Wednesday, January 31, 2007

House arrest for pharmacist

From the Winnipeg Sun:
A Winnipeg pharmacist who stole $28,000 in "customer refunds" that didn't exist has been sentenced to 18 months house arrest.

Lorraine Anne Hilderman, 53, was also ordered to pay back the stolen money within the next 45 days or face serving her sentence in a real jail. ...more

Sunday, January 28, 2007

Medical record system cited for needless deaths

The lack of easily accessible electronic medical records should be a bigger issue than it currently is. The focus by patients and the media are ER lineups and surgical waiting lists more than anything else, and this is somewhat reasonable as they are big issues. Even though the lack of e-records is not that sexy a topic, it should still be addressed. Some provinces have made steps in the right direction, but our health remains one of the least "connected" part of our lives.

I'd prefer that control of a personal health record is given to a patient themselves. Why can't a patient carry their medical records on a flash drive that gets inserted into a computer at each health care provider? This would require an easy to use program that could be used as an industry standard and this currently doesn't exist.

From the Globe and Mail:
After more than 20 years as a family physician, Michelle Greiver questions why Canadians can access bank accounts 24/7 but when they go to the hospital after hours, their medical records are unavailable.

She's among a minority of Canada's doctors trying to update the health care system's archaic processes, which by one estimate costs up to 24,000 lives each year. ...more

Pfizer to Appeal Canadian Decision

It will be interesting to see where this legal battle goes. I think we'll be hearing about this for most of 2007.

From Forbes:
Drug developer Pfizer Inc. said Friday it will appeal a Canadian federal court decision denying its application to block approval of a generic version of the cholesterol-lowering drug Lipitor.

Indian generic drug maker Ranbaxy Pharmaceuticals Inc. is asking for approval of its version of Lipitor. The ruling deals with a patent that Pfizer (nyse: PFE - news - people ) said holds market exclusivity until July 2010. ...more

Justice dispensed to pharmacist fraudster

From the Winnipeg Free Press:
A well-respected Winnipeg pharmacist has flushed her 33-year career down the drain after being caught stealing more than $28,000 from her employer, a Winnipeg court heard Friday.

Lorraine Hilderman, 52, broke down in tears as she apologized for a crime that shocked her friends, family and co-workers.

"I am so sorry for the embarrassment, pain and shame they have endured," said Hilderman. ...more

Thursday, January 25, 2007

Antidepressants may raise fracture risk for those over 50

The most popular pills for depression might substantially raise the risk for bone breaks in older people, a drawback that should be considered when the drugs are prescribed, Canadian researchers say.

People aged 50 and older who took antidepressants, including Zoloft, Prozac and other top-sellers, faced double the risk of broken bones during five years of follow-up, compared with those who didn't use the drugs, the study found. ...more

Folic acid pills 'can slow mental decline'

From the Times Online (UK):
Taking folic acid supplements can slow the mental decline in older people, a study suggests.

A Dutch team studied 400 people aged between 50 and 70 who were split into two groups. Those in one group were given 800 micrograms of folic acid a day; the others were given a placebo. ...more

Top Ont. pharmacist warns of national security threat posed by U.S. drug bill

I don't agree with Marc Kealey's assertions in his latest speech.

"Who can say with absolute certainty that the next $19 million worth of phoney drugs could be sent to America not by criminals in Belize, but by terrorists determined to kill American citizens? That the fake pills from a purported Canadian Internet pharmacy will contain not talcum powder or baking soda, but cyanide or anthrax?"
Kealey suggests that terrorists purporting to be Canadian pharmacies could attack the United States. This is of course possible, just as some shadowy organizations in obscure countries are selling Viagra through websites with maple leaves on them. But is this reason enough to ban legitimate Canadian online pharmacies? If all cross-border pharmacy was closed tomorrow, the criminal organizations claiming to be Canadian would still exist.

"Picture an open floodgate. Picture a medicine cabinet with the door ripped off the hinges. Picture a made-in-America problem being solved on the backs of Canadians."

