Wednesday, December 31, 2008

Manufacturer warns of serious infections related to psoriasis drug

From CBC News:
The manufacturer of a drug that treats psoriasis has issued new safety information for doctors and patients.

EMD Serono Canada says Raptiva has been associated with a risk of serious infections, including progressive multifocal leukoencephalopathy, a rare and sometimes fatal brain disorder.

Raptiva suppresses the body's immune response to reduce psoriasis inflammation; however, the company says that by diminishing the body's natural defence system, it can also increase the risk of serious infections in some patients.

Signs and symptoms of PML may include difficulty thinking, walking or speaking, or other behavioural changes, weakness, loss of balance or co-ordination, visual impairment, partial paralysis of one side of the body, or seizures.

Other serious infections may be indicated by fever, weakness, cough, flu-like symptoms, warm, red or painful skin, or open sores on the body. ...more

Tuesday, December 30, 2008

Treating the flu isn't easy

From the Owen Sound (Ont.) Times:
Early signs from this flu season suggest doctors face a vexing dilemma in treating the illness. Testing to date in Canada, the United States and Europe shows that nearly all H1N1 viruses are resistant to oseltamivir (sold as Tamiflu) and susceptible to the adamantane drugs, amantadine and rimantadine.

The inverse is true for H3N2 viruses, which are universally resistant to the adamantanes and susceptible to oseltamivir.

Given that in reality little point-of-care testing is done to determine whether a patient actually has influenza, let alone which variety of the bug is behind the illness, the resistance situation could see doctors making choices that lead to treatment failure this season.

"It definitely adds to the complexity of trying to manage influenza,'' said Dr. Maria Zambon, head of the respiratory viruses unit of Britain's Health Protection Agency. ...more

Optimal Warfarin Dosing Improves Anticoagulation Control

From the Washington Post:
While the anticoagulant warfarin can be highly effective in preventing strokes and treating venous thromboembolism, doctors have long struggled with finding the best way manage the drug therapy.

Boston University School of Medicine (BUSM) researchers now claim to have figured out the optimal dosing levels to help patients, according to a study published in December online issue of the Journal of Thrombosis and Haemostasis.

The research team analyzed warfarin use in almost 4,000 patients to determine what are the most effective levels of the drug in a patient's system under different circumstances.

"The study suggests that anticoagulation control could be improved considerably by changing the warfarin dose only when the ratio is 1.7 or lower/3.3 or higher," lead author Dr. Adam Rose, an assistant professor of medicine at BUSM, said in a university news release. "In addition to offering warfarin to as many optimal candidates as possible, we also need to optimize warfarin dose management to fully realize the benefits of anticoagulation." ..more

Monday, December 29, 2008

Anti-smoking law forces retailer to phase out pharmacy

From the Edmonton Journal:
With the final phase of Alberta's Tobacco Reduction Act set to take effect on New Year's Day, Stadium Drug and Food Mart owner Jack Au had a business choice to make.

Either keep his grocery store where more than 50 per cent of sales come from tobacco products or hang on to the less lucrative pharmacy and watch his former smoking customers buy their cigarettes elsewhere.

"So I closed up the pharmacy. It made no sense to continue with that business when over 50 per cent of the business is tobacco here," Au said.

Au now uses the corner where the pharmacy once stood to rent out videos.

When Jan. 1 rolls around, he will permanently seal up the double doors leading to the pharmacy which moved next door.

There will be no access from his store. He intends to be in compliance with the province's anti-smoking legislation, considered by some to be among the toughest in the country.

Under the legislation, all pharmacies, stores that have a pharmacy in them, health-care facilities and post-secondary institutions in Alberta will no longer be allowed to sell tobacco products as of Jan. 1. ...more

Saturday, December 27, 2008

Pharmacists take on expanded role starting January

From Arrow Lakes (BC) News:
As part of a new agreement between the government of B.C. and the B.C. Pharmacy Association, pharmacists will be taking on a bigger role when it comes to prescription medications.

As of Jan. 1, B.C. pharmacists will have the legal authority to renew or adapt existing prescriptions to better suit the patient.

Pharmacist Troy Clark of People’s Pharmacy in Nakusp says it’s a step up for the role of pharmacists.

“[It is] increasing our scope of practice,” says Clark. “It’s something that we’re capable of doing.”

A pamphlet available at People’s Pharmacy states benefits of the change include allowing your pharmacist to help manage medications for patients between visits to the doctor.

“This medication management thing that’s coming now, the new policy that’s come out, it’s just giving us the authority,” says Clark. “Now we have the legal authority to do some of those things that we were maybe doing already.” ...more

Application of pharmacy standards slackens

From VietNamNet:
Many drugstores at large hospitals have not yet applied the Good Pharmacy Practices (GPP), let alone private pharmacies, although the deadline is only one week away, said HCMC health officials.

The Ministry of Health last year introduced the GPP standard and required all drugstores at hospitals nationwide to brace for the standard before January 1 next year. The standard is aimed at helping State agencies ensure the quality of drugs, better manage drug manufacturing and distribution, protect the people’s health as well as prepare the market for foreign drug distributors who will be allowed to enter the market early next year.

Under the ministry’s requirements, all drugstores must operate in modern facilities, only sell drugs with known origin, employ qualified pharmacists and provide drug consultations. However, even in HCMC where the pharmaceutical market is more developed, the standard has not been attended to by drugstores, said Pham Khanh Phong Lan, deputy director of HCMC’s Department of Health.

She told the Daily that the GPP implementation in hospitals would fall behind the ministry’s deadline given the current progress.

“Up to this month, 52 hospital-based drugstores in HCMC have been completing procedures to apply the GPP plus about 10 district-level hospitals,” she said. Of this figure, only 30 drugstores have successfully deployed the GPP standard. ...more

Pharmac hits back at talk of stinginess

Medicine funding is "not about counting votes" or making popular decisions, says Pharmac chief executive Matthew Brougham.

In the national drug-buying agency's annual review, Mr Brougham hit back at accusations of stinginess.

This month the Government took the unprecedented step of bypassing Pharmac's independent decision-making process to directly fund 12 months' of the costly breast cancer drug Herceptin.

Earlier this year, a group of cancer patients took Pharmac to court over its decision to offer just nine weeks' treatment.

The High Court ordered Pharmac to do more "public consultation", which attracted more than 300 submissions, but did not overturn the original decision.

Mr Brougham said Pharmac was making efforts to improve the way it consulted with and relayed its decisions to the public. ...more

Tuesday, December 23, 2008

PCA wants rules to play by

From the Financial Post:
In all businesses, entrenched interests -- "the club" -- can and do play a large role in ensuring life isn't made easy for a bunch of newcomers, as existing players protect their interests by any and all means.

Enter Peter Suma and Don Waugh, founders of PCA Services, which regards itself as "an innovator of hardware and software for the dispensing and ongoing management of patient drug therapy." PCA (PharmaTrust) recently launched its second dispensary at Toronto's Sunnybrook hospital.

Getting to that stage hasn't been easy. The 40-person company has invested $9-million in a kiosk that allows patients to talk to a pharmacist via video conferencing and enables the pharmacist to monitor and control each step of the dispensing process from a video call centre. Medication is dispensed from the kiosk by the pharmacist in a few minutes. And PCAS has fought numerous battles with the club. "Only a wet baby likes change," said Suma, whose MBA from the University of Chicago makes him a supporter of free and open markets. PCA wants rules to play by

Old-time remedies best when it comes to fighting kids’ colds

From the Lethbridge (AB) Herald:
When coughs and colds hit kids, old remedies may be the best.

That’s the message from local pharmacist Rick Siemens, after Health Canada announced this week that children under six years old shouldn’t be treated with over-the-counter cough and cold medications, because the potential risks outweigh any possible benefits.

Siemens, pharmacy manager at London Drugs in Lethbridge, was busy Friday moving the store’s supply of children’s cough and cold medicine behind the pharmacy counter. He said parents should consult with a pharmacist to determine whether such medicines are the right solution and if so, what kind of dosage to give.

“Those medications, if they’re used properly, are safe. It’s just that the effectiveness has never been proven to be that great for any cough and cold medication,” Siemens explained. ...more

Thursday, December 18, 2008

Health Canada says children under 6 shouldn't get cough and cold medication

From the Canadian Press:
Children under six years old shouldn't be treated with over-the-counter cough and cold medications because the potential risks outweigh any possible benefits, Health Canada says.

The warning follows a recently completed review of scientific data on the products by the federal department, which recommended in October 2007 that children under two shouldn't be given the cough and cold remedies.

"The current decision expands on those preliminary recommendations," Dr. Marc Berthiaume, director of Health Canada's marketed pharmaceuticals and medical devices bureau at Health Canada, said Thursday from Ottawa.

The review, which included advice from an expert scientific advisory panel, concluded "there is limited evidence supporting the effectiveness of these products in children," the agency said.

"In addition, reports of misuse, overdose and rare side-effects have raised concerns about the use of these medicines in children under six. The rare but serious potential side-effects include convulsions, increased heart rate, decreased level of consciousness, abnormal heart rhythms and hallucinations." ...more

Pushing more doctors to ditch the prescription pad

From the Associated Press:
The push for paperless prescriptions is about to get a boost: Starting in January, doctors who e-prescribe can get bonus pay from Medicare.

