Fioricet and Esgic are brand name drugs made from a combination of acetaminophen (325 mg), butalbital (a barbiturate, 50 mg), and caffeine (40 mg). They are indicated for the treatment of tension headaches and muscle contraction headaches. Although not indicated, they are commonly used to treat migraines and other pain related ailments.

Usage and Dosage

Fioricet is indicated for the treatment of complex tension and muscle contraction headaches. It is also commonly prescribed for migraines although it is not FDA indicated for this use. The usual adult dose is 1-2 tablets every four hours as needed, not exceeding six tablets in a 24 hour period.

Variations

* Phrenilin is an equivalent combination of butalbital and acetaminophen, without the caffeine (325/50).
* Esgic Plus and Phrenilin Forte contains 500 and 650 miligrams of acetaminophen respectively, instead of 325 milligrams. Additionally, Esgic Plus contains 40 milligrams of caffeine.
* Fiorinal contains aspirin instead of acetaminophen.
* Fiorinal and Fioricet also come as a combination drug with codeine called Fiorinal with Codeine and Fioricet with Codeine which adds 30 milligrams of codeine phosphate to each mixture.

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Finasteride (marketed as Proscar, Propecia, Fincar, Finpecia, Finax, Finast, Finara, Finalo, Prosteride, Gefina, Finasterid IVAX) is an antiandrogen which acts by inhibiting type II 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone (DHT). It is used as a treatment in benign prostatic hyperplasia (BPH) in low doses, and in prostate cancer in higher doses. It is also indicated for use in combination with doxazosin therapy to reduce the risk for symptomatic progression of BPH. Additionally, it is registered in many countries for male-pattern baldness.

Finasteride was approved initially in 1992 as Proscar, a treatment for prostate enlargement, but the sponsor had studied 1 mg of finasteride and demonstrated hair growth in male pattern hair loss. On December 22, 1997, the FDA approved finasteride to treat male pattern hair loss.

The Prostate Cancer Prevention Trial (PCPT) showed at a dosage of 5mg per day, as is commonly prescribed for BPH, though much higher than the 1mg generally prescribed for hair loss, participants taking finasteride were 25% less likely to have developed prostate cancer at the end of the trial compared to those taking a placebo.[1] Further, finasteride increased the specificity and selectivity of prostate cancer detection, thus, a seemly increased rate of high Gleason grade tumor.

Recognized side effects, experienced by around >1% of users, include erectile dysfunction, and less often gynecomastia (breast gland enlargement). As expected from its short 6-8 hour half-life, in trial studies, side effects ceased after dosage was discontinued.

Brand names

Drug trade names include Propecia and Proscar, both products of Merck & Co. (the former is marketed for hair loss in male pattern baldness, and the latter for BPH). There is 1 mg of finasteride in Propecia and 5 mg in Proscar.

Cipla also manufactures finasteride (trade names Fincar and Finpecia), as does Dr. Reddy's (trade names Finax and Finast), Ranbaxy (trade name Finara), Intas (trade name Finalo), and Aleppo Pharmaceutical (trade name Prosteride), who sell the drug at a significantly lower cost than Merck.

Use as a treatment for hair loss

In a 5-year study of men with mild to moderate hair loss, 48% of those treated with Propecia (finasteride 1mg) experienced some regrowth of hair, and 42% had no further loss. Average hair count in the treatment group remained above baseline, and showed an increasing difference from hair count in the placebo group, for all five years of the study.[2]. Propecia is effective only for as long as it is taken; the hair gained or maintained is lost within 6-12 months of ceasing therapy (Rossi, 2004). In clinical studies, Propecia, like minoxidil, was shown to work on both the crown area and the hairline,[6] but is most successful in the crown area.

Some users, in an effort to save money, buy Proscar instead of Propecia, and split the Proscar pills to approximate the Propecia dosage. Doing so is generally considered unadvisable if women of pregnancy age are in the household; this is because finasteride, even in small concentrations, can cause birth defects in a developing male fetus. The birth defects involve the development of male genitalia (no such effects have been noted in developing female fetuses). On most product inserts, it will be mentioned that the dust or crumbs from broken Propecia tablets should be kept away from pregnant women.

Propecia has been shown to be ineffective for treating hair loss in women.However, Propecia's supporters respond that the study was on post-menopausal women whose hair loss was more likely related to the loss of estrogen versus a sensitivity to testosterone. Many doctors prescribe it for women, but not without either careful birth control measures or assurance that the woman cannot become pregnant.

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Tadalafil is a drug used to treat male erectile dysfunction (impotence). It was developed by the biotechnology firm ICOS and marketed worldwide by Eli Lilly and Company under the brand name Cialis.

In the United States, tadalafil has Food and Drug Administration approval and became available in December, 2003 as the third impotence pill after sildenafil (Viagra) and vardenafil (Levitra). Due to its 36-hour effect it is also known as the weekend pill. It should be noted that the drug has not been formally studied in regard to multiple sexual attempts during a 36 hour period.

Tadalafil is also currently undergoing Phase III clinical trials for the treatment of pulmonary hypertension.

History

The history of Cialis cannot be discussed without mentioning Pfizer's drug, Viagra. The FDA's approval on March 27, 1998, led this prescription drug, Viagra, to a ground breaking success in just the first year of introduction as Pfizer sold drugs worth over a billion dollars. However, things changed considerably for the giant of erectile dysfunction drugs when the FDA also approved Levitra on August 19, 2003, and Cialis on November 21, 2003. In 1993 the drug company Icos began studying IC351, which is a PDE5 enzyme inhibitor, and this is basically the process through which the erectile dysfunction drugs work. In 1994, Pfizer scientists discovered that sildenafil citrate, which is a white crystalline powder that temporarily normalizes erectile function of the penis by blocking an enzyme known to inhibit the production of a chemical that causes erections, caused the heart patients that were participating in a clinical study of a heart medicine to have erections. Although the scientists were not testing the chemical compound IC351 for erectile dysfunction, the compound seemed to have a side effect which could potentially be worth millions, if not billions of dollars. Soon Icos received its very first patent in 1994 on IC351, and the clinical trials of phase 1 took place in 1995. In 1997, phase 2 clinical studies began and Icos performed its first study on patients with erectile dysfunction. Phase 2 lasted about two years, and after that phase 3 began.

In 1998, ICOS Corporation, and Eli Lilly and Company, commercialized the drug for erectile dysfunction, and two years later they filed a new drug application with the U.S. Food and Drug Administration for IC351; the only difference was that this time they decided to call the drug Cialis. In May of 2002, Icos and Eli Lilly and Company reported to the American Urological Association that the phase 3 tests show that Cialis works for up to 36 hours, and one year later Icos and Eli Lilly and Company received the U.S. FDA's approval for Cialis. One advantage that Cialis has over Viagra is that tadalafil has a half-life of 17.5 hours[2] (and thus Cialis is advertised to work for up to 36 hours, even if by that time there is still about one quarter of the absorbed dose in the body) as compared to 4 hours half-life for sildenafil (Viagra).

Eli Lilly purchased ICOS corporation for $2.1 billion dollars in 2006.

Chemistry

The empirical formula for tadalafil is C22H19N3O4, and its official organic name is (6R,12aR)-6-(1,3-benzodioxol-5-yl)-2,3,6,7,12,12a- hexahydro-2-methyl-pyrazino[1 ,2 :1,6]pyrido[3,4-b]indole-1,4-dione. The molecular weight is 389.41. Tadalafil tablets are yellow, film-coated, and almond-shaped, and are produced in 5, 10, or 20 mg doses.

Mechanism of action

Tadalafil works by inhibiting PDE5, an enzyme found primarily in the arterial wall smooth muscle tissue of the penis and the lungs. A 20 mg dose of tadalafil is comparable to a 100 mg dose of sildenafil (Viagra).[citation needed] By inhibiting PDE5, tadalafil relaxes blood vessels in the penis, thereby increasing blood flow and aiding in erection.

Part of the physiological process of erection involves the parasympathetic nervous system causing the release of nitric oxide (NO) in the corpus cavernosum of the penis. NO binds to the receptors of the enzyme guanylate cyclase which results in increased levels of cyclic guanosine monophosphate (cGMP), leading to smooth muscle relaxation (vasodilation) in the corpus cavernosum, resulting in increased inflow of blood and an erection.

Tadalafil is a potent and selective inhibitor of cGMP specific phosphodiesterase type 5 (PDE5) which is responsible for degradation of cGMP in the corpus cavernosum. The molecular structure of tadalafil is similar to that of cGMP and acts as a competitive binding agent of PDE5 in the corpus cavernosum, resulting in more cGMP and better erections. Without sexual stimulation, and therefore lack of activation of the NO/cGMP system, tadalafil should not cause an erection. Other drugs that operate by the same mechanism include sildenafil (Viagra®) and vardenafil (Levitra®).

Tadalafil is currently undergoing clinical trials for the treatment of pulmonary hypertension. The clinical trials are based on tadalafil's inhibitiong of PDE5. It is hoped that by inhibiting this enzyme, tadalafil will prove effective in opening up blood vessels in the lungs, lowering pulmonary arterial resistance and pressure, and thus reducing the workload of the right ventricle of the heart.

Side effects

The most common side effects when using tadalafil are headache, indigestion, back pain, muscle aches, flushing, and stuffy or runny nose. These side effects usually go away after a few hours. Back pain and muscle aches can occur 12 to 24 hours after taking the drug, and the symptom usually disappears after 48 hours.

In May 2005, the U.S. Food and Drug Administration found that tadalafil (along with other PDE5 inhibitors) could lead to vision impairment in certain patient groups, including diabetics. An investigation is currently ongoing.

Drug interactions

Since PDE5 inhibitors such as tadalafil may cause transiently low blood pressure (hypotension), organic nitrates should not be taken for at least 48 hours after taking the last dose of tadalafil. Using organic nitrates (such as the sex drug amyl nitrite) within this timeframe may increase the risk of life-threatening hypotension.

Since people who have taken tadalafil within the past 48 hours cannot take organic nitrates to relieve angina (such as glyceryl trinitrate spray), these patients should seek immediate medical attention if they experience anginal chest pain.[5] In the event of a medical emergency, paramedics and medical personnel should be notified of any recent doses of tadalafil.

Marketing

In the United States, Eli Lilly has a multiyear agreement to promote tadalafil (Cialis) with professional golf's PGA Tour.

Cialis is one of the most frequent offerings of spam.

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Mechanism of action

Part of the physiological process of erection involves the parasympathetic nervous system causing the release of nitric oxide (NO) in the corpus cavernosum of the penis. NO binds to the receptors of the enzyme guanylate cyclase which results in increased levels of cyclic guanosine monophosphate (cGMP), leading to smooth muscle relaxation (vasodilation) in the corpus cavernosum, resulting in increased inflow of blood and an erection.

Sildenafil is a potent and selective inhibitor of cGMP specific phosphodiesterase type 5 (PDE5) which is responsible for degradation of cGMP in the corpus cavernosum. The molecular structure of sildenafil is similar to that of cGMP and acts as a competitive binding agent of PDE5 in the corpus cavernosum, resulting in more cGMP and better erections. Without sexual stimulation, and therefore lack of activation of the NO/cGMP system, sildenafil should not cause an erection. Other drugs that operate by the same mechanism include tadalafil (Cialis®) and vardenafil (Levitra®).

Sildenafil is metabolised by hepatic enzymes and excreted by both the liver and kidneys. If taken with a high-fat meal, there may be a delay in absorption of sildenafil and the peak effect might be reduced slightly as the plasma concentration will be lowered.

Dosage and price

As with all prescription drugs, proper dosage is at the discretion of a licensed medical doctor. The dose of sildenafil is 25 mg to 100 mg taken once per day between 30 minutes and 4 hours prior to sexual intercourse.

It is usually recommended to start with a dosage of 50 mg and then lower or raise the dosage as appropriate. The drug is sold in three dosages (25, 50, and 100 mg), all three costing about US$10 per pill. Name-brand Viagra sildenafil is not scored and a fairly hard coating makes it more difficult to accurately cut the pills in half, even with a pill cutter.

Viagra pills are blue and diamond-shaped with the words "Pfizer" on one side, and "VGR xx" (where xx stands for "25", "50" or "100", the dose of that pill in milligrams) on the other.

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From Wikipedia, the free encyclopedia
The Center for Drug Evaluation and Research is a division of the FDA that deals with the approval of drugs. CDER reviews New Drug Applications to ensure that the drugs are safe and effective.

