Fake drugs hurt patients and pharma

Your Word on Health bloggers suspect that there’s probably not a single one of our readers who hasn’t, at one time or another, received a spam e-mail promising erectile dysfunction drugs at bargain prices.  While annoying, we can get rid of these with fast and judicious use of the delete button.Counterfeit drugs, made in Asia and other emerging markets, are however a more serious and growing problem.  According to the Pharmaceutical Security Institute (PSI), last year, almost 1,700 incidents of counterfeit drugs were reported worldwide –  triple the number in 2004.Estimates for the size of the counterfeit drug market range from $75 billion to $200 billion a year.  The World Health Organization suspects that more than 50% of the medicine bought from certain illegal websites are fake. As frightening as that figure is, the market is probably much bigger because many cases are hard to detect…and the problem is expected to get worse.

Fake drugs are a “money machine.” Sales are growing at twice the rate of legitimate pharmaceuticals, says Peter Pitts, president of the Center for Medicine in the Public Interest.  A weak economy along with rising drug prices are likely leading consumers to seek out cheaper products online or from unauthorized providers.

However, others believe that it’s not cheaper prices that drive consumers to counterfeit medicine, but their “lack of education and awareness of the dangers.” Counterfeit medicine may include too much, too little or none of the ingredients found in the real product, causing injury and, in extreme cases, death.

While fake drugs have been around for decades, the Internet’s growth and the popularity of Pfizer’s erectile dysfunction drug Viagra in the 1990s created the “perfect storm” to fuel this underground industry.

Today, drug rings in Asia, particularly in China and India, are increasingly churning out fake versions of popular brands and generics, then selling them to consumers online or in the black market.

Counterfeiters are now able to fake drugs so well, even experts find it hard to distinguish the copies from the real deal. And they’re able to replicate security devices such as holograms only a few months after pharmaceutical companies put these features on their packages.

You can make more money in counterfeit drugs than heroin,” says Tom Kubic, CEO of PSI. “There’s a major financial incentive for criminals because of the low risk of detection and prosecution.”

Now, drugmakers are fighting back.  Most pharmaceutical companies routinely gather information about fake drugs and pass it along to authorities. Some are even sharing such information with their competitors, sometimes leading to raids of suspected manufacturing facilities.

Fake medicines put both the reputation of the industry and, even more importantly, patients’ lives at risk.  They also divert consumers away from the legitimate products.

The FDA has produced some great resources to educate people about dangers of fake drugs.

Along with tips for buying medicines, the Agency’s website offers summaries of recent safety alerts and how to spot and report fraudulent or dangerous products.

One example of this is their “Warning Signs” of an unsafe drug web site.

They advise consumers to stay away from any site that:

  • offers prices that are dramatically lower than the competition
  • may offer to sell prescription drugs without a prescription—this is against the law
  • sends you drugs with unknown quality or origin
  • gives you the wrong drug or another dangerous product for your illness
  • doesn’t provide a way to contact the web site by phone

Seems the old adage “you get what you pay for” applies to drugs too

Goodnight, sleep tight, don’t let the bedbugs…make you paranoid!

SRxA’s Word on Health bloggers have been keeping a watchful eye on the impact of the recent bedbug outbreak on North Americans’ health.  Although bedbugs present only a mild threat to physical health, their impact on psychological well-being can be more serious.

Anxiety, paranoia and stress are common results of the social rejection some bedbug victims face.  Bedbugs not only consume a person’s blood, but also a person’s social interactions:  Can a victim hug her family?  Can she have guests over?  Is it okay for her to sleep at a friend’s place?  Even the decision to tell friends and colleagues about a bedbug infestation can cause distress.

The Toronto Globe and Mail reports that social rejection can occur in the workplace as well.  After a sleepless night in her condo, one victim showed up to work groggy and on edge. When her co-workers asked if she was okay, she broke down into tears and confessed she might have bed bugs.  They responded, ‘We’re going to support you, but we’re not going to touch you or go near you,’ the victim recalls.

People whose homes are infested with bedbugs face social stigmas.  Although even top-tier luxury hotels have fallen victim of bedbug infestations, the stereotype still exists that infestations are caused by a person’s dirtiness or poor hygiene.