For patients, the benefits are obvious — from shorter drugstore waits to increased safety, as pharmacists no longer squint to decipher doctors' messy handwriting.

But persuading U.S. doctors to ditch their prescription pads for electronic prescribing so far has been a long, uphill battle. Only about 10 percent of doctors are taking the plunge like Dr. Ted Epperly in Boise, Idaho, who's adopting the technology now.

Still, the movement is gaining steam as Medicare warns that its bonus payments are for a short time only: Holdouts still sticking to paper in 2012 will find their Medicare payments cut.

And continuing the push for medical information technology is a key part of President-elect Barack Obama's health-reform plans, in hopes that moving to computerized records — not just prescriptions, but all those troublesome paper charts that contribute to medical errors and wasted care — ultimately could save millions of dollars a year. ...more

Pill to be given out by chemists

From BBC News:
A pilot scheme allowing pharmacists to give women the contraceptive pill without a prescription has been given the go-ahead for next year.

Women and girls aged over 16 will be able to get the pill at two London primary care trusts, Southwark and Lewisham, Pulse magazine says.

If the pilots are successful, the pill could become available over the counter like the morning after pill.

Officials say this might help reduce the UK's high teen pregnancies.

Although the teenage pregnancy rate in Britain is falling in many areas, it remains the highest in Western Europe.

A spokeswoman for the Department of Health said: "We want to improve women's access to contraception and help reduce the number of unintended pregnancies without undermining patient safety. ...more

Liver function a concern for lung cancer patients taking Tarceva

From CBC News:
Drug company Hoffman-La Roche is telling doctors prescribing Tarceva to lung cancer patients to closely monitor the liver function of those who recently have taken or who are taking the drug.

The drug Tarceva (erlotinib) is used to treat patients with non-small-cell lung cancer at an advanced stage when chemotherapy has not helped to stop the disease.

The letter issued by Hoffman-La Roche says a study of patients with advanced cancer and moderate liver impairment found that a higher number of patients died during treatment or within 30 days of the last dose, compared to patients with normal liver function. ...more

Seniors' drug plan unveiled

From the Edmonton Journal:
Low-income seniors in Alberta will be paying less and in some cases nothing for prescriptions under a new pharmaceutical plan that will also hike drug costs for high-income seniors and triple the premiums for those on Blue Cross.

"I think it's a good idea," said Patricia O'Reilly, a volunteer at the Seniors Association of Greater Edmonton. She and her husband have an income lower than $42,650, so they won't have to pay for drugs under the new pharmaceutical strategy, which kicks in January 2010.

Currently, seniors have to pay 30 per cent of their prescriptions up to $25 for each drug, no matter what their income. A senior on 10 different drugs, for instance, would be paying $250 or less, depending on the cost of the medications.

Under the new regime, couples earning less than $42,650 and singles earning less than $21,325 won't have to pay anything.

The new program will save O'Reilly, 66, between $45 and $50 each month. "Sometimes, it's a bit tough with the cost of living," she said. "Everything else goes up. I will definitely benefit from it." ...more

No benefit from multiple steroid injections in preterm births: study

From CBC News:
Giving many courses of steroids to women at risk of giving birth prematurely increases the risk of having a smaller-sized baby, a Canadian-led international study suggests.

A single course of corticosteroids has been shown to reduce the risk of death in newborns, respiratory distress and bleeding in the brain of infants born to women at risk of giving birth before 37 weeks of pregnancy.

But doctors have moved beyond what the evidence supported and repeated courses of the prenatal drugs — also known as antenatal — has become common, according to a commentary that accompanies the study in the Dec. 20 issue of the medical journal The Lancet.

In the largest trial to date, Dr. Kellie Murphy of the department of obstetrics and gynecology at Toronto's Mount Sinai and her colleagues analyzed data on more than 1,800 women at risk of preterm birth who received one course of prenatal corticosteroids 14 to 21 days before the study began. ...more

Wednesday, December 17, 2008

On-site pharmacy must monitor care home's drugs, owner says

From the Globe and Mail:
Sunridge Place residents whose medication costs have shot up since they were forced to move out of Duncan's Cowichan Lodge care home can complain all they want. But whether it's vitamins, minerals, herbal remedies or prescription medications, there's no way around purchasing the pills they need from the private-care home's on-site pharmacy.

According to Bob Mehr, owner of Pacific Compounding Pharmacy, the company under contract to Sunridge Place, said the B.C. College of Pharmacists requires that the same designated provider supply all medications for long-term care residents.

"When you have a contract with a particular nursing home, you are responsible for all the medications provided at that particular nursing home, including vitamins and over-the-counter medications," said Mr. Mehr, who owns nine pharmacies on Vancouver Island, including three that are located in P3 long-term care homes.

"Where you are in a care facility, everything the patient gets has to be prescribed by a physician and the pharmacy is obligated to supply that. If we don't we are interfering with the doctor's care." ...more

Tuesday, December 16, 2008

Medical schools urge limits to drug makers' influence on students

From CBC News:
There may soon be no more free lunches — or fridges to store them in — in the student lounges of Canadian medical schools.

No talks given by physicians' experts paid handsomely by pharmaceutical companies. Or unsupervised meetings with drug reps.

The association that represents Canada's medical schools announced Tuesday it is endorsing the principles that lie at the core of rules such as these introduced by its American counterpart earlier this year.

The Association of Faculties of Medicine of Canada said the aim is to limit the influence the pharmaceutical industry has on medical students and residents and assuage the public's concerns about the perceived cosiness between medical schools and drug makers.

"There's no question that the environment within which you're trained will have some sort of impact on the way you perceive these issues," Irving Gold, the association's vice-president of government relations and external affairs, said from Ottawa. ...more

Indonesia scraps plans to tag HIV patients

From the International Herald Tribune:
An Indonesian province beleaguered by a spiraling HIV infection rate scrapped plans to implant microchips in those with full-blown AIDS on Tuesday, following strong opposition from government officials, health workers and rights activists.

Papua's parliament agreed to drop a section of the health development bill that supported the tagging of some HIV patients with small computer chips inserted beneath the skin — part of extreme efforts to monitor the disease, lawmaker Weinard Watori said. ...more

Monday, December 15, 2008

Generic drug maker suit against federal government reaches trial stage

From the Canadian Press:
Federal regulations that bar Canada's generic drug makers from copying brand-name products for eight years after patents expire will come under the judicial microscope Tuesday as a two-year-old lawsuit reaches Federal Court.

The generic drug makers want the court to set aside rules that they argue cost consumers $115 million in extra drug costs every year.

The regulations, implemented in 2006 under the Food and Drugs Act, were designed to protect the extensive and expensive data that manufacturers need to seek approval for a drug. The data include the results of studies and clinical trials.

The rules prohibit Health Canada from licensing a generic version - generally cheaper than the brand-name equivalent - until after the eight-year period for those drugs where patent protections have lapsed. ...more

Tuesday, December 09, 2008

Most Alberta seniors to pay less under new drug plan

From CBC News:
About 60 per cent of Alberta's seniors will see their prescription drug costs lowered or eliminated starting in January 2010, but others will pay more, Alberta Health announced Monday.

Single seniors with an annual income of less than $21,325 and senior families with an annual combined income below $42,650 will not have to pay for medication.

But other seniors who have high incomes will pay more for drug coverage.

Deductibles will be based on a sliding scale and the highest earners could pay up to $7,500 a year if they have high medication costs.

Alberta Health Minister Ron Liepert said the change will make the system fairer to everyone.

"We have a philosophy in government that we need to — and it's our responsibility to — ensure that those who can't afford it or don't have it, that there are programs in place by government," he said. ...more

Pharmacist wins national award

From the South Shore (NS) Now:
A dispensary manager at a Mahone Bay drugstore has received a national award for patient care.

Susan Beresford of Kinburn Pharmasave in Mahone Bay recently earned the award for overall patient care in the 2008 Commitment to Care and Service Awards Program, sponsored by Pharmacy Practice and Drugstore Canada magazines.

In a recent press release marking the announcement, representatives of the two magazines cited Ms Beresford for her 30-year career as a pharmacist, saying the model she exemplifies of accessible, informative and supportive services "has embraced a collaborative approach to aiding patients." ...more

Alberta will fund drugs to treat rare diseases

From the Globe and Mail:
As Ontario was defending its refusal to fund a costly drug for an ailing man, Alberta ushered in a new strategy that will ensure those with rare, genetic diseases are provided medicine - even for drugs that cost $1-million a year.

Alberta's move yesterday is believed to be the first in Canada for rare diseases and will provide coverage starting in April.

Eligible patients will be required to pay premiums and make co-payments for the drugs, which typically total $250,000 to $1-million annually for each patient and are often the only medicine approved for their condition.

"Currently, today, we don't have a policy in place, and quite frankly, it becomes a pick and choose by the Minister, and the Minister isn't going to choose for somebody to die," Alberta's Minister of Health and Wellness, Ron Liepert, said in a telephone interview yesterday. "This way, it's part of our drug policy." ...more

Sympathy, but no help for a rare disorder

From the Globe and Mail:
Once a husky machinist, Greg Troy is a diminished figure who fights for every breath. He navigates his home in Waterloo, Ont., by grasping pieces of furniture. He can sleep only when attached to a ventilator.