Kealey isn't afraid to try to make Canadians afraid. I can't see his gloomy scenario ever happening. I don't agree with bulk exports and I'd be okay with laws to that effect. However, even if no laws are changed, I would think that the Canadian pharmaceutical companies wouldn't allow sales to American bulk buyers just as they choose to not sell to known Canadian internet pharmacies. Even a change in American law will not be able to compel the Canadian branch of Pfizer or Merck for example to sell millions of Canadian Lipitor or Fosamax tablets to the American branch of Safeway or Wal-Mart Pharmacy (all examples).

As for individual purchases, the current market conditions simply don't allow for the grim predictions. Has the sky fallen in the last several months now that U.S. Customs isn't seizing packages from Canadian pharmacies? I am not aware of any substantial changes to the available medication supply in Canada since then, and my understanding is that Canadian internet pharmacies have not seen any signficant surge in business as a result either. As long as the dollar stays above 80 cents U.S. (which is somewhat likely) and the drug companies maintain their existing controls on supply (which will absolutely continue), cross border pharmacy will be a niche market only.

From the Canadian Press:
A U.S. bill that would legalize bulk imports of Canadian prescription drugs should be nixed because it poses a health threat to Canadians and a security risk to Americans, Ontario's top pharmacist said Wednesday.

The legislation, introduced in the Senate and House of Representatives earlier this month, will encourage the proliferation of mail-order and Internet drug sales, which could open the door to drug counterfeiting and drug terrorism, said Ontario Pharmacists' Association CEO Marc Kealey. ...more

Forces' drug needs different, MD says

From the Globe and Mail:
The Canadian Forces say their members don't need access to the full range of medication offered through the drug plans provided to politicians and bureaucrats.

Physician Ken Scott, the colonel who is director of medical policy for the military's health services, said yesterday that members of the Forces have different physical characteristics than the average Canadian and don't suffer from the same types of disease. ...more

Tuesday, January 23, 2007

'Credibility' at issue

Final arguments were made today at the Norvascgate trial. Look for a verdict by the end of February. Personally, I can't see how pharmacist Abadir Nasr can be found anything but guilty. Even if you buy his defense that he was ignorant and didn't intentionally do anything wrong, what he did was criminally reckless. And this is the most positive scenario for Nasr. The other possibilities are much worse.

From the Hamilton Spectator:
The lawyer representing accused Hamilton pharmacist Abadir Nasr argues the Crown's attack on his client's credibility has become a futile exercise in pill counting.

Dean Paquette told Ontario Court Justice Richard Jennis no one will ever know precisely how many counterfeit and grey market cardiac pills were dispensed at the King West Pharmacy in spring 2005. That's because much of the Norvasc dispensed there, including vials with authentic pills mixed in with fake and foreign-market tablets, had been consumed by Nasr's customers in the months before the RCMP raided his drugstore June 15. ...more

Johnson & Johnson Customers in Canada Can Sue Over Prepulsid

From Bloomberg:
Johnson & Johnson customers in every Canadian province except Quebec can sue the drug company as a group over injuries linked to the drug Prepulsid, an Ontario judge ruled.

Justice Ellen Macdonald of the Ontario Superior Court certified a class-action lawsuit Jan. 18 against Johnson & Johnson, Toronto-based law firm Rochon Genova LLP said today in a Canada NewsWire release. Rochon Genova represents one of the plaintiffs in the case. ...more

Cholesterol drugs don't help 'bulk' of takers

From the National Post:
Healthy women should not be put on a cholesterol-lowering drug to prevent heart disease, suggests a new analysis that raises questions about widespread over-prescription of the fastest growing drug class in Canada.

Millions of Canadians take cholesterol reducers, called statins, to lower their risk of heart attacks and cardiovascular disease. For people who already have artery disease, statins save lives. ...more

Monday, January 22, 2007

Red flags raised over anti-smoking guide

Over the last while, we've seen the mainstream press corps write stories about topics that are mostly common knowledge in the pharmacy/medical community but unknown to the public at large. Here is another one that questions the relationships between charities and their donors.

From the Ottawa Citizen:
The Canadian Cancer Society is about to publish an update to its guide that helps smokers who want to quit.

It cost $75,000 to redevelop the popular book, One Step at a Time, but the national charity didn't have to worry about the price. That's because it asked Pfizer Canada, the country's largest maker of nicotine replacement therapy products, to pay the cost.

