Category Archives: Prescription drugs
Experts Debate Expected Changes to ADHD Diagnosis
Medical experts are at odds as to what to ultimately expect from the predicted changes to the diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 will be released in May by the American Psychiatric Association. The broadened criteria should increase the number of people diagnosed with ADHD in part by expanding the age time frame for the onset of symptoms. "In the current version, it's seven years,” James Norcross, MD, a child and adolescent psychiatrist at the University of Texas Southwestern Medical Center at Dallas. “That will be changed to 12 years in the DSM-5, which may make things easier for adults and adolescents, because they'll be able to better recall some of the challenges that may have occurred." Norcross said the changes are positive overall. However, Allen Frances, MD, chair of the task force for the DSM-4 and former chair of psychiatry at Duke University School of Medicine in Durham, N.C., worries the new criteria will serve to increase the unnecessary use of stimulant medications. "We're already overdiagnosing ADHD,” he said. “Almost 20 percent of teen boys get the diagnosis of ADHD, and about 10 percent of boys are on stimulant drugs. We don't need to make it easier to diagnose ADHD.” Read more on mental health.
FDA Releases Violations on Several Dozen Compounding Pharmacies
Yesterday the U.S. Food and Drug Administration (FDA) released a list of violation reports for 28 of the 31 drug compounding pharmacies it’s inspected since April. The safety of drugs produced at compounding pharmacies came into question last year after the Framingham, Massachusetts-based New England Compounding Center was linked to a meningitis outbreak that caused 39 deaths and 656 cases of illness in 19 states. Found violations range from “inappropriate clothing for sterile drug processing to insufficient testing for contaminants,” according to Reuters. Still, FDA reiterated its stance that it needs more increased regulatory authority when it comes to compounding facilities. Last month Commissioner Margaret A. Hamburg, MD, proposed the FDA be given greater authority to oversee high-risk sterile compounding facilities that distribute drug products in advance of or without receiving a prescription. Read more on prescription drugs.
USPSTF: Limit Oral Cancer Screenings to Patients with Signs, Symptoms
Primary care physicians should limit oral cancer screenings to adult patients who actually show signs or symptoms of the condition, according to new draft recommendations from the U.S. Preventive Services Task Force (USPSTF). "The evidence shows that it is difficult to detect oral cancer and that the evidence is not clear whether oral cancer screening improves long-term health outcomes among the general adult population or among high-risk groups," said Jessica Herzstein, MD. "We need more high-quality research on whether screening tests can accurately detect oral cancer and if screening adults for oral cancer in primary care settings improves health outcomes." Tobacco and alcohol are both major risk factors for oral cancer. The task force also recommended physicians take into account patient wishes, medical histories and other expert opinions when making decisions. Read more on cancer.
Hospital-based Quality Improvement Programs Cut Early Elective Deliveries
Elective early term deliveries are down significantly in part due to multistate, hospital-based quality improvement programs, according to a new study in the journal Obstetrics & Gynecology. Labor inductions and Cesarean sections without a medical reason were down 83 percent from 27.8 percent to only 4.8 percent over a one-year program at 25 hospitals. Early term babies are at increased risk of a host of medical problems and even death, according to the March of Dimes. “Reducing unnecessary early deliveries to less than five percent in these hospitals means that more babies stayed in the womb longer, which is so important for their growth and development,” said Edward R.B. McCabe, MD, medical director of the March of Dimes. Read more on maternal and infant health.
Study: School Lunch Standards Help Kids Maintain Healthy Weight
States with strict school lunch standards may be helping students maintain healthier weights, according to a new study in JAMA Pediatrics. The U.S. Department of Agriculture’s National School Lunch Program standards include maximums calories for lunches and the serving of only skim or reduced-fat milk. Depending on grade level, school lunches are between 550 and 850 calories. The preliminary findings help refute the concern that students would simply compensate with unhealthy snacks, according to Daniel Taber, MD, lead author from the Institute for Health Research and Policy at the University of Illinois at Chicago. Nutritionist Marion Nestle of New York University said that this “is important work and should stimulate government agencies to take a closer look at what they might do to make the food environment a lot healthier for children and adults.” Read more on obesity.
