Prescription Abandonment

You get sick, you go to the doctor, he or she writes you a prescription for some pills, you take it to the pharmacy and then…   Logic would suggest that the next steps would be that you pick up the prescription, take the medicine and get better.

Well, not always.  According to a new study published in the Annals of Internal Medicine almost 2% of these prescriptions are never picked up.

Using databases from a large retail pharmacy chain and a pharmacy benefits manager, researchers examined factors associated with prescription abandonment over a 3-month period.

Unsurprisingly, drugs with high copayments are the most likely to go unclaimed.  Prescriptions with copayments of $40 to $50 and prescriptions costing more than $50 were 3.40 times and 4.68 times more likely, respectively, to be abandoned than prescriptions with no copayment.

In addition, electronic prescriptions were 1.6 times more likely than non-electronic prescriptions to be left behind, and new prescriptions were almost three times more likely to be abandoned than previously filled prescriptions.

Interestingly, young adults were more likely than older patients to abandon their prescriptions, while opiates and anti-platelet agents were the least likely to be left behind.

Although the accompanying editorial called the low rate of abandonment “reassuring,” they suggest that physicians “remain mindful that costs are an important barrier to adherence and should aim to prescribe or recommend less expensive alternatives whenever feasible.”

SRxA’s Advisors can help pharmaceutical companies increase medication compliance and implement programs to lower the consumer cost of prescription drugs. Contact us today for more information.

Pass the Nuts!

Although living with an acute peanut allergy can be scary and potentially life-threatening, according to the latest research from the American College of Allergy, Asthma and Immunology (ACAAI) it doesn’t mean that schools and airlines should totally eliminate peanuts from their surroundings.

“People with severe peanut allergies can work with their allergist to develop an action plan to prevent or manage attacks,” said ACAAI President, Dr. Sami Bahna.

Highly allergic people may react after ingesting minute hidden quantities of peanuts or even after touching or smelling peanuts. These patients often live in fear they will come in contact with peanuts but however much they try to avoid them, there is no guarantee that specific allergens can be removed entirely from an environment.

“Unfortunately, life is not risk-free,” said Dr. Bahna. “A minority of people are severely allergic to peanuts, but it is not reasonable or possible to expect schools or airlines to be peanut-free. Consideration should be also given to the freedom of the vast majority of non-allergic persons. Also, peanut is not the only food that can cause severe allergy.”

Dr. Bahna suggests that people and parents of children with severe peanut allergies check to be sure the school and airline carry emergency treatment and educate their personnel about food allergies, rather than call for an out and out ban.

Beating the Thanksgiving Guilt

With the holidays right around the corner, we suspect that many of our readers will already be worrying about the consequences of overindulgence and the missed days at the gym.

Fear not!  According to experts at The University of Texas MD Anderson Cancer Center, you can get daily exercise throughout the holiday season, by adding heart-pumping twists to tasks already on your holiday to-do list.

“Many holiday activities offer ways to get the 30 minutes of daily moderate physical activity that your body needs to help fight off many forms of cancer and other diseases,” says Karen Basen-Engquist, Ph.D., Professor in the Department of Behavioral Science at MD Anderson.

How, you may ask, is that possible?  Food, family and hours of watching football are hardly traditional calorie burners.

Well,  true to our mission statement, Transforming Challenges into Opportunities, SRxA’s Word on Health brings you our top exercise tips for the holidays:

Shopping?

Instead of driving around in search of a parking space near the door of the grocery store or mall, park as far from the entrance as you can.    Or, if you’re taking the bus, get off a stop or two early. Once  inside, opt for the stairs instead of the elevator and, if possible, carry your purchases instead of using a shopping cart.

Hosting guests?
Readying the house for guests and cleaning up after they leave is a great way to sneak in aerobic activity. With the right mindset, vacuuming, mopping, scrubbing, gardening and the multiple trips upstairs to put away laundry or holiday decorations become exercise opportunities, rather than chores.

Traveling?

If you’re flying or taking the train or bus take a brisk walk around the terminal while waiting to depart, and when you arrive at your destination, make your walk to baggage claim or the exit a quick one.

Whichever you chose, by making physical activity part of your holiday plans, you’ll ensure you have the momentum to keep exercising in the New Year.

Happy, Healthy Holidays to you all.

Hold That Call!

Could you be allergic to your phone?  In the second of our series of stories emanating from this year’s American College of Allergy, Asthma and Immunology allergists warn that “increased use of cell phones with unlimited usage plans has led to more prolonged exposure to nickel.”