The 62-year-old inherited a rare metabolic disease called Pompe that causes excessive amounts of glycogen to accumulate in the body, disabling skeletal muscles and damaging the heart.

Although there is a drug to treat the often fatal illness - costing up to $600,000 a year - access to it in Canada is unequal. Ontario has a policy to provide it only to babies, where it has been shown to improve survival significantly. Quebec is paying for one infant to receive it, while Alberta funds three patients of various ages under a special grant.

Mr. Troy was refused the enzyme-replacement drug, called Myozyme. In rejecting his request, the Ontario Ministry of Health said in a Sept. 12 letter that there is a lack of evidence concerning the efficacy of the drug in adults - but that it extended its "full sympathy" to Mr. Troy. ...more

Rx plan cuts Montgomery County costs nearly in half

From the Schenectady (NY) Daily Gazette:
The cost of prescription medications for employees of Montgomery County and the city of Amsterdam has been cut nearly in half since they began participating in the CanaRx prescription drug plan.

More than 5,000 prescriptions have been issued since the program’s start in 2006 for participants, according to statistics provided by CSEA Local 829 President Eddie Russo.

The cost for 5,403 prescriptions under a typical U.S. prescription plan is estimated at $1.97 million, but instead cost roughly $1 million through the end of October, according to the report from CanaRx.

Including employees, their family members and retired employees, 1,474 people are covered under the Canadian drug plan. ...more

Lawsuit filed against Bayer over drug risks

From CTV News:
Lawyers have filed a multi-million dollar lawsuit against drug giant Bayer Inc. and related companies because one of its drugs, which was given to patients to inhibit bleeding during cardiac surgery, has been linked to a higher risk of death.

Bayer voluntarily withdrew the drug, known as Trasylol, from the market a year ago after a clinical trial found that patients treated with the drug were 53 per cent more likely to die than those treated with older, less expensive anti-bleeding medications.

That study, known as the BART trial, was stopped early and Trasylol was pulled from the market in several countries, including Canada. However, the drug is still available in Canada to some doctors via special-access programs.

Trasylol was originally approved for patients who were at an increased risk of blood loss and blood transfusion while undergoing heart surgery, particularly cardiopulmonary bypass. It is estimated that 4.3 million patients worldwide were given the drug since it was approved in 1993. ...more

Diabetes drugs double women's fracture risk

From USA Today:
Long-term use of a popular class of oral diabetes drugs doubles the risk of bone fractures in women with type 2 diabetes, a new study reports.

According to researchers at Wake Forest University School of Medicine who reviewed 10 previous drug trials, for every 20 women in their 70s with type 2 diabetes who took thiazolidinediones — rosiglitgizone (brand name Avandia) and pioglitazone (brand name Actos) — for at least one year, one of them has a chance of suffering a fracture. In women in their mid-50s, the figure equals one fracture in every 55 women. That's more than double the normal risk for those age groups. ...more

Check your medicine cabinet

From the Saskatoon Star Phoenix:
It's the middle of the night when your bedroom door creaks open. Here it comes: "Mommy, I don't feel good."

Whatever ailment has wakened your child, getting a fix on it is easier when you keep a few kid-friendly remedies stocked in your medicine cabinet. It's often dependent on what kids are already prone to -- pharmacist Margaret Leenders has kids with sensitive skin, so hydrocortisone cream is a must.

Adult medicine is "a really big no-no" unless parents are extremely well versed in translating milligrams into child-size doses, warns physician Mark Sherman. Children need much smaller doses due to their size but also because they metabolize drugs differently. ...more

Expect vaccine to inhibit HIV within 5 years: Nobel winner

From CBC News:
A therapeutic vaccine to inhibit the spread of HIV will be available within five years, according to a Nobel Prize-winning scientist who helped discover the virus.

Luc Montagnier, director of the World Foundation for AIDS Research and Prevention, said he thinks it is "a matter of four to five years" before such a vaccine is developed. Restricting the transmission of HIV, he said, would change how the disease is managed and controlled.

Montagnier, 76, said a therapeutic vaccine, to be given to those who are already infected in order to inhibit the likelihood of transmission, would be a key step in fighting the virus. By comparison, a preventative vaccine would protect people from contracting HIV in the first place. ...more

Saturday, December 06, 2008

Windsor's born-again pharmacist

From the Financial Post:
Rocco D'Angelo is a born-again pharmacist.

He used to own a Wyandotte Street pharmacy that was flush with business. They filled 800 prescriptions a day at a hectic pace. Then he and his pharmacist wife got divorced and he started travelling around the province working at pharmacies on short-term contracts. D'Angelo, a father of two daughters, soul searched and decided to return to the roots of his profession.

"I didn't go to pharmacy school to sell shampoo or motor oil," D'Angelo said. "I went to study chemistry and help people."

He bought a condominium downtown and opened Royal Windsor Pharmacy, a tiny storefront at the corner of Park and Pelissier streets. The shelves are stocked with over-the-counter medications and vitamins that D'Angelo recommends. There isn't a bottle of shampoo or pack of batteries in sight.

D'Angelo, 55, dove into his new life. His business is small, and while he wants it to grow, he doesn't want to expand too much, otherwise he wouldn't be able to spend as much time with patients. ...more

Grads ‘not fully competent’

This is not much of an endorsement of new pharmacy graduates...

From the Irish Medical News:
Pharmacy graduates are only 60 per cent competent one year after graduating from university, according to Prof Ian Bates, School of Pharmacy, University of London, who spoke at the Pharmaceutical Society of Ireland (PSI) council meeting held at Trinity College Dublin (TCD) last week.

Prof Bates suggested that there is a mismatch with what graduates think they should learn and what they need to learn. He also stated that the learning experience of pharmacy students across the world in countries such as Bangladesh, Canada, the UK, Switzerland and Japan vary from one another even though they should be showing similar trends.

The need for “life-long learning” among pharmacists is critical to a sturdy pharmacy service in Ireland, he said. The Pharmacy Act of 2007 allows for continued professional development and competence to be upheld in Ireland. ...more

Pharmacies 'join the chain'

From the Cape Town (S.Afr.) Independent:
A body representing the country's pharmacies wants to meet Health Minister Barbara Hogan to propose that pharmacies become part of the supply network, so allowing state patients to collect their medication there, rather than at state health facilities where long queues are problematic.

In an open letter to Hogan, United South African Pharmacies (Usap) asked that community pharmacists be allowed to distribute and fill prescriptions issued by public sector health services in an effort to reduce medicine costs, improve access to medication and eliminate long queues at overcrowded hospitals.

One of their proposals was that they be paid subsidies or delivery fees by the government in return for the service. ...more

Ministry says 85 City chemists meet standards

From Viet Nam News:
Around 85 drug stores in HCM City are qualified to meet the new Good Pharmacy Practices (GPP) standard.

This follows an order from the Ministry of Health last year that requires all pharmacies to meet the GPP standard by 2011 in order to remain in operation.

The GPP standard requires pharmacy owners to have a pharmacist’s certificate and a pharmacist always on duty. It further requires that drugs clearly display their origin of manufacture and instructions for storage and use.

Out of the 85 GPP-compliant drug stores, 41 are managed by city hospitals, with the rest being privately-owned.

Recently, the HCM City Department of Health has set a target to get 100 percent of the city’s pharmacies GPP-compliant in 2009. Out of the country’s approximate 3,816 pharmacies, 70 percent are in HCM City. ...more

Thursday, December 04, 2008

Drugs, drugs, drugs

From the Kawartha Lakes (Ont.) This Week:
As a third generation pharmacist, Marc Scanlon has seen the profession evolve since his grandfather's time.

In 1925 when Mr. Scanlon's grandfather began his career, pharmacists were not even allowed to print the names of the drugs on the prescriptions' labels, he says. But things have changed and they continue to change.

In a report to the Minister of Health and Long-term Care released in September, the Health Professions Regulatory Advisory Council is recommending expanding the power of pharmacists to include some services that normally require a doctor.

"In this upcoming holiday season I will probably see people every day in my pharmacy who need medication that they need to see a doctor for, and their doctor is away," says Mr. Scanlon of the Clinic Pharmacy--Pharmasave in the Peterborough Clinic. ...more

Tuesday, December 02, 2008

Canadians fall through cracks without pharmacare: report

From CBC News:
The rising cost of drugs prevents some Canadians from getting the treatments they need, the Canadian Health Coalition says in renewing its call for a national pharmacare plan.

The group held public hearings across the country from October 2007 through last March, with more than 250 Canadians talking about the difficulties faced with the cost, effectiveness or availability of prescription drugs.

Brenda Young of Prince Edward Island told the hearings that she and her husband work hard to support themselves and their two teenage children, but they live paycheque to paycheque.

"When I go for surgery, everything is covered," said Young, who has neurofibromatosis, an inherited condition involving fibre-like growths of the nerves and skin.

"But as soon as I am out of the hospital, there is no money for ongoing drugs or physical therapy.… If the children need prescriptions, I sometimes have to tell them to wait until payday." ...more

Change to GP dispensing opposed

This is more evidence that there are turf wars between pharmacists and physicians throughout the world. The battles involve different topics: pharmacist prescribing in Canada has been covered here before. The article below talks about physician dispensing in the U.K.

