Just a quick one-off post. In my last post on the Part D optimizer, I was thinking how I’d wished I’d had some references for rates of compliance based on qd, bid, tid, qid, etc. dosing. In general, compliance tends to fall off the more often someone has to take a medication. it does for me, for instance, and I know better, as I mentioned in my Atripla post.

Anyway, I messed about with Google Scholar back a few years ago when it first came out. It wasn’t especially useful then, but it seems to have gotten better as its index has grown. In any event, it was nice to find links to extracts of articles dealing with the topic. Most of them related to AIDS — since consistency is so crucial for keeping HIV in remission — but I think the findings can probably be extrapolated to non-HIV-related compliance as well.

Unfortunately most of the databases that are indexed require paid logins to read the fulltext, so it may not be quite so useful to the public at large.

[tags]Medicine, pharmacy, Google scholar, Google, research, science[/tags]

Yesterday I got a bit carried away in my post on organ donation. I didn’t say it in that post because it seemed fairly obvious to me that the reason it’s verboten by Uncle Sam is to ostensibly protect individuals from being exploited for their organs. To me that seems like it would simply force the practice underground, whereas I think it would be better to have it out in the open and regulated for the safety of all parties involved. (I think the same thing about prostitution, as you might guess.) I am not aware of a thriving black market for human organs in the United States, however such markets exist in other countries.

Anyway, the whole point of yesterday’s post was to mention baby steps towards creating a legitimate market for organs. A Jerusalem district court ruled that Israeli HMOs must pay kidney donors NIS 63,000 (~$14,300) to cover their expenses, but it stopped short of saying whether they’re allowed to pay for a kidney:

The Western world generally forbids organ trade. In Israel the ban came in a directive by the CEO of the Health Ministry. But Jewish law (halakha) does allow payment for organs and even considers selling one to be a mitzvah.

In a precedent-setting ruling on Monday by the Jerusalem District Court, Judge Joseph Shapira instructed HMOs to pay 31 kidney donors NIS 63,000 each to cover expenses. Shapira stipulated that the ruling is not on the more fundamental issue of whether payment should be allowed for the kidney itself.

An interesting ruling. But since most kidneys are donated by living relatives, it would almost seem a little odd for an HMO to be giving money to the donor outside of expenses. It would seem like it would be the responsibility of the private parties to handle that sort of thing.

I believe Levitt is wrong in his blog post on the topic when he says that these people are getting an extra $13,000 in their pockets. It reads to me that the Israeli HMO’s are merely covering the expenses of the second party involved rather than allowing them to take home some extra pocket cash. How do you all read it?

[tags]Medicine, organ donation, economics, healthcare, Israel, ethics[/tags]

Conceptually, economics is a fascinating field to me, and it’s an invisible factor that’s often overlooked by the mainstream media and by independent writers and bloggers. Naturally, for every action, there are consequences, no matter if the decision is a policy decision or a financial decision, or something in between. The threads that connect everything to everything else are some of the most interesting facets of the world we live in. Healthcare is certainly no exception.

The authors of Freakonomics (an excellent book, by the way) have covered the economics of organ donation in a New York Times article from July 9, 2006. (“Flesh Trade: Why Not Let People Sell Their Organs“) All jokes about people selling kidneys on eBay aside — which has been tried — there doesn’t seem to be anything inherently unethical about doing so. While I wouldn’t sell one of my kidneys (though I might give one away) I don’t see anything wrong with the practice for those interested in doing so. Levitt and Dubner agree, noting that the practice could help alleviate the organ shortage:

Continue reading The economics of organ donation →

Before I saw this news story, I was talking to a friend of mine whose girlfriend is a pharmacy student. He mentioned that she hasn’t been vaccinated. At all. Against anything.

My mind was boggled.

1) I thought it was required for all students, particularly those in the medical field, so they don’t endanger their patients — immunocompromised individuals are susceptible to these diseases even if they are vaccinated. I was required to be vaccinated against several specific diseases as a condition of being accepted to pharmacy school. The requirements were different if you were a pre-med or a PA student (which makes sense).

2) Why would a pharmacy student not be vaccinated against things like polio? MMR? Sure, there’s the old (unfounded) worry that MMR vaccines increase rates of autism, but the benefits clearly outweigh the consequences.

It seems there are loopholes: students can apparently opt out of it conflicts with their personal or religious beliefs. I think this is a danger specifically to one’s patients, and to the public at large: by it’s very nature, the medical profession exposes personnel to more sickness and disease than would otherwise be the case. I’d almost go so far as to call not being immunized unethical.

