Halloween “Creepy-Crawlies” give parents the Heebie-Jeebies

For many parents one of the scariest things this Halloween will be the note their little monster brings home from school saying that a case of head lice has been detected.

“While the make-believe vampires are prowling for candy, head lice are looking for a real blood meal,” says Dr. Andrew Bonwit, a pediatric infectious disease expert at Loyola University Health System.

According to the Centers for Disease Control and Prevention (CDC), an estimated 6 to 12 million infestations occur each year in the United States among children aged 3 to 11.

Although head lice biting feed on blood the bite will rarely, if ever, be painful. In fact, the two main consequences of lice infestations are itching and emotional distress, particularly of the parent!

So, in the interests of parents mental health this Halloween, SRxA is pleased to share with you Dr Bonwit’s Top Tall Tales About Lice. (Try saying that one with your mouth full of candy!)

Myth 1: Lice are caused by being dirty. Personal hygiene and socioeconomic status have nothing to do with having or transmitting head lice. The head louse is an equal-opportunity pest!

Myth 2 Pets spread lice: Animals are not known to carry head lice nor to transmit them to people

Myth 3: Beware sharing hairbrushes and personal items to avoid lice. Although it’s probably best not to share such items as combs, hairbrushes and hats, these do not seem to transmit the pest. Transmission of lice seems to occur only by direct head-to-head contact from one person to another

Myth 4: Kids with lice should be sent home from school immediately. The American Academy of Pediatrics does not endorse “no-nit” policies that exclude children from school because nits are present. In fact, even the presence of mature head lice is not considered a valid reason to exclude children, only a cause for prompt referral to the physician for treatment

Myth 5: Lice carry disease. Head lice do not transmit serious infectious.

Having got that straight, it’s worth emphasizing that lice are very treatable.  A simple over-the-counter or prescription insecticidal shampoo or lotion applied to the scalp, left on for a specified time and rinsed off is usually all that’s needed. As the life cycle of lice is about seven days from the laying of the eggs to the hatching, a second treatment, seven days after the first is recommended to prevent further infestation.

Which only leaves you with the vampires to worry about!

Happy Halloween.

Doctors don’t care if patients take their medicine

When SRxA’s Word on Health read the above title from fellow healthcare blogger Lucy Pyne, we were intrigued.

Could this be true?   Citing a 2008 study entitled “Just What the Doctor Ordered,” she argues that physicians don’t consider adherence to be their primary responsibility and seriously underestimate the incidence of non-adherence, often thinking that they are unable to address the issue themselves. Instead, they believe that patients are responsible for their own adherence.

Could this be right? When prescribing new or different medication regimens, physicians spend most of the time explaining the purpose and side effects of the drug and sometimes how to take it. Less, and often no time, is spent on consequences of non-adherence, potential interactions, and refills. And in today’s high-volume pharmacy environment,  busy check-outs, drive-thrus, internet pharmacies and home delivery services in-depth pharmacist-to-patient counseling on the safe use of medication is no longer the norm.

Does it matter anyway? There’s plenty of research out there to show that the average patient forgets about half the information provided 15 minutes after meeting with a doctor. Studies also show that patients remember more about diagnosis than the details of treatment.

Hell, Yeah, it does! As a result patients are not being treated properly and the health industry is losing hundreds of millions in revenue. Adherence does matter, and it needs to matter more. There’s an abundance of reasons why patients don’t adhere to their medication. A fear of it harming rather than helping is particularly common.  No surprise then that the most frequently used health-related Google search term is ‘drug side effects.’ And while much of the information on the Internet is accurate, much of it isn’t, requiring healthcare professionals to rebut false information and deliver accurate instructions.

So, what are the options? According to Pyne, the pharma industry must review its approach to marketing. In order to maximize sales and overcome the dangerous consequences of patient non-adherence, the issue of non-adherence cannot be ignored for much longer.  Something needs to change. The simple truth is, drugs don’t work if patients don’t take them. SRxA can help industry address and solve their adherence problems. We have developed a number of unique programs that not only improve medication usage and prescription refills, but deliver better health and reduced costs. Contact us today to learn more.