According to allergist Luz Fonacier, MD, “Patients come in with dry, itchy patches on their cheeks, jaw lines and ears and have no idea what is causing their allergic reaction.”

Nikel is one of the most common contact allergens, and affects up to 17% of women and 3% of men. Contact with objects containing nickel, such as keys, coins and paper clips are generally brief, so the nickel allergy may not occur on the area of contact. However, the risk is increased by frequent, prolonged exposure to nickel-containing objects, such as cell phones.

Symptoms of nickel allergy include redness, swelling, itching, eczema, blistering, skin lesions and sometimes oozing and scarring. Avoidance of direct skin contact is the best solution and experts suggest that if you have a nickel allergy or are experiencing symptoms that you try using a plastic film cover, a wireless ear piece, or switch to a phone that does not contain metal on surfaces that contact the skin.

Those who suspect they have allergies to cosmetics, tattoos or nickel should be tested by an allergist – a doctor who is an expert in diagnosing and treating allergies and asthma.

To learn more about allergies and asthma, take a free relief self-test or find an allergist near you visit www.AllergyAndAsthmaRelief.org.

Love Hurts!

SRxA’s Word on Health team just returned from a memorable trip to Phoenix, Arizona.  In addition to managing a number of highly successful events, meeting many of our wonderful clients and spending some quality time with our Advisors; we were able to catch up with all the latest news from the field of asthma, allergy and immunology.

During one of the more memorable sessions, we learned that kissing and um, er, let’s just say, more intimate contact, can be fraught with danger for those with allergies, while in another we found out that everything from our makeup, to our cell phones might be making us sick.

Over the coming days we’ll be sharing the congress highlights with are readers, but in the meantime, let’s get back to kissing…

According to Dr. Sami Bahna, President of the American College of Allergy, Asthma and Immunology (ACAAI), while allergic reactions from kissing are relatively uncommon, they do occur.

Apparently, allergens from food substances can linger in a partner’s saliva up to a full day following ingestion, irrespective of tooth-brushing, rinsing, flossing  or other interventions such as chewing gum.

And if you’re one of the 7 million Americans who suffer from food allergies we’re not just talking about a passionate kiss. Even a kiss on the cheek or the forehead from a partner who has consumed an identified allergen can cause a severe reaction ranging from lip-swelling, throat-swelling, rash, hives, itching, and/or wheezing immediately after kissing.

And kissing isn’t the only form of romantic activity that can trigger allergic reactions in the highly sensitive. The ACAAI notes that sexual intercourse can pose its own hazards, given that some patients are allergic to chemicals found in spermicides, lubricants and/or latex condoms.  Even sperm can prompt an allergic reaction in some, as can the more general emotional and physical exertion of intercourse itself.

When it comes to semen allergy, Bahna said antihistamines can sometimes help with mild issues, as can immunotherapy treatments offered by allergists. Condoms can also help, as long as a person is not allergic to latex!

Despite these warnings, Bahna stressed, “I do not want this discussion to cause all people with allergies to live in fear. If your girlfriend or your wife is not very allergic to peanuts she won’t be affected by a kiss from a person who ate peanuts.”

Additionally, allergists can help determine what’s causing the allergy and find the right treatment. They have the training and expertise to treat more than just symptoms. They can identify the source of your discomfort and develop a treatment plan to eliminate it.

You can follow the ACCAI annual meeting on Twitter at #ACAAI2010.

Return of the Andromeda Strain?

The discovery of an exotic, infectious virus reveals leads to treatments for common lung diseases. Sounds like the plot of a new sci-fi novel turned movie?  Beautiful scientists battling a new superbug from outer space!

Not so, this one is all home grown and 100% non-fiction. According to the CDC, there have been three recent outbreaks of monkeypox in the United States.

Monkeypox is a rare viral disease that occurs mainly in the rain forest countries of central and west Africa. First discovered in laboratory monkeys in 1958, it has since shown up in rodents, squirrels, mice, rats, and rabbits. In 1970, monkeypox was reported in humans for the first time and in June 2003, the first documented infection occurred in the United States, most likely from imported pet prairie dogs.

Monkeypox infections in humans have been on the rise. Up to 10% of those infected, die of the disease. It can be caught from infected rodents, pets and monkeys and is thought to be transmitted by respiratory droplets during direct and prolonged face-to-face contact. Researchers attribute the rise of monkeypox infections to the end of smallpox vaccinations, which provided protection due to the similar nature of the two pox viruses.

Signs and symptoms of infection include fever, headache, muscle aches, backache, swollen lymph nodes, a general feeling of discomfort, and exhaustion. Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a papular rash. Death, when it occurs, is generally due to pneumonia.