CDC: Many Skipping Medications to Save on High Health Care Costs
Lack of insurance and other factors are leading many Americans to request cheaper medications or even skip taking prescribed drugs, according to a new report from the U.S. Centers for Disease Control and Prevention. "Adults who do not take prescription medication as prescribed have been shown to have poorer health status and increased emergency room use, hospitalizations and cardiovascular events," said Robin Cohen of the NCHS's Division of Health Interview Statistics. About 20 percent of U.S. patients ages 18 to 64 requested cheaper medications from their health care providers; the uninsured in that group was also twice as likely—23 percent total—as those ages 65 and older to simply skip the medications entirely. Read more on prescription drugs.
Each year hundreds of public health researchers and practitioners meet to share research and best practices on creating a stronger public health system at the annual Keeneland Conference in Lexington, Ky. The conference, which will be held this year April 8-11, is sponsored by the National Coordinating Center for Public Health Services and Systems Research, based at the University of Kentucky.
Paul Kuehnert, MS, RN, senior program officer and director of the Public Health Team at the Robert Wood Johnson Foundation (RWJF), will speak at the opening lunch about threats and opportunities for public health, and how we can re-shape the system to create a healthier future for all. We caught up with him to get his insights before the conference on the evolving role of public health. Prior to joining the Foundation, he was county health officer and executive director for health for Kane County, Ill., where he led a partnership between the health department, hospitals and other partners to assess and address the community’s health needs. Kuehnert is a Pediatric Nurse Practitioner and worked as a primary care provider in schools and other community settings in Missouri and Illinois.
NewPublicHealth: What are you going to talk about at Keeneland?
Paul Kuehnert: I think a lot of us are familiar with the data on our health care system, and the inter-twined issues of access, quality and cost. And the fact that younger Americans have a lower life expectancy than young people in other developed countries. We’re just not getting the health outcomes that one would expect from the amount we’re spending.
When you pit that against our legacy in public health, and what’s happening in the environment we operate in, I think there’s a real need to identify the threats and opportunities and re-imagine what we’re doing. We’re working from old models that need to be really questioned. What I’m hoping to do, and that others will do, is to provoke some creative thinking about where we need to go in public health to truly meet the challenges that face our communities and our nation.
NPH: What do you see as some of the major public health challenges today?
Kuehnert: For me, one of the first that comes to mind is that issue of life expectancy. With all the resources we have, we’re actually losing ground. It’s extremely concerning and has to do with a number of underlying dynamics—but particularly the epidemic of chronic disease, things such as obesity, heart disease, cancer, and all of those threats to our health. And there are also the incredible health disparities, the inequities that are reflected in our health across the country.
Analysis: ‘Big Box’ Stores Offer Best Costs on Prescription Drugs
People looking to save money on generic prescription drugs should ask their pharmacists about comparison shopping and should generally look to big box stories rather than smaller pharmacies, according to a new analysis by Consumer Reports. The report found the lowest prices at Costco and the highest at CVS Caremark. "Especially for the independent pharmacies, if they want to retain your business and loyalty, they will help you get the best price," said Lisa Gill, an editor at Consumer Reports. "It really comes down to a store's business model. For example, big box stores tend to use their pharmacies as a way to get consumers through the door with the expectation that they'll buy other things.” Read more on prescription drugs.
CDC: Sharp Increase in Valley Fever in Past Decade
The U.S. Centers for Disease Control and Prevention has identified changes in weather, an increase in population of changes in disease detection and reporting as possible explanations for the dramatic increase in Valley Fever from 1998 to 2011. In Arizona, California, Nevada, New Mexico and Utah there were about 22,000 cases in 2011; there were only 2,265 in 1998. The fungal respiratory infection, caused by a fungus found in the southwestern United States, is caused by flu-like symptoms that can lead to hospitalization. "Valley Fever is causing real health problems for many people living in the southwestern United States," said CDC Director Tom Frieden, MD, MPH. "Because fungus particles spread through the air, it’s nearly impossible to completely avoid exposure to this fungus in these hardest-hit states. It’s important that people be aware of Valley Fever if they live in or have travelled to the southwest United States." Read more on infectious disease.