SRxA’s Word on Health is pleased to learn that online support forums are available.  While some sites provide tips on how to prevent bedbugs, others such as BedBugger.com, specifically address the anxiety, paranoia and stress they cause.

Sweet Dreams!

Ever Heard of a “Fun” Explanation of Health Care Reform?

While explanations of the implications of president Obama’s 2010 Affordable Care Act (ACA) are painfully boring for most Americans, a surprisingly comprehensive and entertaining video, aims to change all that.  The non-partisan, non-profit research organization, Kaiser Family Foundation, produced this delightful video narrated by NPR’s senior news analyst, Cokie Roberts.

We know that many industry and healthcare-insider readers can likely recite pages of the Act, but maybe this video will help convince your family and friends to become involved in the discussion.

We can always go back to boring them again tomorrow!

Broken promises & fresh starts

SRxA’s Word on Health can’t help but wonder how Abbott employees are feeling today after learning that 3,000 jobs are to be cut.  According to Bloomberg, the corporate axe will fall as part of the company’s restructuring plan following its acquisition of Solvay’s pharmaceuticals business.

How ironic and painful it must be each time they see their corporate mission statement:  “A Promise For Life.”

So who will stay and who will go?  According to the company, most of the positions to be eliminated will be in sales, corporate staff, manufacturing and research.  While we’re not quite sure who that leaves, we do know that there will soon be a lot more pharma people out there looking for jobs.

Though few Abbott workers will take comfort from the fact that the restructuring will result in savings of $810 to $970 million over the next two years, they are certainly not alone.

2010 has been a busy year for the pharma chopping block.  A Google search on “pharmaceutical sales job cuts + 2010” elicited 331,000 results.

In the last quarter alone, Astra Zeneca, Merck, GlaxoSmithKline, Pfizer, Roche, Takeda, and UCB have all announced significant reductions of their sales force.

It’s all a far, far cry from the pharmaceutical industry zenith of 2004 when roughly 105,000 sales reps were employed in the US.

These latest job cuts appear to support the notion that the pharmaceutical industry is moving away from transactional selling to more value-oriented or solution-oriented selling.  Without its traditional army of sales reps the pharmaceutical industry will need to come up with new and better ways of engaging the physicians.

SRxA is here to help.  Contact us today to learn how we can help you to create and deliver successful programs in these changing times.

Lack of Trust deters African Americans from Blood Donation

As reported previously by Word on Health, racial disparities in healthcare are rife in the United States. Even though most of these show that ethnic minorities have poorer outcomes, we were surprised by a newly published study in Transfusion that explored why African Americans donate blood at lower rates than whites.

The findings revealed that there is a significant distrust in the healthcare system among the African American community, and African Americans who distrust hospitals are less likely to donate.

Led by Beth H. Shaz, MD, Chief Medical Officer of the New York Blood Center in New York, New York, researchers created a survey to explore reasons for low likelihood of blood donation in African Americans. 930 people  from 15 African American churches in metropolitan Atlanta participated the survey.

The most frequent reported motivators were:

  • donating to help save a life (96%)
  • donating because blood is needed (95%)

…while the most frequent barriers were that they rarely think about it and they were afraid, nervous, or anxious to give blood (35%). The association of barriers with donation status, age, gender, and education level was stronger than for motivators.

The study’s results also showed that about 1 in 5 African Americans (17 %) do not trust hospitals. This lack of trust was positively correlated with not donating blood even compared against other risk factors. Lack of trust in hospitals was also associated with not wanting to participate in research and less knowledge about the blood supply.

Respondents who did trust hospitals had more knowledge of the blood supply, less fear of donation, and were more likely to respond to blood needs of the community.

Clearly, blood centers and hospitals need to build trust with the African American community. SRxA’s transfusion medicine experts can help.

Contact us today to learn how.

Patients are from Mars, Physicians are from Venus!

Or so it would seem.  According to a study just published in the Annals of Internal Medicine there is a huge disparity between patients’ expectations of angioplasty versus those of their cardiologists.  While the majority of heart patients harbor the notion that angioplasty, a procedure performed to unblock clogged arteries, will cut their risk of heart attacks and death, cardiologists believe that its value is limited to reducing chest pain.

The research involved 27 cardiologists and 153 patients who consented to elective coronary catheterization and possible angioplasty, from Baystate Medical Center, Springfield, and Tufts University School of Medicine, Boston.

