Wheezing: Whining or Winning?

Many people with asthma avoid exercise because they’re afraid it could trigger symptoms such as shortness of breath, wheezing or a full-blown asthma attack.

However, a new report from The Cochrane Library turns these fears on their head. The authors conclude that not only is it safe for people with asthma to exercise, but it could also reduce their risk of asthma symptoms or attacks!

Study author, Kristin Carson, from The Queen Elizabeth Hospital, Clinical Practice Unit, Adelaide, Australia explains that over time patients with asthma who avoid exercise can become out of shape, losing muscle mass and cardiovascular fitness. That makes any future attempts at physical activity significantly harder, increasing the chances that patients will become fatigued and breathless and further discouraging physical activity. “This results in a spiraling cycle,” she says, in which patients are even more likely to avoid exercise.

To determine whether exercise was a danger to asthmatics, Carson and her colleagues reviewed previous studies that looked at the effects of physical training on people with asthma comparing patients who received no or minimal physical activity to those who exercised for at least 20 minutes, twice a week, over the course of four weeks.

The researchers found that the patients who had exercised, using physical training such as running outdoors or on a treadmill, cycling, swimming or circuit training were no more likely to have a serious asthma-related problem than those who weren’t exercising or who did light exercising such as yoga.

The patients who exercised also improved their cardiovascular fitness, which in turn can reduce asthma symptoms over time. There was also some evidence to suggest that exercise improved patients’ quality of life.

We found no reason for people with stable asthma to refrain from regular exercise,” Carson said. “Physicians should encourage their patents with stable asthma to engage in physical training programs.”

Even though this research suggests that exercise is safe for asthmatics, we suspect that many people will still think they can use their asthma as a reason to avoid physical activity.

Well now there is no excuse, and just in case you’re in any doubt consider the following list of people who never let asthma stop them:

Do you have any asthma and exercise stories to share?

Memorial Day Health Tips

Happy Monday and Happy Memorial Day to our US readers.  Today, we would like to start by thanking our servicemen and women for all they do in the line of duty, and reflect on those who have died serving our country.

Later today, many people will be celebrating this unofficial start of summer. And with that comes  BBQs, beer, and burgers. I could go on. And so could you. But don’t!

Instead, Word on Health would like to offer the following tips to help you enjoy the day – healthily:

Don’t talk with your mouth full!

It’s all too easy to wolf down food during holiday cookouts because we’re so busy talking and laughing with friends. But, eating too quickly leads to swallowing air, which leads to indigestion and bloating. By all means, talk to your friends, laugh and have a great time, but do it in-between eating and try to not talk until you have chewed properly and swallowed.

Eat the fruit first!

Summer cookouts are synonymous with overeating.  One of the worst habits is to get loaded up with burgers, chicken and hot dogs, then bring out the watermelon as an afterthought. From a digestive standpoint this is about as wrong as it gets. Fruit digests very quickly, whereas heavier foods don’t. Eating fruit first can help to prevent bloating and other digestive issues.

Don’t Fry!

Avoid sun burning, by applying sunscreen generously before you go out and after each dip in the pool. Wear sun-protective clothing, a wide-brimmed hat, and sunglasses and seek shade in the heat of the day.

Pack Light!

If you are planning on traveling, pack a cooler of low-fat, healthy snacks and water. This will help curb the temptation of drive-thru fast food restaurants.

Whatever you end up doing, we wish you a happy, healthy, and safe Memorial Day!

Could “No See” docs be doing a disservice to patients?

One of the biggest challenges facing any Pharma rep is the increasing number of  doctors who won’t see them. Every week, more and more physicians are restricting, and some even eliminating, their face time with sales reps.

In fact, the number of doctors willing to see reps has declined by about 20% since 2008.  And while some clinicians chose to do this, others have had it thrust upon them by their institutions or employers who are concerned that medical practice may be unduly influenced by pharmaceutical industry representatives.

Although  “no see” advocates argue that removing commercial influence is better for patients, a new study suggests the practice has downsides too.

This should be good news for the Pharma, who has always maintained that the clampdown on reps amounts to overkill and that more than selling, reps  provide information that can benefit patients.