The CDER receives considerable public scrutiny, and thus implements processes that tend toward objectivity and tend to isolate decisions from being attributed to specific individuals. In keeping with this, reviews are generally staffed by teams that are intended to come to consensus on decisions.

Within the CDER "Review teams" of around 1,300 employees approve new drugs. Additionally, the CDER employs a "safety team" has 72 employees to determine whether new drugs are unsafe or present risks not disclosed in the product's labeling.

The FDA's budget for approving, labeling, and monitoring drugs is roughly $290 million per year. The safety team monitors the effects of more than 3,000 prescription drugs on 200 million people with a budget of about $15 million a year. The FDA requires a four phased series of clinical trials, with phase three being the largest and usually requiring 1,000-3,000 patients.

The current Director is Dr. Steve Galson.

Role of Advisory Committees

CDER submits requests for advice to many different Advisory Committees. These committees, composed of experts in their respective fields, provide non-binding advice to CDER about the advisability of approving particular drugs.

There are sixteen advisory committees functioning within CDER:

* Anesthetic and Life Support Drugs
* Anti-Infective Drugs
* Antiviral Drugs
* Arthritis Drugs
* Cardiovascular and Renal Drugs
* Dermatologic and Ophthalmic Drugs
* Drug Safety and Risk Management
* Endocrinologic and Metabolic Drugs
* Gastrointestinal Drugs
* Nonprescription Drugs
* Onologic Drugs, also known as the Oncology Drug Advisory Committee
* Peripheral and Central Nervous System Drugs
* Pharmaceutical Science and Clinical Pharmacology
* Psychopharmacologic Drugs
* Pulmonary-Allergy Drugs
* Reproductive Health Drugs

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From Wikipedia, the free encyclopedia

Recently, a number of pharmacies have begun operating over the internet. Many such pharmacies are, in some ways, similar to community pharmacies; the primary difference is the method by which the medications are requested and received. Some customers consider this to be more convenient than traveling to a community drugstore.

Some internet pharmacies sell prescription drugs without requiring a prescription. Some customers order drugs from such pharmacies to avoid the inconvenience of visiting a doctor or to obtain medications which their doctors were unwilling to prescribe. However, this practice has been criticized as potentially dangerous, especially by those who feel that only doctors can reliably assess contraindications, risk/benefit ratios, and an individual's overall suitability for use of a medication. There have also been reports of such pharmacies dispensing substandard products.

In the United States, there has been a push to legalize importation of medications from Canada and other countries, in order to reduce consumer costs. Although importation of prescription medication currently violates Food and Drug Administration (FDA) regulations and federal laws, enforcement is generally targeted at international drug suppliers, rather than consumers.

Overseas online pharmacies and U.S. law

Legality and risks of purchasing drugs online depend on the specific kind of drug being purchased, as well as its amount.

* It is illegal to purchase controlled substances from an overseas pharmacy. Generally speaking, a person purchasing a controlled substance from such a pharmacy may be violating two federal laws which can carry stiff penalties. The act of importation of the drug from overseas violates 21 USC, Section 952 (up to 5 years in prison and $250,000 fine for importation of non-narcotic Schedule III, IV, or V drugs; possibly more for narcotics and Schedule I and II drugs). The act of simple possession of a controlled substance without a valid prescription violates 21 USC, Section 844 (up to 1 year in prison and $1,000 fine). Note that FDA does not recognize "online prescriptions"; in order for the prescription to be valid, there has to be a face-to-face relationship between the patient and the health care professional prescribing the drug. Sections 956 and 1301 provide exemptions for travellers who bring small quantities of controlled substances in or out of the country in person, but these exemptions do not cover delivery via a mail carrier.
* The act of importation of any prescription drug (not necessarily a controlled substance) violates 21 USC, Section 301(aa), unless the following conditions are met (as listed in Section 804):
1. The drug is imported from Canada, from a seller registered with the Secretary (i.e. with FDA);
2. The drug is imported from a licensed pharmacy for personal use by an individual, not for resale, in quantities that do not exceed a 90-day supply;
3. The drug is accompanied by a copy of a valid prescription;
4. The drug is a prescription drug approved by the Secretary;
5. The drug is in the form of a final finished dosage that was manufactured in an establishment registered under section 510; and
6. The drug is imported under such other conditions as the Secretary determines to be necessary to ensure public safety.
* The law further specifies that enforcement should be focused on cases in which the importation by an individual poses a significant threat to public health, and discretion should be exercised to permit individuals to make such importations in circumstances in which the prescription drug or device imported does not appear to present an unreasonable risk to the individual.
* According to Department of Homeland Security Appropriations Act, Section 535, Customs and Border Patrol are not allowed to prevent people from importing FDA-approved prescription drugs. Although originally the law was worded to cover all prescription drugs, countries of origin, and methods of delivery, its final edition specifies that it only applies to importation from Canada, and to "...individuals transporting on their person a personal-use quantity of the prescription drug, not to exceed a 90-day supply". Controlled substances are also explicitly excluded. Therefore, it does not disallow Customs to screen and intercept drugs sent by mail.
* It is also technically illegal to import non-approved drugs (21 USC sections 331(d) and 355(a)); however, FDA policies suggest that, under certain circumstances, the patients may be allowed to keep these drugs.
* Individual U.S. states may implement their own laws regulating importation, possession, and trafficking in prescription drugs and/or controlled substances.

Enforcement

Laws listed in the previous section are not always enforced (or otherwise all online pharmacies would quickly run out of customers and go bankrupt). Among other reasons, strict drug law enforcement is politically unpopular because many customers of online pharmacies are seniors who can't afford to buy their prescription drugs in the United States.

* Any package containing prescription drugs may, in principle, be seized by customs. The package may be held until the addressee provides proof that he is allowed to receive these drugs (e.g. a valid prescription), and eventually returned to the sender if the addressee does not respond. (Sample package detention notification letter) In practice, the number of packages containing prescription drugs sent to United States on a daily basis far exceeds customs' capabilities to inspect them. In the past, packages often passed through customs even if they weren't sent from Canada or otherwise didn't meet the requirements of section 804 of 21 USC. Up until recently, about 5% of all prescription drug packages sent from Canada were being seized.
* At the present time, US customs do not seize packages from Canada.
* DEA and FDA generally do not target consumers unless drugs are imported in large quantities (suggesting intent to distribute) or represent danger to public health (opiates, amphetamines). However, this may change at any time.
* Sometimes drug importation laws are enforced on the local level. For example, in June 2005 in Baton Rouge, Louisiana, a number of customers of online pharmacies were arrested by local law enforcement officers and charged with possession of a controlled substance without prescription.

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Labels: No Prescription, Online Pharmacy, Prescription Drugs

Online Pharmacy No Prescription (www.noprescriptiondrugstore.com) sells Prescription Drugs online without any prior prescription at the best price, plus fedex overnight delivery.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

As a rallying cry, it may lack some of the fire of Patrick Henry's
famous 1775 speech on the supremacy of liberty, but it might just
serve to illustrate a point that is of great importance to many of our
nation's citizens today.

Prescription drugs are a large part of contemporary health care in the
United States, but the cost of pharmaceuticals greatly exceeds the
price of those same drugs in most other nations.

We're talking about vastly different prices for a prescription drug
that is marketed and sold in the United States and that same drug when
it is marketed and sold in Canada. Even when the drug was manufactured
here before being shipped across our northern border.

Such an arrangement might make good sense to the head of a
pharmaceutical company, but it is more than a little perplexing to
someone who is paying big bucks just to try to stay healthy here in
the United States. And it's baffling to those who make it their
business to take a good look at pharmaceutical price structures.

Locally, Springfield began a program several years ago that allowed
municipal employees and retirees to get cheaper prescription drugs by
allowing them to reimport medication from Canada. That program is
coming to an end with city workers being switched to state-run health
plans, but the city's program, which was the first of its kind in the
nation, ought to remain a model for the country as a whole.

The issue is about to come to the fore again with the seating of the
110th Congress just after the start of the year. We're fully expecting
to hear all the same tired arguments against allowing drugs across the
border from Canada, but they won't make any more sense this time
around. Prescription drugs from Canada are not in any way unsafe. And
they will not in any way aid terrorists. And barring them is not basic
economics.

In fact, it's quite the opposite: It is price fixing by another name.
And it's awfully expensive to American consumers.

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At Sutton's Drug Store, packages of nonprescription Plan B are behind the counter. Sutton's has carried the so-called morning after pill for several years. Only now, it is available to women 18 years and older without a prescription.

"We've had calls for it, to want to know if we do carry it," explained John Woodard, the pharmacist who owns Sutton's Drug Store. "I don't know if it's from people who want to know if they can come and get it, or whether it's just from people who want to know if we're stocking it."

In August, the FDA decided to make Plan B available as a nonprescription. Pharmacies like Sutton's have to keep it behind the counter and check buyers' IDs to make sure they are at least 18.

"It allows [women] to actually have exactly what the name is, a Plan B," said Christopher Hollis, who is with Planned Parenthood Health Systems. "It certainly opens up access to a drug that is long overdue for behind the counter usage. We know that it prevents unintended pregnancies."

But some opponents argue the pill is essentially a medical abortion, although Plan B is not the same thing as the abortion pill, RU-486. Opponents also say the morning after pill encourages frequent use, which could have risks.

"We don't give people open access to antibiotics or other things like that for similar reasons -- just because people would tend to take them way too much, and that causes problems," said Dr. Omar Hamada, who is an OB/GYN.

Back at Sutton's, pharmacist John Woodard says he has not seen much demand for the pill, but says it is available, now without a prescription.

Women under the age of 18 need a prescription to get Plan B, and one dosage costs about $40. The drug was first approved by the FDA in 1999.

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A breakthrough class of breast cancer drugs, which were trialled in Dorset, have been made available nationwide.

The drugs, used in Bournemouth, were found to cut the risk of a relapse by a third in post-menopausal women who had had two to three years of therapy.

A Royal Bournemouth Hospital consultant said the decision to make the drugs available on the NHS was "momentous".

The National Institute for Health and Clinical Excellence (NICE) released its guidance for the drugs on Wednesday.


The decision to make these medications available on the NHS is momentous for all affected women

Tony Skene,
consultant breast surgeon

Aromastase inhibitors (AIs) are licensed to treat the early stages of the most common form of breast cancer, which affects about 33,000 women a year.

The drugs, which have been available to patients in Scotland for a year, have been hailed as one of the most cost-effective treatments available.

Research carried out by NICE showed that by switching to exemestane, a type of AI, after two to three years of tamoxifen treatment the risk of cancer returning can be reduced by nearly a third.

It can also cut the chance of cancer occurring in the other breast by a half.

'Great news'

Tony Skene, consultant breast surgeon at the Royal Bournemouth Hospital, said: "The decision to make these medications available on the NHS is momentous for all affected women and for those involved in the management of women with breast cancer in the UK."

Elaine Pollington, from Ferndown, is one of those who took part in the trial and was treated with the exemestane drug Aromasin.

She told BBC News: "I feel really well now. I think it's great news and I'm sure it will help a lot of people in the future."

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If you are a Medicare beneficiary, you are eligible for Medicare prescription drug coverage, regardless of your income, health status or current prescription expenses.

There are two types of Medicare plans that provide prescription drug coverage: Medicare Prescription Drug Plans and Medicare Health Plans. Following are descriptions of each from the Web site Medicare.gov.

Medicare Prescription

Drug Plans

Offered by insurance companies and other private companies approved by Medicare, they add coverage to:

n The original Medicare plan

n Some Medicare Cost plans

n Some Medicare Private Fee-for-Service plans

n Medicare Medical Savings Account plans

With a Medicare Prescription Drug Plan:

n Generally, you pay less for your prescriptions

n You will get a plan member card after you enroll. You use this card when you go to the pharmacy to get your prescriptions filled

n You will pay the copayment, coinsurance, and/or deductible, if any

If you have limited income and resources, you may get extra help to pay for your Medicare drug plan costs.

Medicare Health Plans

Some of these plans cover both health care and prescription drugs. Medicare Health Plans include:

n Medicare Advantage plans

n Other Medicare Health plans

Medicare Advantage Plans (like HMOs and PPOs) that include prescription drug coverage as part of the plan are health plan options that are approved by Medicare but run by private companies. They are part of the Medicare Program. If you join a Medicare Advantage Plan you are still in Medicare.

