Monday, September 27, 2010

Doctors over-prescribe, test: report

From the National Post:
Swayed by pharmaceutical sales reps and less than fully versed on new technology, family doctors may be prescribing drugs improperly and ordering too many expensive diagnostic tests, warns a new federal-provincial report.

Governments must give such primary-care physicians the tools to make better decisions if they want to corral spiralling health-care costs, says the Health Council of Canada in a report to be released on Monday.

"Our research points to inappropriate prescribing of drugs and over-use of diagnostic imaging," says the report, Decisions Decisions. "If there is no change in how family physicians are supported in their role as gatekeeper, we can expect a surge in health service use."

The council's head stressed the group is not attacking the competency of the doctors Canadians visit most often, but issuing a "call for action" to help them better assess a barrage of new medications and technologies. ...more

Canada weighs tighter rules on Avandia diabetes drug

From the Globe and Mail:
Popular diabetes drug Avandia is being pulled off the market in Europe and will face tighter restrictions in the U.S. because of fears patients who take it face an increased risk of heart attacks, stroke and other cardiovascular problems.

The decision is a blow to GlaxoSmithKline Inc., the company that sells Avandia, the brand name of the diabetes drug rosiglitazone.

It also raises questions about further regulatory restrictions in Canada. Health Canada said in 2007 that, because of the potential for cardiovascular problems, Avandia shouldn’t be taken on its own unless patients can’t tolerate other diabetes drugs. Similar restrictions were announced Thursday by the U.S. Food and Drug Administration.

But the European Medicines Agency, which evaluates drugs in the European Union, recommended suspending Avandia’s market authorizations and said it would no longer be available there in the next few months.

In July, Health Canada said it was continuing to review the safety of Avandia and that it was closely monitoring developments in the U.S. The department issued a public advisory in July saying it would take “the appropriate regulatory action necessary” pending the outcome of safety investigations in other countries. ...more

Stricter controls on the way for methadone in B.C.

From CTV News:
.C.'s pharmacists will face stricter controls on their methadone supplies, and the province's pharmacy watchdog says even more rules could be on the way to stop kickback schemes and scams.

Starting in October, pharmacists will have to keep records of all narcotics in their possession to better report theft of the drugs and keep track of methadone use, according to B.C.'s College of Pharmacists.

"This policy change adds more rigour and structure to what many pharmacists were doing in the first place," said the college's deputy registrar Suzanne Solven.

She said the policy came into being as a result of increased concerns about thefts from pharmacies, but that the rules would work in tandem with anti-kickback regulations that have been announced already.

Other rules could be on their way after the college completes a review of methadone practices by the end of the year, she added.

Methadone is a daily medication that satisfies cravings for addicts and keeps them away from hard drugs. ...more

Bismarck Pharmacist Creates Gel to Help Chemo Patients

From KFVR-TV (ND):
A Bismarck pharmacist has been receiving phone calls from physicians all over the world after he created a special gel to relieve pain some patients experience after undergoing chemotherapy.

Mike Riepl is a personalized medication specialist. He created the gel for one patient of his and couldn`t have guessed it would help people across the globe.

Riepl has spent many hours in his pharmacy lab. Mixing chemicals to help people feel better is nothing new to him.

"I was talking to a patient who had gone through chemotherapy, and sometimes chemo will damage the nerve endings or the nerves in the hands and the feet," explained Riepl. "She was complaining she was having a burning sensation, pins and needles. She asked if there was anything that would help."

Riepl talked to the woman`s physician, and then decided to come up with a new solution to help the patient. He created BAK gel, which stands for its three main ingredients, baclofen, amitriptyline and ketamine. ...more

Feeling the effects of a drug shortage

From the Ottawa Citizen:
Claudia McKeen's pharmacy fills 200 to 300 prescriptions a day, but she has to scramble for a couple of dozen of those because her suppliers keep running out of stock.

"There's no penicillin right now in Canada," she said Wednesday -- at least, none of the 300-milligram tablets, a standard size, which stopped coming a few weeks ago. That means a call to each doctor who prescribes it. Would amoxicillin be OK instead? The same goes for a host of drugs. Warfarin, a blood thinner, is now in short supply. So is hepatitis B vaccine; adults have to get two pediatric doses instead of a single shot.

"It's just craziness." Next week, who knows what will run out? There's seldom any warning.

McKeen owns the Glebe Apothecary on Bank Street. There have always been occasional drug shortages, but for the past year it has become much worse, she says.