From BBC News:
Patients are opposed to any plans to reduce the ability of rural GPs in England to provide drugs directly to their patients, a poll suggests.

There are fears that plans laid out in a government White Paper will threaten the future of GP dispensaries.

The Dispensing Doctors Association surveyed more than 6,000 patients who currently get their drugs this way.

They found 95% would find it difficult or inconvenient if their surgery stopped dispensing.

The Pharmacy White Paper - designed to increase the role chemists play in providing care for patients - includes a number of options to reform the existing rules which govern dispensing by doctors.

Currently, patients who live more than a mile from a chemist can choose to have their medicines dispensed by their GP. ...more

Kids' cholesterol pills worry MDs

Canada's top medical journal is warning doctors about giving cholesterol pills to children, saying there is scant direct evidence statins are safe for children and that doctors risk committing kids to "decades of therapy."

Millions of Canadian adults take the cholesterol reducers to lower their risk of heart attacks and cardiovascular disease.

Now, the American Academy of Pediatrics says the drugs should be considered for children as young as eight who have high concentrations of LDL, or low-density lipoprotein, the "bad" cholesterol.

But a leading editorial in this week's Canadian Medical Association Journal says statins haven't been widely tested in children, most studies involved kids whose high cholesterol is due to an

inherited blood disorder -- not obesity -- and that only one study followed children for more than a year.

The journal calls it the latest example of "age indication creep" -- giving drugs approved for adults to kids. ...more

Swiss approve pioneering legal heroin program

From the Associated Press:
The world's most comprehensive legalized heroin program became permanent Sunday with overwhelming approval from Swiss voters who simultaneously rejected the decriminalization of marijuana.

The heroin program, started in 1994, is offered in 23 centers across Switzerland. It has helped eliminate scenes of large groups of drug users shooting up openly in parks that marred Swiss cities in the 1980s and 1990s and is credited with reducing crime and improving the health and daily lives of addicts.

The nearly 1,300 selected addicts, who have been unhelped by other therapies, visit one of the centers twice a day to receive the carefully measured dose of heroin produced by a government-approved laboratory.

They keep their paraphernalia in cups labeled with their names and use the equipment and clean needles to inject themselves — four at a time — under the supervision of a nurse, and also receive counseling from psychiatrists and social workers. ...more

More time on the side of treating stroke

From the London (Ont.) Free Press:
The window for delivering critical clotbusting drugs after a stroke is slightly bigger than was thought, updated guidelines for stroke care suggest.

The revised best practice recommendations say the drugs, which can prevent or minimize the damage from a stroke, can be given within 4.5 hours of a stroke. Previous guidelines suggested the drugs had to be administered within three hours to be effective.

The larger window may mean more people who have strokes get care, a welcome development if it occurs.

It's estimated that less than a third of people who have had a stroke get drugs that can break up the blood clots clogging an artery and cutting off blood supply to a part of the brain.

If untreated within the optimal window, that damage becomes permanent and can lead to speech and motor difficulties and cognitive impairments.

It's why those who work in stroke medicine use the adage "time is brain."

Even though the new guidelines suggest there's more time than was thought, that shouldn't slow anyone's pace, suggested Dr. Stephen Phillips, head of the expert panel that revised the recommendations. ...more

Anti-bleeding drug alternatives less risky, cheaper and nearly as effective: study

From the Canadian Press:
A new analysis of clinical trials of a controversial anti-bleeding drug used in heart surgery says that cheaper, safer alternatives work nearly as well and should be recommended.

The review was rushed to print Tuesday by the Canadian Medical Association Journal in advance of a hearing Wednesday of a panel of experts who have been asked to advise Health Canada on future use of the drug, aprotinin.

"For routine use there is no clear advantage of aprotinin that justifies the apparent increase in mortality and the undoubted increase in cost," said Dr. David Henry, lead author of the review and CEO of the Institute of Clinical Evaluative Sciences in Toronto.

"So that in routine clinical practice, there is not now a role for this drug as an adjunct to cardiac surgery."

Aprotinin - which is sold under the brand name Trasylol - was used to reduce bleeding and minimize the need for blood transfusions during coronary artery bypass surgery. Made by pharmaceutical giant Bayer Inc., the drug was thought to be more effective than older anti-bleeding therapies tranexamic acid and aminocaproic acid.

But a landmark clinical trial comparing aprotinin to the alternatives was stopped in October 2007 when it was found that the rate of deaths among people who were given the drug was higher than that of people who got the older, cheaper drugs. ...more

Monday, December 01, 2008

More female physicians, pharmacists working in Canada: reports

From CBC News:
More women are joining the health-care occupations in Canada, including the traditionally male-dominated professions of medicine and pharmacy, according to a report released on Monday.

The Canadian Institute for Health Information said women make up about 80 per cent of the health care workforce, which includes more than one million people. The reports included information on the supply, distribution, migration, education and demographic trends for:

* Doctors.
* Regulated nurses — registered nurses (RNs), licensed practical nurses (LPNs) and registered psychiatric nurses (RPNs).
* Pharmacists.
* Occupational therapists.
* Physiotherapists.

In 2007 for example, 56 per cent of family physicians under the age of 40 were women, compared with 16 per cent of family doctors aged 60 and over, the institute said.

There were 63,682 active physicians in Canada in 2007, and the total ratio of physicians to 100,000 population increased to 192 last year from 187 in 2003, report said.

Among pharmacists under the age of 40, 64 per cent were women, compared to 27 per cent of those over 60. More than 75 per cent of pharmacists worked in the community setting, while fewer than 20 per cent worked in hospitals. ...more

Drive-through drugstore opens

From the Regina Leader Post:
There won't be any supersizing and you won't be able to get fries with that order, but Regina now has its first drive-through pharmacy.

Rexall Drug Store at 420 Albert St. has a two-lane drive-through to accommodate people who would prefer not to leave the comfort of their vehicle when dropping off prescriptions or picking them up. The service is restricted to prescriptions only.

Kevin Melnyk, regional pharmacy director for Saskatchewan, said there had been some earlier attempts at drive-through pharmacies in the city, but "this one is state of the art. Our whole store is designed with the drive-through in mind." Unlike the usual order screen and drive-through window at a fast-food outlet, this drive-through relies on a hatch system for dropoffs and pickups. There is no open window. All communication is handled through a phone.

He said the drive-throughs have proven popular in places like Alberta and Ontario, so the time had come for Regina. ...more

Sunday, November 30, 2008

Looking good in a recession

From the Globe and Mail:
It's September and retailers are already feeling the pinch of sluggish consumer spending, but not here in a wealthy enclave in north Toronto. Shoppers Drug Mart Corp. is opening one of its biggest, glitziest new outlets and it doesn't look much like a drugstore, with its high ceilings, large windows and bright ambience.

Glass shelves filled with fancy bottles of cosmetics and fragrances greet consumers at the entrance. Organic foods and Nintendo portable consoles are among the products further inside. Customers could pick up $435 facial creams, pose for passport photos and even drop off their prescriptions (it is, after all, still a drugstore).

Under the direction of former chief executive officer Glenn Murphy, Shoppers transformed itself into a Canadian retail powerhouse. Its expansion has been dramatic, growing to more than 1,100 stores from about 800 in 2001. These were the best of times, and they continued under the leadership of Jurgen Schreiber, who became CEO in early 2007. Shoppers has been continually evolving, branching out into high-end beauty products, groceries and seasonal gifts to the point where it is more like a neighbourhood mini-department store. Throw in a burgeoning array of high-margin private labels, a loyalty card that is the envy of retailers across the country and a near doubling of profit in the past five years and it's not hard to make a case it is the most successful retail chain in the country.

But all that was during good times for the broader economy. Now that the tide is turning, it's up to Mr. Schreiber to keep up the momentum. ...more

Prescription drug program under review

From the Fredericton (NB) Daily Gleaner:
The feds need to chip in to improve access to drugs for those with a serious illness, says New Brunswick's health minister.

Four health charities met with Mike Murphy recently to urge him to introduce a catastrophic drug program for New Brunswick that would provide better coverage for people battling serious illnesses such as cancer, diabetes and arthritis.

Provincial chapters of the Canadian Cancer Society, Heart and Stroke Foundation, Kidney Foundation of Canada and the Canadian Diabetes Association reminded Murphy that New Brunswick is one of only two provinces without a catastrophic drug program.

Murphy said he's hoping to change the way the drug program determines who's eligible for provincial coverage.

"This review will focus on providing drug coverage based on the ability to pay rather than on age or disease, which is now the case with the existing prescription drug program," he said.

"We will complete this review within the next year and we'll then know what is doable and at what cost."

Murphy said he met with health ministers from across the country two months ago and a big part of their discussion was devoted to the National Pharmaceuticals Strategy. ...more

Pharmacy wins green award

From the Sudbury (ont.) Star:
A Greater Sudbury pharmacy manager has come up with a winning prescription.

Jenny-Lyn Faught, the frontshop manager of Health Care Pharmacy Pharmasave on Lasalle Boulevard, was named Outstanding Frontshop Manager or Staff in the 2008 Commitment to Care & Service Awards -- a national awards program hosted by Pharmacy Practice and Drugstore Canada, Canada's leading pharmacy magazines.

