Shaking the hubris of the profession
My friend Danny Sands writes a remarkable story about a recent medical problem he faced. It's called "On The Ultimate Loss of Control, Living with Uncertainty, Reflecting on the Future, and Being a Patient." It is beautifully written and worth a look.I have been struck by a number of similar types of stories recently in which doctors have become patients or have been with close families members in that situation. I think it is a wonderful thing that physicians now feel comfortable relating such experiences. The common theme is one of shock and a new understanding of what it is like to be a "customer" in t...
Source: Running a hospital - November 29, 2013 Category: Health Managers Source Type: blogs
Statins in the Spotlight
By Quinn Phillips
Two weeks ago, at the annual meeting of the American Heart Association, that group — in partnership with the American College of Cardiology — released sweeping new guidelines on drug treatments for the prevention of cardiovascular disease. Of the new recommendations contained within the guidelines, the one that is getting the most attention is a dramatic expansion in the number of people for whom statin drugs are recommended. Statins — the group of cholesterol-lowering drugs that includes atorvastatin (brand name Lipitor), simvastatin (Zocor), and rosuvastatin (Crestor) — were prev...
Source: Diabetes Self-Management - November 27, 2013 Category: Diabetes Authors: Quinn Phillips Source Type: blogs
Digging deeper into the new cholesterol guidelines
The American Heart Association, in collaboration with the American College of Cardiology, recently released recommendations that should change the way we prescribe medications called statins, including drugs like Lipitor and Crestor and their generics, atorvastatin and rosuvastatin.
The headlines say stuff like, “More Americans may be Eligible to Receive Cholesterol Lowering Drugs!”
I am a bit skeptical of news about statin therapy because Lipitor, before it went generic, was responsible for over 6 billion dollars in revenue for Pfizer and since it went generic, AstraZeneca is raking in more revenue than they...
Source: Kevin, M.D. - Medical Weblog - November 26, 2013 Category: Family Physicians Tags: Meds Heart Medications Source Type: blogs
MKSAP: 61-year-old woman with hot flushes
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 61-year-old woman is evaluated for hot flushes, which have been persistent for the last 10 years. They occur at least 7 times per day, last for approximately 60 seconds, and are associated with severe sweating, palpitations, and occasional nausea. She is awakened several times per night. She has tried herbal medications, including soy and black cohosh, but has not experienced any benefit. She has hypertension, type 2 diabetes mellitus, and hyperlipidemia. Five years ago, she developed deep venous thrombosis af...
Source: Kevin, M.D. - Medical Weblog - November 16, 2013 Category: Family Physicians Tags: Conditions Heart Medications OB/GYN Source Type: blogs
Greatly improved new statin guidelines – with one exception
The Twitterverse blew up yesterday when they released the new lipid guidelines. I read many articles and finally think I am understanding the big progress these guidelines achieve.
My favorite review is on Medscape (free registration required) – New Cholesterol Guidelines Abandon LDL Targets. I titled this post the statin guidelines, because these guidelines no longer focus on LDL levels, but rather the use of statins. We are no longer asked to treat to goal, rather to put appropriate patients on a statin.
The four major primary- and secondary-prevention patient groups who should be treated with statins were identi...
Source: DB's Medical Rants - November 13, 2013 Category: Health Medicine and Bioethics Commentators Authors: rcentor Tags: Medical Rants Source Type: blogs
Ranbaxy whistleblower reveals how he exposed massive pharmaceutical fraud
(CBS News) Among the drugs prescribed to Americans, 80 percent are generic drugs, and 40 percent of drugs are now made overseas in countries such as China and India where U.S. oversight is weaker.
Recently, CBS News' senior correspondent John Millerhas been looking at one of those companies -- Ranbaxy.
Dinesh Thakur, an American-educated chemical engineer, was hired by Ranbaxy, back in 2003. He would later become a whistleblower, exposing massive fraud by the generic pharmaceutical giant, a company that sold Americans drugs like the generic version of Lipitor. His information led to Ranbaxy pleading guilty to seven f...
Source: PharmaGossip - November 6, 2013 Category: Pharma Commentators Authors: insider Source Type: blogs
A Fading Vertex Drug Was Also Fastest To Become A Blockbuster
How is this for irony? The same week that Vertex Pharmaceuticals (VRTX) cuts 15 percent of its workforce due to plunging sales of its Incivek treatment for hepatitis C, the drug has been identified as having achieved blockbuster status faster than any other medicine. Incivek was launched in 2011, by the way, and surpassed Celebrex, which is sold by Pfizer (PFE) but was launched in 1999 by Pharmacia.
The analysis was conducted by EvaluatePharma which reviewed quarterly US products sales and aggregated the first four full quarters after each drug launch in the region. Only five drugs have ever achieved blockbuster status in ...
Source: Pharmalot - October 31, 2013 Category: Pharma Commentators Authors: esilverman Source Type: blogs
Drug which blocks intestinal absorption of cholesterol
:
a) Atorvastatin
b) Gemfibrozil
c) Ezetimibe
d) Rosuvastatin
Correct answer: c) Ezetimibe
Ezetimibe acts by selectively blocking the uptake of cholesterol and other sterols by intestinal epithelial cells. The action is on Niemann-Pick C1-like 1 (NPC1L1) cholesterol uptake receptors.