Pharmaceutical giants are some of the top financial contributors to groups such as the Canadian Lung Association, the Canadian Cancer Society, the Toronto-based Centre for Addiction and Mental Health, and others. ...more

Islanders going on their own with Gardasil

Look for the Gardasil debate to heat up this year. While the medical benefits of this product seem very clear, the questions of who is going to cover it and if it should be a required vaccination remain largely unanswered.

From CBC News:
Many Prince Edward Islanders aren't waiting for the provincial government to start paying for Gardasil, a vaccine approved by Health Canada last year to help in the fight against cervical cancer.

The Department of Health would like Gardasil added to the vaccines covered by the province, but it has been waiting for recommendations from two national committees on who should get it and at what age, and whether governments should cover the cost. ...more

Edmonton aims to screen all for diabetes

I don't know if making diabetes a reportable disease is of any real benefit. It's not like it's a communicable disease and others are at risk. The whole concept seems like to evoke shades of Big Brother. Why stop at diabetes? Maybe the next step is to start a database on every disease group. If you see your doctor and have a high blood pressure reading, are they going to have to report you? What about starting a list of obese people? They are at future health risk just like diabetics. I think that one would be challenged in court about five minutes after it was instituted.

From CBC News:
A new diabetes screening program in Edmonton goes further than any other in North America, effectively making diabetes a reportable disease.

Under the program, whenever someone in the city visits a doctor, hospital or walk-in clinic, their blood-sugar information is recorded in a central database. Edmonton's Capital Health Region plans to use the information to identify and treat anyone with diabetes or at risk for the disease. ...more

Be cautious when taking St. John's wort with other drugs

This is more of a patient-specific article, but it's a good reminder that St. John's Wort interacts with many different drugs.

From the Fort Wayne (Ind.) News Sentinel:
Q: Can St. John's wort cause the birth control pill to fail, as I've heard?

A: St. John's wort, an over-the-counter herbal supplement, can be effective for milder forms of depression. Case reports do suggest that St. John's wort could lead to unwanted pregnancies in women using oral contraceptives. ...more

Thursday, January 18, 2007

Shoppers Drug Mart's new CEO will help push cosmetics

Typically I avoid the business part of pharmacy in this blog. If you want to read about Jean Coutu's earnings this quarter or projections for Shoppers Drug Mart stock, there are probably some great business blogs out there that will provide more info and better analysis.

I'm making an exception this time. The article below talks about Shoppers Durg Mart hiring a new CEO with a background in cosmetics. The report mostly talks about the plans to focus primarily on cosmetics as well as food items. There is not one word about pharmaceuticals, pharmacists, or anything relating to medicine. There is absolutely nothing wrong with this from a business standpoint. Anyone who holds stock in Shoppers Drug Mart would probably agree with their plans. However, as a pharmacist I find it disappointing that the biggest "pharmacy" chain in Canada these days really doesn't seem to be even thinking about pharmacy.

From the Calgary Sun:
Jurgen Schreiber's international experience and his work at the helm of a beauty company make him the perfect choice to lead Shoppers Drug Mart Corp. (TSX:SC) as the retailer seeks more global suppliers and higher profits from cosmetics, the company said Thursday.

The firm was looking to focus more on its cosmetics section and "you will find that already in Q1, where we bring in new brands, we enhance around 700 stores," the new CEO said during a call with analysts. ...more

Wednesday, January 17, 2007

Testing Of Bioidentical Hormones Urged, North American Menopause Society Says They Might Not Be Safe

I have never heard of the North American Menopause Society before, but their comments against bioidentical hormones (and natural remedies like soy and black cohosh) would likely be rejected by some of the compounding pharmacists that make these products.

From CBS News:
The North American Menopause Society says bioidentical hormone treatments might not be the best way to combat the symptoms of menopause.

In an editorial in the journal Menopause Management, the society's executive director says the recent hype surrounding bioidenticals masks the fact that the ingredients are basically no different from those in FDA approved hormone treatments whose use has fallen since a study in 2002 found women using hormones faced a higher risk of breast cancer. ...more

Tuesday, January 16, 2007

Canada's pharmacists seek ban on exports to U.S.

There's nothing much new here. A few of the tradtional enemies of internet pharmacy are calling for the federal government to put in new rules regarding drug importation. The new push is based on concerns regarding new legislation in the States.