CDC Study Offers More Proof of Non-link Between Vaccines, Autism
A new study in the Journal of Pediatrics offers yet more scientific proof that there is no link between vaccinations and autism. Researchers at the U.S. Centers for Disease Control and Prevention (CDC) found that exposure to vaccine antigens was the same for kids with and without autism. "This should give more reassurance to parents," said lead researcher Frank DeStefano, MD, director of the CDC's Immunization Safety Office. A small study in the Lancet in 1998 originally linked vaccinations and autism; the study has since been retracted. Still, about one-third of parents believe young children receive too many vaccinations and that they could lead to autism. Read more on vaccines.
Study: One-quarter of Doctors’ Offices Not Equipped for Patients in Wheelchairs
Despite the requirements of the Americans with Disabilities Act, about one quarter of doctors’ offices are not equipped to treat patients in wheelchairs, according to a new study in the Annals of Internal Medicine. The biggest obstacle to treatment was being able to transfer patients to exam tables. “This is affecting a large number of patients, certainly the 3 million who use a wheelchair, but many more than that who have difficulty getting up to an exam table,” said lead author Tara Lagu, an academic hospitalist at Baystate Medical Center in Springfield, Massachusetts, and an assistant professor at Tufts University School of Medicine. “The point of the study is to help doctors realize what the problems are and to help them become more aware of the Americans with Disabilities Act and to identify what the difficulties patients who use wheelchairs are having in accessing health care.” Read more on access to health care.
FDA: Voluntary Recall of Tainted Medical Med Prep Consulting Inc. Products
The U.S. Food and Drug Administration (FDA) has announced a voluntary recall of all products produced by Med Prep Consulting Inc. of Tinton Falls, N.J., after fungus was found in several bags of magnesium sulfate intravenous solution in Connecticut. The magnesium sulfate products may also have been shipped to New Jersey, Pennsylvania and Delaware. While no illness has been reported, FDA is working with the U.S. Centers for Disease Control and Prevention to identify the scope of the contamination. “Giving a patient a contaminated injectable drug could result in a life-threatening infection,” said Janet Woodcock, MD, director of the FDA’s Center for Drug Evaluation and Research. “We do not have reports of patient infections. However, due to a lack of sterility assurance at the facility and out of an abundance of caution, this recall is necessary to protect patients.” Read more on infectious disease.
New Insight into Why Black Kids Receive Fewer Antibiotics
Among all demographics, black children are the least likely to receive antibiotics, according to a new study in the journal Pediatrics. Researchers say this racial disparity in terms of treatment is likely because non-black children are actually over-prescribed the drugs. "The fact that black kids are given fewer antibiotics and fewer broad-spectrum antibiotics may come across as a bad thing to the casual reader, but perhaps it's not an issue of under-treating black kids, but over-treating non-black kids," said Allison Bartlett, MD, a pediatric infectious disease specialist at LaRabida Children's Hospital in Chicago. Read more on prescription drugs.
U.K. Reports Additional Case of SARS-like Virus
The World Health Organization (WHO) has been informed by health officials in the United Kingdom of an additional case of a patient infected with the novel coronavirus (NCoV), which appears to be similar to the SARS (severe acute respiratory syndrome) virus which struck in several countries a few years ago. The most recent patient is related to the first patient announced several days ago, which may be an indication that the virus may be able to spread from person to person. The most recent patient is in the intensive care unit of a U.K. hospital, and may have an underlying health issues that made him susceptible to the virus. The WHO says “on the basis of current evidence, the risk of sustained person-to-person transmission appears to be very low.” Eleven confirmed cases of human infection with NCoV have been reported to WHO since 2011, with five deaths since April 2012. WHO says that testing for the new coronavirus should be considered in patients with unexplained pneumonia or in patients with unexplained severe, progressive or complicated respiratory illness not responding to treatment, and then reported to national health authorities and WHO. Read more on infectious disease.
IOM Report: Efforts Needed In U.S. and Abroad to Combat Counterfeit and Adulterated Drugs
Combating counterfeit and adulterated drugs will require efforts in the United States as well as an improved international regulatory system, according to a new report released by the Institute of Medicine. The report calls for a tracking system to monitor drugs as they enter the distribution system and efforts by the World Health Organization to set and enforce standards for tracking medications. Read more on prescription drugs.