Continue reading Diseases eliminated by vaccines making a triumphant return (in certain circles) →

I have a special place in my heart for microbiology in general, and superbugs in particular. Ever since microbiology lab, I’ve loved playing with bacteria. In fact, I still have a urea agar slant vial that’s a lovely shade of flourescent pink — thanks to proteus vulgaris — that I stoletook from lab. (They were just going to throw it away!) It was hanging from my rearview mirror in my car for a while, and now it sits on my desk, an old friend from a favorite class. It looks something like this, only the agar is translucent rather than opaque, and is quite pretty when it catches the sun just right. Maybe I’ll take a picture of it one of these days. I’m surprised it’s as vibrant pink as it is — it’s quite old.

Alas, I’m showing my nerdy side. On with the real news…

MRSA is turning into a real problem in prisons. Not only for prisoners, but for guards as well. I’ve been watching this blog for a while, and following the comments therein. There’s some scary stuff going on:

K Schacht Says:

Until recently I was employed as an part-time instructor in two of our local jails. I had been working just a few months when suddenly I began to not feel well, and then the symptons developed… which were misdiagnoised for several months. Finally, I was correctly diagnoised with MRSA, but six months later I’m still ill and the antibiotics are not working.

Yes, I’m mad and yes I do feel the jails have a culpability of informing and educating not only outside and inside staff, but the inmates as well.

I had no idea of this risk and was not informed at each jail orientations. The choice of exposure was not an option and the lack of information has prolonged and perhaps worsened my health.

Continue reading MRSA infections in prisons on the rise →

And both groups rank below pharmacists by a large margin.

I think this graph is very telling. (Thanks to John Mack from Pharma Marketing Blog.) Click it for a larger image.

The results are from Medco’s 2006 Drug Trend Report. As one of the largest PBMs in the country, Medco is in a unique position publish statistical analysis of drug trends because their subscribers are from every conceivable demographic.

“The survey found that physicians trail consumers and pharmacists regarding their knowledge of and confidence in the safety and effectiveness of generic drugs which could have broad implications for the forthcoming boon in savings from the expected drug patent expirations of branded drugs worth over $40 billion in U.S. sales:

• “One quarter of the physicians surveyed stated that they do not believe generic medications to be chemically identical to their branded counterparts; more than 8 percent said they were unsure. This despite FDA rules that require generic versions of the drug be bioequivalent to the brand medication
• Nearly one in five physicians believes generic drugs are less safe than brand-name medications, and more than one in four doctors (27 percent) believe generic medications will cause more side effects than brands”

Just wonderful. It’s true there are slight differences between brand and generics. Dyes, binders, and disintegrants may be slightly different, but these differences are usually negligible, to say nothing of potential side effects. After all, who is to say that the brand name drug’s binders, disintegrants, and dyes are less likely to cause problems than the generic equivalent’s? Answer: impossible to know without trying. Doh!

Now seems like a good time to link up my generic drug FAQ post.

Continue reading Physicians score worse than consumers when it comes to generic drug knowledge →

There’s a new image database from UCLA cataloging medieval medical images. It’s an interesting little website, particularly if you’ve got an interest in art, history, or historical medicine. Some of the science is dead wrong (duh), but it’s pretty cool from a historical standpoint.

The Index of Medieval Medical Images project began in 1988 and aimed to describe and index the content of all medieval manuscript images (up to the year 1500) with medical components held in North American collections. The goal of this 2001 pilot project was to make a substantial sample of the images and descriptions available via a searchable database on the Web.

Try a search if you’re so inclined, or you can browse by subject.

As technology and science has progressed, our quality of life has improved and our lifespans have gotten longer, leading to different challenges as we live to be older and hopefully wiser.

[tags]Medicine, medieval, history, art[/tags]

I love to see this stuff, and (as you might have guessed) the article was the catalyst for me gushing about the impact of technology on the future of medicine in my primer on evidence-based medicine.

Instead of Willey having to rely strictly on his experience and memory, the computer kicks out the latest information that he can use for his patients.

[…]

For example, Willey showed the computer’s reply to a diagnosis of an ear infection that was caused by antibiotic-resistant bacteria. Conventional medicine says the most common antibiotic, amoxicillin, doesn’t work on resistant bacteria. But the information in the computer said studies had shown that doubling the dosage of amoxicillin would cure the infection and was safe.

Continue reading Evidence-based medicine in the Real Worldâ„¢ →

Bad handwriting accounts for a small (but significant) percentage of medication errors, as was reported in a study I wrote about a few days ago. It is not the biggest problem, but it is a real problem. Techies and techno-literate healthcare professionals like to tout the advantages of e-prescribing systems to get around this problem. And indeed, often electronic prescriptions are blessedly clear compared to their handwritten counterparts.

And sometimes they’re not.

Allow me to explain… This past week, we received a electronic prescription for Vagifem that had contradictory directions in the sig code. While not exact, it was something like “Use once a week for two weeks for two weeks twice a week for a week once a week.”

Continue reading Electronic prescriptions are not a panacea →