The study, published in the Journal of Clinical Hypertension, divided medical practices into four categories. Based on the degree of sales representative access to clinicians, they were classified as either very low, low, medium, or high.

The clinical decisions, and prescribing behavior of over 72,000 physicians were then statistically analyzed, with regards to the drugs listed below:

The authors found that after the FDA approved Januvia, docs who had little interaction with reps took longer to write prescriptions than docs whose access to reps was not as restricted. Meanwhile, physicians who rarely, if ever, saw reps were slowest to change their prescribing habits after negative news emerged about Avandia and Vytorin .

Specifically, the study found that docs with very low access to reps had the lowest adoption rates for Januvia. They took between 1.6 and 4.6 times longer to start writing prescriptions after the pill was launched than docs who had low, medium or high access to reps. Docs who had very low access to reps were also 4 times slower than those of their counterparts to reduce their use of Avandia, after the Black Box warning was issued in 2007.  There was also “significantly less” change in the prescribing habits of those who had less access to reps in response to controversial and disappointing trial results released in 2008 for Vytorin, than those with fewer restrictions on rep interactions.

The study authors commented, “These findings emphasize that limiting access to pharmaceutical representatives can have the unintended effect of reducing appropriate responses to negative information about drugs just as much as responses to positive information about innovative drugs.”

George Chressanthis, professor of healthcare management and marketing, and acting director for the Center for Healthcare Research and Management at Temple University Fox School of Business, agrees.

The study affirms simple intuition that when physicians have to make decisions involving complex issues with less than complete information available to them, and where the consequence of a wrong decision is significant… unintended consequences are likely to appear. Policies that promote physician ignorance of new medical information resulting from access limits, run counter to protecting patient health.”

Could increasing, rather than decreasing  sales representative access to physicians lead to better clinical decision making and better patient health? Let us know what you think.

Nurse Practitioners Ready to Mind the Gap

Obamacare’ is expected to expand health insurance to 32 million Americans over the next decade. This will inevitably lead to a spike in demand for medical services; leading many people to wonder who will provide that care. Maybe we need to wonder no more.

As you read this post, nurse practitioners (NPs) are throwing their hats in the ring and gearing up to be among the front runners.

Through advertisements, public service announcements and events, the American Academy of Nurse Practitioners (AANP) will try to raise the profile of the country’s 155,000 nurse practitioners.  Their campaign aims to explain exactly what nurse practitioners do and why patients should trust them with their medical needs.

AANP will also exploit the very real, looming doctor shortage. According to the Association of American Medical Colleges  the country will have 63,000 too few doctors by 2015.

With the serious shortage of family doctors in many parts of the country, nurse practitioners  will claim, in a series of radio public service announcements, that they can provide expert, compassionate and affordable care. The AANP will follow up on the public relations blitz with state-level lobbying efforts, looking to pass bills that will expand the range of medical procedures that their membership can perform.

A fully enabled nurse practitioner workforce will increase access to quality health care, improve outcomes and make the health-care system more affordable for patients all across America,” ­ says Penny Kaye Jensen, president of the AANP. “It is our goal to empower health care consumers in all 50 states with clear confirmation that NPs provide professional, compassionate and cost-effective primary health care, as we have done for more than forty years.”

In 16 states, “scope of practice” laws allow nurse practitioners to practice without the supervision of a doctor. Other states, however, require a physician to sign off on a nurse practitioner’s prescriptions, and/or diagnostic tests.

As the health insurance expansion looms, expanding those rules to other states has become a crucial priority for NPs. “We’re all educated and prepared to provide a full range of services,” said Taynin Kopanos, AANP’s director of state government affairs.

The nurse practitioners’ campaign, however, is unlikely to move forward without a fight. Physician groups, such as the American Medical Association (AMA), contend that such laws could put patients at risk and oppose the efforts of other professional societies to expand their medical authorities.

Nurse practitioners argue that they do have the skills necessary to treat patients with more autonomy. Unlike other nurses, all nurse practitioners hold either a master’s or doctorate degree in medical education.

Alongside the legislative push, the group also will focus on public education. Data suggest that they have their work cut out for them.

A 2010 AANP poll found that while most Americans report having been seen by a nurse practitioner, few knew that their medical expertise goes beyond that of traditional, registered nurses.

