did not assess the effects of any treatments. This Behind the Headlines appraisal focuses on the former of these papers as online news reports tended to focus on the possibility of developing new treatments.
This HDAC inhibitor study was carried out by researchers from the University of Edinburgh, and other research centres in the UK and Germany. It was funded by SMA Trust, BDF Newlife, the Anatomical Society and Germany’s DFG research fund.
The study was published in the peer-reviewed medical journal Human Molecular Genetics.
The report from BBC News gives a very brief summary of the two studies, and provides more information about the condition SMA itself. It does report the fact that the treatment study was in mice.
What kind of research was this?
Spinal muscular atrophy (SMA is a form of motor neurone disease that is caused by mutations in the SMN1 gene, leading to degeneration of a type of nerve cell found in the spinal cord. These nerve cells, called motor neurones, normally carry messages from the brain to the muscles. In SMA, motor neurone degeneration causes progressive weakness of the limbs and trunk, followed by muscle wasting. About 1 in 6,000 to 1 in 10,000 babies are thought to be affected. Some forms of SMA typically lead to death in the first few years of life, and the condition is reportedly among the most common genetic causes of infant death. Other forms become apparent later in life and are less severe.
SMA is an ‘autosomal recessive’ disease, meaning that it only becomes apparent if an individual has two copies of a faulty gene, one inherited from each parent. People with only one faulty copy of the gene will not have the condition but are known as carriers, and can have a child with the condition if their partner is also a carrier. People with the condition have low levels of a protein called SMN.
This was animal research that looked at the changes that occur in the muscles of a mouse model of spinal muscular atrophy (SMA . It also looked at whether the changes could be reversed by a specific type of drug called a histone deacetylase (HDAC inhibitor.
The researchers say that, thus far, most research has looked at how this disease affects the nerves that send messages to the muscles, rather than the muscles themselves. They wanted to look at the effect of the disease on the muscle in mouse models of SMA.
Animal models are very useful for studying aspects of the biology of human diseases that would be hard to study in humans. They are also essential for the initial testing of drugs that might be useful for treating human conditions, to make sure they are safe and effective enough to test in humans. These animal tests should be seen as only the first of many stages, as drugs that show promise in these tests are not always effective or safe in humans, due to differences between the species.
What did the research involve?
In their first set of experiments the researchers used a mouse model of SMA that causes a severe form of the condition.
In SMA the nerves that send signals to the muscles break down, and this then leads to loss of muscle fibres. The researchers looked specifically at one muscle that does not lose its nerve signals early in the disease, so they could see whether any changes in the muscle happen independently of the problems with the nerves.
The researchers looked at what changes happened to the proteins in this muscle before the mice developed any symptoms. They found that the proteins that were affected related to cell death, so they then looked at whether there were signs that more cells were dying in muscles of SMA mice than in muscles of normal mice. They also looked at whether some of the protein changes seen in mice were also seen in samples of muscle taken from human SMA patients.
Previous research has suggested that chemicals called HDAC inhibitors can increase levels of the SMN protein in mouse models of SMA, and reduce muscle loss. Based on this the researchers decided to test whether HDAC inhibitors directly affected the muscle. These experiments used a different mouse model that causes a less severe form of the condition. They say that this model is better for testing the effects of potential treatments for the disease because the mice live slightly longer.
The mice were given an HDAC inhibitor called suberoylanilide hydroxamic acid (SAHA orally from birth. Control mice were given no SAHA. The researchers looked at the effect of this treatment on the levels of the different proteins in the muscles that are affected by SMA. SAHA (Vorinostat is approved by the US Food and Drug Administration for use as a treatment for a specific type of cancer in humans.
What were the basic results?
The researchers found that the muscle from pre-symptomatic SMA mice showed differences in the levels of a number of proteins compared with normal mice. This was despite the fact that the nerves sending messages to the muscle were not yet affected. This finding suggests that the condition starts to affect the muscle even before any deterioration occurs as a result of changes in the nerves.