From Reuters:
Canada's pharmacists said on Monday they are banding together to fight a U.S. bill that could see a flood of brand-name prescription drugs diverted south of the border.

The group, which includes the Canadian Pharmacists Association, the Ontario Pharmacists Association, the Best Medicines Coalition and the Canadian Association for Pharmacy Distribution, warns the bill could deplete the supply of prescription drugs in Canada. ...more

Pharmacists help provide patient care

From the Halifax Chronicle Herald:
Truro pharmacist Wanda Woolaver says her work is very satisfying as rarely a week goes by without a patient coming by and thanking her for her help. She said the profession has moved away from simply dispensing drugs to patient care.

When Ms. Woolaver first went to work in a pharmacy, she spent a lot of time with a mortar and pestle mixing and mashing various ingredients together to make medications prescribed by doctors. ...more

Monday, January 15, 2007

Halting heart drugs a big risk, study finds

From the Globe and Mail:
About a third of heart attack survivors stop taking prescribed medications within a couple of years and, as a result, their risk of dying shoots up, new Canadian research shows.

Those who take drugs such as statins and beta blockers routinely, on the other hand, see their risk of dying fall by about 25 per cent, according to the study. ...more

Pharmacy Students Do First-Time Flu Vaccinations

This isn't a Canadian pharmacy story, but I thought that it was worth mentioning that some American states are also attempting to expand the scope of pharmacists' practice. Alberta and other provinces are also looking at allowing pharmacists to administer injections. In fact, there are plans to set up teaching programs to show Alberta pharmacists how to do this. There is no official word as to when the classes will be, but I expect they will happen this spring.

From the University of Maryland Baltimore News:
Sana Majid leaned over David Roesner's right arm and quickly injected a dose of influenza vaccine. It was an utterly ordinary moment of health-care delivery, yet a significant step for Maryland pharmacists and University of Maryland School of Pharmacy students.

Before this flu season, Maryland pharmacists were not permitted to administer flu shots. But a change in state law, and new industry regulations, now allow specially certified pharmacists-and supervised pharmacy students-to give the shots. A collaboration between the School of Pharmacy and Shoppers Pharmacy, spurred by the efforts of J. Bradley Thomas, RPh, Shoppers Pharmacy district manager and a member of the School's class of 1982, led to a series of flu shot clinics at the pharmacies this month. ...more

Cold medicine warning for toddlers

More than 1,500 toddlers and babies wound up in emergency rooms over a two-year period and three died because of bad reactions to cold or cough medicine, federal health officials reported Thursday.

The U.S. Centers for Disease Control and Prevention warned parents not to give common over-the-counter cold remedies to children under two years old without consulting a doctor. ...more

Drugstore Owner Sues Michael Jackson

It's not often that I include celebrity news on this site, but I thought it was worth mentioning that Michael Jackson owes an independent pharmacy over $100,000. I've heard of running a tab but this is ridiculous. One can only imagine what meds were filled at the pharmacy.

From Starpulse:
Michael Jackson is being sued by the bosses of a Los Angeles pharmacy, who claim the pop superstar is behind on his pill bills. The owners of famous Beverly Hills drugstore Mickey Fine Pharmacy claim they had an oral bill-paying agreement with Jackson, but the King of Pop still owes them over $100,000. ...more

Thursday, January 11, 2007

U.S. bill aims to import cheaper medications from Canada

From CBC News:
The solution to high medication costs in the U.S. is importing cheaper drugs from Canada, a group of U.S. politicians said Wednesday.

Members of both the Democratic and Republic parties announced plans for legislation to allow imports of prescription medicine from other countries....more

Wednesday, January 10, 2007

Brain Bleeds From Blood Thinner on the Rise

The knee-jerk response to this article by some would be that "Coumadin is dangerous." However, I think this has a lot more to do with poor monitoring. During my time in a hospital-based pharmacist-run anticoagulation clinic, I am regularly amazed by the casual approach of many family physicians when it comes to warfarin monitoring. This attitude results in some of the problematic cases that I see.

Physicians have a lot on their plate. It seems to make a lot of sense to offload this task to pharmacists who have studied and specialized in this area. I don't think a physician who glances at a lab report in the middle of a busy day seeing patients provides more value when compared to a specially trained pharmacist who devotes their entire day to the subject. The Alberta College of Pharmacists seems to agree as they have indicated that this could be one of the first clinical areas noticably impacted by pharmacist prescribing. I'm planning on applying for my clinical prescribing rights for warfarin and other anticoagulants when the opportunity arises later this year. It should be an interesting experience.