Only 14% of the adults surveyed thought that nurse practitioners could prescribe medication, an authority they have in all states and only 18% thought NPs could order diagnostic tests such as X-rays and MRIs.

People stop at the word nurse and don’t understand the word practitioner,” Jensen said. “Obviously we are nurses, but we also have advanced education. We think there’s a misunderstanding on the patients’ behalf.”

Lend your voice to the healthcare debate by sharing with us your thoughts on NPs, their visibility, their scope of practice and their role in the healthcare of our nation.

Abbott Gets a Shellacking

Last week, the street.com -a leading online provider of financial news, commentary, analysis, ratings, business and investment content- took a major swipe at Big Pharma, in general, and Abbott, in particular. Under the headline ‘Abbott Helps Big Pharma Look Even Worse’ author Vince Crew, lambasts the drugmaker for its past marketing practices and warns that unless Pharma adheres to a zero tolerance policy for illegal practices, the industry’s reputation will be doomed forever. Here’s a verbatim copy of what he had to say – On May 7, Abbott reached an agreement with the federal and nearly all state governments to pay $1.6 billion in connection with its illegal marketing of the anti-seizure drug Depakote.

And yes, it’s even more despicable because it represents the unfortunate, illegal, unethical, typical temptation of off-label marketing — promoting a product for usage contrary to its approval.

Someone(s) at Abbott thought it a good idea, according to the Justice Department confirmation, to have a “specialized sales force” market Depakote in nursing homes to dementia patients, even though there was no evidence that it was safe and effective for such use. By the way, in the spirit of “someone will always tell,” several employees blew the whistle on the pharma behemoth. No doubt the settlement has caused Abbott investors, stakeholders, competitors and the industry in general, to pause. Before you think Abbott is doomed because of a reprehensible thing like this, 11 days following this settlement, Abbott Laboratories reported better-than-expected earnings as sales surged on its injectable arthritis drug, Humira. So, no tears for Abbott, unless they regard ongoing settlements as business as usual and don’t actively adhere to a zero tolerance policy for illegal practices. In that case, we should weep for the industry as a whole. Time will tell.”

Abbott, has a very different story to tell. In their mia culpa press release regarding the settlement, Laura J Schumacher, Executive Vice President, General Counsel and Secretary says, “The company takes its responsibilities to patients and healthcare providers seriously and has established robust compliance programs to ensure its marketing programs meet the needs of health care providers and legal requirements.” As Mr. Crew says, time will indeed tell. However, everyone would do well to heed the warning. According to Deputy Attorney General James M. Cole, “Today’s settlement shows further evidence of our deep commitment to public health and our determination to hold accountable those who commit fraud. We are resolute in stopping this type of activity and today’s settlement sends a strong message to other companies.”

In the meantime, if any pharmaceutical companies are looking for help to ensure that their marketing practices are compliant, please remember SRxA is here to help.

Food Allergy Organizations Unite to Combat the Crisis and Find a Cure

In the United States, food allergies send a person to the emergency room every three minutes and account for over a million emergency department visits each year. For about 140,000 patients each year, their food allergies result in anaphylaxis – a serious life-threatening consequence. Of these, up to 1,000, many of them children, will die.

Which is why we were pleased to learn that the nation’s two leading food allergy organizations are planning to merge.

Rather than competing for funding, as they have in the past, the Food Allergy Initiative (FAI) and the Food Allergy & Anaphylaxis Network (FAAN) will unite. In doing so they hope to secure the private and public support needed to advance a cure for food allergies, and provide critical resources for food-allergic individuals and families.

Recent research shows that food allergies are a significant and growing public health issue affecting 1 out of every 13 children – roughly two in every classroom. With nearly 40% of these children already having experienced a severe or life-threatening food-allergic reaction, the need for a cure is urgent.

The merger will combine FAAN’s expertise as a trusted source of information, programs, and resources related to food allergy and anaphylaxis with FAI’s leadership as the world’s largest private source of funding for food allergy research.

FAI and FAAN have collaborated for nearly 15 years on initiatives to increase understanding of the severity of food allergies and to support food-allergic families,” said Todd Slotkin, chairman of FAI. “Bringing together the considerable expertise and resources that both organizations offer will elevate both our ongoing private commitment to find a cure for food allergies and our work on behalf of the food-allergic community.”