Many of the proteins affected by the condition were found to be involved in muscle function or cell death. The researchers found that there were also other signs of increased cell death in the muscle of SMA mice compared with normal mice.
The researchers then examined human SMA muscle to look at two proteins found at abnormal levels in SMA mouse tissue: one protein called Vdac2 that was found at higher levels in the SMA mouse muscle and one protein called parvalbumin that was found at lower levels in the SMA mouse muscle. They found that levels of these two proteins were similarly affected in human SMA muscle tissue.
Treating SMA mice with the HDAC inhibitor drug SAHA from birth increased levels of SMN protein in their muscle. SAHA treatment also reversed the changes seen in the levels of the proteins Vdac2 and parvalbumin, although the levels of parvalbumin were still not quite as high as in normal muscle. SAHA treatment also reduced the levels of a protein called H2AX, which is involved in cell death and which was significantly raised in SMA mice.
How did the researchers interpret the results?
The researchers concluded that the molecular effects of SMA on muscle in mice were improved by the existing FDA-approved drug SAHA. They say that their study showed that abnormalities in skeletal muscle tissue proteins are an important and potentially reversible part of SMA.
Conclusion
This study has shown that in mouse models of spinal muscular atrophy (SMA , before problems develop in the nerves that send messages to the muscles, the muscles themselves have abnormal levels of certain proteins. Human SMA muscle tissue was also found to have some of these abnormalities. Notably, the researchers also showed that, in mice, some of these abnormalities could be reversed using a drug called SAHA, which belongs to a group of drugs called the HDAC inhibitors.
Previous studies have suggested that SAHA treatment increased the lifespan of mice with SMA. The current study did not look at the effect of this drug on symptoms or lifespan in these mice, just at its effect on particular proteins within the muscle.
The drug SAHA is already approved by the US Food and Drug Administration for use in a very specific form of cancer (cutaneous manifestations of cutaneous T-cell lymphoma . The drug does not appear to have been approved for use in Europe for this type of cancer or for other conditions. The fact that this drug has already been tried in humans for another condition may make it easier to test this drug in people with SMA. Such trials will need to be carried out before we can say whether this drug is effective and safe for the treatment of SMA. New treatments for this condition would be valuable, as there is currently no cure.
Analysis by Bazian
Links To The Headlines
Child motor neurone disease treatment clue. BBC News, February 27 2012
Links To Science
Mutsaers CA, Wishart TM, Lamont DJ et al. Reversible molecular pathology of skeletal muscle in spinal muscular atrophy. Human Molecular Genetics (2011 20 (22 : 4334-4344
One of the new Blue and Blue Shield stores in Florida. Photo courtesy of Kaiser Health News.
When Ronda Austin's employer stopped offering health coverage last spring, she bought an individual policy from Blue Cross and Blue Shield of Florida. A month later she was given a diagnosis of multiple myeloma and began chemotherapy at her oncologist's office near her home in Tampa.
But after several sessions, the physician's office said that her plan covered chemotherapy only if it was provided in a hospital and told her she owed the practice $15,000. Austin called her plan's member-services number but didn't get anywhere.
So she stopped in at a new kind of insurance facility - her local BCBS of Florida retail store. There, a customer service rep sat down with her and called up her plan information online. She referred Austin to nearby Moffitt Cancer Center for subsequent chemotherapy treatments and explained how to address the problem with the oncologist's billing department, which had misread her policy. The problem was quickly resolved.
"It's a great feeling to know the insurance company is standing behind you," says Austin.
Health insurers increasingly want to make shopping for a new health plan as easy and convenient as dropping into a local retailer to buy a TV. In recent years, a number of them have opened stores where consumers can stop by to talk with a customer service representative about buying a plan or resolve questions about their current coverage. Some stores also sponsor health fairs or community seminars on nutrition and exercise. A few have primary-care doctors on-site.