Should Pharma Pay Patients?

Paying patients to take their medicine. It may sound crazy, it may freak out compliance folks, but apparently it works. As previously reported by Word on Health, one -third to one-half of all patients do not take their medication as prescribed, and up to one-quarter never fill their prescriptions. These lapses cost more than $100 billion dollars annually because those patients often get sicker.

To combat this, both the US and Europe, have begun to use financial incentives to improve patient adherence. Here in the US, insurance companies have started to fund incentive schemes as they have found it costs them less in the long run if medication adherence improves. Last year, the New York Times published an article advocating the use of incentives to improve adherence. They cited a successful Philadelphia program whereby people prescribed the blood-thinner drug warfarin could win $10 or $100 each day they took the drug. A computerized Informedix Med-eMonitor pillbox recorded if they took the medicine and whether they won that day. Among patients enrolled in the program, the average amount of incorrectly taken pills or missed pills dropped from 22% to 2.3%.

Another study at Queen Mary’s hospital in London looked at the effect of incentives on the adherence of schizophrenia patients. Investigators found that offering financial incentives increased adherence, improved health and social outcomes and prevented rehospitalizations in 4 out of 5 patients. Preventing re-hospitalization saves a vast amount of money and is far better for the patient.

But, is paying patients really the answer? Maybe not.  A review of patient targeted incentives by The Health Care Foundation concluded that, while “financial incentives can work to bring about discrete, one-off changes in patient behavior…there is insufficient evidence to say that financial incentives can affect complex behavior change, although there is some evidence for temporary improvements.” The key words here are ‘one-off’ and ‘temporary’ – this is a short-term solution, not long-term. In both the aforementioned studies adherence went back down after the incentives finished.  In the study at Queen Mary’s, lead investigator and psychiatry professor Dr. Stefan Priebe admitted that, for most patients, you would probably have to keep the incentive going. The Philadelphia study showed similar results. However, given the potential long-term savings, if payments must continue indefinitely, Dr. Kevin Volpp said “it wouldn’t necessarily be a bad thing.”

So, is there another option? In 2004, Malotte et al. constructed one of the only incentive experiments that simultaneously looked at other methods of improving adherence. They compared different  methods to increase repeat testing in persons treated for gonorrhoea and/or chlamydia at sexually transmitted disease clinics. The results suggested that monetary incentive did not increase return rates. In this study, a reminder telephone call was the most effective intervention.

Although financial incentives work, they are not a realistic long-term solution. Better communication and patient empowerment appears to be the key. Find out how SRxA’s team of Health Outcomes specialists can improve your adherence programs.

A vitamin-a-day may do more harm than good

One of the few businesses that has benefitted from the current U.S. recession has been the dietary supplements industry. While some predicted that falling disposable income would hamper sales of vitamins and supplements, the opposite actually occurred: As more people lost their jobs and ability to pay for healthcare, many turned to supplements to remain healthy and ward off expensive doctor visits and pharmaceutical drugs. 

However, the results of two studies, published last week may signal a  reverse of the fortunes of this $30 billion per year industry.

Last week researchers from the Cleveland Clinic announced that vitamin E can enhance chances of prostate cancer. A study involving more than 35,000 men found that those who took a daily dose of 400 IU of vitamin E had a 17% increased incidence of prostate cancer than men who took a placebo.

“For the typical man, there appears to be no benefit in taking vitamin E and, in fact, there may be some harm,” said Dr. Eric Klein, an internationally renowned prostate cancer expert who served as the national study coordinator.

This surprising news was followed in short order by a report that dietary supplements can also increase mortality rate in older women.

The Iowa Women’s Health Study, which started in 1986, set out to determine to what degree diet and other lifestyle factors influence risk of chronic disease.

By the end of the study period in 2008, a total of 41,836 postmenopausal women were investigated – of which 15,594 had died. Multivitamins, vitamin B6, folic acid, iron, magnesium, zinc and copper were all associated with increased total mortality risk.  Supplemental iron was most strongly associated with increased mortality whereas, calcium supplements, were associated with a decreased risk.