Every day we work with thousands of families across the United States who are dealing with the serious physical, social, and emotional impacts of food allergies,” said Janet Atwater, chair of FAAN. “The unification of FAAN and FAI allows us to move forward together as an even stronger champion for these families and the driving force advancing research to find a cure.”

SRxA’s Word on Health applauds this initiative and looks forward to seeing the benefits of this collaboration. In the meantime we think the ‘more can be achieved by collaborating than competing‘ message could be an important one for congress.

Prescriptions, Physicians, Patients and Payers: Let the battle commence!

Last week the FDA announced that it wants to remove obstacles to America’s most commonly used drug treatments.  If the Agency gets its way, some drugs used to control chronic conditions, such as high cholesterol, diabetes and asthma may soon be available without prescription.  But in doing so, they have reopened a  big can of worms. One that brings into question the very nature of health reforms, preventative medicine and improved access to healthcare.

Here’s the proposal: The FDA would create a new class of “safe use” drugs. While consumers would not need a prescription, they would still need to get clearance from a pharmacist or from specially designed websites to purchase them.

Battle lines are being drawn! With physicians on one side, and patients, pharmacists, pharma and payers on the other.

Doctors are most definitely not thrilled by the idea. Removing the prescription requirement for an inhaler refill, for example, doctors fear they would be taken out of the loop on everyday care decisions.

Insurers, on the other hand are embracing the move. They recognize that they could save big bucks if physician visits weren’t required for run-of-the-mill complaints and ongoing medication monitoring. They might even save on the costs of the drugs themselves because, depending upon how they’re classified, most health plans don’t pay for over-the-counter treatments.

Pharmacists see it as validation of their expertise and pivotal role in primary healthcare and the pharmaceutical industry, who has repeatedly asked for permission to sell such drugs over-the-counter, must surely be cautiously optimistic.

Even normally conservative regulators are supporting the move. “Greater over-the-counter and behind-the-counter access will lower costs and make healthcare more accessible to consumers,” former FDA commissioner Scott Gottlieb said via Twitter. “It’s a good idea, long overdue.”

Even so, the FDA will have a fight on its hands as it moves to turn its proposal into reality. The American Medical Association lambasted the idea in USA Today, saying that patients need guidance from doctors. The doctors’ association also points out that giving patients more control could complicate coordinating care, such as, tracking all the drugs a patient uses to prevent interactions.

But, as The Washington Post points out, FDA sees the doctor’s visit as a hindrance to care; some patients don’t seek treatment if they have to see a physician first. “Obviously, it’s much easier for you to go to your drug store and pick up an item than it is to make an appointment, take a prescription, drop it off and get it filled,” says Nancy Chockley, president of the National Institute for Health Care Management.

About 20% of prescriptions written in the United States currently go unfilled. Removing obstacles that keep Americans from managing their own health care is, according to one patient, namely me, a good thing.

The FDA contends, and I agree, that some consumers may not even go as far as getting a prescription because of the “cost and time required to visit a health-care practitioner.  Earlier this month, I stood in line at my local pharmacy for thirty minutes to pick up a refill prescription for blood pressure meds. On reaching the end of the line I was told that there was no prescription. The pharmacist called my doctor and the lack of prescription was confirmed. I called my doctor and was told I would need to make an appointment to have the prescription renewed. I pointed out that I had done that one month earlier and that nothing had changed regarding my health. I was then informed that it was a new policy to issue prescriptions on a month-by-month basis rather than provide automatic refills. Even when I pointed out that I have a chronic condition that I’m doing my best to manage and part of that management is the medicine I have been taking for years, they wouldn’t sway. No doctors visit, no prescription.  And the kicker, I couldn’t get an appointment to see my doctor for a week…meaning, I had to go 7 days without blood pressure meds, all so my doctor could better manage my care!

Practicing medication adherence is very hard when your doctor won’t give you medication…and leaves me wondering if this policy change had more to do with revenue generation than improving chronic disease management.

My personal experience aside, at the heart of this discussion is a fundamental disagreement over what role doctors play in managing patient care. The FDA proposal views a trip to the physician as a hindrance to care, whereas doctors see that visit as crucial, especially as chronic conditions become increasingly prevalent.