"The stores are big, bold and easy to see," says Marc Pierce, president of Stonegate Advisors, a research and strategy company in Chicago that has helped several insurers evaluate retailing. "For insurers, the impetus is to provide a tangible touchpoint so they can provide more value for their customers." The trend should continue, he says, unless the U.S. Supreme Court strikes down the 2010 health-care law.
The number of individual health insurance customers is expected to grow significantly in coming years. Employer-sponsored health coverage is eroding, and in 2014 the law will require nearly everyone to have insurance, adding millions to the ranks of the insured.
The stores are "a reaction to the shift from wholesale to retail in insurance sales," says Paul Ginsburg, president of the Center for Studying Health System Change. "In wholesale sales, employers were the buyers. Now insurers are recognizing that retail will be more important."
Bricks and Mortar
Insurers Highmark in Pennsylvania and BCBS of Florida have the largest retail presence to date, with several stores throughout those states. In New York, UnitedHealthcare recently opened a 16,000-square-foot facility in the Flushing section of Queens; it operates a number of smaller storefronts as well.
As insurers see it, bricks-and-mortar stores are one more way, along with online and telephone support, to reach out to consumers.
"This is a third service option for people that like high-touch service," says Craig Thomas, senior vice president for consumer and government markets at BCBS of Florida.
Insurers also hope that their visible presence in communities may generate some positive buzz. "We don't really drive a whole ton of word-of-mouth on the positive side," says Matt Fidler, vice president of consumerism and retail marketing at Highmark, a BCBS plan.
BCBS of Florida and UnitedHealthcare both emphasize providing comprehensive services. At the Queens store, for example, visitors, many of them Asian-American Medicare and Medicaid beneficiaries, can get their claims questions answered in their native languages and get help signing up for social services programs such as food stamps and a pharmaceutical assistance program for seniors.
"We want to afford people a 360-[degree] experience, and give people access to all the information they need to take care of their health care," says Yasmine Winkler, UnitedHealthcare's chief product and marketing officer. Offering a smorgasbord of services also keeps people coming back, creating consumer "stickiness," she says.
Strip-Mall Service
In Pennsylvania, Highmark stores focus on sales. Ninety percent of the traffic at its eight stores is sales-related, says Fidler.
After being laid off from her job, Heather Manning bought insurance at the Highmark store at a strip mall in Easton shortly before her second child was due.
Although she wasn't able to get coverage for herself until after she had the baby -- her pregnancy was a preexisting condition, which individual insurance policies typically don't cover -- she bought coverage for her 6-year-old son. Once the baby was born in January, she bought a separate policy for the two of them. She pays $400 a month for all three of them.
The experience was very positive, she says. Before signing on with Highmark, she had gotten online quotes from several other insurers, which led to a barrage of sales calls from agents.
Highmark customer service reps, however, don't get sales commissions. "It sets the tone to have it be educational," says Fidler. "It differentiates us [from brokers] from the get-go."
Although there are many upsides to the new insurance stores, Pierce cautions that they could backfire. Consumers already think that health plans make too much money, he says. "Here's the potential for consumers to say, 'Why are you building this big store? Why don't you just reduce my premiums by 20 percent?'"
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.
On February 22-24, the Generic Pharmaceutical Association ("GPhA" held its
Annual Meeting in Orlando, Florida to a first-time, sold-out crowd of approximately 625 attendees. During the public sessions to which this blog refers, representatives from the generic industry along with guest speakers such as FDA Commissioner Margaret A. Hamburg, M.D., addressed a variety of issues facing generic drug manufacturers in the upcoming year and years to come. Key topics throughout the conference included drug shortages, biosimilars, and challenges to survival of generic industry despite the promise of the user fees from the Generic Drug User Fee Act ("GDUFA" to shorten abbreviated new drug application ("ANDA" review times. This is part one of a two-part series.