Petition Calls on FDA to Limit Sugar in Soft Drinks
The Center for Science in the Public Interest, a Washington, D.C.-based advocacy group, together with a group of health experts, has sent a petition to the U.S. Food and Drug Administration (FDA) calling on the agency to determine safe levels of high-fructose corn syrup and other sugars in sodas and assorted soft drinks. According to the petition, a 20-ounce bottle of soda contains about 16 teaspoons of sugar made from high-fructose corn syrup. The American Heart Association recommends that men not consume more than nine teaspoons of added sugars each day and that women restrict their added sugar intake to no more than six teaspoons. Read more on obesity.
New Report Widens Information on Veteran Suicide
The Department of Veterans Affairs (VA) has released a comprehensive report on Veterans who die by suicide—include veterans who had not sought VA health care services. Previous reports included information only on those who had sought those services. The VA has recently implemented broader suicide prevention initiatives, including a toll-free Veterans Crisis Line; placement of suicide prevention coordinators at all VA medical centers and large outpatient facilities; and improvements in case management and reporting. Immediate help for veterans is available at www.VeteransCrisisLine.net or by calling the Crisis Line at 1-800-273-8255 (push 1) or texting 838255. Read more on military.
FDA Approves Generic Version for Cancer Drug Doxil in Short Supply
The U.S. Food and Drug Administration (FDA) has approved the first generic version of widely used cancer drug Doxil (doxorubicin hydrochloride liposome injection). This approval is critical because the drug is currently on the FDA’s drug shortage list. The agency is using a priority review system to expedite the review of generic applications to help stem shortages. Doxil is used for several cancers, including ovarian cancer, multiple myeloma and AIDS-related Kaposi's sarcoma. Read more on prescription drugs.
Stroke Victims Need Therapy Within 60 Minutes of Hospital Arrival
People having an ischemic stroke should receive clot-dissolving therapy within 60 minutes of arriving at the hospital, according to new American Stroke Association guidelines published in the journal Stroke. Ischemic stroke, which accounts for nine in 10 strokes, is caused by a blood clot in the arteries leading to the brain. According to the American Heart Association, calling 9-1-1 immediately after recognizing any of the warning signs of stroke—and getting to a stroke center as fast as possible—are critical steps for optimal stroke care. That’s because during an acute stroke, physicians must quickly evaluate and diagnose patients to determine whether they are eligible to receive the clot-dissolving drug recombinant tissue plasminogen activator which has to be given within hours of symptom starting.
Other new changes to stroke guidelines include:
- If feasible, transfer patients to the closest available certified primary care stroke center or comprehensive stroke center, which might involve air medical transport, though telemedicine with a stroke center may also be appropriate.
- Create multidisciplinary quality improvement committees within hospitals to review and monitor stroke care.
Read more on heart health.
New CT Device Offers Improved Imaging, Substantially Reduced Radiation
A new type of CT scanner from National Institutes of Health (NIH) researchers and engineers at Toshiba Medical Systems offers improved image quality while reducing the amount of potentially harmful radiation to patients by as much as 95 percent. This device will enable doctors to better diagnose conditions such as heart disease, according to coauthor Andrew Arai, MD, chief of the Cardiovascular and Pulmonary Branch at the NIH’s National Heart, Lung, and Blood Institute (NHLBI). Author Marcus Chen, MD, a clinician in the NHLBI’s Advanced Cardiovascular Imaging Laboratory, said the “improvements could help clinicians identify problems in even the smallest blood vessels or enable them to conduct complicated tests like measuring blood flow in the heart while limiting radiation exposure.” The U.S. Food and Drug Administration has approved the CT scanner, which still requires additional study. Read more on heart health.