"We're dispensing things in quarter-tablets because we can't get the right strength. It's a nuisance and a massive headache. It's a big, big concern and a time-waster. I think it's a very bad situation." McKeen warns shortages will likely cause more drug errors. Some of her older customers have trouble keeping track of their drugs already. If she substitutes three small blue pills for one big red pill, they'll have more trouble, she says. ...more

OxyContin cure often worse than ailment

From the Calgary Herald:
Sometimes armed, and always desperate, Cory Alan Sharlow terrorized pharmacists across the city during a series of brazen robberies last fall.

His pattern was wellplanned and predictable: Steal a car. Rob a pharmacist. Make his getaway.

His motive was less complex, but always the same: to get the OxyContin his body craved.

The plan worked so well he robbed 10 pharmacies in a month, until he was caught and later jailed.

Police and addictions experts say Sharlow's case typifies the danger and desperation of addicts driven to get their fix of OxyContin, the brand name given an opioid painkiller that dispenses the drug, oxycodone, through time release. When crushed, the high dosage is released at once, producing a euphoric feeling.

"They find themselves cheating, lying, exaggerating (and) violating their own sense of ethics with the end of satisfying the habit," says Dr. David Hodgins of the University of Calgary's addictive behaviours lab. ...more

Sunday, September 12, 2010

Insomnia and anxiety medications increase mortality risk by 36%: Canadian study

This is a decent enough article except when it comes to listing the drugs in the table. Ambien - not available in Canada. Lunesta - not available in Canada. Rozerem - not available in Canada. Sonata - was called Starnoc in Canada but has been discontinued. Silenor - not available under this name. No mention of Imovane at all, which is easily the most prescribed sleeping pill in this country. Memo to the reporter: check more than one source and make sure one of them is Canadian.

From the National Post:
A new comprehensive Canadian study that looks at 12 years’ worth of Statistics Canada data has concluded that taking medications to treat insomnia and anxiety increases mortality risk by 36%.

Genevieve Belleville, a professor at Universit√© Laval‘s School of Psychology, published her finding in the September edition of the Canadian Journal of Psychiatry.

Belleville arrived at these results through analysis of over 14,000 Canadians in Statistics Canada’s National Population Health Survey. The data includes information on the social demographics, lifestyle and health of Canadians age 18 to 102, surveyed every two years between 1994 and 2007. She also considered the possibility that depression, alcohol and tobacco consumption, physical health and physical activity level could contribute to mortality rates and controlled for these factors.

Respondents who reported having used medication to treat insomnia or anxiety at least once in the month preceding the survey had a mortality rate of 15.7%. Respondents who reported not having used such medications had a rate of 10.5%. ...more

Lack of training for Canadian doctors contributing to narcotics crisis: report

From the Toronto Star:
Canadian doctors are woefully undertrained in pain management and addiction, a shortfall that is contributing to Ontario’s prescription narcotics crisis, says the body that regulates the province’s doctors.

Medical schools in this country devote a meagre 16 hours on average to proper pain education, half of the training nurses receive and less than one fifth the time that veterinary schools devote to the subject.

In a sweeping set of recommendations aimed at stemming epidemic abuse of narcotics like OxyContin, the College of Physicians and Surgeons of Ontario is urging beefed-up academic training in pain relief and addiction.

“Pain management training in its present format in undergraduate education, particularly for physicians, is insufficient,” said Dr. Stephen Wetmore, who headed the report’s education working group.

“Physicians receive less pain management training than virtually any other health care provider,” he said. ...more

Diabetes could cost Ontario $7B a year by 2020: report

From the National Post:
More than one in 10 Ontarians could be living with diabetes by 2020, costing the province $7-billion a year in health care and lost productivity, a new report reveals.

The study, released on Wednesday morning by the Canadian Diabetes Association, urges the Ontario government to rethink how it fights the epidemic.

According to the report, the number of Ontarians with diabetes has nearly doubled since 2000, from 546,000 to more than 1.1 million, and is on track to grow over the next decade to 1.9 million.

That means 12% of all Ontarians could be diagnosed with the disease by 2020.

Diabetes already costs Ontario $4.9-billion annually, mostly in lost productivity ($2.8-billion) and long-term disability claims ($998-million). Another $1-billion is spent on hospital visits, doctors’ fees and medications. ...more

Wednesday, September 01, 2010

Next Front In Border Debate: IUDs

From the National Post:
In an unusual twist on the cross-border trade in medical products, doctors in the United States are coming under fire for ordering much cheaper, but apparently identical, versions of IUD birth-control devices from Canada.

The U.S. Food and Drug Administration says it has not approved the Canadian products, so cannot guarantee their safety. Critics argue the agency is only propping up inflated, U.S. prices, underscoring the high cost of health products generally in the U.S. system.