Hamburg said that she had hoped to announce a new director for the Office of Generic Drugs ("OGD" . In the meantime, a big OGD focus will be gearing up to effectively utilize the $299 million per year user fees (to be adjusted by need and inflation with the goal to shorten review times from a mean of 30+ months to 10 months. One of the challenges will be addressing the need to conduct overseas inspections now that approximately 40% U.S. generic drugs are imported and 80% U.S. generic drugs utilize imported active pharmaceutical ingredients. FDA also hopes to streamline the review process by issuing single response letters rather than multiple deficiencies, resulting in less review cycles.
According to Hamburg, the generic drug industry must continue to demonstrate therapeutic equivalence and equality to maintain that generics are as good as innovator products. Hamburg explained that the OGD will continue to address new scientific topics, such as bioequivalence for inhalation products, and hopes to tackle additional issues surrounding more complex dosage forms. In turn, Hamburg asked the generic industry to help support studies on generic drugs to address key patient concerns and to invest generally in high quality production to reduce drug shortages. Hamburg warned GPhA's members that currently there are more drug shortages attributed to generics, which could lead to a public misperception that generic drugs are not as good. Hamburg also discussed internal changes made within FDA to reduce drug shortages after President Barack Obama's Executive Order in October 2011, which has resulted in 195 shortages prevented in 2011. The generic drug industry can help, Hamburg said, by providing early notification of potential shortages. Hamburg also briefly discussed FDA's new biosimilar guidances and FDA's biosimilars statistics to date: 35 pre-investigational new drug ("IND" application meeting requests, 21 pre-IND meetings, and 9 in-house INDs.
By Ben Hirschler
LONDON, Feb 28 (Reuters - How to measure medical corruption? Tuan Anh Nguyen, a researcher at Hanoi University of Pharmacy, believes informal payments to doctors are "a dominant factor" in high prices of the older off-patent drugs that make up the lion's share of prescriptions in many emerging markets.
After interviewing doctors, pharmaceutical companies, government officials and pharmacists in both the private and state hospital sectors, he concluded in a study published last year that around 40 percent of the drugs' price in Vietnam is typically spent on offering financial inducements to doctors.
"When I talk to colleagues in some other Asian countries they say the situation is the same," he told Reuters.
His investigation broke down the different legal and illegal components that contribute to the cost of drugs in Vietnam, and found 40 to 60 percent of the final price could be spent to induce prescribers to use particular medicines, and to persuade procurement officers inside hospitals to buy them. The biggest share went to doctors.
Nguyen said the problem was worse with generic medicines sold by Asian companies, although his study did not name any firms. In Vietnam the price of these is sometimes even higher than that of the original branded product, in order to recoup payments made to doctors by drug companies trading these medicines.
But Western drug firms are not immune: pharmaceutical company representatives who spoke to Nguyen reported that doctors typically expect a commission of about 15 percent from European drug makers; the figure they look for from Asian producers is nearer 40 percent.
The study, which was presented at the International Conference for Improving Medicines in Antalya, Turkey, last October, found multinational companies tend to prohibit bribes, officially at least, although pressure to achieve sales targets often means representatives ignore this and give money to prescribers.
At other times, multinationals pay for one-off benefits like luxury holidays that would be prohibited under anti-kickback rules adopted by the drug industry in the United States.
Doctors surveyed said they took the cash and non-cash offers to make up for low salaries, and it was common for commissions from the pharmaceutical industry to become the main source of income for some physicians, leaving those reputable doctors who are determined to stay "clean" out in the cold.
It's a situation one foreign drug salesman says has turned the system upside down: "Now, the worse the doctors, the more money they have. It's ridiculous."
Jefferson City, MO (KSDK - The state's Medicaid program will receive more than $289,000 to settle allegations that a St. Louis-based pharmaceutical company lied to customers by saying two drugs were approved for coverage under state and federal health care programs.