Study: Black Patients Less Likely to Receive Kidney Transplants before Needing Dialysis
Patients who are black or do not have private insurance are less likely than others to receive a kidney transplant before having to go on dialysis, according to a new study in Clinical Journal of the American Society of Nephrology. The study was conducted by researchers at the Johns Hopkins University School of Medicine, including lead author Morgan Grams, MD, who told Reuters it shows "just another disparity" for African American patients. Douglas Scott Keith, MD, head of the kidney transplant program at the University of Virginia Medical Center in Charlottesville and not part of the study, said studies "over the last 10 to 15 years have consistently shown that minorities have poorer access to transplantation. This article basically shows that it's persisting, it hasn't gotten much better.” African American patients are about 56 percent less likely than white patients to receive a kidney transplant before needing dialysis. Read more on health disparities.
Medical School Conflict of Interest Policies May Affect New Doctors’ Prescription Habits
Doctors who graduate from medical schools with policies restricting gifts from pharmaceutical companies may be less likely to prescribe new medications over current options, according to a new study in the BMJ. "Our findings suggest that conflict of interest policies, which have been increasingly adopted by medical schools since 2002, may have the potential to substantially impact clinical practice and reduce prescribing of newly marketed pharmaceuticals," wrote Marissa King, an assistant professor of organizational behavior at the Yale University School of Management, and colleagues. The researchers say further study is needed to determine whether the measures affect the prescription of all new medications, or if the effect is more selective. Read more on prescription drugs.
MLB to Test for Human Growth Hormone During the Season
Major League Baseball and the Major League Baseball Players Association have agreed to perform in-season blood testing for human growth hormone, as well as a test to detect synthetic testosterone. The use of performance-enhancing drugs has become a significant issue in baseball over the past several years, calling into question the accomplishments of many players going back to the 1980s. Earlier this week the sport’s Hall of Fame announced no one had been elected on this year’s ballot, which included perhaps the greatest batter and the greatest pitcher of the past 40 years—both of whom are tainted by the scandal of the steroid era. Read more on substance abuse.
Flu Season Seeing Shortages of Vaccine, Tamiflu
The increasingly bad flu season is also now seeing a shortage of flu vaccine and the Tamiflu treatment for children. Many forms of the vaccine are sold out and major vaccine provider Sanofi SA said it cannot make any more vaccine for this season because its facilities are already preparing for next season, according to Reuters. "People who haven't been vaccinated and want to get the vaccine may have to look in several places for it," said Tom Skinner, a spokesman for the U.S. Centers for Disease Control and Prevention. Earlier this week the city of Boston declared a public health emergency due to the flu. The city has reported about 700 cases since October 1. Read more on influenza.
Prescription Painkiller Misuse Trails only Marijuana Abuse In U.S.
Prescription painkillers trail only marijuana when it comes to substance abuse in the United States, according to a new report from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). Approximately 22 million people have misused the drugs since 2002. "Any time you have 2 percent of the population using medications like this there is a lot to do, but we are doing a lot with a combination of putting tighter controls on who can get these drugs and public education," said Peter Delany, director of SAMHSA's Center for Behavioral Health Statistics and Quality, according to HealthDay. Painkiller abuse is also taking a growing toll on emergency departments who deal with people seeking treatment. Read more on prescription drugs.
The U.S. Food and Drug Administration (FDA) yesterday announced it is requiring the manufacturers of widely used sleeping pills that contain the active ingredient zolpidem, to lower current recommended doses. Recommended doses will be required to be lowered on drug labels that doctors use to prescribe medicines and on medication guides given to patients, for the following drugs: Ambien, Ambien CR, Edluar and Zolpimist. FDA is also urging physicians to prescribe the drugs at the lowest dose capable of treating the patient’s insomnia.
The FDA announcement is based on driving simulation and laboratory studies showing that, in some individuals, zolpidem blood levels the morning after use appear capable of impairing driving to a degree that increases the risk of a motor vehicle accident. Reducing deaths from motor vehicle accidents is a priority for the Centers for Disease Control and Prevention. While these deaths declined between 2000 and 2009, car crashes are still among the top ten causes of death for all Americans.
New data is driving the announcement, according to the FDA. “Over the years FDA has received spontaneous adverse event reports of driving impairment and motor vehicle accidents associated with zolpidem, but these reports lacked the information necessary to fully understand whether and how zolpidem affected people’s mental alertness and ability to drive,” said Dr. Unger. “Recently, data from clinical trials and other types of studies have become available, which allowed FDA to better characterize the risk of next-morning impairment.”