With Medicare Advantage Plans:

• You generally get all your Medicare-covered health care through that plan.

• You may get extra benefits, such as coverage for vision, hearing, dental, and/or health and wellness programs.

• You usually will have to pay some other costs (such as copayments or coinsurance) for the services you get. Out-of-pocket costs in these plans are generally lower than in the Original Medicare Plan, but vary by the services you use.

• You may have to see doctors that belong to the plan or go to certain hospitals to get covered services.

• You don't need to buy a Medigap policy.

Medicare Advantage Plans include:

• Health Maintenance Organizations (HMO)

• Preferred Provider Organizations (PPO)

• Private Fee-For-Service (PFFS) Plans

• Medicare Medical Savings Account (MSA) Plans

• Medicare Special Needs Plans (SNP)

Other Medicare Health Plans

There are some types of Medicare Health Plans that include prescription drug coverage as part of the plan but that aren't part of Medicare Advantage that are still part of the Medicare Program. With these plans, you generally get all your Medicare-covered health care through that plan.

• Medicare Cost plans

• Demonstrations/Pilot Programs

• PACE (Programs of All-inclusive Care for the Elderly)

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US pharmaceutical giant Pfizer has taken a Chinese pharmaceutical company to court over infringing its copyright for its erectile dysfunction drug Viagra, state media reported Friday.

The case against Guangzhou Welman pharmaceutical company was heard in a Beijing court on Thursday but a verdict was not delivered immediately, the Beijing News reported.

No one at Pfizer's China office was immediately available to comment on Friday.

The legal action comes after New York-based Pfizer won a court ruling upholding its China patent for Viagra in June.

Pfizer had originally obtained a Chinese patent license for Viagra in 2001.

However the country's patent review board, the State Intellectual Property Office, revoked the license in July 2004 following complaints by 12 Chinese pharmaceutical companies.

In delivering its ruling, the patent review board claimed Pfizer was in breach of intellectual property law because it failed to accurately explain the uses of the pill's key ingredient, sildenafil citrate.

But the Beijing Intermediate court ruling in June reversed the review board's verdict.

The Chinese drug companies from various cities around the country claim to have invested over 100 million yuan ($12m) in less expensive imitations of the little blue pill.

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Doctors are warning that obese children may have to start taking adult cholesterol-lowering drugs amid evidence that 5-year-olds are developing heart disease.

Canadian researchers believe the explosion in child obesity means that medication may be the only way to help youngsters who already run the risk of premature heart attack.

They also recommend regular cholesterol and diabetes checks for children, particularly if there is a family history of either condition.

Speaking at a major heart disease conference in Chicago, researchers from McMaster University said 15 studies from around the world showed early signs of heart disease were being detected in children as young as 5.

Those who were obese and had high blood pressure or cholesterol had almost 10 per cent more thickening of their arteries than children without any risk factors.

Lead researcher Sanaz Piran said that while diet and exercise were still the key to preventing childhood obesity, earlier treatment could include more aggressive use of statin drugs.

But cardiologist Michelle Ammerer said not enough was known about the side effects of strong heart disease drugs on young bodies.

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WASHINGTON (MarketWatch) -- A Food and Drug Administration panel is set to meet Thursday to discuss the safety review of 16 drugs, including flu drug Tamiflu, in pediatric patients.
The pediatric advisory committee will evaluate new and updated reports by the FDA staff that include information on the drugs' safety compiled over a year. The panel will then make recommendations that could include label changes or further investigation of adverse events.
The FDA isn't required to follow the panel's suggestions, but it usually does.
Although the panel was to issue an opinion on Tamiflu's label Thursday, on Tuesday its manufacturer, Roche Holding AG (RHHBY), said it would follow the FDA staff's recommendation in the report and update the label to warn patients of potential abnormal behavior during treatment, including delirium and hallucinations.
In its report, the staff said the label should be changed following a review that found 103 cases of "neuropsychiatric adverse events," including the death of a 14-year-old boy who fell after climbing on his condominium balcony's railing.
According to documents posted on the FDA Web site ahead of Thursday's meeting, eight drugs under review didn't raise any safety concerns. They include cholesterol-lowering medications Lipitor from Pfizer Inc. (PFE) and Zocor from Merck & Co. (MRK), Eli Lilly & Co.'s (LLY) cancer drug Gemzar, and Johnson & Johnson's (JNJ) Ditropan to treat bladder instability.
The other eight drugs either presented new unlabeled safety concerns or "other attributes," including labeled but "serious adverse events of interest" and past safety concerns, the FDA said.
Included in this group are Pfizer's Zyvox, GlaxoSmithKline PLC's (GSK) Zofran and Avandia, Forest Laboratories Inc.'s (FRX) Celexa, Novartis AG's (NVS) Trileptal, Wyeth's (WYE) Rapamune and Abbott Laboratories' (ABT) Norvir.
In an updated report for depression drug Celexa, the FDA staff identified three new cases associated with QT prolongation, which can cause a fatal arrhythmia, since August 2003. The FDA requested the review following a prior report that found a possible association between the drug and the problem in all ages.
"However, this updated review of three new cases...didn't find any well-documented cases of QT prolongation associated with using regular doses of (Celexa) in pediatric patients," the FDA staff concluded.
On Pfizer's Zyvox, which is indicated for treatment of certain bacterial infections, the FDA staff found six unlabeled events of "cardiac nature" during the one-year review. The report, however, said the cases "cannot be definitively associated" with the drug.
In the report on epilepsy drug Trileptal, the FDA staff recorded 84 adverse events in children taking the drug in the year-long review. Those events included one death, 52 unlabeled and 31 labeled cases. The staff said the unlabeled cases were too few to "characterize any one adverse event as a potential safety signal."
On Wyeth's Rapamune, the investigation found 19 pediatric cases of adverse events, including two reports of fluid collection that develops between the lining of the heart and the heart itself, and one report of cerebral bleeding.
Rapamune is indicated for the prophylaxis of organ rejection in patients ages 13 or older receiving a renal transplant. The FDA staff, however, said the majority of children it studied were under 12 years of age.
The report found it was "premature" to determine if the drug "played a clear role" in the adverse events reported.
On Glaxo's Zofran, used to prevent nausea and vomiting associated with chemotherapy and radiotherapy for cancer, the FDA staff identified 20 adverse events over a year, including one death. The report said, however, that most patients had underlying conditions or were taking other medication, making it difficult to link the events to the use of Zofran.
In the review of diabetes drug Avandia, the staff found two adverse cases during the one-year period, one involving accidental ingestion and the other involving behavioral changes. It said there were too few reported events to draw any safety conclusion.
On Abbott Labs' Norvir, used to treat HIV patients, the review found 33 adverse events in children in a period of one year, including skin reactions, anemia and pancreatitis. There were three deaths, none directly related to the use of the drug, the FDA said, adding it didn't find any safety concerns.
In the reports, the staff said it will continue to monitor adverse events related to the drugs. The FDA panel will meet at the agency's headquarters in Rockville, Md.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

In the past year, Pfizer has successfully tagged more than 2 million bottles, 55,000 cases and 400 pallets of Viagra. Now, the drug manufacturer is ready to start tagging another of its top-selling drugs: Celebrex.

In 2007, Pfizer plans to affix UHF Gen 2 RFID tags to all cases and pallets of the drug—a pain reliever and anti-inflammatory—bound for the U.S. market. This is part of an effort to expand the scope of Pfizer's RFID initiative, the drugmaker announced at this week's RFID Health-Care Industry Adoption Summit conference in Washington, D.C. The Celebrex trial will require Pfizer to build out its RFID infrastructure and expertise beyond its plant in France, which produces and packages Viagra, to a much larger plant in Caguas, Puerto Rico.

The initiative will incorporate four assembly lines used to produce and package Celebrex, each of which operate at a speed four times that of a Viagra line. The expansion will enable Pfizer and its trading partners to vet findings established in the past year with the Viagra RFID project. For example, says Byron Bond, director of trade operations and customer service for Pfizer's U.S. pharmaceuticals division, the Celebrex pilot will provide the drugmaker a more accurate picture of tag read rates, which have thus far proven very high in the Viagra trial, involving only one product and one assembly line.

"This will be a little more challenging environment," Bond says. "The higher volumes will help us validate what we've learned and better understand RFID's costs. Celebrex has significant volumes, so for [distributors], as well as us here at Pfizer, who really want to look at operational efficiencies, we'll all be able to get a clearer picture."

Celebrex's annual volumes are significantly higher than Viagra's and, therefore, more costly to tag. As such, Pfizer has opted not to tag at the unit level. Moreover, tagging cases and pallets of Celebrex will allow the manufacturer to test the concept of case-level serialization and authentication, which could help wholesalers identify counterfeit drugs. "I'm not going to tell you we're convinced that case-level validation is the only solution, but it can enable systemic counterfeit detection," Bond says. "You don't always have to go to the expense of item-level tagging."

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That pain medications formedications for arthritis or athletic injuries this drug may make ... Tell your doctor or carisoprodol prescription immediately. ...Doctor if you carisoprodol online pharmacy an infection while you are using

Labels: No Prescription, Online Pharmacy, Prescription Drugs

The high cost of prescription drugs has everyone looking for ways to save. Hospitals, HMOs and insurance plans are as upset about their pharmacy bills as individual patients are.

One popular solution is to buy generic drugs. Doctors are encouraged to prescribe generic equivalents when possible. Patients may be penalized if they insist on a brand name. The co-pay for branded medications is often double or triple that for generics.

People without insurance often can't afford anything other than generic medicine. How good are these substitutes?

For 30 years we have defended generic drugs. The Food and Drug Administration assured us that its rigorous standards ensured quality. A few years ago, however, we started to get reports from readers about generic-drug failures.

Some parents claimed that when a child with ADHD was shifted from Ritalin to generic methylphenidate, his behavior and attention deteriorated. Patients whose epilepsy was well controlled on the anticonvulsant Dilantin reported seizures when switched to generic phenytoin.

An article in the journal Neurology (Oct. 26, 2004) confirmed that some generic phenytoin did not perform up to standards. The neurologists reported breakthrough seizures in patients under good control for years.

We also heard from people who had problems with irregular heartbeats, hypertension, acid reflux or pain when they were switched. Many found the generic version of their medication seemed less effective than the original.

We were puzzled by this spate of reported problems with generic medicines, so we contacted the FDA to find out how the agency monitors the quality of drugs after they are approved. We were not reassured by what we learned.

As far as we can tell, the pharmaceutical marketplace in the U.S. works on the honor system. The FDA relies on drug companies to be honest.

For such a profitable industry, there is remarkably little oversight. Airplanes, elevators and even restaurants are inspected on a regular basis. But more than 3 billion bottles of pills are dispensed in the U.S. each year, and only a relative handful are actually tested. The FDA says it pulls about 300 pill bottles off shelves to test for content and dosage strength. This amounts to 1 in 10 million.

Where do ingredients for generic drugs come from? More and more often, countries like China and India are getting into the game. The competitive nature of the generic-drug market makes low-cost source materials very attractive. Without constant quality surveillance, we worry that U.S. consumers may not always be getting what they expect.

We have examined the controversy over generic drugs in much greater depth in our new book, Best Choices From The People's Pharmacy (Rodale Books). It offers guidelines for using generic drugs safely. Tips include:

• Record numbers (blood pressure, blood sugar, etc.) that show if the drug is working.

• Monitor lab results (cholesterol, thyroid, INR).

• Observe your subjective response to antidepressants, pain medicine or sleeping pills.

With care, you can use generic drugs safely. If you suspect your medicine is not working properly, notify your doctor immediately. Switching back to the brand name might cost more, but it could preserve your health.

THE PEOPLE'S PHARMACY

Q. I have taken both Viagra and Cialis. They work well, but I do get sinus-pressure headaches when I take these drugs. I feel this has contributed to sinus infections that have required lengthy courses of antibiotics. Is this possible?

A. Nasal stuffiness is a relatively common reaction to drugs for erectile dysfunction like Viagra, Cialis and Levitra. People who experience chronic congestion may develop an infection and sinusitis as a consequence.

Please discuss this issue with your physician. There are other ways to treat erectile dysfunction.

Q. You have suggested that people should check prescriptions carefully to avoid pharmacy errors. How many people read Latin? Why aren't prescriptions written in English? Start a crusade!