Under the agreement, KV Pharmaceutical Company, parent company of now-defunct Ethex Corporation, will pay approximately $17 million to the federal government and participating states to compensate for Ethex's conduct.
According to the suit, Ethex misrepresented the regulatory status of Nitroglycerin Extended Release Capsules (Nitroglycerin ER and Hyoscyamine Sulfate Extended Release Capsules (Hyoscyamine ER .
Despite not being covered by federal and state health care programs, the two drugs do not pose a risk to patients. At present, neither drug is on the market.
Koster said citizens should report suspected Medicaid provider fraud or abuse and neglect to his Medicaid Fraud Hotline toll free at 800-286-3932, e-mail the complaint to
attorney.general@ago.mo.gov or complete a complaint form at the
Attorney General's Medicaid Fraud Website.
ADMISSOIN NOTIFICATION 2012 : JAMIA HAMDARD, NEW
Delhi
Online / offline applications (under general categroy and NRI/Sponsored category as per detail given below are invited for admission to the following programmes :
FACULTY OF PHARMACY :
1.
PhD
- Pharmaceutics, Pharmacognosy & Phytochemistry, Pharmaceutical Chemistry, Pharmacology, Pharmaceutical Medicine
2. M Pharm - Pharmacuetical Chemistry, Pharmaceutics, Pharmacognosy & Phytochemistry, Pharmacology, Pharmacy Practice, Quality Assurance, Pharmaceutical
Biotechnology
3. Bachelor of Pharmacy (B.Pharm
4. Diploma of Pharmacy (D.Pharm
FACULTY OF INFORMATION TECHNOLOGY :
1.
M.Tech
Bioinformatics
FACULTY OF SCIENCE :
1.
PhD
-
Biochemistry
,
Biotechnology
,
Botany
, Toxicology
2.
M.Sc
-
Biochemistry
,
Botany
,
Biotechnology
, Toxicology, Bioelectronics & Instrumentation
FACULTY OF ENGINEERING AND INTER-DISCIPLINARY SCIENCES :
1.
PhD
-
Bioinformatics
,
PhD
- Chemoinformatics
2.
M.Tech
- Food Technology
- Online application form is available on our website :
www.jamiahamdard.edu w.e.f. 1st february 2012.
- Offline (Printed application form will be available from 1st march 2012 at Jamia Hamdard counter and form may also be obtained by post from Asst Registrar (Admissions , Jamia Hamdard by sending a draft of Rs 600/- for General Category and Rs 3100/- (for NRI/Sponsored category in favour of Jamia Hamdard payable at New
Delhi
by 31.03.12
- The Entrance Test will be held at Allahabad / Calicut /Lucknow /
Delhi
/hyderabad /
Kolkata
/Kota / Patna /Pune /Srinagar, Anantnag (J & K
Deadline : 05.04.12
Who would have thought that in this day and age we would experience a shortage of cancer drugs that are essential to a favorable outcome? Sad, but true, the US is facing a major shortage of some cancer drugs. Those taking methorexate or Doxil are hurting the worst, as slow and delayed production by the drugmakers have caused a substantial shortage. It doesn't stop at these two cancer drugs, unfortunately. There is a shortage of over 200 different drugs used to treat a variety of diseases and conditions, according to The American Society of Health Systems Pharmacists (ASHP . Want to check to see if your drug is in short supply? The ASHP has an
interactive tool that allows you to check the status of your drugs.
In relation to living a healthy lifestyle you will discover that there are millions of people who want to accomplish this, they just don't know where to begin. You ought to realize that doing just one thing to be healthy will be beneficial, however you ought to recognize the more healthy lifestyle traits you pick up the healthier you will be. As you continue to read you're going to find I will be offering you a few suggestions that you need to end up following which can help you lead a much better life.