But until now there have been few studies to look at how monkeypox infection damages the lungs. In the latest study, researchers at the Oregon National Primate Research Center infected macaque monkeys with the virus and followed the course of infection in the lungs of individual animals.

What they found was not only does the infection from monkeypox virus increase production of inflammatory proteins, it also decreases production of proteins that keep lung tissue intact and lubricated.

“Going into this study, we thought monkeypox caused disease primarily by inducing inflammation in the lung, and that leads to pneumonia,” said lead author Joseph Brown, a systems biologist at the Department of Energy’s Pacific Northwest National Laboratory. “We were surprised to see how badly the virus wrecked the structural integrity of the lungs.”

The results suggest that inflammation contributes to disease but it may not be the main component. Interfering with the structural proteins may play a major role.

Ultimately, this type of research could have wider implications than viral infection. “This study serves as a great reference for pulmonary diseases,” said co-author Josh Adkins. “It opens up the doors for other lung fluid studies.”

If these results can be reproduced in people, doctors might be able to give surfactants – lubricating chemicals that aid in gas exchange – to help the lung function in patients with altogether more common diseases such as bronchitis, emphysema or even flu.

As always, SRxA’s Word on Health will keep you informed of all developments.

The skinny on blood transfusions: a modern day miracle?

Most of us have read the biblical accounts of water being turned into wine.  Now Canadian scientists have discovered how to turn skin into blood.  This miraculous breakthrough could revolutionize cancer treatments and solve the blood donor shortage.

What is more because the blood is made from the patient’s own cells, there is no danger of either rejection or infection.

The team from McMaster University, Ontario say that the process has been so successful that treatment could be available within two years.

Dr Mick Bhatia who headed the team said “People will effectively become their own donors. We are very excited and very enthusiastic about it. There is a lot of work to be done but I would be disappointed if we were not trying it on patients by 2012.”

The research, published in Nature, is part of ongoing attempts across the world to revert adult cells back to their original stem cell form. Stem cells are “master cells” which can potentially be manipulated in a laboratory to become any other cell in the body.

Human Skin Cells

What’s unique about this process is that it misses out the “in-between” stage of turning the skin cells back to stem cells and then converting them to blood cells. Instead, the cell is reprogrammed directly by inserting a specific transcription factor – a protein that interacts with DNA to activate genes – and applying cytokines or signaling molecules.

The result – within a month the skin is converted to blood.

Leukemia patients are likely to be the first to receive transfusions of perfectly matched blood generated from their own skin. In future, laboratory manufactured blood could help to plug the gap caused by donor shortages. The technique also holds out the promise of making other kinds of cell, including neurons with the potential to treat brain diseases such as Parkinson’s and Alzheimer’s.

Skin cells from both young and old people were used in the research to prove that age of donor made no difference to the process.

Next the team plans to assess what kind of production capacity might be possible with the cells, and whether they can successfully be stored in deep freeze.

As always, SRxA’s Word on Health will be watching these developments and bringing them straight to you.

Veterans Day: Saluting those who have served and those who are helping them

In observance of Veterans Day, SRxA’s Word on Health is honored to spotlight a charity that provides wounded veterans with custom-engineered prosthetics and life-changing specialty equipment.

Working with students at California Polytechnic State University (Cal Poly) the nonprofit organization Quality of Life Plus (QL+) fosters and generates innovations to aid and improve the quality of life for those injured in the line of duty.

QL+ encourages military veterans and other public servants who have sustained life-changing injuries to submit “Challenges” through their website.  “Challenges” arising from the physical limitations faced by the injured Vets are then transformed into “projects”.  Once a challenge is identified and accepted the QL+ team and the Cal Poly students develop innovative solutions that help our nation’s heroes to live, to work and to play.

These achievements have been recognized far and wide.  According to Mark Sopp,  CFO and EVP of the Fortune 500 company Science Applications International Corporation ,“The organization and the students have made remarkable technological advancements that truly improve the quality of life for our wounded servicemen and servicewomen.”

The projects currently in development are fascinating.  One student team is working on a pressure-sensitive glove capable of simulating the sense of human touch.  The realistic-looking silicone skin will incorporate tactile sensors to reproduce the lost sense of touch for amputees.  Another project aims to research and develop a radar-type system to provide a wider scope and more detailed level of feedback for a visually impaired person.

“It’s amazing to have a direct, immediate impact for the good on the lives of those in need, like our nation’s war veterans.” says Nickolas Butler a 5^th year biomedical engineering student at Cal Poly, who is part of a team working on a new prosthetic hand that will give amputees greater functionality and yet will be more affordable than other prosthetic hands currently available.