Faught has significantly boosted staff morale and performance since being promoted to the position four years ago, according to a testimonial letter submitted by Julie Lajeunesse, the pharmacy's regional operations manager.

To enter the awards competition, Faught collected 15 testimonials and also wrote a 750-word essay. She beat out dozens of people for the honour.

As frontshop manager, Faught oversees coaching and development of all staff. She also manages merchandising, team-leading and team-building, as well as design and revision of policies and procedures.

An avid environmentalist, Faught is proud of her store's recent attempts to become greener, including introducing biodegradable plastic bags earlier this year and staff creating a raincoat out of the old traditional plastic bags which will be up for auction. ...more

Taking Canadians 'where no one else has gone'

From the Globe and Mail:
Last summer, when Jurgen Schreiber reviewed his latest batch of consumer research reports, one item in particular grabbed his attention: For the first time, just about as many consumers thought about Shoppers Drug Mart Corp. for beauty products as they did for its pharmacy.

The finding was the catalyst for Mr. Schreiber, chief executive officer of Shoppers, to decide to expand even further into high-end makeup and fragrances.

Shoppers had already built a network of in-store beauty boutiques stocked with some high-end (and high-margin) brands. Now Mr. Schreiber wanted more.

This month, Shoppers launched its first Murale store, a standalone upscale beauty and spa retailer with 200 brands such as Bobbi Brown, Chanel and Estée Lauder - more than 16 times more labels as in a Shoppers beauty boutique. Prices range from $1,060 for a jar of Natura Bisse skin cream from Spain to $12 for eye shadows.

While Mr. Schreiber didn't plan for the launch to come in an economic downturn, he's resigned to the fact - and not letting it deter his plans. ...more

Thursday, November 27, 2008

Druggists afraid of squeeze on payments

From the Toronto Star:
Brampton pharmacist Ben Shenouda says it costs $10 on average to fill a prescription in Ontario, but the provincial government pays him just $7 for the seniors, welfare recipients and others who qualify for provincial drug coverage.

The owner of an independent pharmacy, Shenouda says he makes up the shortfall by using some of the "professional allowances" he receives from generic drug makers for stocking their products.

Ontario pharmacists fear those payments are under attack, as the government eyes the millions of dollars they received in allowances from generic drug makers. Under Ontario law, pharmacies are supposed to use the allowances to improve patient care, providing such things as flu and diabetes clinics.

This week, the federal consumer watchdog released a report that said Canadian taxpayers, consumers and businesses could save up to $800 million a year if the generic drug industry were more competitive. The Competition Bureau concluded the market would improve if pharmacists passed on the allowances they get from generic drug makers to customers – something the bureau says rarely happens. ...more

Whitehorse pharmacy to stop selling cigarettes

From CBC News:
Yukon smokers are about to lose a popular supplier of cigarettes: the new owner of a prominent Whitehorse pharmacy says she'll be phasing out all tobacco sales by the end of this year.

Since taking over the Shoppers Drug Mart location on Main Street earlier in November, pharmacist and owner Tracey Keefer said she has been planning to get rid of cigarettes, which are currently for sale there.

"I don't think pharmacies should be selling cigarettes, if you're trying to promote healthiness," Keefer told CBC News, adding that tobacco sales are already banned from pharmacies in some other parts of Canada.

"We don't sell alcohol, we don't sell other … street drugs or anything here, so we're going to get rid of the cigarettes," she added. ...more

Wednesday, November 26, 2008

Pharmacists shouldn't prescribe smoking drugs: critics

From the Globe and Mail:
Smokers looking to kick the habit might chew nicotine gum or wear a patch sold over the counter in drug stores across Canada to give them an extra boost. But should they also be able to bypass the doctor and head to the drugstore if they're looking for something stronger?

A growing number of pharmacists across Canada think they should - and the idea is drawing sharp criticism from some drug-safety experts.

A few dozen Alberta pharmacists are currently authorized to write prescriptions for Zyban and Champix, the brand names of two common smoking-cessation drugs.

An advisory council to Ontario's health ministry is recommending that pharmacists in the province also be allowed to write prescriptions for smoking-cessation drugs. The recommendation is contained in a broader report that supports expanding the power of pharmacists to prescribe drugs for minor ailments, as well as to alter prescriptions or change dosages.

While Ontario's Health Professions Regulatory Advisory Council admits that nicotine addiction is not a "minor ailment," it says pharmacists in the province should be able to write prescriptions for stop-smoking drugs as a way to improve access for those who want to quit. ...more

Selling generic drugs in more competitive market could save millions: study

From the Canadian Press:
A more competitive generic drug market could save Canada's health-care system $800 million a year, the Competition Bureau says in a study released Tuesday.

Some of this money could be used to maintain or improve drug plans, reduce premiums or directly fund some pharmacist services, competition commissioner Sheridan Scott said in a Toronto speech.

"Progress is being made to get generic drugs at lower prices," Scott told the Economic Club in Toronto.

"We expect this amount (of savings) will climb significantly over the next three years, as some of the blockbuster brand-name drugs that came on to the market in the 1990s lose their patent protection and generic equivalents appear on the market."

The study, entitled Benefiting from Generic Drug Competition in Canada: The Way Forward, estimates the potential savings at more than $1 billion in coming years if changes are made to how generic drugs are paid for.

"Obtaining these savings, however, requires changes to allow the price Canadians pay for generic drugs to be based on the competitive price of the drug," Scott said. ...more

Vancouver pharmacy closed over methadone kickback claims

From the National Post:
A Downtown Eastside pharmacy has been told to close its doors amid allegations it provided cash kickbacks to addicts filling methadone prescriptions.

The AYC Pharmacy on East Hastings has had its licence suspended and was ordered to close indefinitely after an investigation by the College of Pharmacists, according to CBC News. The pharmacy must close by Dec. 1, but will operate on shortened hours until then so customers can find another place to fill prescriptions.

The college said the closure was a result of "medicine-management" issues involving patient safety, according to CBC.

The pharmacy is also being investigated by the Ministry of Health over allegations that it provided drug addicts with cash inducements to fill methadone prescriptions. Methadone is sometimes prescribed to drug users as an alternative to heroin.

B.C. pharmacies are paid $8.60 each time they dispense a drug. If pharmacies dispense methadone and supervise the patient as they take it, they receive an additional $7.70. ...more

Pharmacists' care drops blood pressure: study

From the Edmonton Journal:
Patients with high blood pressure who received enhanced care from pharmacists saw their blood pressure go down more than patients who received normal care from their pharmacists and family doctors, a new study has found.

The drop reduces a patient's risk for stroke by 30 per cent and risk of heart attack by 23 per cent, as long as the patient maintains the lowered blood pressure long-term, said Dr. Ross Tsuyuki, a pharmacist and the senior author of a paper published Monday in the journal, Archives of Internal Medicine.

"That's what we were really excited about -- a 30-per-cent reduction in stroke is quite a bit," Tsuyuki said.

He enlisted the help of pharmacists in 14 Medicine Shoppe pharmacies in urban Edmonton, Mill Woods, Sherwood Park and Spruce Grove, who identified 227 diabetic patients whose blood pressure was above the recommended 130/80 millimetres of mercury for diabetics. High blood pressure is anything above 140/90. ...more

Pharmacists eye greater responsibilities

From the Midland (Ont.) Mirror:
Ontario pharmacists could soon be able to fill and write prescriptions for minor sicknesses without a doctor’s order, recommends a report released Nov. 18 by the provincial health ministry.

Rather than having to go to a doctor or hospital for every small health issue, pharmacies could become the first stop for prescription extensions, drug adjustments and medication monitoring through pharmacist-ordered lab tests, the Health Professions Regulatory Advisory Council has recommended.

The report also suggests pharmacists be allowed to:
• adjust prescriptions;
• extend some refills;
• order lab tests to ensure medications are working properly;
• teach people how to inject themselves with medications and use blood-testing devices;
• initiate smoking-cessation treatments, including the use of prescription addiction suppressors. ...more

LGH gets high-tech meds dispenser

From the Montreal Gazette:
The Lakeshore General Hospital has a new member on its pharmaceutical team: a semi-automated medication distribution system, much like a high-tech vending machine, designed to not only save money but to reduce human error.

"This machine can package medication individually, without human manipulation. This way, surplus tablets can be reused, representing approximate savings of $150,000 per year," said Pierre Gendreau, head of the Pointe Claire hospital's pharmacy department.

Hospital spokesman Louis-Pascal Cyr said that under the old system, patient prescriptions were prepared by hand for four to six-day periods.

"And if a patient left before those periods were up, we'd have to throw away the leftover medication," he said.

"With the new system, patient medications are prepared in sealed packets on a daily basis," Cyr said. "And that translates into less loss of medication," he said. ...more

Tuesday, November 25, 2008

Cleverer drug buying could save $800M a year, competition czar says

From the Toronto Star:
Canadian taxpayers, consumers and business could save up to $800 million a year if private and public sector plans changed the way they paid for generic drugs, Canada's consumer watchdog says.