Study leader Dr Lisa Harnack, associate professor of epidemiology at the University of Minnesota, said: “Among the elderly, use of supplements is widespread, often with the intention of attaining health benefits by preventing chronic diseases. Our study raises concerns regarding their long-term safety.”

SRxA’s Word on Health won’t be taking any chances. No more once-a-day for us!

Asthma Drug Spending Soars in U.S.

According to new government figures U.S. spending on asthma drugs more than quadrupled in the 10 years from 1998 to 2008.  During that time, annual costs rose from $527 million to $2.5 billion.

Many of the reasons are clear.  Firstly, the the number of people diagnosed with asthma grew by 4.3 million between 2001 to 2009. Asthma rates rose 50% among black children during that time.  And the problem is still growing. The U.S. Centers for Disease Control and Prevention (CDC) estimates that 7 million kids and nearly 17.5 million adults suffer from asthma.

Secondly, the proportion of children who used a prescribed drug to treat their asthma doubled from 29% between 1997-1998 to 58% between 2007-2008.  Overall, spending on drugs to control asthma grew from $280 million in the late 1990s to $2.1 billion by 2008. In that same period, spending on drugs to relieve immediate symptoms grew from $222 million to $352 million.

Thirdly, annual spending on older, less expensive drugs such as oral corticosteroids has fallen, while newer more expensive medications have taken their place.  Examples of more expensive medications include,  inhaled corticosteroids which prevent inflammation and control asthma; reliever drugs such as short-acting beta-2 agonists (SABA’s) that make breathing easier and leukotriene receptor antagonists which help prevent asthma symptoms from occurring in the first place.

Over the past decade there has been a 25% rise in the number of patients using inhaled corticosteroids, a 10% rise in the use of beta agonists and a 31% rise in leukotriene receptor agonists such as Montelukast (sold as Singulair®) and Zafirlukast (sold as Accolate®).

Do these spiraling costs take your breath away or suggest that asthma is being better controlled?  Let us know your thoughts.

The provider will see you now!

Back in the days when I was training, medical students had to study Latin in order to achieve fluency in the language of medicine.  Today, it seems, doctors are learning an entirely new lingo consisting of buzzwords and business speak! According to Pamela Hartzband and Jerome Groopman, two Harvard Medical School / Beth Israel Deaconess Medical Center physicians, current healthcare reforms mean that hospitals are becoming factories and clinical encounters are becoming little more than economic transactions. Writing in the latest edition of the New England Journal of Medicine they claim that, “Patients are no longer patients, but rather ‘customers’ or ‘consumers’. Doctors and nurses have transmuted into providers.” The combination of the ongoing economic crisis and efforts to reform the health care system have resulted in many economists and policy makers proposing that patient care should be industrialized and standardized and that hospitals and clinics should be run like modern factories.  At the sane time, archaic terms like doctor, nurse and patient are being replaced with terminology that fits this new order. In the process, the special knowledge that doctors and nurses possess and use to help patients understand the reason for and remedies to their illness get lost in a system that values prepackaged, off-the-shelf solutions. “Reducing medicine to economics makes a mockery of the bond between the healer and the sick,” they write. Hartzband and Groopman say the new emphasis on ‘evidence-based practice’ is not really a new phenomenon at all. ‘Evidence’ was routinely presented on daily rounds or clinical conferences where doctors debated numerous research studies. Back then, the exercise of clinical judgment, which permitted the assessment and application of data to an individual patient, was seen as the acme of professional practice. Now, health policy planners, and even some physicians, contend that clinical care should essentially be a matter of following operating manuals containing preset guidelines, like factory blueprints. Even more troubling, the authors suggest, is the impact of the new vocabulary on future doctors, nurses, therapists and social workers who care for patients. “Recasting their roles as providers who merely implement prefabricated practices diminishes their professionalism. Reconfiguring medicine in economic and industrial terms is unlikely to attract creative and independent thinkers.” When we are ill, we want someone to care about us as people, rather than as paying customers. Despite the lip service paid to ‘patient-centered care’ by the forces promulgating the new language of medicine, their discourse shifts the focus from the good of the individual to the exigencies of the system and its costs. Should we celebrate the doctors whose practices maximize profits or those who show genuine concern for their ‘customers’ or better still patients? Let us know what you think.