Interestingly, it has been recently shown that NPC1L1 expression is necessary for HCV (hepatitis C virus) infection. Ezetimibe can block the entry of HCV into the cell, in experimental situations. Clinical effect on this aspect has to be further studied [Sainz B Jr et al. Identification of the Niemann-Pick C1-like 1 cholesterol absorption...
Source: Cardiophile MD - October 31, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Niemann-Pick C1-like 1 receptor NPC1L1 Source Type: blogs
Really?! Ranbaxy Wins FDA Clearance For Important US Facility
In a rare bit of good news for Ranbaxy Laboratories, the generic drugmaker says its Ohm Laboratories facility in New Jersey successfully passed an FDA inspection. The move is significant because the plant is the only Ranbaxy manufacturing facility that is permitted to supply products to the US market after three plants in India were prevented from doing so thanks to serious quality-control issues.
The FDA endorsement means that Ranbaxy can use the Ohm facility to file for FDA approvals for drugs, such as a generic version of the widely used Diovan heart drug sold by Novartis (NVS). Ranbaxy had been expected to win agency a...
Source: Pharmalot - October 11, 2013 Category: Pharma Commentators Authors: esilverman Source Type: blogs
Fighting the patient-computer attention war
I recently supervised a new intern as she conducted a patient interview. Following procedure, the intern reviewed the patient’s electronic medical record (EMR) and checked his lab results. She noticed that his cholesterol was high, and he told her that he had stopped taking his atorvastatin due to a recent trip to the Dominican Republic.
“It’s no problem,” my intern replied. “We’ll get you back on the medication.” She began to navigate through the online prescription ordering system.
“I had to go to Santo Domingo because my brother died,” the patient said, tearing up.
As she searched the computer screen f...
Source: Kevin, M.D. - Medical Weblog - October 2, 2013 Category: Family Physicians Tags: Tech Health IT Primary care Source Type: blogs
Drug eluting stent
Drug used for coating coronary stents to reduce restenosis:
a) Atorvastatin
b) Aspirin
c) Sirolimus
d) Clopidogrel
Correct answer: c) Sirolimus
Sirolimus is an antimalignant drug which is used in drug eluting stents which reduces neo-intimal proliferation, the important cause of in stent restenosis after coronary angioplasty with stenting. All the other drugs are helpful in reducing the chance of progression of coronary artery disease and are invariably given after coronary stenting, but are not used for coating drug eluting stents. (Source: Cardiophile MD)
Source: Cardiophile MD - September 5, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Can Statins Prevent Dementia?
A study of nearly 58,000 patients found that high potency statins had the strongest protective effects against dementia.
+Alzheimer's Reading Room
High doses of statins prevent dementia in older people, according to research presented at the European Society of Cardiogists by Dr Tin-Tse Lin from Taiwan.
The study of nearly 58,000 patients found that high potency statins had the strongest protective effects against dementia.
“Statins are widely used in the older population to reduce the risk of cardiovascular disease. But recent reports of statin-associated cognitive impairment have led the US Food and Drug Admi...
Source: Alzheimer's Reading Room, The - September 2, 2013 Category: Dementia Authors: Bob DeMarco Source Type: blogs
A Pfizer Whistleblower, Lipitor Marketing And Free Speech Rights
Will free speech rights factor into a long-running dispute between Pfizer and a former executive over guidelines used to market its Lipitor cholesterol pill?
The issue is being raised by Jesse Polansky, who filed a whistleblower lawsuit accusing the drugmaker of illegally scheming to boost Lipitor sales by misrepresenting product labeling and federal cholesterol guidelines. He also charged Pfizer paid kickbacks that resulted in off-label marketing that allegedly defrauded Medicaid and Medicare. A federal judge dismissed his case last fall and he is now appealing (back story and here is his lawsuit).
In his legal brief, the...
Source: Pharmalot - August 22, 2013 Category: Pharma Commentators Authors: esilverman Source Type: blogs
Pfizer's Umpteenth Settlement (for $491 Million Plus a Guilty Plea), but No Person Held Responsible
The world's largest research based pharmaceutical company was in court again, as reported by the New York Times, The drug maker Pfizer agreed to pay $491 million to settle criminal and civil charges over the illegal marketing of the kidney-transplant drug Rapamune, the Justice Department announced on Tuesday. In particular, The recent case centers on the practices of Wyeth Pharmaceuticals, which Pfizer acquired in 2009.Rapamune, which prevents the body’s immune system from rejecting a transplanted organ, was approved by the Food and Drug Administration in 1999 for use in patients receiving a kidney tra...
Source: Health Care Renewal - July 31, 2013 Category: Health Medicine and Bioethics Commentators Tags: Wyeth impunity crime marketing Pfizer whistle-blowers legal settlements Source Type: blogs
Pfizer Creates Three Separate Businesses, But Spinoffs Are Not Imminent
As promised, Pfizer execs have settled on the latest installment in a much-discussed plan for splitting apart their various businesses. The next step begins in January and involves creating three entities - two will collect prescription drugs, over-the-counter items and vaccines, while a third will specifically house drugs that already face generic competition and still more that will lose patent protection by 2015. Each will operate as a separate global business.
The idea, of course, is to eventually ‘unlock’ shareholder value, a move the drugmaker has increasingly explored over the past two years as a way to deflect ...
Source: Pharmalot - July 29, 2013 Category: Pharma Commentators Authors: esilverman Source Type: blogs