A. We have been campaigning against Latin abbreviations in prescriptions for nearly 30 years. There is no excuse for physicians to use this archaic system in the 21st century.

This idea makes some doctors angry, though. One took us to task after we wrote a column calling for prescriptions to be written in legible English: "You do not have a right to tell us to change the standard format in which pharmacists provide service to physicians by saying that we should change the way prescriptions are written and have been forever. Pharmacists are here to serve, not to instruct."

Despite this objection, the leading pharmacology textbook used in medical schools is clear: "The directions to the patient should always be written in English. The use of Latin abbreviations serves no useful purpose."

Q. I have had weakness in my arms and legs, pain in my back, aching arms, loss of memory and fatigue. I have not been able to play golf for more than two years, and I totally lost the quality of life I enjoyed prior to undergoing angioplasty and starting on Lipitor.

If there is to be a class-action suit, I would like to be included. Your article helped me understand the pain and suffering I have endured.

A. Millions of people are able to take cholesterol-lowering drugs like atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor) without complications. But some experience debilitating muscle, nerve or joint pain, weakness, skin rash or memory problems.

The nutrient Coenzyme Q10 may help counteract some of these side effects. You can learn more about how to use it and alternative ways to control cholesterol in our new book, Best Choices From The People's Pharmacy (Rodale Books).

We cannot offer legal advice, though. Several lawsuits have been filed claiming deceptive marketing of statins.

Q. Do nitroglycerin heart tablets lose their potency once the bottle is opened for the first use, or can I go by the expiration date on the bottle? I have gotten conflicting answers from my doctors and my pharmacist. I'm not sure what to believe.

A. Nitroglycerin evaporates easily, which is why these pills should never be left out in the open or in a plastic pillbox. Store them in the original amber glass bottle with the cap screwed down tightly.

If there is cotton in the bottle, take it out and throw it away, as it can absorb the medicine. If you replace the cap firmly as soon as you remove a pill, you should be able to rely on the expiration date on the label.

THE PEOPLE'S HERBAL PHARMACY

Q. I suffer from gout from time to time. Have you ever heard of curry relieving the symptoms? My wife made a soup containing curry, and within one hour after eating it, I could feel the pain going away. I ate the soup the next two nights, and my gout was 95 percent gone. This worked much better than cherries for me.

A. Thanks for the tip. Gout is a painful inflammatory condition in which uric-acid crystals collect in the joints. The yellow spice in curry powder is turmeric. It has been used for centuries in the traditional medical system of India to treat inflammation. Research in animals confirms that turmeric extracts can reduce joint swelling from experimental arthritis (Journal of Natural Products, March 2006).

Q. I am taking a product that contains cascara sagrada to promote healthy digestion and relieve hemorrhoids. How often should I take it?

I took one dose of it at night, and the next afternoon experienced diarrhea. That has me a bit worried about taking it every day.

A. Cascara sagrada is a strong laxative, so we're not surprised it gave you diarrhea. We don't recommend taking stimulant laxatives on a regular basis since they can deplete the body of essential minerals. Daily use also may lead to dependence.

Q. My 8-year-old son has eczema. We have been alarmed by the recent studies about Elidel increasing the risk of cancer.

We also do not want to go back to topical steroids because they might thin his skin too much. Are there any other treatments that we can consider?

A. Besides a good moisturizer to keep the skin from drying out, you might want to consider DermaSmart undergarments and pajamas (www.dermasmart.com). This special fabric is super-soft and nonirritating.

A firefighter told us that he developed eczema after exposure to mold in an older fire station. When he put on his protective gear the itching nearly drove him crazy. The DermaSmart T-shirt and pants reduced the irritation and itching.

Another interesting product is CamoCare Soothing Cream (www.CamoCare.com). It contains a camomile-derived oil that is anti-inflammatory.

Q. I take prescription heart and blood-pressure medicine that keeps me awake. My doctor has prescribed Ambien, but my insurance company rations me so I can't take it every night. When I don't take Ambien I don't sleep.

What's the problem with this sleeping pill? What else can you suggest so I can get some sleep?

A. A surprising number of prescription and OTC medicines can cause insomnia. If your doctor could prescribe different drugs, your insomnia might disappear.

If that is not an option, ask your doctor to intervene with the insurance company. Some insurers restrict prescription sleep aids on the grounds that the Food and Drug Administration has not approved these drugs for daily use.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

Labels: No Prescription, Online Pharmacy, Prescription Drugs

In this booming age of information technology, online marketing is the preferred marketing option for the people. Though there are plenty of benefits associated with online marketing, the facilities given by online marketing have always been overshadowed by the risk factor. But gradually, people are becoming accustomed to and confident with the ease with which they can transact through Internet.
Online pharmacy is a significant part of online marketing where medicines are made available online to customers at the comfort of their home. Online pharmacy offers the best avenue for pharmaceutical companies to promote their drugs, health products and other products. They have found their profit grow larger with the expansion of their marketing initiatives in the virtual world.

The importance of online pharmacy has grown equally for the general consumers as well. In this fast paced world, people often feel shortage of time, time are minutely divided for professional life and people hardly can manage time to go for shopping or regular check-up to a physician. Their hectic work schedules do not allow them to have extra time.

So the best possible option to compensate their urgency is the online pharmacy. Online pharmacy is the perfect resource for people to get their drugs without any hassles or discomfort.

People today are highly benefited with online pharmacy because they can order the required medication by doing thorough research and study of the medicine that they are ordering or about the online pharmacy from which they are making an order. Moreover, they can also do their own research about the prices charged by various pharmacies on the required drugs, so that they can choose the cheapest offer.
Another great benefit is the option of online consultation offered by online pharmacies, through which individuals can share their health condition with a physician online, they can obtain the online prescription and get the desired medication online in a very short period.

In comparison, online pharmacies are relatively cheaper than real pharmacies. Online pharmacy offers the drugs in competitive price and sometime even in lesser cost than in normal pharmacy. You will save lots of money if you reorder the drug.
Online pharmacy sometimes gives you the discount of up to 80%, they do not charge any membership fee. You may have to pay just for shipping and handling of the drug.

It is advantageous to go for online pharmacy because they offer the drugs in competitive price and sometime even in lesser cost than in normal pharmacy. They also cost you less if you order the medicine after your first order.
Online pharmacy sometimes gives you the discount of up to 80%, they do not charge any membership fee. You have to pay just for shipping and handling of the drug.

Apart from this, people are running after online pharmacy because they are bound by privacy and security policy that safeguards the identity of customers and delivers the drug in complete privacy.
So, online pharmacy offers a safe, secure, private, and convenient way to get online prescription of drugs. Join the bandwagon of growing Internet users and form the habit of buying drugs online.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

Labels: No Prescription, Online Pharmacy, Prescription Drugs

Major depression often retreats only after patients have tried multiple drugs, and a large minority still have disabling symptoms even after using many medications, a landmark study suggests.

The good news from the federal study of 3,671 patients is that about two-thirds were depression-free after trying up to four different combinations of drugs or therapy.
Only 37 percent went into remission after trying the first drug, the antidepressant Celexa, says the study leader, psychiatrist A. John Rush of the University of Texas Southwestern Medical Center in Dallas.
And as each new treatment was tried, it worked on fewer and fewer patients. About a third did not go into remission, despite trying up to four rounds of treatments. And many dropped out at each step, perhaps because they were discouraged or disliked drug side effects.
"But persistence pays off," Rush says. "For those who hang in there, recovery is possible."
The study, reported this past week in the American Journal of Psychiatry, is the largest ever on treating depression and the first to look at what happens when adults not helped by one drug are given others and/or therapy, Rush says.
Some patients received cognitive therapy, a structured type of counseling, either alone or in combination with a drug. No single treatment relieved depression better than any other.
Patients were followed for up to a year. Those who had to try more than one drug were most likely to relapse.
The study adds to growing evidence that major depression is a chronic disease, says John Greden, executive director of the University of Michigan Depression Center in Ann Arbor. Patients must be treated aggressively and closely monitored, he says.
Real-world success in treating depression may be considerably less than in the research, Greden says, because primary-care doctors write about 70 percent of prescriptions for antidepressants, and they're less likely to try multiple treatment steps.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

Cancer patients who cannot get the modern drugs they need on the NHS are ordering them directly from international 'internet pharmacies', often without their doctors' knowledge.

Patients are beginning to self-prescribe cancer treatments by ordering them online, after learning about the newer therapies, such as Avastin for bowel cancer and Tarceva for lung cancer. Many treatments have not yet been licensed by the government's watchdog, the National Institute for Health and Clinical Excellence (NICE), but are widely promoted on the internet.

One of Britain's leading cancer specialists, Karol Sikora, told a meeting of politicians and doctors last week that he had a number of private patients who had begun to order drugs from one of the largest internet pharmacies in Canada, CanadaDrugs.com. 'These patients are well informed, and they shop around for the cheapest prices,' he said. 'I had one patient, a very well educated young woman who wanted Tarceva for lung cancer. She couldn't get the drug on the NHS. The price from a Harley Street clinic worked out at around £75 a tablet - but ordering from Canada would bring it down to £35 a tablet.'

He told the conference that a younger generation of patients would demand the best treatments, even if the NHS decided they were not affordable. 'We're in a world where an easyJet flight can be booked within minutes. The idea that you can't get a cancer drug that will extend your life because a government body has decreed you can't have it just won't work.'

In the past, the worries have been about patients ordering so-called 'lifestyle' drugs online to reduce weight, cope with depression or boost sex life. Viagra or Cialis for impotence, Prozac for depression and Reductil for weight loss have been widely ordered online over the past five years. But there are concerns over safety when consumers move into ordering more mainstream medicines.

One of the biggest exporters is Canada Drugs, a company in Winnipeg that sells both prescription and over-the-counter medicines online. It offers Tarceva for lung cancer, but also asks patients to provide a note from their doctor (or details of their doctor's surgery) as part of their application for buying the drug.

The company exports more than 3,000 prescriptions a day around the world, mostly to America, where medicines are far more expensive. An attempt by President Bush to crack down on the use of such companies failed after pressure from senators and the public.

The Food and Drug Administration still intercepts thousands of prescriptions ordered from Canada that are sent in the post. It was announced yesterday that US policy will be changed, so that customs agents will focus only on intercepting large imports, rather than the smaller packages that are often for individual use by the elderly who cannot afford the medicines from any other source.

A spokesman for CanadaDrugs.com told The Observer: 'Britain has so far not been a big market for us, but we are getting more customers now. At the moment it's only a few UK clients each month, but we think it is working by word of mouth. People know that our drugs are from reputable suppliers and that we are efficient.'

Many cancer specialists question whether all the internet sites actually demand a bona fide prescription from an oncologist. They urge patients not to go to internet suppliers for their drugs. Professor John Toy, medical director of Cancer Research UK, said: 'It is very worrying that patients may be purchasing medicines online to treat themselves. Anyone thinking of procuring their own drugs should speak to their cancer doctor, as it could interfere with their treatment programme and could do them more harm than good.

'Cancer is a complex illness and requires specialist knowledge and expertise. The drugs involved are extremely sophisticated and potentially dangerous, and therefore should always be given under close medical supervision.'

The Medicines and Healthcare Regulatory Authority is also aware of the trend, but is powerless to intervene. A spokesman said: 'We do have worries. Patients should ask themselves where the medicines come from, and we know that, while some websites are lawful, other are operated by criminals.'

But in the UK there is little that can be done to stop the move. The Royal Pharmaceutical Society of Great Britain, which represents UK pharmacies, has been working on ways of advising patients how to tell if an online pharmacy is safe and properly regulated - but it only applies to British-registered pharmacies. The society's spokeswoman said: 'Sadly, we have no influence or say over what happens abroad. We can only warn people about the dangers. Our message is simple - don't do it.'

However, the number of cancer patients looking to find different ways of ordering drugs is likely to grow, as new and expensive therapies appear for which there is no funding. Last month, three bone and blood cancer victims began to campaign over Velcade, a drug not licensed on the NHS because NICE has stated it is not cost-effective at £18,000 a course, as it can prolong the life of a multiple-myeloma patient only by a few months, not years. Jacky Pickles, 44, Janice Wrigglesworth, 59, and Marie Morton, 57, all have the disease and are demanding the drug.

