How Pharmaceutical Companies Influence Doctors

Natural Alternative to Doctors & Big Pharma -- Health Blog

Here's an interesting site you might want to take a look at. Although designed for doctors, the information is fascinating for the layperson as well. The MGH Institute of Health Professions, an academic affiliate of Massachusetts General Hospital, launched a new continuing education documentary and interactive websitedesigned to educate doctor/prescribers about drug industry influence. Ironically, the program is funded by Pfizer as a result of the Neurontin settlement.

In particular, you might want to check out their documentary film modules that explain how drugs get approved and marketed -- and the influence pharmaceutical companies have on those outcomes. It's surprisingly pointed, considering that it came out of mainstream medicine. Then again, the documentaries were produced by former pharmaceutical rep, now filmmaker and consumer health advocate, Kathleen Slattery-Moschkau.

Rebutting Robert Carroll's Skeptic Dictionary -- Natural Health Newsletter

Rebutting Robert Carroll's Skeptic Dictionary -- Natural Health Newsletter

Several weeks ago, the staff here at the Foundation brought to my attention Robert Carroll's "Skeptic's Dictionary" website that focuses on "exploring strange beliefs, amusing deceptions, and dangerous delusions." High on the site's list is alternative medicine. As the site says, "Some will be harmed by AM [alternative medicine] and many people will benefit from it, but the entire benefit from AM comes from the placebo effect and the reduction of stress hormones due to the calming effect of good ritual" -- a rather sweeping indictment, I must say. In any case, the reason the staff brought it to my attention is that there is now a featured page on the site -- dedicated to me.1 When I read the page, I found it uproariously funny, filled with misstatements, distortion of fact, and packed with innuendo and a number of juvenile comments -- surprising, considering that the site's author is a retired teacher of "logic" and "critical thinking," albeit at a city college. In any case, the staff insisted we craft a response, even though the site has no facility for leaving comments, and the site says that it will only rarely post them anyway. Nevertheless, I wrote one up, which the staff then toned down and sent on to Dr. Carroll (Ph. D.). The rebuttal was never published, and no response to the email was forthcoming from Dr. Carroll.

Overuse of Antibiotic Use In The Southeastern US

New research suggests a pattern of outpatient antibiotic overuse in parts of the United States-- particularly in the Southeast --a problem that could accelerate the rate at which these powerful drugs are rendered useless, according to Extending the Cure, a project of the Center for Disease Dynamics, Economics & Policy.

These findings come out just as the Centers for Disease Control and Prevention (CDC) kicked off an annual effort to reduce overuse of antibiotics called "Get Smart: Know When Antibiotics Work." The campaign, which lasts throughout the week, urges Americans to use antibiotics wisely. The CDC estimates that $1.1 billion is spent annually on unnecessary antibiotic prescriptions for adult upper respiratory infections alone. These prescriptions also speed the development of resistance to important antibiotic therapies.

Also, on Monday of this week, Extending the Cure introduced a new tool that allows non-experts to track changes in antibiotic effectiveness over time. The new Drug Resistance Index (DRI) is similar in concept to the Consumer Price Index and is described in a paper in the British Medical Journal Open.

Trends in Antibiotic Use Paint a Troubling Picture

Interactive maps released by Extending the Cure track antibiotic use in the United States from 1999 to 2007 and show how overall antibiotic dispensing has decreased; consumption fell by about 12% over this time period. However, they also highlight alarmingly high antibiotic use across the Southeast compared to states in the Pacific Northwest. For example, residents of West Virginia and Kentucky, where antibiotic use rates are highest, take about twice as many antibiotics per capita as people living in Oregon and Alaska.

Additional key findings include: 

• The five states with the highest antibiotic use in the nation are West Virginia, Kentucky, Tennessee, Louisiana and Alabama. However, the maps show higher than average use of antibiotics in other regions of the country as well. Check your state's antibiotics use at ResistanceMap.
• Prescribing rates for a powerful class of antibiotics known as fluoroquinolones shot up by 49 percent from 1999 to 2007. At the same time, antibiotic resistance is increasing: these drugs are now seven times less likely to work against Escherichia coli, the most frequent cause of bacterial infections, than they were in 1999.
• Penicillins remain the most popular antibiotics -- accounting for nearly one out of three prescriptions filled in the United States. At the same time, the market share of these standard drugs has declined by 28 percent as physicians increasingly turn to more powerful antibiotics.

High per capita antibiotic use rates could reflect an environment in which consumers mistakenly demand antibiotics – and physicians prescribe them -- when they have a cold or the flu, which are caused by viruses and cannot be treated with these drugs. However, additional research must be done to better understand the driving factors behind antibiotic use.

The data was released today as part of Extending the Cure's ResistanceMap, an interactive web-based tool that tracks drug resistance.

Novel Way to Track Resistance: Drug Resistance Index (DRI)

In a report published this week in the British Medical Journal Open, Ramanan Laxminarayan, Director of Extending the Cure, and Keith P. Klugman, Professor of Global Health at Emory University, describe a first-of-its-kind index for tracking resistance. Like a Consumer Price Index (CPI) for drug resistance, the tool aggregates information about resistance trends and antibiotic use into a single measure of antibiotic resistance over time.