Meanwhile, one practitioner faces fraud and other criminal charges for importing Canadian IUDs, and some state governments have mounted high-profile crackdowns, ordering doctors to stop using the devices.

"Anybody who takes a look at this scenario can see the problem," said Erin Cassinelli Couch, an Arkansas lawyer who represents the specialist awaiting trial on federal charges.

"You have a private corporation that sets the price quite a bit higher than they set for the same product in other countries, and they've gotten the U.S. government to limit purchases to that company and at that price." ...more

New Pharmacy building slated for 2012 opening

From the Ubyssey (BC):
The latest gaping hole of construction at UBC is an indication of good things to come, as the Faculty of Pharmaceutical Science finds a new home on campus.

Expected to open in September of 2012, the faculty’s new home will cost $133.3 million. Around 900 pharmacy students will make use of the building by 2015, a 50 per cent increase. It will also include the Canadian Drug Research and Development (CDRD).

Dr. Helen Burt, the faculty’s acting dean, is excited for the structure and design of the new building.

“We’re going to have some of the best infrastructure for teaching and learning anywhere on campus—state of the art teaching facilities for small group learning and for larger groups we’re going to have a real pharmacy clinic located in the building,” said Burt. ...more

Alberta rejects therapy to quit smoking

From the Calgary Herald:
The Canadian Medical Association Journal is calling on provincial governments to publicly fund medications designed to help Canadians quit smoking, but Alberta is closing the door on the idea for now.

In an editorial published Monday, the authors suggest tax revenues collected on the sale of tobacco products could fund reimbursement for smoking cessation therapies.

Last year, 5.7 million Canadians -- or 20 per cent of those who are 12 and older -- smoked either daily or occasionally, according to Statistics Canada.

Among provinces, Alberta and Nova Scotia had the highest smoking rate, at 23.3 per cent.

The medical association editorial notes the number of smokers has remained relatively stagnant in recent years despite provincial and federal programs geared to help Canadians quash their nicotine addition. ...more

Angina medication could save patients with heart failure

From the Toronto Star:
A $16.50-a-week drug used to treat angina has been shown in a European trial to be an effective treatment for heart failure and could save the lives of thousands of Canadians who suffer from the disease.

Researchers, who presented their findings Sunday at the European Society of Cardiology congress in Stockholm, estimate the drug, ivabradine, could save 5,000 to 8,000 lives annually in the U.K. About 700,000 people, or one per cent of the population there, have the disease. About 400,000 Canadians suffer from heart failure.

The study was also published in the respected British medical journal the Lancet.

“It’s a very large trial, which is hugely positive and will make a big difference to the way people with heart failure are treated,” said Martin Cowie, a cardiologist at London’s Royal Brompton Hospital who led the U.K. arm of the study.

Ivabradine is already licensed in Europe to treat angina and can now be prescribed off-label to treat heart failure. In the U.K., the cost of treatment with ivabradine is the equivalent of about $16.50 per patient per week. ...more

Ontario to track overuse of OxyContin and other prescriptions drugs

From the Western Star:
Ontario plans to launch a new tracking system to curb the abuse of the highly addictive painkiller OxyContin and other prescription drugs, a growing problem that's sparked crackdowns in other provinces.

The system would monitor prescription narcotics and other controlled substances, from painkillers such as oxycodone, morphine and codeine, to stimulants and sedatives like Ritalin, Valium and phenobarbital.

The misuse of prescription narcotics isn't just a problem in Ontario, said Health Minister Deb Matthews.

"Canada does have one of the highest per capita usages of anywhere in the world, and Ontario is more than double the rate of the rest of Canada," she said in an interview Friday. ...more

Liberating the pill

From the Montreal Gazette:
t's not addictive, it's easy to take and 50 years of use shows it's safe.

So why do women still need a prescription for the birth-control pill?

A move to make oral contraceptives available over the counter is gaining momentum in the United States - and any regulatory changes there would have significant ramifications for Canada.

Proponents for taking the pill off prescription-only status say the benefits outweigh the risks, the potential for misuse is minimal and easier access could help lower rates of unintended pregnancies and abortions.

But the prospect of women gaining unfettered access to the pill has some doctors and sexual health counsellors uneasy. Would women still see their doctor for Pap smears? Could they safely screen themselves for contraindications - conditions under which the pill should not be used? Would it unleash a marketing bonanza for drug-makers and a huge increase in users?

Nevertheless, a Canadian leader in reproductive medicine and editor of the Journal of Obstetrics and Gynaecology Canada says it seems wrong and paternalistic that, half a century after the pill's debut in the U.S. and 41 years after coming to Canada, women still cannot get access to the most effective, self-administered birth control on the market without a doctor's blessing. ...more