Bill & Melinda Gates Foundation
Ethiopia
February 27, 2012
Bill & Melinda Gates Foundation
Phone: +1.206.709.3400
Email:
media@gatesfoundation.org
SEATTLE -- The Bill & Melinda Gates Foundation today announced the appointment of its first official representative in Ethiopia. Haddis Tadesse, who has worked as an external relations officer for the foundation since 2007, will assume the new position later this month and be based in Addis Ababa.
Tadesse, who grew up in Ethiopia and was educated in the United States, will serve as the foundation’s liaison to the federal government of Ethiopia and the African Union. He also will help the foundation strengthen its relationships with health and development partners operating in Ethiopia, including donor agencies, international NGOs and local Ethiopian organizations.
The foundation works to help all people lead healthy, productive lives. In developing countries, it focuses on improving people’s health and giving them the chance to lift themselves out of hunger and extreme poverty.
“We invest more than half of our resources in Africa, and we want to build closer and more effective relationships with valued partners on the ground,” said foundation co-chair Melinda Gates. “Ethiopia is making great progress in health and economic growth, and we hope to support these efforts by appointing Haddis, who possesses deep knowledge of the country, its challenges, and its huge potential.”
Ethiopia is an important focus country for the foundation, which currently provides more than USD $265 million in funding to partner organizations that are operating health and development programs across the nation. That amount includes funding to help small farmers increase food production, as well as grants to expand access to childhood vaccines, maternal and child health programs, financial services for the poor, safe water and sanitation, and other effective, low-cost innovations.
Ethiopia also benefits indirectly from the foundation’s investments in global partner organizations such as the GAVI Alliance and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which provide grants to country governments to expand vaccine delivery and increase the diagnosis, treatment, and prevention of major diseases.
The foundation made its first program investments in Ethiopia in 2000, and it has since made more than 125 grants to partner organizations that are either working in Ethiopia or conducting research and development designed to benefit Ethiopia.
“I am very excited to be the foundation’s first representative in Ethiopia,” said Tadesse. “I am especially thrilled to have an opportunity to help expand access to health and development in the land where I was raised.”
One example of the foundation’s efforts to build effective partnerships in Ethiopia is its support for the Agricultural Transformation Agency (ATA . It has provided a total of USD $25.1 million to three partners – the United Nations Development Program (UNDP , the International Food Policy Research Institute, and Synergos Institute – that are working to strengthen ATA’s capacity to stimulate the Ethiopian economy by increasing production among smallholder farmers.
Other examples of foundation-supported efforts in Ethiopia include grants to:
JSI Research & Training Institute to improve the delivery of maternal and child health through support provided by rural extension workers;
FHI Solutions to develop better approaches to nutrition in the first 1,000 days of a child’s development between pregnancy and age two;
AGRA to improve the soil management skills of small farmers and their access to local fertilizers; and
The World Food Programme to improve market opportunities for smallholder farmers to sell surplus food to UN agencies that respond to humanitarian emergencies in the Horn of Africa
Tadesse earned a bachelor’s degree in business management and a master’s in public administration from the University of Washington in Seattle. He began working at the foundation as an advisor to the Agricultural Development program and has recently served as an external relations officer, managing the foundation’s engagement with key stakeholders in Africa.
Bill & Melinda Gates Foundation
Guided by the belief that every life has equal value, the Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives. In developing countries, it focuses on improving people’s health and giving them the chance to lift themselves out of hunger and extreme poverty. In the United States, it seeks to ensure that all people—especially those with the fewest resources—have access to the opportunities they need to succeed in school and life. Based in Seattle, Washington, the foundation is led by CEO Jeff Raikes and Co-chair William H. Gates Sr., under the direction of Bill and Melinda Gates and Warren Buffett.
the PPRS report also shows that not a single drug company has taken advantage of new rules championed by Sir Andrew and introduced three years ago allowing price increases if new medicines prove more effective than initially believed. That implies disappointing levels of innovation.