Other new cancer drugs are coming on stream next year, such as Tykerb, a new tablet for breast cancer, which has shown to work in women whose cancer is resistant to the drug Herceptin. It is likely to be just as expensive as Herceptin, at about £20,000 a course. In the case of Tarceva, a drug for lung cancer patients, its full assessment by NICE is not even scheduled to happen for another year. In some patients Tarceva can prolong life by up to 18 months.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

In health, a sex drug for women is being tested in Philadelphia; it is like a female version of Viagra and doctors are already predicting it will be a blockbuster and Medical Reporter Stephanie Stahl reports on the details.

There's one thing missing from Irene's busy life, she never feels like having sex.

"I'm in love with my husband, I love to be physical with my husband, but it is something body wise, it is almost like something stops you from wanting to do it," said Irene.

It is a common problem, some estimates say half of all women are just like Irene; never in the mood and she's just 37

"I just didn't have the desire, I just didn't have the mindset," said Irene.

The brain is in fact at the center of female sexual dysfunction.

Unlike, men when it's usually more physical that can now be treated with several drugs, which improve blood flow to the pelvis.

It is different with the new sex drug for women; it works directly on the brain.

Those areas that influence arousal, mood sexual performance and desire.

Dr. Marvin Kalafer, who is testing the new, un-named female sex drug, says once the brain is stimulated women then feel the physical benefits.

"This agent has preliminarily shown a lot of benefit and increase in sexual arousal and desire," said Dr. Kalafer.

Ironically, it was discovered by accident; originally the drug was being tested as an anti-depressant.

However, women said they felt a renewed sexual desire.

"I would call it a fortuitous side effect," said Dr. Kalafer.

Finally something to help women in the bedroom and it has nothing to do with depression.

"I think it has the potential for being a blockbuster," added Dr. Kalafer.

Irene says she's thinking about testing the new drug that's long overdue.

"They have a lot of things out there for men that help them out, it would be nice to have something that a woman could go to," said Irene.

Women testing the new drug have to stay anonymous for the research, so we couldn't talk to them.

But they're looking for more local, women to try it. At this point they don't know if it should be taken daily or on an as needed basis.

Again this is till in the testing phase; it could be years away from being available.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

Residents in most areas of the state can get discounts of about 20 percent on prescription drugs through the Kentucky Association of Counties.

The program offers discount cards that apply to most drugs at more than 1,000 pharmacies in Kentucky, including many national chains, said Bob Arnold, the association's executive director.



About two-thirds of the state's 120 counties have signed up for the program since the association made it available last month, Arnold said.

In the Louisville area, Bullitt, Shelby and Spencer counties have joined the program, while Oldham County doesn't plan to.

Louisville metro government expects to join once officials decide how best to distribute the cards to people who need them, said Chad Carlton, spokesman for Metro Mayor Jerry Abramson.

The discount program was started last year by the National Association of Counties. The state association made it available to all Kentucky counties recently by paying their dues to join the national group. That cost about $73,000, Arnold said.

There is no cost to a consumer to take part in the program. There are no forms to fill out and no age or income requirements. A family is covered by one card.

Arnold said the cards probably will be most beneficial to people without health insurance. But others could find them useful -- for example, if their insurance doesn't cover a certain drug.

Caremark Rx, a pharmaceutical services company, administers the program. Discounts range from about 13 percent to 34 percent, according to the National Association of Counties.

Bullitt County started distributing discount cards Monday through the county judge-executive's office, the county health department, and city halls in Mount Washington, Hillview and Lebanon Junction.

At The Medicine Shoppe in Shepherdsville, pharmacy technician Crystal Akridge said the first four or five customers to use the cards were uninsured.

"It saved them anywhere from a couple of dollars to half the cost," Akridge said. "If I didn't have insurance, I'd get a card."

But Oldham County Judge-Executive Mary Ellen Kinser said her county won't take part because much cheaper drugs are available elsewhere.

She cited Wal-Mart's program to fill many prescriptions for $4 and Meijer Inc.'s giveaway of several common antibiotics. The Wal-Mart program isn't available in Kentucky yet.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

One-third of people who tried to fill a prescription in the past year using their insurance report having had a problem, including the pharmacist needing to call the person's doctor or health plan before the prescription could be filled, the plan not paying for the medicine, or the pharmacy not having current information about the person's insurance. Knowing the dos and don'ts of using your coverage can help you solve problems and access the medicines you need.

When you're told there's a problem filling your prescription:

DON'T walk away from the pharmacy counter until you know what the problem is.

• The problem may be easy to fix. For example, if the information in the pharmacy computer doesn't match what is on your current pharmacy ID card, you may just need to show your card to update your record.

• Sometimes the problem is something your doctor should know about. For example, if the medicine could react badly with another medication you take, your plan may need your doctor to confirm that you should take it before the plan will pay.

DON'T give up if you're told a medicine you need is not covered.

• If your doctor thinks it's important for you to have a medicine that your plan won't cover, you can appeal the plan's decision. Write a letter to the plan and ask for the medicine to be covered or to be paid back for the cost of the medicine if you have already paid for it yourself. Your doctor may have to explain why you need this specific medicine.

To help head off problems before you get to the pharmacy:

DO know what you can expect to pay.

• Most plans only cover certain medicines. You can find out what medicines your plan covers by looking at the plan's "formulary." Find this list on your plan's Web site, or call your plan to request a copy.

• Plans usually expect you to pay a portion of the cost for your medicines. The portion you pay is called a "co-pay" or "co-insurance." Your plan can tell you what your share is for any medicine you are prescribed.

DO look at all your options.

• If you have a choice of plans at work or from Medicare, you have a chance to change plans each year. It makes sense to look at your options and see if another plan would better meet your needs. When you compare plans, look at the coverage for medicines you take now and for medicines you are likely to take sometime during the year (for instance, for seasonal allergies).

www.YourPharmacyBenefit.org has more information about choosing and using the pharmacy benefits under your insurance coverage, or call (888) 8-PUEBLO (1-888-878-3256) for a free copy of the brochure "Your Pharmacy Benefit: Make it Work for You" (publication #524N).

If your prescription isn't covered by your plan, there are other programs that may be able to help. Contact the Partnership for Prescription Assistance at (888) 4PPA-NOW (1-888-477-2669) or www.pparx.org for more information.

Knowing the dos and don'ts of using your coverage can help you solve problems and access the medicines you need.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

There is only one way to check how Phentermine works. If you are overweight try Phentermine died pills and see how quick they work. I used to try different sort of tablets but the matter of the fact is that none of them helped me complitely. I became rude awakening each time but after all I tried to find a good medicament to lose my weight. I didn't give up and on no account stopped looking for some died pills. Finally I found an offert of Phentermine died pills and decided to try them. My doctor suggested me to take the dose half an hour in the morning before a meal. I have been using Phentermine pills for four months now with a big effect. Sandra, age 45.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

It began about one year ago, when suddenly during the act I lost my erection. I started to worry about my sexual condition but tried to not panic. But after a while, I noticed that something is really wrong with me. I went to a doctor who chose Cialis pills for me, due to my age. I didn't say anything to my wife, because at first I wanted to know if it really would work. I was nicely supriced after the first dose I had taken, I hadn't any erection problems, even so I was really hard like a rock! It was hard to believe but my wife enjoyed it so much and had many orgasms that time! I have been taking Cialis till now and really love these pills! Nicolas, age 35.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

Jeanette McLaughlin risked getting diabetes unless she changed her ways. To help her in the quest, she turned to the Green Prescription programme. By Kelly Andrew.

On the table in Jeanette McLaughlin's sunny living room are three glass bowls – one containing walnuts and dried apricots, one biscuits and one a handful of caramel lollies.

It's a deceptively treat-laden selection of snacks laid out for a guest reporter. Jeanette has become an expert in checking food labels. The biscuits are the most low-fat and low-sugar option available and the sweets are low in sugar.

She has been rigorously following a healthy diet and exercise regime since joining the Green Prescription programme 12 months ago.

A green prescription is a doctor's written advice to a patient to increase his or her physical activity. Patients who sign up receive free follow-up advice and support for three months from local sports trusts, in Jeanette's case Sport Wellington.

She is a success story of the Government-funded programme. The 69-year-old, who has close-cropped white hair and a ready smile, seems full of life and energy. But a year ago she weighed 115 kilograms and struggled to work in the garden she loves because of painful arthritis and fatigue.

The spur for Jeanette's dramatic change in lifestyle was the threat of diabetes. A test last October showed her blood-sugar levels had risen dangerously high. Newtown Union Health Service GP Kathy James told her she had pre-diabetes.

Jeanette says the news hit her hard. Her weight had crept up gradually and looking back now she is shocked by how big she was.

Photos of herself taken last year have been unceremoniously ditched from her photo albums. She went through them a week ago and was so horrified by her size that she threw them all away.

The message that she had to make a change was delivered bluntly and strongly, Jeanette says.

"Kathy's a fabulous doctor, she just tells you straight. I asked her if I had a choice. She said, 'you're very lucky you do, now do something'. So that was it."

Jeanette has lost 26kg after removing high-fat foods from her diet, cutting out late-night carbohydrates such as white bread and potatoes and giving up what she calls lazy food – snacks that are convenient but not very nutritious.

Dr James is impressed by what her patient has achieved. From having pre-diabetes a year ago, she now has normal blood-sugar, blood pressure and cholesterol levels.

"It's just fantastic, especially the weight that she's lost," Dr James said. "She decided that she really wanted to make the change and the Green Prescription was really helpful in getting her going and keeping her focused. She's loved doing it."

Also on Jeanette's table is a vase full of velvety Dublin Bay red roses that grow against the fence in her compact garden.

Getting outside and tending the garden is now part of her exercise programme – when she is not dancing to a tape of music from the 1960s and 70s or striding around her Miramar neighbourhood.

The results of her self-disciplined approach have been obvious.

Along with the substantial weight loss she has increased her fitness and energy levels. She has also noticed pain from her arthritis has dramatically decreased.

"Now I feel like getting up in the morning. Before I just got up."

The Green Prescription scheme, which is run by Sport and Recreation New Zealand (Sparc) and Pharmac, has been running for nine years and has an annual budget of $1.7 million.

At present about 20,000 people a year take part, but Sparc is considering expanding the scheme. Annual surveys of its effectiveness have shown that about half of all participants are still active six to eight months after they have taken part. Nearly all reported noticeable health benefits.

Jeanette had never heard of the programme before she started, but now she swears by it.

"You're not really aware of the amount of weight you've put on until you start to lose it. I love gardening and I can do it now without my arthritis hurting as much, I used to really be in pain a lot."

She has dropped four clothes sizes but hasn't gone on a shopping spree for a new wardrobe yet because she plans to lose even more weight.

Her goal is to reach 80kg within the next six months and then, hopefully, go on a tramping trip. At present she weighs 89.5kg.

"I could go a lot smaller," she says, flapping her baggy trouser legs. "I keep thinking, 'Gosh, these are big', but they've got to get bigger."

Jeanette was sporty as a teenager, involved in a marching team and playing tennis. Her downfall was her sweet tooth, and her love of biscuits and desserts. Now she doesn't deny herself the occasional treat if she has a craving, but she reads the labels on the packets and chooses the treat with the lowest fat and sugar content, and she watches her portion sizes.

"Instead of having half a packet of biscuits, I'll have one."

Jeanette has lived in Wellington for most of her life and worked for drag queen performer Carmen for 12 years as a manager at The Balcony nightclub. She caught up with Carmen recently at her 70th birthday celebrations.

"She's a very kind person, she was too kind for her own good."

Jeanette credits her success with the Green Prescription programme to her Sport Wellington patient support person Helene Kay who calls her once a month to offer motivation and support. Though she has never met Helene in person, Jeanette says that from the outset she liked Helene's lovely friendly voice.

"I wouldn't have done it without her. You're conscious of knowing that someone's going to ring up and check on you as well. When you're a little bit down and you haven't lost any weight that particular week, she gives you that help that boosts you up again. She says, 'Pat yourself on the back, you've done really well'."

Helene helped her work out an exercise programme, which started with a daily 30-minute walk and has increased to a 90-minute walk three times a week and water aerobics.

She also sent Jeanette the 1960s and 70s music compilation that she enjoys – "I just bop by myself, the neighbours must think I'm mad. It's such a fabulous tape it really makes you feel like moving" – and gives her advice on eating healthily and avoiding the pitfalls of low-fat packaging.