Improving Survival with AAA

Question: What do Albert Einstein, Lucille Ball, Conway Twitty and my high school physics teacher have in common?

Answer: They all lost their lives as a result of a ruptured (or dissecting) abdominal aortic aneurysm (AAA).

Unlike many fatal illnesses that are preceded by warning signs, a ruptured AAA tends to happen suddenly and spontaneously. Usually described as either a searing, ripping or tearing pain it’s generally the worst pain the patient has ever experienced.

“There are no early signs. It just happens. It presents as sudden severe chest pain, oftentimes between the shoulder blades,” says John Eidt MD, head of vascular surgery at the University of Arkansas Medical Sciences Medical Center.

An AAA is a bulge in the large blood vessel that supplies blood to the abdomen. The bulge typically develops slowly over many years. The larger the aneurysm, the more likely it is to rupture and cause massive bleeding.

Dissection occurs when the aorta tears due to high blood pressure or a trauma and blood leaks out of the wall of the aorta eventually stopping the blood supply to the kidneys, brain, bowels and other extremities.

A burst AAA causes massive internal bleeding that few survive. My physics teacher was playing squash when his ruptured and never even made it off the court.  Of the 15,000 or so Americans who suffer AAA ruptures each year, about 80% die before they get to the hospital. Among patients who make it to the hospital in time, only about 50% survive traditional open surgery, during which a surgeon makes a large incision in the abdomen and replaces the damaged portion of the aorta with a Dacron tube.

However a new minimally invasive endoscopic procedure is changing all that.

Loyola University Medical Center vascular surgeon Dr. Richard Hershberger and his vascular colleagues are pioneering a technique known as endovascular surgery. In the last four years, they have performed endovascular surgery on 12 patients with ruptured AAAs, and they all survived.  The endovascular technique involves inserting a catheter into a groin artery, guiding it through blood vessels to the site of the burst aneurysm and inserting a GoreTex® stent graft that allows blood to flow safely through the stent, rather than gushing into the abdominal cavity.

Despite the improved odds of survival, SRxA’s  Word on Health should point out that it is much easier and safer to repair an aneurysm before it bursts. Risk factors for AAAs include smoking, high blood pressure, high cholesterol, male gender, emphysema, and obesity. As such, all  men 65 and older who have smoked more than 100 cigarettes in their lifetime should be screened for AAA’s.

Treating asthma leads to better diabetic control

At first glance asthma and diabetes would seem to have very little in common, other than they are both diseases that often appear in childhood.

However, a new study published in the journal Pediatrics shows a new link.  Researchers have found that kids with diabetes may have a higher-than-average rate of asthma, and those with both conditions seem to have a tougher time keeping their blood sugar under control.

Among 2,000 3- to 21-year-olds with diabetes, 11% had asthma – higher than the expected 9% rate among children and young adults in the U.S.

The difference was even bigger when the researchers looked at type 2 diabetes, the form associated with obesity, and usually diagnosed in adults. In that group, 16% had asthma.

Researchers also showed that kids with both type 1 diabetes and asthma were more likely to have poor blood sugar control than their peers who were asthma-free.

The reasons for the findings are not completely clear.  However, the higher rate of asthma among young people with type 2 diabetes suggests a role for obesity, according to lead researcher Mary Helen Black, of the department of research and evaluation at Kaiser Permanente Southern California.

Some past research has found that people with poorly controlled diabetes are more likely to show diminished lung function over time than those with well-controlled diabetes. But the reasons for that are also unknown.

Black suggests the reason may simply be that it’s tougher for kids with type 1 diabetes to control their blood sugar when they have another chronic health problem.