And it’s not only the injured who are benefitting from this collaboration.  Butler says that the real-world design experience he has gained through the QL+ Laboratory has opened many doors to post-graduation opportunities. After graduating from Cal Poly, he plans to continue working on prosthetics and helping amputees live independent lives.

This Veterans day SRxA proudly salutes not only all of our service men and women but also those working for and with QL+.

Bitter Sweet News for Asthma Sufferers!

In a discovery that could potentially transform asthma treatment, researchers from Maryland have found our lungs carry receptors for bitter tastes.

The study, just published in Nature Medicine, found that receptors in the lung are the same as those that cluster together as taste-buds on our tongue.  In experiments using human and mouse lung tissue and mice with asthma, they found stimulating these receptors in the lungs with bitter substances  opened the airway more extensively than any known drug currently available for the treatment of asthma or chronic obstructive pulmonary disease.

These results came as a surprise to the scientists, who had expected bitter substances to constrict the airways rather than open them.

“I initially thought the bitter-taste receptors in the lungs would prompt a ‘fight or flight’ response to a noxious inhalant, causing chest tightness and coughing so you would leave the toxic environment, but that’s not what we found,” said lead researcher Dr Stephen Liggett.

In their experiments, the researchers tested bitter compounds such as quinine and chloroquine substances commonly used  to treat malaria.  However, there are thousands of other non-toxic, bitter compounds that are known to activate these receptors including natural plant substances and some synthetic agents.

Sadly for the campari, citrus and bitter chocolate lovers among us, the researchers did not find any link between eating bitter foods and improved breathing.  “Based on our research, we think that the best drugs would be chemical modifications of bitter compounds, which would be aerosolized and then inhaled into the lungs with an inhaler,” Liggett said.

Even then, inhaled therapies may not be available for years.

SRxA’s Word on Health will continue to follow this story and bring you all the latest developments.  In the meantime, if you want to spread the word about currently approved asthma treatments, please contact us to learn more about how our world class teams of Clinical Advisors can help.

Big Brother may not be watching, but the FDA, it seems is!

Here at SRxA, we all know how much physicians like to put on their marketing hats. In future, it seems, they might have to reach for their safety helmets instead!

According to our fellow bloggers at Good Promotional Practices doctors are starting to be held accountable to the same promotional compliance standards as pharmaceutical companies.

As most of our readers know, when FDA approves a drug it does so for a given use or indication. However, physicians are still free to make their own decisions based on how a device is used based on their best judgment. When a drug, biologic, or medical device is used for some indication other than the one approved by the FDA it is said to be “off-label.”

In this almost perfect dichotomy, it is perfectly legal, in the United States, for a physician to use a drug or device for “off-label” but it is unlawful to market, advertise or otherwise promote the off label use of a device or drug. Furthermore, based on the flurry of DOJ, OIG and FDA activity, such as the massive fines leveled out to Allergan ($600M), GlaxoSmithKline ($750 M), Novartis ($422 M) and Pfizer (2.3 billion) companies must keep the practices of their marketing and sales department in check to ensure compliance.

Until now the “it is unlawful to market, advertise or otherwise promote off label use of a drug” has been aimed at Pharmaceutical companies and third parties acting on their behalf.  Now people are asking “What if the hospital or physician group is doing the marketing themselves, not the company?”

We’ve all seen the billboards and free in-flight magazine ads promoting the latest medical treatments from liposuction to joint and hormone replacement.  With physicians are competing harder than ever to bring patients to their doors, what’s to stop them from stepping over the same lines that the companies may have, either willingly or not?

Blogger Sean McCarthy uses the example of the irregular heart rhythm Atrial Fibrillation (AF, AFib).  While there are very few approved drugs or devices to treat atrial fibrillation, upwards of 2.5 million Americans suffer from this debilitating condition.  Not so surprising then, that physicians use an array of off-label drugs and devices to treat this disease. So, now the hospital or physician communicates their ability to help AFib patients by promoting their latest treatment for the disease on a billboard or newspaper article. Isn’t this the same thing as a company promoting off-label use?

State Attorney Generals, the DOJ and FDA must be taking notice. They drive by the same billboards we do and read the same newspapers.  McCarthy says he’s heard rumors of a state Attorney General investigating a doctor about his referral patterns and advertising activities.

Who better than the pharmaceutical industry to take the lead in providing education to physicians  to help them prevent compliance snafus.  After all we’ve been there, done this!

Contact SRxA today to see how we can get you started.