Both the private sector and governments could start now using tools that encourage pharmacies to compete more aggressively for their business and ensure they pass on millions in savings they receive from generic drug makers, the competition bureau said.

Such strategies could include using more mail-order pharmacies, shopping around for the lowest drug-dispensing fees and negotiating group rates from preferred pharmacists, federal competition commissioner Sheridan Scott said in prepared notes for a speech to be delivered today.

"We believe Canadians deserve a health system that is safe and effective, but also delivers the maximum possible value to Canadians," Scott said in the notes.

The potential savings from more competitive pricing could climb to over $1 billion a year in coming years as several blockbuster patent drugs lose their patent protection, the federal competition bureau also said in a report issued today. ...more

A new remedy for medicine

From the Ottawa Citizen:
You walk into a drug store to get your prescription renewed. It's a drug you've taken for years and you are seeing medical professionals about its use.

The pharmacist tells you the two-year prescription has expired. You can't get the drugs you need. That's not good.

Getting the prescription renewed means taking time from a general practitioner, or worse, a specialist who is being run off his or her feet by the problems of an aging population. There should be an easier way.

The Health Professions Regulatory Agency Council, an advisory group of seven members of the public who report to the provincial minister, says pharmacists should have the power to write prescriptions for minor health problems without a doctor's permission. And the pharmacy should be allowed to extend prescriptions, order lab tests and adjust drugs, the council said. In theory, this would cut the volume of patients visiting doctors or going to emergency wards. ...more

Pharmacy workers reach deal with Rexall

I realize this article is quite old, but somehow I missed the resolution of this dispute, and thought maybe some of you did as well.

From the Edmonton Journal:
A tentative agreement has been reached between Daryl Katz's Rexall pharmacy group and the union representing 30 specialized pharmacists and pharmacy technicians.

The agreement was hammered out Sunday morning after an all-night marathon bargaining session and helped avert a pending strike set to start this morning. ...more

Pfizer pulls E.U. application to sell Viagra over the counter

Changing Viagra to OTC status has to be years away at least, but wouldn't it be a fascinating counseling challenge for the pharmacist in the local drugstore?

From MarketWatch:
Pfizer said it still thinks that Viagra at a 50-milligram dose is a suitable candidate for non-prescription supply through pharmacists.

But it's withdrawn its application after the European Medicines Agency's Medicinal Products for Human Use said it had some concerns.

"The withdrawal of the application will enable evaluation of further information and additional data that may be required to allow any future assessments under the centralized procedure," Pfizer said. ...more

Cases of asthma in Canada may be overdiagnosed by 30 per cent: study

From the Canadian Press:
Almost a third of adult Canadians diagnosed with asthma and taking medications to treat their wheezing, coughing and shortness of breath may not actually have the allergic respiratory condition at all, researchers say.

In a study of about 500 adults who had previously been told they have asthma, airway-function and other tests showed that about 30 per cent did not in fact have the disease, suggesting that asthma may be significantly overdiagnosed in Canada.

"What we think is happening ... is that if patients come to a physician complaining of shortness of breath or cough or wheeze, oftentimes the physician will assume that the diagnosis is asthma, and based on the patient's history and complaints prescribe medicines to treat asthma," lead investigator Dr. Shawn Aaron said from Ottawa.

"And what they won't do is order the appropriate diagnostic test to confirm asthma."

Aaron, head of respiratory medicine at Ottawa Hospital and the University of Ottawa, said a doctor's suspicion that a patient has asthma should be followed up by confirmatory tests, including spirometry. ...more

Italian-Canadian Citizen of the Year

From the Hamilton Spectator:
Marita Zaffiro doesn't believe in just handing out pills to cure what ails you.

She believes in a community approach to health care, which includes making sure the needs of the multicultural denizens around her downtown pharmacy and across the city are met.

These are some of the reasons why the Hamilton-born pharmacist was named the Italian-Canadian Citizen of the Year by the Hamilton-based Sons of Italy organization on the weekend.

It will add to the long list of accolades Zaffiro has racked up, including being named Distinguished Citizen of the Year by the city of Hamilton in 1998 and one of the country's most influential pharmacists by the Canadian Pharmacists Association last year. ...more

Methadone could help cocaine addicts: study

From the Calgary Herald:
Methadone, a drug used for many years to treat heroin addiction, also appears to work well against cocaine addiction, a new Canadian study suggests.

Psychologist Francesco Leri of the University of Guelph has been making rats addicted to cocaine, and then treating them with methadone.

Most of the rats responded well, he says. They lost their powerful urge for cocaine and, in addition, their brains "re-set" themselves into the same pattern that existed before they first used cocaine.

"It can be done tomorrow with humans, and should be done tomorrow," Leri said.

That's because methadone--unlike some new drug -- already exists as a tested drug, with clear prescription rules and clinical staff trained in giving it out.

"There is an entire system that is already in place for the employment of methadone," that could be used for cocaine addicts, Leri said. ...more

Monday, November 24, 2008

Skip the doctor's office, go right to the drugstore

I shudder when I read the first paragraph of this article. While I am in favour of pharmacist prescribing, we have to remember the difference between prescribing and diagnosing. Pharmacists aren't trained to diagnose most ailments. Our role needs to be the optimizers of drug therapy, but this is after a dignosis is made. I can adjust warfarin dosages at least as capably as a physician, but I can't diagnose any of the conditions that would lead to being on the drug such as a deep vein thrombosis, pulmonary embolism, or atrial fibrillation for example.

From the Globe and Mail:
Should a nasty cold or poison ivy require a trip to the doctor to get a prescription? What about an earache, urinary tract infection or something as serious as a pre-existing heart problem?

Those are the questions many health professionals across Canada are grappling with as more provinces look to grant pharmacists greater power to prescribe drugs.

This week, an advisory council to Ontario's Health Ministry recommended that pharmacists in the province be allowed to write prescriptions for minor conditions, adjust dosages, extend prescriptions and order laboratory tests in some instances.

The move follows developments across the country to expand the role of pharmacists. ...more

Pharmacist Donates Kidney to Customer After Falling in Love

From ABC News:
Some romances build over dinner and flowers. This one blossomed over medication and dialysis.

A pharmacist in Kansas donated her kidney to a customer she fell in love with.

What began as a simple pharmacist-customer relationship turned into much more for Julie Wallace and Justin Lister, who struck up a friendship, then a romance that led to Wallace giving Lister a kidney.

When they met a little more than a year ago, Wallace, 46, was working as a pharmacist and manager at Dillon's grocery store pharmacy in McPherson, Kan., where Lister, 26, was dragging himself in to pick up a cocktail of prescriptions for his kidney disease.

"He kept coming into the pharmacy, getting all kinds of medication and just looking really bad," Wallace told "I told him that if there's anything I can ever do for him to let me know." ...more

Roche ordered to pay $13M to users of acne drug

From the Associated Press:
A jury has ordered drugmaker Roche to pay nearly $13 million to three patients who claim they developed a chronic bowel disorder because of the company's acne drug Accutane.

Roche's U.S. subsidiary Hoffman-La Roche said it would appeal the verdict.

The money, handed down in New Jersey State Superior Court on Thursday, will be split among the three Florida residents, their attorneys said in a statement. All three began using Accutane a decade ago to treat teenage acne. One of the group is expected to soon have his colon surgically removed while the others will require long-term drug therapy, the attorneys said.

The award is the latest stemming from a wave of lawsuits that accuse Roche of downplaying a link between Accutane and inflammatory bowel disease, which afflicts about 1.4 million people in the U.S. and Canada.

Accutane's warning label notes that the drug is "associated with" chronic bowel problems, but the company has argued that there is no direct connection between its drug and the disease. ...more

Indonesian AIDS patients face microchip monitoring

I realize this isn't really a pharmacy story, but it it heath/medical related and extremely troublesome so I thought I'd include it here.

From the Associated Press:
Lawmakers in Indonesia's remote province of Papua have thrown their support behind a controversial bill requiring some HIV/AIDS patients to be implanted with microchips — part of extreme efforts to monitor the disease.

Health workers and rights activists sharply criticized the plan Monday.

But legislator John Manangsang said by implanting small computer chips beneath the skin of "sexually aggressive" patients, authorities would be in a better position to identify, track and ultimately punish those who deliberately infect others with up to six months in jail or a $5,000 fine.

The technical and practical details still need to be hammered out, but the proposed legislation has received full backing from the provincial parliament and, if it gets a majority vote as expected, will be enacted next month, he and others said.

Indonesia is the world's fourth most populous country and has one of Asia's fastest growing HIV rates, with up to 290,000 infections out of 235 million people, fueled mainly by intravenous drug users and prostitution. ...more

When it comes to statins, don't believe the hype

From the Globe and Mail:
The headlines were dramatic and unequivocal:

"Cholesterol drug causes risk of heart attack to plummet" - Fox News.

"Cholesterol-fighting drugs show wider benefit" - The New York Times.

"Cholesterol drug cuts heart risk in healthy patients" - The Wall Street Journal.

The New York Times article summarized the exciting news in a front-page story saying that "millions more people could benefit from taking the cholesterol-lowering drugs known as statins."

That's big medical/business news, because statins are already the bestselling drugs in the world, with sales in excess of $20-billion (U.S.).