During angioplasty, a tube is inserted at the groin and snaked up to the affected artery, where a balloon opens the blockage. A stent is often left in place to help prop open the artery and maintain blood flow. Angioplasty involves some risk but the rate of death during the procedure is less than 1 percent, experts note.

Although 63% of cardiologists believed that the benefits of angioplasty were limited to angina symptom relief:

  • 88% of patients believe that angioplasty would prevent heart attacks or fatal heart attacks
  • 74% of patients thought that without the procedure  they would probably have a heart attack within 5 years

Furthermore, most patients stuck to their beliefs even after spending time with a cardiologist who explained the risks and benefits to them, and had them sign an informed consent form prior to the angioplasty.

The authors of the study noted that the benefits obtained by angioplasty can often be achieved with medication alone, and only patients who are actually having a heart attack or coronary event can expect a reduced risk of future heart attacks and death from angioplasty.

The number of angioplasties done for stable heart patients has decreased lately.  According to the American Heart Association, about 1.3 million such procedures are done in the United States each year.

Once again, this study highlights the “disconnect” between what doctors know and what patients understand. In order to have real informed consent, patients have to understand not just the risks, but also the benefits of whatever treatment is proposed.

One reason for patients’ misunderstanding is the common belief, that if a treatment is offered, it must have curative benefits.

However, the problem of patient understanding isn’t limited to angioplasty but is common in many areas of medicine. According to a previous study from the Mayo Clinic, doctors don’t always do a good job of knowledge transfer in a way that patients and family members can understand. Graphs and charts are not going to work for many patients.

SRxA and our team of problem based learning expert Advisors can help physicians, institutions and device manufacturers produce patient-centric materials to assist with informed consent. Contact us today to find out more.

Your Life in “It’s” Hands

Videoconferences may be known for putting people to sleep, but never quite like this.

In a world first, Canadian scientists, last week treated patients undergoing thyroid surgery in Italy –  remotely from Montreal.  The approach is part of new technological advancements, known as Teleanesthesia.

The operations involved a team of engineers, researchers and anesthesiologists who controlled the administration of anesthetic agents from thousands of miles away using an automated system.

Four strategically placed video cameras monitored every aspect of patient care in Pisa, Italy, in real time.

Ventilation parameters, such as the patient’s breathing rate, vital signs (ECG, heart rate, oxygen saturation) and live images of the surgery were monitored by each camera, with the fourth used for special purposes.

A remote computer station known as the ‘anesthesia cockpit’ handled the audio-video link between the two centers. Prior to the operation, an assessment of the patient’s airway and medical history was performed via video-conferencing.

For those people concerned that computers can and do go wrong, chief investigator Dr. Thomas  Hemmerling offers the following reassurance, “Obviously, local anesthesiologists can override the process at any time.”

SRxA’s Word on Health will be monitoring all developments!

Hang on to your head! – New hope for migraine sufferers

Last week gene detectives revealed an important clue that could bring hope to millions of migraine sufferers worldwide.

After poring over the genetic profiles of more than 50,000 people, scientists announced that they had found the first inherited link to one of the most common types of the disease. This could be a huge breakthrough, both in terms of health, economics and quality of life.

Recent statistics from the National Institute of Health suggest that 11.7% of Americans (17.1% of women and 5.6% of men) suffer from migraines.  In Europe, the figures are reportedly even higher.  According to the World Health Organization (WHO), migraine is one of the top 20 diseases in terms of handicap. Indeed, a 2009 study put migraine’s economic cost on a par with diabetes.

Despite this, migraine is often perceived as a condition that imposes a minimal burden on society. Indeed sufferers are often accused of malingering.  These misperceptions persist, in part, because the disorder is episodic and rarely causes long-term physical disability. It’s also under-diagnosed and under-treated. As such, analyses of claims data underestimate the condition’s prevalence and economic impact.

In this latest breakthrough, scientists from 40 medical centers compared the genetic profiles of those who suffered from migraines with people who were otherwise healthy.  What they found was a tiny but telltale variant of DNA that boosts the risk of getting migraines by about a fifth.

This is the first time we have been able to peer into the genomes of many thousands of people and find genetic clues to understand common migraine,” said Aarno Palotie, head of the International Headache Genetics Consortium.