Helene has more than 50 Green Prescription clients on her books at any one time and she calls them all at least once a month. The aim is to increase their daily activity to 30 minutes.

She also works as a fitness instructor. She says Jeanette is a star. "She set herself some goals, which she has constantly achieved. Her self- motivation has been really great."

Her role is like being a personal trainer over the phone, she says.

"It's about listening to their needs and what they want to achieve and then finding ways of helping them by offering suggestions or putting them in touch with the right groups. If it hasn't been that successful a month, I'll say, 'That's okay, you can try again next month'."

Jeanette says the first six months were a struggle, but her old ways of cooking and eating have gone for good and she doesn't miss them.

"You're brought up with your roast dinner on Sunday cooked in fat. I never cook with fat now. No potatoes at night, I have kumara and very little red meat. I eat mostly chicken or fish and a lot of vegetables and I steam those. You can vary your food now – sticking a baked dinner in the oven on Sunday is gone."

A prescription for exercise has been the best help her doctor could give her, she says.

"I'd recommend Green Prescription and I would always want to help anyone who wants to join."

Labels: No Prescription, Online Pharmacy, Prescription Drugs

Codeine, a common ingredient in over-the-counter cold medicines, has been more lethal than OxyContin in Newfoundland and Labrador, according to provincial government data.

The office of Newfoundland and Labrador's chief medical examiner listed codeine as the cause of death for 16 people between 2000 and 2005.
Don Rowe, registrar of the Newfoundland and Labrador Pharmacy Board, said he was not aware of the volume of codeine-related deaths.
(CBC)

By contrast, OxyContin — the subject of a 2004 task force on how the prescription painkiller became a popular street drug — was identified as a cause of death eight times.

CBC News, in a request under the provincial Access to Information Act, sought data on narcotic-related deaths over that period.

"Most people are aware of OxyContin deaths in this province, but to read that 16 deaths in the province attributed to codeine overdose or abuse — it's a startling number," said Don Rowe, registrar of the Newfoundland and Labrador Pharmacy Board.

Rowe told CBC News that he had not been made aware of the impact of codeine.
Continue Article


Codeine can be obtained by prescription, but it's also found in popular non-prescription products. It can be extracted from such products to make a powerful narcotic that is similar to morphine.

In the United States, all drugs with codeine are only available by prescription.

Rowe said Canada's registrars of pharmacy boards had recommended that Health Canada follow suit a couple of years ago, but federal authorities rejected the advice.

Since 2004, pharmacists in Newfoundland and Labrador have been advised to stock non-prescription remedies containing codeine behind their counters.

St. John's pharmacist Tom Healey said he will not provide the drug to customers if he thinks they will abuse it.

"They have to have a lot of the product in order to lead to death, and large quantities I myself do not like dispensing and I won't dispense," Healey said.

Healey, however, does not believe that all codeine-containing products should be available by prescription only.

"I think we would be punishing the majority of people to try to stop a few that are going to obtain this drug by legal or illegal methods," Healey said.

It's not clear how many of the 16 deaths are related to prescribed codeine or over-the-counter remedies.

Dr. Simon Avis, the provincial chief medical examiner, was unavailable for comment.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

One area retailer is giving away some prescription drugs - free of charge. You may have heard Wal-Mart is selling some generic drugs at $4 per prescription ... you can get some at Meijer without paying a dime.

If you fill your prescription at any Meijer ... and get the generic version ... you'll get the drugs free.Meijer announced the deal Monday.

The covered drugs are: Amoxicillin, Cephalexin, Smz-Tmp, Ciprofloxacin, Penicillin VK, Ampicillin and Erythromycin.


The target drugs are fairly common and typically prescribed to children, but anyone - regardless of insurance or copay - can pick them up, as long as you come in with a prescription.

K-Mart also offers 184 generic prescriptions at $15 for a 90 day supply. That deal is at any K-Mart.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

Chicago researchers find college students who use prescription drugs illicitly are three times more likely to choose Adderall than Ritalin.

Northeastern University pharmacy professor Christian Teter says that the top motive for use is to increase concentration -- probably due to academic competitiveness, not to get high.

More than 75 percent of college students who reported using prescription stimulants illicitly last year chose amphetamine-dextroamphetamine products, like Adderall, over methylphenidate products, like Ritalin, according to the study published in the journal Pharmacotherapy.

The study randomly sampled 4,580 undergraduate college students from a large Midwestern university and assessed lifetime and past-year prevalence of prescription drugs.

"We also found that students who started illicitly using prescription stimulants during college were motivated primarily by a desire to improve concentration, possibly due to academic competitiveness," says Teter. "However, most pre-college initiators reported using it to get high, lose weight, and for experimentation."

Labels: No Prescription, Online Pharmacy, Prescription Drugs

Viagra may ease blood pressure in the lungs of people with chronic obstructive pulmonary disease (COPD).

That's according to a small Dutch study presented in Salt Lake City at Chest 2006, held by the American College of Chest Physicians.

COPD is the No. 4 cause of death in the U.S. and worldwide, according to the National Heart, Lung, and Blood Institute (NHLBI).

COPD is a lung disease in which breathing is difficult. It's usually caused by smoking cigarettes, but it can also be caused by other lung irritants.

The disease develops slowly and may take years to show symptoms, which include:
Cough
Sputum (mucus) production
Shortness of breath (especially with exercise)
WheezingWheezing
Chest tightness

Those symptoms may or may not indicate COPD, states the NHLBI's web site.

Viagra Study

The Viagra study included 12 COPD patients, half of whom had high blood pressurehigh blood pressure in the pulmonary artery, which brings blood to the lungs. The development of pulmonary hypertensionpulmonary hypertension is a complication of COPD, but not everyone with COPD will develop it.

The researchers included Sebastiaan Holverda, MSc, of Amsterdam's University Medical Center.

They tracked the patients' pulmonary artery blood pressure before and after taking Viagra.

Why Viagra? It relaxes (dilates) blood vessels, lowering blood pressure and helping blood to flow.

First, the patients rested. Then they pedaled a stationary bike for three minutes at a mild pace.

As expected, pulmonary artery blood pressure was higher during exercise, since the lungs were working harder.

Next, the patients took a Viagra pill, waited 45 minutes, and repeated the rest and exercise tests.

Their pulmonary artery blood pressure during exercise was lower after taking Viagra.

"These data suggest that during daily activities some COPD patients may benefit" from drugs that dilate blood vessels, the researchers write.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

The Sutter Visiting Nurses Association and Hospice is holding a series of flu clinics throughout October. Flu shots are available for adults and children for a fee of $25. There is no charge with proof of Medicare Part B. Call 1-800-500-2400.

Local donation sites and hours include:

- Colma, 11 a.m. to 1 p.m. Oct. 30, Drug Barn, 4925 Junipero Serra Blvd.
- Menlo Park, noon to 3 p.m. Tuesday, Preuss Pharmacy, 844 Santa Cruz Ave.; 10 a.m. to 12:30 p.m. Saturday, Menlo Park Pharmacy, 1610 El Camino Real; noon to 3 p.m. Sunday , Draeger's Supermarket, 1010 University Ave.
- Pacifica, 2 to 5 p.m. Saturday, Manor Fire Station, 616 Edgemar Ave., Pacifica
- Palo Alto, 4 to 6 p.m. Friday, Andronico's, 500 Stanford Shopping Center.
- San Mateo, 9 a.m. to 2 p.m. Tuesday, San Mateo Expo Center Drive Thru, 2495 Delaware St.; 9 a.m. to noon Friday, Borel Bank, 160 Bovet Road.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

After a major government study four years ago raised questions about the safety of hormone drugs, many women stopped taking the pills.

But that doesn't mean they stopped taking drugs.

Today, women are using a litany of drug regimens to cope with many symptoms of menopause that in the past were treated by hormones alone. Antidepressants are prescribed to calm hot flashes and mood changes. Bone drugs are offered to prevent osteoporosis. Sleep aids help with the restless nights that often afflict middle-aged women. Prescription anti-inflammatory pills help ease the aches and pains common in menopause.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

A woman arrested on suspicion of driving while intoxicated attempted to hide prescription medication inside her body, Cape Girardeau County officers testified Friday.

Kathryn G. Drury, 47, was charged with felony possession of marijuana, tampering with physical evidence, and misdemeanor driving while intoxicated and failure to drive on the right side of the road.

She was arrested early in September when deputy Todd Stevens saw the vehicle she was driving east on County Road 314 travel into the lane of oncoming traffic and nearly strike a westbound vehicle.

Testifying before Judge Gary A. Kamp during a preliminary hearing for Drury Friday, Stevens said that the defendant appeared lethargic and under the influence of medication after he pulled her over.

Kamp continued the hearing until Nov. 2, by which time lab reports on the suspected drugs would be returned.

Drury admitted to the deputy that she had taken one pill of prescription pain medication. After conducting a field sobriety test, Stevens said he brought Drury back to the sheriff's office for a urine sample.

While watching over Drury in the bathroom, communications officer LaTasha Tidwell testified she found pills on the floor which were not there when the defendant was brought in.

In the back of Stevens' squad car, where Drury had been, the deputy found a generic Xanax drug.

Trooper Aaron Harrison testified that after seeing Drury tamper with a trash can in her cell, he found pills inside.

The pills found in both the bathroom and jail cell were hydrocodone, and all were suspected of being concealed in Drury's body cavities, according to a probable-cause statement.

The defendant told officers she hid the drugs because, although she a prescription for them, she feared going to jail for not having the pills in a prescription bottle, according to the statement.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

When you have your prescription filled at the pharmacy how do you know you're getting what your doctor ordered?

It's not easy to make sure you're getting what you pay for. You have to rely on the pharmacist, who's selling you the drugs, but you can also do some digging  on-line.

With hundreds of prescriptions filled everyday many of us have blind faith in our pharmacists and that the medicines we get are the real deal.  Most pharmacists buy their medications from wholesalers, who they trust are buying directly from the drug companies.

"We put trust in them buying direct from the manufacturer as they state they do. But there could be places out there that people are buying drugs from that aren't reputable and could possibly have some potential to be counterfeit," pharmacist Joe Wapelhorst said.

So how can you make sure your getting what the doctor ordered?
   
"Webmd.com," Wapelhorst said. "You type in the medicine, they'll give you a tablet image and a brief graph about what the drug is."

You can also look up medicines in the Physician's Desk Reference.

The state requires pharmacists to provide invoices as proof of where they brought their medications, so if you have doubts about whether you're getting the real thing that's another way to check it out.

Zach Koffenberger said when he gets a prescription filled he sticks with national chains and he's not alone.

"I have a two-year-old and a four-year-old and I'm highly concerned with the prescription drugs," Jennifer Pence said.

"It's basically like counterfeit money," Wapelhorst said. "They look pretty darn close but you have to take the word from the person that's supplying it that it's actually coming from the manufacturer."

Labels: No Prescription, Online Pharmacy, Prescription Drugs

When it comes to prescription drugs, it turns out buying generic doesn't always mean the most savings. A Consumer Reports investigation found you still have to shop carefully to get the best deals.

We all know generic drugs are a lot cheaper than their brand name versions.

Take prozac. A year's supply of the generic, Fluoxetine, averages $433. Prozac averages more than four times that -- $1,863.

But Consumer Reports says despite big savings for generics, you can easily pay more than you need to.

"We did price comparisons at 132 pharmacies across the country. Those included drugstore chains, independent pharmacies, mass merchants, supermarkets, as well as online pharmacies," said Dr. Marvin Lipman.

The price check covered five common generic prescription drugs; Lisinopril for blood pressure, Lovastatin for cholesterol,
Metformin for diabetes, Warfarin the blood thinner, and Fluoxetine.

Consumer Reports found big price differences for a 30-day supply of these drugs.

"The range of prices for these 5 generic drugs varied widely at independent pharmacies, anywhere from $82 to $295."

And at drugstore chains, there were significant price differences too.

The median price for the five drugs at CVS was $116. At Walgreens, $157. And at Rite Aid, $162.

Consumer Reports found buying the generic drugs online is often one of the best deals, but not always.

Ordering from Cigna Teldrug's web site turned out to be very pricey --- $228 for the five drugs.

Costco stores had the best prices -- just $48 for the same five generic drugs.

And although Costco usually requires a membership, you don't need to be a member to shop either at its online pharmacy or at the pharmacy located in its stores.

Consumer Reports found Walmart charged more than twice as much as Costco for the five generic drugs but that could change.