Hospitals can use the DRI to track resistance levels in their facility and to measure the success of interventions including antibiotic stewardship and infection control programs. The tool also offers decision makers a convenient way of communicating progress and pitfalls in the fight against resistance, according to the study authors. The index is designed to be applicable at any level, from local hospitals to national healthcare system surveillance.

In this paper, researchers explain how the index can be used by assessing trends in resistance associated with two disease-causing micro-organisms: Escherichia coli and Acinetobacter baumannii. The index can also illuminate how physicians adapt to trends in resistance. For example, in this analysis, the index showed how physicians were able to use other drugs to treat infections caused by resistant strains of E. coli but had very few options left for treating Acinetobacter, a superbug that increasingly is resistant to all available antibiotics.

"Mapping the geography of antibiotic use and summarizing their effectiveness with a Drug Resistance Index bring us one step closer to the solutions we urgently need in order to curtail this public health crisis," Laxminarayan said. "If we do nothing, resistance will continue to develop and our most valuable antibiotics ultimately will fail."

Extending the Cure research suggests that policymakers must address the broader problem of antibiotic resistance by putting comprehensive solutions in place, including better infection control and surveillance as well as stepping up efforts to curtail overuse of antibiotics, a solution that would help preserve the power of the drugs we have left on the shelf.

Provided by Burness Communications

Be Careful With Your Pain Meds

Patients who are dependent on opioids (narcotic pain relievers) for pain management before knee replacement surgery have much more difficulty recovering, a study recently published in the Journal of Bone and Joint Surgery (JBJS) has found. These patients tend to have longer hospital stays, more post-surgical pain, a higher rate of complications, and are more likely to need additional procedures, than patients who are not opioid-dependent.

"We expected to find that the opioid-dependent patients have worse outcomes," says orthopaedic surgeon Michael A. Mont, M.D., the principal investigator and Director of the Center for Joint Preservation and Reconstruction at the Rubin Institute for Advanced Orthopaedics at Sinai Hospital of Baltimore. "But the differences between the two groups of patients were even greater than we thought they would be. The chronic narcotics users did significantly worse in every category."

Study Findings:

Patients included in the study were matched according to age, sex, body-mass index, insurance type, as well as a variety of medical factors. When those factors were accounted for, the study still found that chronic opioid users: 

• had to remain in the hospital longer after surgery
• were more likely to need referrals for pain management
• were more likely to suffer unexplained pain or stiffness
• had lower function and less motion in the replaced knee

"This doesn't mean that opioid users shouldn't have the surgery," Mont says. "But those patients and their physicians should know that their results may not be as optimal. It might be possible that we can work with these patients to improve theirsurgical outcomes."

Dr. Mont and his co-authors outline several strategies to help improve patient outcomes; including: 

• weaning patients off strong opioid medications prior to surgery
• prescribing alternate, non-opioid pain medications
• considering non-pharmaceutical pain management strategies

The study's authors acknowledge that some patients who become dependent on opioids before surgery may have lower pain thresholds than those who do not. In addition, those patients may be less compliant with rehabilitation plans and other post-surgical treatments. However, the results of this study are important enough to warrant attention to this issue.

"Previous studies have found that patients who use opioids are more dissatisfied after surgery," Mont says. "But these are more powerful findings since patients require additional surgeries. This is a topic our orthopaedic community and other care providers need to address together."

Provided by American Academy of Orthopaedic Surgeons (news : web)

I found this study to be a bit alarming because I have used Tramadol since 1998 to control my pain and I have had total knee replacement with absolutely no complications.  As a matter of fact, my therapist and doctor were amazed at my recovery.  I was a month ahead on my rehab then everyone else who had the surgery the same day I did.

Opioid Painkillers for Abdominal Pain More Than Doubled

Across U.S. outpatient clinics between 1997 and 2008, opioid prescriptions for chronic abdominal pain more than doubled, according to a new study in Clinical Gastroenterology and Hepatology, the official journal of the American Gastroenterological Association.

Chronic abdominal pain is a common symptom and a frequent reason for health-care visits. Because it is often incurable, clinicians often find it challenging to help their patients manage their abdominal pain over time.

"Opioid use for persistent abdominal pain highlights the growing challenges clinicians face trying to manage chronic illness without the time, infrastructure and incentives needed to take the integrated approach that experts suggest," said Spencer D. Dorn, MD, MPH, of the University of North Carolina and lead author of the study. "Writing a prescription for a pain killer may be the path of least resistance; doing so may satisfy the patient's demand for relief and mitigate the clinician's possible feelings of inadequacy."

The researchers concluded that the dramatic nationwide rise in opioid use to treat chronic abdominal pain is concerning for several reasons. First, using opioids to treat non-cancer chronic pain is supported by very limited evidence. Second, opioids are frequently misused and sometimes abused. Finally, when used over long periods of time, opioids may trigger other gastrointestinal symptoms, such as constipation, nausea and vomiting, and may even paradoxically worsen abdominal pain.

The researchers speculate that the growth in opioid use has likely been driven by numerous factors, including a tendency to generalize recommendations for the use of opioids in treating pain, campaigns to recognize pain as the "fifth vital sign," and widespread direct-to-consumer advertising, which, in the case of OxyContin, was considered misleading and illegal.

Provided by American Gastroenterological Association (news : web)