Although previous research has found links for some extreme forms of migraine this is the first to pinpoint an association for common types of the disease.

The tiny genetic variant, or allele, is called rs1835740.

Lying between two genes on Chromosome 8, rs1835740 allows glutamate – a messenger chemical to accumulate in junctions between brain cells.  According to the team, accumulated glutamate then unleashes the migraine.  Although the authors say further work is needed to confirm the findings, if confirmed, all scientists have to do is find a drug that prevents glutamate build-up.

Easier said than done?  Only time will tell.

Meantime,  SRxA’s Word on Health would love to hear from you with your migraine stories and tips.

Pedestrian Struck!

As a volunteer EMT and trainee paramedic, this SRxA Word on Health blogger has seen, all too frequently, the tragic consequences of pedestrian trauma.

These are never good calls. Regardless of the cause or the circumstances, in the battle of man-versus-metal, it’s rarely the car that suffers.  In such circumstances, we do everything we can, and like to think that our interventions play a critical role in the survival of such patients.

However, new research from Johns Hopkins suggests that the victims’ race and economic factors are also crucial determinants of outcome.  According to a study just published in Surgery, even if the injuries sustained are similar, uninsured, minority pedestrians hit by cars are at a significantly higher risk of death than their insured white counterparts.

The death rate disparity is compounded by the fact that minority pedestrians are far more likely than white pedestrians to be struck by motor vehicles.

It’s a double whammy,” says Adil H. Haider, M.D., M.P.H., an assistant professor of surgery at the Johns Hopkins University School of Medicine and the study’s senior author. “Minorities are much more likely to get injured by this mechanism and much more likely to die by this mechanism.”

Researchers reviewed National Trauma Data Bank information on 26,404 patients hit by vehicles between 2002 and 2006. African-American patients had a 22% greater risk of death and Hispanic patients a 33% greater risk of death than white patients involved in similar crashes. Meanwhile, the researchers said, uninsured patients had a 77% greater risk of death than those who were insured.

Do we treat minorities and the uninsured differently? I don’t think so, but we’ve got to ask the question,” added Haider.

A greater prevalence of, or lack of treatment for, co-morbidities, such as obesity, diabetes or hypertension, could be factors that raise the risk of death among injured minority or uninsured crash victims.

Since the underlying causes of the disparities can’t be easily answered, Haider says, policy makers need to focus in the short term on better pedestrian injury-prevention programs, particularly in the inner city, where many of these deadly crashes occur.

Here at Word on Health, we say “Be Careful.”   Much as we love our readers, let’s not meet on an ambulance.

Animal, Vegetable, or …Clinical Trial?

Several clinical trials in the past 10 years have demonstrated that a low-carbohydrate, high-fat, high-protein diet is at least as effective as a calorie-restricted, high-carbohydrate, low-fat diet for weight loss and improvement of risk factors such as blood pressure, blood sugar and lipid levels.

While older observational studies linked dietary fat with poor health outcomes, newer systematic reviews, have absolved fat, with the exception of trans-fat. Many such studies have implicated refined sugars and starches instead.

Yet, in contrast to the robust understanding we have about diet and risk factors, our knowledge about the effect of diet on mortality is much more sparse, A new study, just published in the Annals of Internal Medicine study attempts to address this gap.

Researchers found that an animal-based low-carbohydrate dietary pattern increased the risk for death, whereas a plant-based low-carbohydrate diet lowered the risk.

Having analyzed food frequency questionnaires from 85,000 women from the Nurses’ Health Study and 45,000 men from the Health Professionals’ Follow-Up Study over  20 years’ they found:

  • People who had the highest scores for an animal-based low-carbohydrate diet were at increased risk for all-cause and cardiovascular mortality.
  • Those with the highest plant-based low-carbohydrate diet scores had a reduced risk for all-cause and cardiovascular mortality.
  • Men who more closely followed any low-carbohydrate diet had a higher cancer mortality risk.

The question is how to understand this new information in the context of the existing knowledge on diet and health and research design.

Observational studies have great strengths but also significant limitations.  For now, it seems that no one can legitimately claim that a low-carbohydrate diet is either harmful or safe with any degree of certainty.

Word on Health would love for you to weigh in on this.