Walmart recently announced it will test market a program and sell generics for as little as $4 for a month's supply.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

Most Medicare prescription drug plans in 2007 will not cover erectile dysfunction treatments such as Viagra, Cialis and Levitra, the St. Louis Post-Dispatch reports. Many plans covered the treatments this year. According to the Post-Dispatch, "[m]any beneficiaries are learning of the change this week as they receive materials explaining next year's benefits." Most plans will continue to cover ED drugs if they are prescribed to treat medical conditions such as pulmonary hypertension, rather than for ED. Many of the insurers who sponsor Medicare drug plans say they support the change, which comes after a similar policy was implemented last year by Medicaid. UnitedHealthcare will market one Medicare drug plan that covers ED drugs, but its other plans will not cover the treatments. Charles Willey -- CEO of Essence, which markets Medicare Advantage plans -- said paying for ED treatments might not be the best use of health care expenditures, adding, "We have to decide what our priorities are"

Labels: No Prescription, Online Pharmacy, Prescription Drugs

We've done many columns on the risks and dangers of new drugs, and here is another variation on that theme - off-label use of drugs. That refers to drugs approved for one reason, but used for another reason unapproved by the FDA. The off-label drugs may even be riskier than the new drugs, which at least have been approved by the FDA.
Off-label use is commonplace, but it is not based on scientific study and has not gone through the FDA-approval process involving clinical trials. But under the law, doctors can prescribe any drug for an unapproved use. That rule is based on the concept that the FDA does not regulate the practice of medicine, and can't tell doctors what to prescribe. In fact, at times, it seems no one regulates the practice of medicine.
The doctor may go to an off-label use based on his theories about the drug, based on his experience with the drug and also based on recommendations from those touting the drug, or on anything else.
Now, there's new proof that, whatever intuition or other powers doctors draw on when making off-label prescriptions, they sometimes miss the mark.
A common off-label use for three drugs in the class called atypical antipsychotics is to treat agitation and aggression of Alzheimer's patients. The new study finds that the drugs are no more effective than placebos, but in addition, they can cause serious and even fatal adverse effects. In other words, the three drugs are worse than nothing.
Here are the names of those three drugs: Zyprexa, Risperdal and Seroquel. Those drugs, for on-label and off-label uses, ring up about $2 billion in sales a year. This new study passed no judgment on these drugs when used for approved purposes.
According to one published report, the drugs are prescribed on this off-label basis because families are so desperate to try to help an Alzheimer's victim, because the drugs seem to help once in a while, because company-sponsored doctors are out pushing the off-label uses and perhaps because doctors often prescribe ineffective and/or unsafe drugs.
I found this great revelation from this study published in the New England Journal of Medicine so interesting because, for years, doctors have been indicating these drugs are of little value and, their benefits, if any, are so negligible as not to be worth the risk of adverse effects, which include increased risk of death (compared to a placebo), sedation and confusion causing increased risk of falls and, in the case of Zyprexa and Risperdal, tremors and other Parkinson-like symptoms.
Another interesting aspect of the study involves the sponsor. The sponsor that financed the study is the National Institute of Mental Health. If this agency did not finance the study, the virtually useless and sometimes dangerous use of these drugs would probably have continued for many years, if not decades. You can be sure the drug industry is not likely to finance any after-approval-of-the-drug study to see if one of its products works or doesn't work. Perhaps an outcome, like the one in question, would be too likely for its tastes.
Still another interesting aspect of the study relates to the prescribing information, which states that patients with Alzheimer's-related psychosis "are at increased risk of death compared to placebo." This suggests that doctors either don't read prescribing information or don't consider death such a big deal when dealing with Alzheimer's patients.
In a published report in The New York Times, Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in the Bronx, observed that the drugs produce improvement that is modest at best, but that environment and behavior are more important in managing the combative behaviors of the patients (which the drugs are used to control). But the health delivery system is so obsessed with drugs that managing environment, behavior and other variables is not high on the priority list, even if such action would produce better outcomes. Prescribing and testing take the place of many things, including managing environment and behavior and talking to patients. It's much easier to write a prescription, especially when the prescribing pen is pushed by the marketing and legalized bribery of the drug industry, than to explore other more promising approaches.
Another expert, Dr. Jason Karlawish of the University of Pennsylvania, says the three drugs may be of use for "a subgroup of patients who can tolerate them, and in facilities that have the expertise to manage side effects." It would be reassuring to think that all facilities would have expertise to manage the side effects of drugs they give their patients, but apparently that is not the case.
Still another point of interest is that the study in question is the third in a series that finds this class of drugs, the atypical antipsychotics, is not as safe as are usually portrayed. When it comes to drugs, what else is new?
Finally, some observers say this study proves we need more research on how to handle the behavioral problems of Alzheimer's. My guess is this conclusion could have been reached by anyone of modest intelligence without the benefit of this study.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

In terms of the number of available vaccinations, the upcoming flu season is expected to go more smoothly than years past.

"There is an ample supply (of the vaccine) in this area," said Guillermo Cole, spokesman for the Allegheny County Health Department.

Guillermo said more than 100 million doses were distributed nationwide, compared to 80 million one year ago.

"There's enough for everyone who wants a flu shot," Cole said.

While several local clinics and physicians have already started issuing flu shots, a number of health centers, including Med-Fast Pharmacy and the Allegheny County Health Department, will begin offering the vaccine this week.

Gino Cordisco, spokesman for Med-Fast Pharmacy, said each location received 240 doses of the vaccine, which will be available at various times and locations beginning today.

Most clinics charge between $15 and $25 for the vaccination and will accept a variety of insurance plans.


Advertisement
Take Care Health Systems, which recently opened a health clinic in the Rochester Eckerd drug store, starting distributing the shots Saturday. Their Web site advises people to get the vaccination in October or November, before the flu season peaks. It takes about two weeks for the vaccination to take effect.

And if you're thinking this winter's mild temperatures will protect you from getting the flu, think again.

There is no correlation between the flu and the weather, Cole said. "All I can say is we know we'll have influenza."

The health department said this year's vaccine will protect against three strains of the virus, including New Caledonia, Wisconsin and Malaysia. They also estimate that between 5 and 20 percent of the nation's population gets the flu virus every year, more than 200,000 are hospitalized and nearly 36,000 people die from complications.

Those who should be vaccinated:

People 65 and older.

People living in nursing homes.

Adults and children older than 6 months with chronic heart or lung conditions and who need regular medical care.

People between the ages of 50 and 64.

Pregnant women.

Health care personnel.

Those who should not be vaccinated:

People with a severe allergy to chicken eggs.

Children less than 6 months old.

People with an illness or fever should wait until their symptoms improve.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

A new state law is expected to make prescription drug labels user-friendly and reduce medical errors, its backers believe.

Assembly Bill 269, which took effect this month, requires doctors — when asked by a patient — to include on the label the symptom or purpose for which the drug is being prescribed.

State Rep. Steve Wieckert (R-Appleton), the bill's author, believes it will reduce medical injuries and potentially save lives.

"It's an exciting thing that we can all use, especially seniors," said Wieckert. "Seniors take an average of 12 different prescriptions in Wisconsin, so they can get confused."

Wieckert said he hopes his bill will remind patients to ask their doctors for the clear labeling.

"They just have to give a little note to the doctor and just say, 'I'd like you to put on the label, in layman's terms, what is this medication for," he said. "A lot of people never thought to even ask. Sometimes when you make the rule, people are now aware that they can even ask."

A pharmacist can only print on a label what a doctor or healthcare provider includes on the prescription order. Patients, unfortunately, usually realize this at the pharmacy counter, Wieckert added.

"I've had some pharmacists tell me that they would issue three or four prescriptions for seniors who would come back and say, 'could you write on the labels what these are for,' but by law, they cannot do that," Wieckert said.

The Coalition of Wisconsin Aging Groups, AARP, the Wisconsin Nurses Association and the Wisconsin Patient Safety Institute were among the bill's backers.

It took Wieckert more than three years to get the bill passed. His original version required that doctors always ask patients if they want the purpose of the medication listed on the label. Doctors objected, arguing it would create another mandate that would interfere with the doctor-patient relationship.

Some doctors, though, remain dissatisfied with the new bill.

"I have a problem with micromanagement legislation," said Dr. John Barkmeier, a family practice and geriatric medicine physician with ThedaCare Physicians – Menasha. "There is no question that medication safety is an issue."

But it has more to do with adverse drug interactions when people take multiple medications, he said.

"I don't see any evidence that this is the solution that will make the biggest difference. Other interventions have proven to be more effective and that is where we are putting our energy."

Wieckert, however, believes the bill will also make it easier for seniors to switch to generic drugs, which could save them money.

"We found that there is a great reluctance among seniors to go from some of the brand-name drugs to generics," he said. "And one of the reasons is the pills are shaped differently and they worry they are going to lose track. Seniors remember to take the small blue pill for this and the square pill for that."

But if the labels say, "take for cholesterol, migraine headaches or blood pressure," he added, they can take their prescriptions with confidence.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

Two classes of drugs commonly used to treat osteoarthritis—non-steroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors (a newer generation of NSAIDs)—present similar, increased risks of heart attacks while offering about the same level of pain relief, according to a new report by the Department of Health & Human Services' (HHS) Agency for Healthcare Research and Quality (AHRQ).

The exception is the drug naproxen, commonly sold as Aleve or Naprosyn, a medication that scientific evidence suggests presents a lower risk of heart attack for some patients than other NSAIDs or COX-2 inhibitors, the study concluded. Researchers emphasized in their analysis, however, that all drugs pose potential harms along with benefits. Patients differ widely on how they react to drugs, how they prioritize risks, and whether risks are acceptable when compared to a drug's benefits. Patients should talk to their doctors before changing any medications.

The report, authored by AHRQ's Evidence-based Practice Center at Oregon Health & Science University, was based on a systematic review of 360 published studies and represents the most comprehensive analysis thus far of arthritis pain medications. Researchers compared the pain medications' effectiveness and health risks, including heart attack and gastric side effects, plus identified topics where more research is needed. While the review yielded important findings about the painkillers, it concluded more studies are needed about the drugs' comparative risks, the consequences of long-term use, and the impact of dosing variations. The authors also suggested that genetic research may one day predict which patients are most likely to develop cardiovascular problems when taking the analgesics.

"These findings represent a vital comparison of medications that are taken by millions of Americans," said AHRQ Director Carolyn M. Clancy, M.D. "The report also shines a bright light on questions that could further our knowledge and give patients research-based evidence to help them choose the best available treatment."

Osteoarthritis is a joint disease that causes erosion of cartilage and leads to friction between bones. Its precise cause is unknown, though it has been linked to aging, specific occupations, trauma, genetics and repetitive, small injuries over time. The rubbing causes pain, swelling, and loss of motion. Osteoarthritis is different from rheumatoid arthritis, an autoimmune disease that causes joint pain and other problems.

Osteoarthritis affects mostly older people, but younger people with joint injuries also may be afflicted. About 6 percent of U.S. adults 30 or older have osteoarthritis of the knee, and about 3 percent have osteoarthritis of the hip. In 2003, Americans spent about $36.6 billion on treatments for osteoarthritis and other non-traumatic joint disorders, including hospitalizations, surgeries, diagnostic tests, drugs, home care and other interventions, according to federal estimates. Of this amount, about $5.5 billion was spent on COX-2 inhibitors and $3 billion on other NSAIDs.

The AHRQ report, which was developed with ongoing input from experts and other members of the public, analyzed the risks and benefits of 26 medications. Among the conclusions:
All NSAIDs and COX-2 inhibitors can cause or worsen hypertension, congestive heart failure, swelling and impaired kidney function.
No clear difference has been shown in pain-relief effectiveness among NSAIDS and COX-2 inhibitors.
Most NSAIDs and COX-2 inhibitors pose similar increased risks of heart attack.
The NSAID naproxen carries a smaller risk of heart attack than other NSAIDs or COX-2 inhibitors.
The risks of serious adverse gastrointestinal events for users of Celebrex are similar to the risks for users of Motrin, Advil, Voltaren and other NSAIDs.
More scientific evidence is needed to compare the cardiac and gastrointestinal risks of aspirin at doses effective for pain relief versus other NSAIDs.
Acetaminophen (Tylenol) generally reduces pain less effectively than NSAIDs but carries a smaller risk of gastrointestinal problems. One study showed high doses posed heart attack risks similar to NSAIDs.