On collective sales of drugs totalling ?7.7bn in 2009, the PPRS report showed 34 companies reported costs of ?7.9bn, representing a return on sales of -1.8 per cent. That was down on profits of ?123m in 2008 and of ?149m in 2007. The figures include a rise in research and development costs of ?1.3bn in 2009, up from ?1bn in the previous year.
The final figures accepted by the Department of Health, recalculated from company returns to exclude profits from “transfer pricing” on medicines they purchased from their foreign subsidiaries, show profits of ?1.4bn for 2009, representing a return on sales of 18.3 per cent.
2 for 1 end of year sale on mini manuals
The Forum is currently offering a wide range of existing titles at 2-4-1 prices until the end of March.
Two boxes will cost the price of one: just £130 - a 50% saving on our previous prices. This cost includes postage and packing. What's more, the MHF are not VAT-registered so VAT is not applicable on any orders.
The list of titles that are available (while stock lasts , is:
- Benign prostatic hyperplasia or BPH (16 pages, 200 copies per box
- Over Active Bladder (p16 200
- Brain booklet - on mental health (p16 200
- Domestic Violence (p16 200
- Alcohol Awareness (p16 200
- Men and Work (in Welsh (p16 100
- Challenges & Choices - a manual highlighting the small changes men can make that will have a positive impact on their health (p32 100
- Surviving Cancer (p32 100
- MS Carers (p16 200
- Man Sexual Health (second edition (p32 100
- Woman (p16 200
- Health Clicks - a guide to health on the internet for beginners or experience surfers (p32 100
- Greenwich Man Time (32p 100
It is possible to mix and match various titles - such as a box of each - depending on your requirements.
Additional discounts will apply should you order more than 10 boxes (please get in touch with Matt:
matthew.maycock@menshealthforum.org.uk to discuss this in more detail . This offer expires at the end of March so please get in touch with us quickly in order to make your order while these limited stocks last.
Please make your order by filling out the form below:
New US research reveals that certain antipsychotics might carry a higher dementia patient death risk than others.
Dementia patients can be prescribed with antipsychotics when in an aggravated or panicked state, since these drugs have a calming effect. However some of them could be putting these patients at extreme risk, a new study intimates.
Over six years ago, the US Food and Drug Administration released an initial antipsychotic drugs warning, with an updated version following three years later. Both concerned the risk, posed to dementia patients, from their use.
Antipsychotic Death Risk Study
Carried out by Harvard Medical School representatives, the new antipsychotic death risk study examined medical data relating to over 75,000 US nursing home residents, all linked by dementia.
The antipsychotic risperidone was used as a platform to compare the effects of the drugs being taken, among which were aripiprazole, haloperidol, olanzapine, quetiapine and ziprasidone.
By the end of the six-month study period, just over 6,500 of these dementia patients had passed away. Circulatory disorders accounted for 49 per cent of deaths, while respiratory conditions claimed another 15 per cent and brain disorders, a further 10 per cent.
Antipsychotic Dementia Death Risk
Taking into account a number of influencing factors including each patient's sex, age and medical history, the researchers established that some antipsychotic drugs raised the risk of death over that produced by risperidone. In the case of haloperidol, the antipsychotic dementia death risk doubled.
‘The data suggest that the risk of mortality with these drugs is generally increased with higher doses and seems to be highest for haloperidol and least for quetiapine', they wrote in a report now published by the British Medical Journal. ‘Clinicians may want to consider this evidence when evaluating...the best approach to treatment of behavioral problems.'
"This study provides an interesting insight into the differential harm of these medicines", UK-based dementia researcher Doctor Chris Fox stated in comments quoted by the BBC, adding: "More work is needed on alternatives to these medicines in dementia with behavioural problems."
Image copyright 'Housed' - Courtesy Wikimedia Commons
We reported last week that drugmakers were seeking to get a
prescription diet pill passed, and that drug is now one stop closer to your local pharmacy. On Thursday, an FDA panel of outside physicians voted 20-2 in favor of the weight-loss drug Qnexa by Vivus.