From Forbes:
The rate of bleeding in the brain associated with use of the anticoagulant drug warfarin quintupled during the 1990s, University of Cincinnati researchers reported Monday.

Moreover, in people over 80, the rate of brain hemorrhages associated with warfarin, best known as Coumadin and used to thin the blood and prevent strokes, increased more than tenfold, according to the study, published in the Jan. 9 issue of Neurology. ...more

Tuesday, January 09, 2007

Pharmacy pamphlets omitting key information

It's good to see someone drawing attention to these handouts, which are often out-of-date or have American-specific information on them.

Why can drug info sheets look so similar whether they are picked up at a chain pharmacy, independent, or grocery store pharmacy? It's likely because First Data Bank has secured the contracts to provide drug information sheets to most Canadian pharmacy software makers.

The worst mistake I can remember on these sheets was on the patient counselling for Lopressor SR (metoprolol extended release) tablets. Lopresor SR is made by Novartis and is available in Canada and not in the United States. The Americans have their own version of metoprolol sustained release tablets called Toprol XL (not available in Canada), which is made by Astra Zeneca. The Lopresor SR patient info sheets said that tablet could be split in half. While the American Toprol XL is designed to be split in half, Lopresor SR must not be cut or else it destroys the sustained release effect. I remember getting phone calls from patients who would listen to me counsel them to not cut the tab, then they'd go home and read the sheet. Fortunately, I think most them believed me and not the printout.

From the National Post:
Information sheets that pharmacies hand out to educate customers about the drugs they are taking actually leave out key safety information in some cases, omissions that are prompting concern from federal regulators.

Pamphlets distributed by two major retailers on attention-deficit medicines, for instance, fail to mention the government directive that patients with certain heart conditions avoid such drugs. ...more

Clinical trial company calls for 'bill of rights'

From CTV News:
A Montreal company that conducts clinical trials is calling on the federal government for an official bill of rights to protect those who take part in human drug trials.

Janice E. Parente, founder and president of Ethica Clinical Research Inc., said Monday there are too many shortfalls in Canadian industry regulations. ...more

Clinical trial company calls for 'bill of rights'

From CTV News:
A Montreal company that conducts clinical trials is calling on the federal government for an official bill of rights to protect those who take part in human drug trials.

Janice E. Parente, founder and president of Ethica Clinical Research Inc., said Monday there are too many shortfalls in Canadian industry regulations. No comments:

Internet Pharmacy in Germany

This article has nothing to do with Canada, but I thought it was interesting to provide some perspective regarding how the internet is changing the way pharmacy operates around the world.

There are definite parallels. A pharmacy in a smaller, more liberal country is trying to sell inexpensive product in a larger neighbouring nation with higher drug prices, but are encountering heavy resistance from a powerful lobby group within the larger country. However, the independent pharmacist plays vastly different roles. Canadian pharmacists have tried to use internet pharmacy to change the business of pharmacy but in Germany they are the powerful establishment trying to maintain the status quo.

From Deutsche Welle:
In Germany, where drug prices are higher than the rest of Europe, certified pharmacists have a virtual monopoly on the sale of over-the-counter and prescription drugs. So when DocMorris, Europe's first mail order pharmacy opened its first affiliate in the western city of Saarbr├╝cken last July and sold non-prescription medication at discount prices, competitors forced the state courts to shut it down in September.

Now, nearly four months later, the Dutch Internet retailer and pharmacy chain wants to get around the German Pharmacy Act, which does not permit corporate entities to sell drugs and limits ownership to three branches that must be in close proximity to each other, by paying pharmacy owners licensing fees to sell its products. ...more

Sunday, January 07, 2007

January a great time to clean medicine cabinet

From CTV News:
January has long been the month of resolutions and renewal. And if Dr. Marla Shapiro had her way, it would also be the month of medicine cabinet cleanup.