The FDA proposal is still in formative stages, meaning there’s still a lot of space for this debate to evolve. Where the discussion heads on this particular issue could end up guiding health policy on what role doctors play in managing patient care – and, at what point, the patient takes charge.

I, for one, can’t wait to see how it plays out, assuming of course that I’m not dead from uncontrolled hypertension!

The Whys and Wherefore’s of White-Coat Hypertension

Yesterday was Mother’s Day for our readers who live in the US.  I do, but my mother doesn’t, so rather than treat her to lunch or chocolate, I’m dedicating this blog to her instead.

Let me start by saying that hypertension runs in our family.  My grandmother and her mother before her had it, my mother has it and even though I was an ultra-fit marathon runner at the time, I also developed high blood pressure around the time I turned 40.

But that’s where the family trait ends. We manage our disease very differently.  I take my meds, try to eat healthily, avoid stress and exercise whenever I can. I also avoid taking my blood pressure.  If I don’t know it’s high, it’s one less thing I have to worry about!  My mom, on the other hand is a much more compliant patient and goes for regular check-ups.

The problem with that, is she worries so much about having her blood pressure taken that it’s always high when she sees her doctor.  She can’t explain why she worries about this, she knows it’s not rational, but still she worries.  And she’s not alone.

For many patients, blood pressure measurements taken in a physician’s office may not correctly characterize their typical blood pressure. Up to 25% of patients evaluated by their doctors, have blood pressure measurements higher than their typical levels. This phenomena is known as white-coat hypertension and is thought to result from anxiety related to examination by a health care professional.

So I was really interested to read a new study from the UK where, incidentally, my mom lives.  It showed that by swapping a doctor for a nurse you can eradicate white-coat hypertension.

The meta-analysis of 14 studies found that mean blood pressures measured by nurses were 8.5/4.2mmHg lower than readings from doctors. When studies with a high risk of bias were removed from the analysis, the gap was reduced but remained, with a mean difference of 4.8mmHg in systolic blood pressure (the top number) and 1.5mmHg for diastolic (the bottom number).

The study concluded that blood pressure measurements taken by primary care doctors might be ‘unreliable for clinical decisions’, and that all measurements should be delegated to nurses.

Study leader Dr Chris Clark, clinical academic fellow at the Peninsula Medical School and a GP in Witheridge, Devon, said: “The difference could affect treatment decisions, especially when the measurement is marginal, between one course of treatment and another.”

Such a recommendation also has wide-ranging implications for how medical practices organize their services.  Researchers told the European Society of Hypertension Congress that the findings meant practices should move to nurse-only or home blood pressure monitoring.

The rationale for the different blood pressure values obtained by doctors and nurses?  The researchers speculate that nurses are better at relaxing patients.

Would you be more relaxed seeing a nurse rather than a doctor?  My mom says yes!

Breaking Cancer News– 122 years later!

On December 3, 1890 William Russell, a pathologist in the School of Medicine at the Royal Infirmary in Edinburgh, gave an address to the Pathological Society of London.  In it he outlined his findings of “a characteristic organism of cancer” that he had observed microscopically in all forms of cancer that he examined, as well as in certain cases of tuberculosis, syphilis and skin infection.

On May 8, 2012, Catherine de Martel and Martyn Plummer from the International Agency for Research on Cancer in France announced: “Infections with certain viruses, bacteria, and parasites are one of the biggest and preventable causes of cancer worldwide.”

In case you haven’t already done the math, that means it’s taken 122 years for someone to take notice.

A hundred and twenty two years ago!  That’s the year Eiffel Tower was completed, it’s around the time that  serial killer Jack the Ripper was terrorizing London, the same year Thomas Edison used electric Christmas lights for the first time and the year Vincent Van Gogh, the Dutch painter, committed suicide.

How, you might ask, have scientists put men on the moon, developed the internet, flying cars and metal-free underwear bombs, but yet remain so ignorant about cancer and its origin?

How can the infectious causes of tuberculosis, leprosy, syphilis, smallpox, polio, malaria, and other viral and bacterial and parasitic diseases be so well understood, but the cause of cancer be unknown?