Quoting some of the world's top heart researchers, media reports touted the importance of a blood test for C-reactive protein. That's because those benefiting from statins had high levels of CRP (a marker for inflammation) rather than high levels of LDL cholesterol, which is usually the criterion for statin prescription. ...more

Health groups call for better drug coverage

From the Miramichi (NB) Leader:
When Ross Costain moved to New Brunswick from Prince Edward Island in April 2006, he went from having provincial health coverage to none at all.

Now he suddenly found himself paying around $759 per month for insulin and other measures he needs to cope with the Type 1 diabetes both he and his daughter Latisha have.

“That’s a house payment,” he said. “That’s a mortgage.”

As it stands, it’s enough medication and equipment to cover a small end table.

That cost includes testing strips, which Costain uses to test his blood sugar levels four times a day, to determine how much insulin his body needs to be injected at that particular moment.

With Latisha, who was diagnosed last September, it’s more complicated.

“I have to check her sugar very often,” he said.

As well, her blood sugar levels can change quickly, sometimes in as little as the 25 minutes it takes to ride the bus to school. ...more

Thursday, November 20, 2008

Doctors allege intimidation in raising drug warnings, investigation shows

From CBC News:
Two physicians who tried to warn about the high risk of serious side-effects of the Type 2 diabetes drug Avandia allege they were intimidated by the company that sells it, a CBC investigation revealed Wednesday.

Last year, a review published in the New England Journal of Medicine found a 43 per cent higher risk of heart attack among people taking Avandia, or rosiglitazone, compared to a control group, and 64 per cent more likely to die of cardiovascular problems.

Avandia was hailed as a breakthrough for blood-sugar control. It is designed to help sensitize the body to insulin.

Both the U.S. Food and Drug Administration and Health Canada have issued strong warnings as a result of the 2007 study. By that point, researchers were estimating thousands of people taking Avandia had died, given it had been on the market since 1999. In Canada in 2007, doctors had written more than a million prescriptions for Avandia, according to IMS Health Canada, an industry trend watcher.

In 2000, Dr. Mary Money, an internist from Hagerstown, Md., raised one of the earliest alarms about Avandia. Of 33 patients she put on the new drug, 20 went on to develop serious edema, or fluid retention — a symptom of heart failure. ...more

Tuesday, November 18, 2008

Pet owners turning to mood altering meds to help their critters cope

From the Canadian Press:
With her pink tongue flapping out the side of her mouth, Winnie bounds across the living room, scoops up a tennis ball and proudly trots it back to her owner.

For the two-year-old mutt, life doesn't get much better than hanging out with Mandy Novak, a master who dishes out cold hot dogs and occasionally offers up her face for a slurp.

It's alone time that has filled Winnie with dread.

Late last year, the collie-Labrador mix, adopted from a shelter in October 2007, cried and paced nervously if she even sensed Novak was getting ready to leave for work.

When left on her own, Winnie marauded through the house gnawing on everything from wooden staircases to drywall.

"We came home and we found that she had eaten through the basement walls," said Novak, who lives in the Montreal suburb of Pincourt.

An animal behaviourist diagnosed Winnie with canine separation anxiety, and like more and more pet owners, Novak has turned to a mood-altering drug to help her dog cope. ...more

Sunday, November 16, 2008

The sleepless epidemic

From the Globe and Mail:
For years, Stacie Fox feared the night. From the moment she went to bed, sleeplessness taunted her. Just as she began to drift off, it would jerk her awake again. As a result, she waded through her days with aching joints, swollen glands and a leaden heart. “I felt like I was 80,” says the 32-year-old actor from Burlington, Ont. “I felt like the whole world was going to end. My brain was in a fog.”

Using makeup and her acting skills to hide her exhaustion, she tried everything she could think of escape her insomnia. A dairy-free diet. Acupuncture. Massage therapy. Tai chi. Good sleep hygiene (no caffeine or alcohol, no TV in the bedroom). She even went to the Matrix Repatterning Centre in Aurora, Ont., where naturopathic doctors claimed to help “correct the imbalance in soft tissue, organs and bones.”

Her family doctor tested her thyroid, liver and kidneys, her levels of blood sugar and cortisol, the “stress hormone.” The results all came back normal. Then her doctor prescribed sleeping pills.

Imovane, a tiny, bitter blue piece of magic, sent her into a sweet, sustained slumber. Comfort, at last. She slept like a baby.

Many are loath to admit it, but more and more people both in Canada and the United States are fed up with punching the pillow until dawn. Consumption of sleeping pills has increased dramatically in the past five years. Prescriptions for zopiclone, the generic name for Imovane, rose 49 per cent from 2003 to last year, according to industry tracker IMS Health Canada, while those for all sedatives went up 15 per cent. ...more

HPV vaccine can protect men too

Soon girls may not be the only ones getting Gardasil injections.

Merck Frosst is moving ahead with plans to extend the use of its controversial Gardasil vaccine to boys and young men.

The cancer vaccine for women could be just as effective for men, Universite de Montreal professor and microbiologist Francois Coutlee said Thursday in a telephone interview at a scientific meeting in Nice, France.

Coutlee was part of the team reporting early results of a Merck-sponsored study showing that 90 per cent fewer men ages 16 to 26 years old developed genital warts and other lesions after receiving Gardasil, a vaccine that targets four human papillomavirus strains that can lead to cancer.

But HPV isn't just a problem for women, Coutlee said. In men, HPV can lead to genital warts, anal cancer, and penile cancer.

"The study is still ongoing, but we're relieved to know that it is as effective in men as it is in women," said Coutlee, who was involved in recruiting test subjects in Montreal. ...more

Test strips now covered for people with diabetes who use insulin

From the Charlottetown Guardian:
Islanders who use insulin to manage their diabetes will have assistance in covering the cost of their test strips beginning tomorrow, on World Diabetes Day.

Premier Robert Ghiz and Social Services and Seniors Minister Doug Currie announced today that all Islanders who are dependent on insulin will qualify to receive up to 100 test strips per month, with a monthly co-pay of $11.

The announcement affects close to 2,000 of the nearly 8,000 people with diabetes on P.E.I.

"We are extremely pleased to fulfil the promise this government made to insulin-dependent Islanders in the Throne Speech," said Premier Robert Ghiz. "This announcement is a $1.5 million investment in the health of Islanders."

Nineteen hundred people in Prince Edward Island use insulin and check their blood glucose levels using test strips and monitors. The strips are sold for one dollar each, while the monitors are provided at no charge by manufacturers. ...more

Peppermint oil, older drugs help treat IBS: review

From CBC News:
Older treatments for irritable bowel syndrome like peppermint oil safely help ease symptoms and should be used, a review suggests.

IBS is characterized by abdominal pain and discomfort accompanied by changes in bowel function, diarrhea, constipation or a combination of both, typically over months or years.

It is estimated to affect 13 to 20 per cent of Canadians, according to the Canadian Society of Intestinal Research.

In Canada and most western nations, IBS occurs more often in women. It can occur at any age, but often begins in adolescence or early adulthood. ...more

Breakthrough study finds simple blood test may detect heart disease

From the Globe and Mail:
Measuring certain proteins through a simple blood test may make heart disease easier to detect and a lot less deadly, according to a study published online Sunday in the New England Journal of Medicine.

People with healthy LDL-cholesterol levels but elevated levels of high-sensitivity C-reactive proteins experienced a nearly 50-per-cent reduction in the risk of heart attack, stroke, and cardiovascular death with a daily dose of a cholesterol-lowering statin drug, the study found.

The reduction in heart-disease risk among people who appear healthy and lack risk factors such as elevated cholesterol – which describes about half of those who experience heart disease – is such a significant finding that the drug trial was cut short in order to publish the results sooner.

The nearly 18,000 patients followed in the study had normal cholesterol levels and slightly elevated levels of C-reactive proteins – markers of inflammation that are known indicators of atherosclerosis, or blockage of the arteries.

The researchers suspected statin medications such as rosuvastatin would lower the risk of cardiovascular events in such patients, whose LDL-cholesterol levels were below 3.36 millimoles per litre, but were surprised by how well they worked. ...more

Saturday, November 15, 2008

Internet drug peddlers raided in 9 countries

From Reuters:
Authorities in nine countries have raided businesses suspected of supplying medicines illegally over the Internet in an unprecedented global swoop coordinated by Interpol, officials said on Thursday.

The operation, codenamed Pangea, involved dozens of locations in Britain, Germany, Ireland, Israel, New Zealand, Singapore, Switzerland, Canada and the United States.

The raids on Wednesday mark the first time that such action has been taken on an international scale, an Interpol spokeswoman said.

Illicit sales of medicines via the Web are a growing problem, since many of the products are counterfeits of dubious quality and potentially dangerous.

Britain's Medicines and Healthcare products Regulatory Agency, which raided 12 residential and commercial premises in the crackdown, said illegal Internet sales posed a serious risk to public health.

"A medicine bought in this way has no guarantee that it is safe or that it is effective and can in fact be harmful," Danny Lee-Frost, head of operations, said in a statement. ...more

OxyContin maker: Pills seized in C.B. weren’t the real deal

From the Halifax Chronicle Herald:
Representatives of the company that makes the powerful prescription painkiller OxyContin flew to Sydney on Thursday to examine a vast quantity of seized pills that turned out to be knock-offs.