Shapiro says the beginning of the year is a great time to go through your cache of medicines, lotions and potions -- and dump the ones that have grown old and could do more harm than good. ...more

Local Rx import programs find fewer takers

Although rolled out with great fanfare a few years ago, state and local programs allowing residents to purchase prescription drugs from Internet pharmacies based in Canada apparently have not been popular with the public.

In September, a state audit of the Illinois importation program revealed that in 19 months, importation outlet I-SaveRx had served fewer than 4,000 residents yet cost the state nearly $1 million. Auditors found I-SaveRx had reached an even fewer 1,265 people in other states. ...more

Saturday, January 06, 2007

Flu drug Relenza gets approval from Health Canada

The headline sounds bigger than the actual news. Relenza now has the official indication for prevention of influenza.

From the Halifax Chronicle Herald:
Health Canada has given pharmaceutical giant GlaxoSmithKline permission to market its flu drug Relenza for the prevention of influenza, not merely the treatment of the illness.

The Canadian approval, announced by GSK on Thursday, follows in the footsteps of similar approvals by regulators in the United States and 15 European Union countries.

Other flu drugs on the market here — Tamiflu and the generic drug amantadine — were already approved for prevention of influenza. ...more

Antibiotic suspected as factor in deaths

From what I've seen, the risk/benefit ratio for Levaquin still looks pretty good...

From the National Post:
A powerful antibiotic used to treat pneumonia, urinary tract infections and other ailments is suspected of causing diabetes like and liver problems in dozens of Canadians, five of whom died, a new Health Canada report reveals.

As the department tries to gauge the extent of the problem, doctors are being urged to report any cases of blood-sugar level upset or liver damage that may be linked to levofloxacin. ...more

MD urges universal testing for HIV

From the Toronto Star:
Making HIV testing a routine part of any doctor's visit is at the heart of a debate in Canada's medical community, which is desperate to reduce the number of people who are infected with the virus but don't know it.

With "universal testing" patients would have to opt out of being screened for HIV during a physical or regular blood work. Taking a detailed sexual history, doing a risk assessment and conducting pre and post-test counselling would no longer be mandatory. a href="" target="_blank">...more

Wednesday, January 03, 2007

Pharmacists seek power to prescribe in some cases

Here's a pretty good article that provides an update regarding pharmacist prescribing. It primarily talks about Alberta, but it also gives some noteworthy updates from other provinces.

Pharmacist prescribing in Alberta is slated to start on April 1, but it's still unclear exactly how everything will play out. It should be an interesting few months.

From the Toronto Star:
Pharmacists in several provinces, wanting to do more than just count out pills, are pushing for the power to prescribe medications and play a more meaningful role in their patients' health care.

But some physicians' groups caution that allowing pharmacists to write prescriptions without consulting a doctor could harm those very patients. ...more

Superbug to 'emerge in force' across Canada

From CTV News:
Doctors warn that a superbug causing infections in pro baseball and football players, as well as toddlers in day care centres in the U.S., is making inroads in Canada and is about to "emerge in force" across the country.

Clones of community-associated Methicillin-Resistant Staphylococcus Aureus, or MRSA, are "spreading with alarming rapidity," according to infectious disease experts in a commentary published Tuesday in the Canadian Medical Association Journal. ...more

Anti-obesity drug no magic bullet

Here's an update regarding Acomplia from CBC. They may state it's not a magic bullet, but if it brings in $5 billion per year in the U.S. alone, it would make it one of the biggest selling drugs in the world.

From CBC News:
Some doctors in Canada are worried about the side-effects of an anti-obesity drug that is expected to hit the market in the U.S. by spring 2008.

Known in Europe as Acomplia and generically as rimonabant, the drug helps people to lose weight, controls Type 2 diabetes, raises high-density lipoprotein or HDL "good" cholesterol and tells the brain to stop craving food and cigarettes. ...more

Tuesday, January 02, 2007

Too Little Bang for the Buck in Drug Research?

I think the idea of longer patents for breakthrough drugs and shorter patents for "me-too" drugs makes a lot of sense.

Whenever critics complain about the high cost of prescription drugs, the pharmaceutical industry's standard defense is that companies have to plow so much money into researching innovative new medicines. But a recently released report from the Government Accountability Office casts doubt on that rationale. Yes the industry is spending heavily on R&D, the GAO found, but it turns out big pharma isn't actually generating such a good return on their investments. ...more