The fact that all cancers could conceivably be caused by an infectious agent now seems a distinct possibility. That, until now,  this has been overlooked, ignored, or unrecognized by twentieth century doctors is simply incredible.

According to de Martel and Plummer, one in six cancers, accounting for around two million cases a year, are caused by preventable infections. They claim “application of existing public-health methods for infection prevention, such as vaccination, safer injection practice, or antimicrobial treatments, could have a substantial effect on future burden of cancer worldwide.”

The percentage of cancers related to infection is about three times higher in developing than in developed countries. For example the fraction of infection-related cancers is around 3.3%in Australia and New Zealand to 32.7% in sub-Saharan Africa.

Many infection-related cancers are preventable, particularly those associated with human papillomaviruses (HPV), Helicobacter pylori (H. pylori), hepatitis B (HBV) and C viruses (HCV).

Of these infection-related cancers, cervical cancer accounts for around half of the cancer in women. In men, liver and gastric cancers accounted for more than 80%.

Dr. de Martel says: “Although cancer is considered a major non-communicable disease, a sizable proportion of its causation is infectious and simple non-communicable disease paradigms will not be sufficient.

Clearly we need to start making up for 122 years of lost time and directing further research and treatment efforts into these preventable causes of cancer.  Since vaccines for HPV and HBV are available, and increasing their availability, and lowering the cost should be a priority for governments and health systems around the world.

Taking on Tanorexia

If you were in the US last week, you’ll recall that you couldn’t turn on the TV or download a news story without being reminded of the latest in the saga of the “tanorexic” mom Patricia Krentcil.

In case you somehow missed this news, let me recap very briefly.  New Jersey native, 44 year old Krentcil, was accused of taking her 5-year-old daughter to a tanning booth after school officials noted the child’s severe sunburn.  She was then reported to social services, arrested and charged with second-degree child endangerment

Whatever the rights and wrongs of this case, and for the record we think they are mainly wrongs, one thing is clear – the leathery Mrs Krentcil has a serious addiction to tanning.

Most of us watching this train wreck of a story unfold, simply want to know why.  Why would someone do that to themselves? Why would you think this looks good? Why oh why?

Well, according to researchers at UT Southwestern Medical Center, people who frequently use tanning beds may be spurred by an addictive neurological reward-and-reinforcement trigger, They found that tanning produces endorphins – the brain the chemicals that provoke feelings of happiness.

This could explain why some people continue to use tanning beds despite the increased risk of developing skin cancer. About 120,000 new cases of melanoma are diagnosed in the U.S. each year. People younger than 30 who use a tanning bed 10 times a year have eight times the risk of developing malignant melanoma. And although public knowledge of these dangers has grown, so has the regular use of tanning beds.

While most people use tanning beds only occasionally, around 10% of indoor tanners use tanning beds for more than 20 hours a year and are motivated not only by their desire to improve appearance but also because it makes them feel relaxed.

To examine what lures frequent tanners to tanning beds,  researchers studied 14 people who used tanning beds 8 to 15 times a month. During tanning sessions on Mondays and Wednesdays, participants spent part of the time in a normal tanning bed and part of the time in a tanning bed that did not emit any UV radiation. The beds were equipped with special filters that made them appear indistinguishable. On Fridays, participants were offered the chance to use the tanning bed of their choice – either one bed for the whole session or a combination of the two. Although the tanning beds looked identical, frequent tanners were not fooled. Out of the 12 people who chose to tan on Fridays, all but one selected the UV-emitting bed for the entire session. What’s more, tanners felt more relaxed and less tense after using a UV tanning bed than they did after using a dummy tanning bed.

Using tanning beds has rewarding effects in the brain so people may feel compelled to persist in the behavior even though it’s bad for them,” said Dr. Bryon Adinoff, professor of psychiatry at the Veterans Affairs North Texas Health Care System.

Participants were also administered a compound that allowed scientists to measure brain blood flow while they were tanning.  What they found was that the brain activity and corresponding blood flow patterns were similar to those seen in people addicted to drugs and alcohol.

However, just as moderate drinkers can enjoy alcohol without being addicted, not all those who go to tanning salons are addicted to UV light.  As always, all things in moderation…except of course your comments on this post, which are, as always, very welcome!