Police in Cape Breton seized 25,000 oxycodone tablets from a vehicle at a parking lot last week in what is considered the biggest bust of its kind in Atlantic Canada.

Staff Sgt. Paul Jobe said police are now confident the drugs, which have an estimated street value of about $700,000, are not of pharmaceutical grade.

Investigators met with drug-makers Purdue Pharma at police headquarters in Sydney where the company made a presentation on their manufacturing and security systems.

"It’s not the same quality they would produce," said Jobe. "They have a coating they put on their pills, they have a stamp they put on their pills, there’s a (certain) way they produce them."

The U.S.-based pharmaceutical company operates a facility in Pickering, Ont., and is the only maker of the brand OxyContin in Canada. There are eight other manufacturers of its generic form oxycodone, though none deal with the high milligram content found on the pills that were seized. ...more

Union Yes?

From the Indianapolis Star:
With their white coats and six-figure salaries, pharmacists might seem like an unlikely group of card-carrying union members.

But around the country, 15,000 pharmacists, or about 6 percent of the U.S. total, belong to the Steelworkers, Teamsters and other unions, joining ranks with blue- collar workers who smelt aluminum, build tires and drive beer trucks.

Most of the unionized pharmacists work in big industrial markets such as Pittsburgh and Chicago, along with smaller cities, such as Tampa, Fla., and Gary, Ind. No union pharmacists work in Central Indiana, according to the Indiana Pharmacists Alliance, a statewide trade group.

But that could change.

The United Steelworkers union is keeping a close eye on a massive mail-order pharmacy springing up in Boone County. The $150 million distribution center, being built by Medco Health Systems, will cover an area the size of six football fields when it opens next year. It eventually will employ 1,300 people, including hundreds of pharmacists and pharmacy technicians who may need help negotiating contracts and addressing grievances. ...more

Teaching boycott planned

From the Montreal Gazette:
Quebec pharmacists frustrated by a serious staffing shortage held a special meeting yesterday to vote on a series of pressure tactics they promise will not affect patients.

The shortage is expected to worsen, which means patients will suffer, warned Linda Vaillant, executive director of the Association des pharmaciens des établissements de santé du Québec.

"We may not be able to give chemotherapy to patients and we don't want to get there," Vaillant said.

About 1,200 pharmacists work in Quebec hospitals and other health-care establishments. But hospitals need another 200 pharmacists to properly serve patients, Vaillant said.

Hospital pharmacists regularly work 45-hour weeks, often covering 12 days in a row, she said.

"The pharmacist is like the goalie in hockey. He has to make sure to stop the puck, to catch the error, the drug interactions, and adjust the dose. There's potential for increased medical error because of the intensity of the workload," she said. ...more

P.E.I. pharmacists to be able to prescribe

I missed posting some articles while I took a break. I will attempt to catch up over the weekend. This one might have been one of the most interesting in the world of Canadian pharmacy.

From CBC News:
Prince Edward Island pharmacists will soon be given the authority to write prescriptions for their customers.

Changes to provincial legislation allowing pharmacists to renew some prescriptions are expected to be passed next month in the legislature.

Currently, when a prescription runs out and a person doesn't have a refill from the doctor, P.E.I. pharmacists can't do much except provide a few pills to tide the person over. The new legislation will change that.

"This is not prescribing something new; we are not diagnosing anything," Neala Auld, registrar of the P.E.I. Pharmacy Board, told CBC News Thursday.

Allowing pharmacists to renew some prescriptions will be a great convenience for patients, said Auld, particularly those without a family doctor.

"It puts patients in a very difficult position having to get a new prescription and wait maybe two or three hours in outpatients for something that easily could be addressed at the pharmacy level," she said. ...more

Ban diabetes drug Avandia: consumer group to FDA

From CBC News:
The diabetes drug Avandia should be banned over its risks of heart and liver damage, a U.S. consumer group urged.

In a petition filed with the U.S. Food and Drug Administration on Thursday, the group Public Citizen called for the Type 2 diabetes drug, whose generic name is rosiglitazone, to be pulled from the market.

Last week, the American Diabetes Association and a European counterpart unanimously advised doctors against using Avandia in updated treatment guidelines.

"The FDA is in possession of clear, unequivocal evidence that (Avandia) causes a wide variety of toxicities," Public Citizen said in its petition.

"Many of these are life-threatening, such as heart attacks, heart failure (and) liver failure."

In November 2007, GlaxoSmithKline Inc., the manufacturer of rosiglitazone, updated its prescribing information in consultation with Health Canada after a study published in the New England Journal of Medicine reported a 43 per cent higher risk of heart attack for those taking rosiglitazone compared to people taking other diabetes drugs or no diabetes medication at all. ...more

Rare Treatment Is Reported to Cure AIDS Patient

From the New York Times:
Doctors in Berlin are reporting that they cured a man of AIDS by giving him transplanted blood stem cells from a person naturally resistant to the virus.

But while the case has novel medical implications, experts say it will be of little immediate use in treating AIDS. Top American researchers called the treatment unthinkable for the millions infected in Africa and impractical even for insured patients in top research hospitals.

“It’s very nice, and it’s not even surprising,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. “But it’s just off the table of practicality.”

The patient, a 42-year-old American resident in Germany, also has leukemia, which justified the high risk of a stem-cell transplant. Such transplants require wiping out a patient’s immune system, including bone marrow, with radiation and drugs; 10 to 30 percent of those getting them die.

“Frankly, I’d rather take the medicine,” said Dr. Robert C. Gallo, director of the Institute of Human Virology at the University of Maryland School of Medicine, referring to antiretroviral drugs. ..more

Thursday, November 13, 2008

Statins: the Aspirin of the 21st century?

From CBC News:
They're the best-selling family of drugs of all time, with annual worldwide sales estimated at more than $20 billion. Every year, Canadian doctors write more than 12 million prescriptions for statins, making them the most-prescribed drugs in the country. They're in a class of drugs that has proven very effective at lowering cholesterol levels and reducing the risk of heart attacks.

The possible effectiveness of statins is so great that surprised researchers reported in November 2008 they have stopped a four-year study two years early in order to present their findings as soon as possible on the drugs' benefits to patients.

The study, which followed nearly 18,000 patients from 27 different countries, found the strongest evidence yet that people with high levels of a particular protein are at increased risk of cardiovascular disease. It also found that the risk dropped by nearly half for patients treated with statins.

All the patients had normal levels of cholesterol (LDL-c) and high levels of hs-CRP (high-sensitivity C-reactive protein) — previously suspected, but not confirmed, to be a critical indicator of heart problems — and as such were not receiving any treatment for cardiovascular disease. ...more

Woman blames drug company for contributing to heart attack

From the Waterloo (Ont.) Record:
Trudy Metzger used to call the little white pill she took daily her miracle drug.

The 38-year-old Elmira woman took the drug to relieve the uncomfortable symptoms of irritable bowel syndrome.

Today, she believes the drug, Zelnorm, contributed to the massive heart attack she suffered two years ago at age 36.

"I could have died," Metzger said yesterday.

The mother of five is the representative plaintiff in a $125-million class-action lawsuit against Novartis Pharmaceuticals Canada Inc., the Quebec-based manufacturer of the drug.

None of the allegations in the lawsuit have been proven in court.

Silvie Letendra, spokesperson for Novartis, declined to comment.

"Since this matter is now before the courts, Novartis cannot comment," she said in an e-mail. ...more

C.B. cops make big Oxy bust

From the Halifax Chronicle Herald:
Some 25,000 OxyContin pills were seized in a downtown parking lot Friday night in what the acting chief of Cape Breton Regional Police says could be the biggest bust of the prescription drug in Atlantic Canada.

Plastic baggies filled with the powerful pills lined a table at police headquarters Monday as Staff Sgt. Paul Jobe told reporters about the takedown.

Members of the street crime unit staked out a car in a parking lot along the Esplanade on Friday and moved in when the suspects got out, he said. A small amount of marijuana was also seized.

Christopher John Allingham of Eastern Passage and Todd Douglas Miller of the Montreal area appeared briefly in Sydney provincial court on Monday....more

AIDS vaccine developed in Ont. nears human trials

An experimental vaccine aimed at combating the HIV/AIDS virus has been developed by a researcher at the University of Western Ontario in London and is ready to be put through a key testing phase, the university announced Wednesday.

The vaccine, developed by virologist Dr. Chil-Yong Kang, will now go through toxicology tests to ensure it can safely be injected into humans.

Toxicology trials using animals will begin in a matter of days at a research facility in the United States with results expected in approximately three months, Kang said.

Phase 1 human clinical trials could begin in early spring.

Unlike other vaccines, which have used only a small amount of HIV's genetic material, Kang said his vaccine uses a whole dead HIV-1 virus, a technique Jonas Salk used in the polio vaccine.

"We have engineered a virus in such a way that it can be produced in larger quantities in shorter periods of time and it is also non-pathogenic. In other words, it doesn't cause the disease," Kang said. "We have tested animals and they do respond to the vaccine and we now have to try it in humans."

The vaccine will be tested in individuals who are HIV-positive, but don't yet have AIDS symptoms, Kang said....more