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 →

I’ve covered the approval of Merck’s HPV vaccine extensively in the last month or so. It’s great news for women everywhere, both here in the United States, and especially in the third world. The question now is “should it be mandatory?” Of course ACIP recommended the vaccine, as I predicted they would, so it’s certainly something to consider.

An editorial by someone published in the NYT this past week questions whether the vaccine should be mandatory. Of course, there are some vaccines that are required for anyone entering a public school, for instance. Gardasil could be among these required vaccines (MMR, etc.) for girls aged 9-26. (So that means college students as well.)

I don’t see the problem with making the vaccine mandatory. While there are some reasons that this might not be necessary — cancer-causing HPV can only be contracted through sexual contact — there aren’t any reasons listed that are compelling safety issues.

So we have a sexually-transmitted disease, and a vaccine to prevent it. Should the vaccine be mandatory?

Continue reading Should the HPV vaccine be mandatory? →

It’s a funny thing, you know, medication errors. But probably not how you’re thinking it. In a retail setting, a pharmacist makes an error, and depending on what part of the country s/he lives in, and who he works for, it can be all over the news. Basically, it’s a publicity circus.

On the other hand, you’ve got hospitals where errors occur almost daily. In fact, these errors occur more often than you’d think:

Mistakes in giving drugs are so prevalent in hospitals that, on average, a patient will be subjected to a medication error each day he or she occupies a hospital bed, the report by a panel of experts said.

Continue reading Medication errors harming millions? →

Over the last year that I’ve been writing about science and medicine, I have argued for protections for those who object to performing procedures or dispensing medications that they find morally reprehensible. The more I read and see about the issue, my feelings lie towards the “find another line of work” slant. I found this editorial in the WaPo the other day, and I’ve only just now gotten around to reading it.

Pharmacists refusing to dispense Plan B. Doctors refusing to prescribe Viagra to unmarried men. Fertility specialists refusing to artificially inseminate a gay woman.

Continue reading Moral and ethical boundaries in healthcare →

Hey now this is pretty cool. Atripla is a once-a-day AIDS, 2-in-1 cocktail of Sustiva and Truvada. The hope is that this formulation will help increase patient compliance, which any medical provider will tell you is one of the biggest problems when it comes to achieving positive therapeutic outcomes.

“We know that an HIV-AIDS patient needs to take 95 percent of his or her pills or they won’t work,” said John C. Martin, chief executive of Gilead Sciences Inc., one of the companies in the Atripla project. “So the fewer pills a patient needs to take, the better the outcome.”

Even I’m terrible at compliance, and I understand this better than most. I’d love to see some graphs that show the correlation between the number of times per day that a drug is taken vs compliance over time. I bet you see much higher compliance rates for a once-a-day drug than you do with twice-a-day regimens, and an even steeper drop-off when you’ve got someone who needs to take something 3 and 4 times a day. I bet it’s particularly bad with 4 times a day dosing, because then you’re not necessarily tying a dose to a specific daily activity (eating).

Hrm.

[tags]Medicine, pharmacy, Atripla, HIV, AIDS, Sustiva, truvada, patient compliance[/tags]

I found this today, and I’m thinking that I should print out about 100 copies and keep them handy for people who are skeptical about the efficacy of generic drugs.

• What are generic drugs?
• Are generic drugs as safe as brand-name drugs?
• Are generic drugs as strong as brand-name drugs?
• Do generic drugs take longer to work in the body?
• Why are generic drugs less expensive?
• Are brand-name drugs made in more modern facilities than generic drugs?
• If brand-name drugs and generic drugs have the same active ingredients, why do they look different?
• Does every brand-name drug have a generic counterpart?
• What is the best source of information about generic drugs?

Straight from the horse’s mouth.