The good news is that when kids with both diseases were on asthma medication, their blood sugar control was better. In particular, poor blood sugar control was seen in less than 5% of those taking leukotriene modifiers such as Singulair, Accolate and Zyflo; compared with about 30% of type 1 diabetics who were not on medication for their asthma.

The researchers are not sure if that means there’s an effect of the asthma drugs themselves. It may just be that kids with better-controlled asthma are also more likely to have well-controlled diabetes.

The bottom line for doctors and parents is to be aware that kids with diabetes may have a somewhat higher rate of asthma – and that those with both may have more trouble with blood sugar control.

Do you or your child suffer from both conditions?  Does this research support your experience?  As always we’d love to hear from you.

What’s In A Name?

Many words sound alike but mean different things when put into writing. Think “accept” – a verb meaning to receive or agree and “except” – a preposition meaning other than. While such confusion may cause grammar teachers to lose sleep and their student’s grades to suffer, the consequences are generally minimal. When it comes to drugs, however, it’s a different matter. The existence of confusing drug names is one of the most common causes of medication error and is of concern worldwide.  Many drug names look or sound like other drug names. Contributing to this confusion are illegible handwriting and similar packaging or labeling.

Recently, the Institute for Safe Medication Practices (ISMP) warned pharmacists and other healthcare providers about mix-ups of a prescription eyedrop solution and a wart-removal drug with similar-sounding names after receiving reports describing situations in which nurses and pharmacists confused Durezol, a prescription corticosteroid eyedrop solution used to treat inflammation and pain following ocular surgery, and Durasal, a prescription wart remover. Both products are packaged in small applicator bottles.

In a case that led to a lawsuit against Walgreens earlier this year, a pharmacist allegedly misread a doctor’s prescription for Durezol eyedrops and instead dispensed Durasal wart remover. The patient put the wart remover into his eye, suffered “grievous personal injury,” and filed a $1 million lawsuit against Walgreens.

SRxA’s Word on Health has learned that this is not an isolated mix-up.  The ISMP has published a list of hundreds of drugs with sound alike names that have come to light because mix-ups have occurred. So, before you inadvertently put wart remover in your eyes…or worse, we strongly recommend that you read the labels and patient information leaflets before taking any new medication.

What’s bugging you this Columbus Day?

If you’re travelling to New England this Columbus Day be prepared for more than the glorious fall leaves.  According to the Massachusetts Department of Public Health (DPH)  both West Nile Virus (WNV) and Eastern Equine Encephalitis (EEE) have been isolated from mosquitoes in the region.

Although most human cases of both viruses are contracted during the summer months, the recent flooding followed by a spell of warm weather means there is still an active disease carrying mosquito population.

“Sometimes it’s hard to believe that mosquito bites, particularly in the fall, are anything other than a minor annoyance,” said Dr. Al DeMaria, State Epidemiologist.

However, these mosquito borne illnesses can cause fever, meningitis or encephalitis and may even be fatal. So far this year, three cases of WNV and one case of EEE have been confirmed in the region.

Mosquitoes acquire the viruses by biting an infected bird and then transmit the virus to humans, horses or other birds.  While WNV can affect people of all ages, those over the age of 50 are at the highest risk for severe disease.

To help protect you and your loved ones from illnesses caused by mosquitoes this Columbus day, SRxA’s Word on Health offers the following advice:

Be Aware of Peak Mosquito Hours. The hours from dusk to dawn are peak biting times for many mosquitoes. Schedule outdoor events to avoid these hours.

• Clothing Can Help Reduce Mosquito Bites. When outdoors, wear long-sleeves, long pants and socks. Cover the arms and legs of children and don’t forget to use mosquito netting over strollers, cribs and playpens.

• Apply Insect Repellent. Use a repellent with DEET (N, N-diethyl-m-toluamide), permethrin, picaridin (KBR 3023), oil of lemon eucalyptus [p-methane 3, 8-diol (PMD)] or IR3535 according to the instructions on the product label.

Wherever you are, and whatever you’re doing, Word on Health wishes you a happy and safe Columbus Day.