For years, NSAIDs were the primary treatment for osteoarthritis. This class of drugs includes prescription medications, such as sulindac (sold as Clinoril) and diclofenac (Voltaren, Cataflam), as well as over-the-counter medicines such as aspirin, and medications with both prescription and over-the counter versions, such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Aleve).

Traditional NSAIDs work by inhibiting the action of two related enzymes. One of the enzymes reduces inflammation, eases pain and prevents blood clotting. But the intervention also limits the other enzyme's ability to protect the stomach lining from digestive chemicals and help maintain kidney function. Each year, an estimated 16,500 people die due to NSAID-induced gastrointestinal problems.

Many experts initially expected that COX-2s, which target only the enzyme that stimulates inflammation, would not cause the same stomach problems as traditional NSAIDs. Unexpectedly, the drugs were linked to serious cardiovascular problems. Two COX-2 inhibitors—rofecoxib (Vioxx) and valdecoxib (Bextra)—were voluntarily withdrawn from the market because of heart attack risks. Evidence on a third COX-2 inhibitor, celecoxib (Celebrex), suggests that it does reduce the risk of bleeding and other ulcer complications in patients using the drug for less than 6 months, but it is not clear if it is safer than other NSAIDs when used for longer periods of time.

The new report, Comparative Effectiveness and Safety of Analgesics for Osteoarthritis, is the newest in a series of Comparative Effectiveness Reviews, and it is available at http://effectivehealthcare.ahrq.gov/synthesize/reports/final.cfm. They are produced by AHRQ's Effective Health Care Program, the first federal program to compare alternative treatments for health conditions and make the findings public. The program is intended to help patients, health care providers, and others choose the most effective treatments. Information on the program and other comparative effectiveness reviews can be found at http://www.effectivehealthcare.ahrq.gov.

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COMBINING the drug, Herceptin, with hormonal therapy can slow the progress of breast cancer by more than half, a report has revealed.The findings have prompted a call for the treatment to be made available for even more women with breast cancer.

The study found the addition of Herceptin to hormonal therapy kept the cancer under control for a significantly longer time than hormonal therapy alone in patients whose advanced breast cancer was hormone receptor-positive, as well as HER2-positive.

The median progression-free survival was doubled at 4.8 months for patients who received the combination therapy compared with 2.4 months for patients who received hormonal therapy.

Another 15 per cent of high-risk patients treated with the combination therapy remained free from disease progress for at least two years. The results from the study have been presented at a meeting of the European Society for Medical Oncology.

Experts said the study demonstrated Herceptin should be considered the essential component in the treatment of all HER2-positive breast cancers.

HER2-positive breast cancer affects up to 30 per cent of women with the complaint. It is an aggressive form of the disease that requires special and immediate attention because the tumours are fast-growing and there is a higher likelihood of relapse.

To date, more than 3000 patients with HER2-positive breast cancer, both early and metastatic, have been treated with Herceptin in Australia.

The drug is available on the Pharmaceutical Benefits Scheme.

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There is some evidence that various types of drugs used to treat high blood pressure could hasten or impede the development of type 2 diabetes, but the latest findings don?t support that idea.

According to the results of a study in the medical journal Diabetes Care, the risk of type 2 diabetes does not appear to be increased or decreased in elderly hypertensive patients who use any of the major classes of blood pressure-lowering medications.

Dr. Raj Padwal, of the University of Alberta Hospital, Canada, and colleagues examined the occurrence of type 2 diabetes among previously untreated elderly patients who started treatment for high blood pressure.

A total of nearly 40,000 subjects were on ACE inhibitors, some 20,000 were taking beta-blockers, and about 20,000 were given calcium channel blockers.

More than half of the subjects (53 percent) were excluded from the analysis because of medication discontinuation, and 17 percent were dropped from the study after another medication was added.

The team found that neither ACE inhibitors nor beta-blockers were associated with a significant difference in type 2 diabetes incidence compared to that seen with calcium channel blockers. Similar results were obtained when a sub-analysis looked at patients who were taking a diuretic in addition to another drug. Padwal?s group thinks diabetes should not be a concern when high blood pressure is being treated.

"We suggest that clinicians guide their choice of initial antihypertensive therapy on the basis of more established factors, such as the available evidence regarding efficacy, economic considerations, and the presence of comorbid medical conditions," the researchers conclude.

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Most Medicare prescription-drug plans will stop covering Viagra and other erectile-dysfunction medications next year.

Many beneficiaries are learning of the change this week as they receive materials explaining next year's benefits.

Medicare is a federal health plan available to all Americans age 65 and older, as well as some younger people with disabilities. Enrollment for 2007 will begin Nov. 15.

Medicare's decision follows a similar policy change last year by Medicaid, the nation's health plan for the poor.

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Several insurers who run the drug plans said they supported the change. Dr. Charles Willey, chief executive of Essence Inc. of Creve Coeur, one of the insurers, said paying for the medications was not the best use of the nation's limited health care dollars.

"We have to decide what our priorities are," said Willey, whose Medicare Advantage plan offers drug, physician and hospital coverage under one benefit.

Most health plans offered by Anthem Blue Cross Blue Shield of Missouri, including plans offered to private employers, don't cover erectile-dysfunction drugs, said Deb Wiethop, a spokeswoman. UnitedHealthcare Corp. offers one Medicare plan that covers the drugs. Its other Medicare plans exclude them.

Medicare will continue to cover the drugs, however, if they're used to treat other conditions, such as pulmonary hypertension, for which they've been approved.

There was a heated debate in Washington two years ago as legislators drafting the Medicare prescription-drug bill grappled with whether to include the drugs in the original benefit.

Drug makers and the American Urological Association successfully fought legislators who questioned whether the drugs were more of a lifestyle choice than a necessary medication.

At the time, the Congressional Budget Office estimated coverage of the drugs would cost Medicare almost $2 billion over 10 years. Negotiating discounts and managing usage probably would have helped reduce that figure.

The Department of Veterans Affairs, which covers erectile-dysfunction medications, has negotiated discounts of up to 50 percent for the pills.

For people without insurance, Viagra, Cialis and Levitra typically cost $9 to $11 a pill. Erectile dysfunction is most prevalent among those ages 65 and above; the Congressional Kidney Caucus estimates it affects 30 million men nationwide.

Medicare beneficiaries looking for more information can use a new feature at the agency's Web site, www.medicare.gov. The prescription-drug plan finder, launched Friday, includes information on premiums, covered medications and costs.

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There is widespread support to make medicines for minor illnesses available from pharmacies without a prescription.

In a survey commissioned by the Irish Pharmaceutical Union (IPU) 86% of people supported the idea of allowing pharmacists to provide routine medicines to medical card holders without a GP's prescription. 

Other findings include:

• 90% would like to see increased services, such as blood pressure and cholesterol testing, offered by pharmacists.
• 20% of Irish people are taking 2 or more medications at the same time.
• More than 20% are concerned that they may not be taking their medication correctly.
• Over half of those surveyed said they rely on pharmacists to solve their healthcare problems.

More than 1,000 people were surveyed for the research conducted by Behavior & Attitudes.

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A protein that may help in the development of new anti-tumor drugs has been identified by Mayo Clinic researchers.

The protein -- cyclin-dependent kinase 2 (CDK2) -- acts as a "quality control inspector" during cell division, and also directs cell death for cells that are damaged during division.

Normal cells pause during the division process if they detect an inaccurate genetic code embedded in their DNA. If possible, repairs are made to those mistakes.

When those genetic code errors are irreparable, CDK2 modifies another cellular protein called FOX01 to send a signal that causes the damaged cell to die, the study found.

"Quality control within dividing cells is essential because mistakes during duplication of the genetic code can lead to cancer. CDK2 is a key protein component in the cellular mechanism that leads to repair of damaged DNA," Donald Tindall, co-leader of the Mayo Clinic Cancer Center prostate cancer research program, said in a prepared statement.

This finding offers scientists a potential "bulls eye" for targeting anti-tumor drugs.

The study was published in the current issue of Science

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A new class of diabetes drugs appears to hold promise against sepsis, Texas researchers report.

In animal studies, giving a compound from the family of aldose reductase inhibitors stopped the deadly inflammation of sepsis, which is caused by the overreaction of the immune system to a bacterial infection, according to a report in the Oct. 9 online issue of Circulation.

"Even if you kill all the bacteria, toxin levels are still too high," explained study author Satish Srivastava, a professor of biochemistry and molecular biology at the University of Texas Medical School Branch at Galveston. "Injected into experimental animals, the aldose reductase inhibitor prevented septic shock."

Sepsis killed more than 120,000 hospitalized people in the United States in 2000, and the incidence has been increasing -- from 82.7 cases per 100,000 Americans in 1979 to 240.4 per 100,000 in 2000. "It affects the lungs and kidneys, but the major cause of death in sepsis patients is cardiovascular collapse," Srivastava said.

He has been working for years on aldose reductase, an enzyme that is found throughout the body. It is part of the process by which glucose is converted to fructose and an alcohol called sorbitol. In diabetics, high levels of sorbitol can cause severe eye damage.

Several drug companies have been working on compounds that inhibit aldose reductase activity. One aldose reductase inhibitor, fiderestat, has been approved for use in Japan, and an application for its use in the United States is expected soon.

In the trial reported by the Texas researchers, mice were injected with chemicals that produced the condition of severe sepsis, including severe inflammation and loss of heart function. Injection of an aldose reductase inhibitor called sorbinil restored heart function to near-normal, the researchers reported.

The results were impressive enough for Srivastava to start planning for human trials. "We do plan to go to clinical trials," he said. "We are meeting with people to talk about funding."

The potential for aldose reductase inhibitors in sepsis "is certainly plausible," said Dr. Herbert Wiedemann, chairman of pulmonary, allergy and critical care medicine at the Cleveland Clinic. But, he noted, "there have been many prior approaches that worked in the laboratory and did not work in humans."

In humans, "sepsis is a very complex situation in which the immunological responses play out over time," Wiedemann explained. "In this animal model, treatment was given at one point in time."

Another reason for caution was that the response to the medication appeared to drop off as time passed, he said. The animals were pretreated, and "the efficacy dropped off quite a bit two hours later," Wiedemann said. "In humans, you usually don't have the opportunity to pretreat."

The work does hold promise, and human trials certainly are warranted, he said. One reason for hope is that the aldose reductase inhibitors appear to stop production of all the toxins causing physical damage, Wiedemann said, but he still counseled caution based on previous experience.

"When you look at these papers, the results are so convincing," he said. "When it works in an animal model, we think we're home, but this has been going on for years."

If this latest research does not pan out, work has shown these compounds can reduce the damaging inflammatory processes in colorectal cancer, the Texas researchers added.

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"The drugs, commonly known as 'Chinese Viagra', are supposedly manufactured by Feng Tai Industry and Company, a Chinese firm, and are allegedly being sold as Baiyee, Yang Gang and Cialis," said an official of the ministry's drug control directorate, who did not want to be named.

"It is also claimed that the use of these drugs increase energy levels.

"Satibo Capsule and Tongkat Ali Plus, which are also allegedly available at some cold stores, have also been banned and should not be consumed."

The official said since these drugs were banned in Bahrain early this year, all stocks had been recalled.

"However, we are trying to track down some consignments, which are probably still there in some pharmacies and also trying to ascertain whether some of them have actually been passed on to cold stores to be sold," he said.

The official said some of these have been found at pharmacies and they have been told to take these off their shelves.

"We advise people not to purchase them since they had failed our tests, which showed they contained the chemical Sildenafil, used in Viagra, but is dangerous if used without medical supervision," he said.

The official said health inspectors were aggressively following up and checking on whether all pharmacies and health food stores have complied with the ministry directives.

A doctor at the Salmaniya Medical Complex said using Sildenafil without proper monitoring could lead to severe hypotension (very low blood pressure), myocardial infarction, ventricular arrhythmias, sudden death, stroke and increased intraocular pressure.

He said some common side effects include sneezing, headache, flushing, dyspepsia, prolonged erections, palpitations and photophobia.

"Visual changes including blurring of vision and a curious bluish tinge on the body have also been reported," he said.

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They were considered the most effective weight loss drugs available. But almost a decade after Fen-Phen was pulled off the shelves, researchers are still looking for a formula to slide the scales toward skinny.

Now a new clinical trial shows promise in melting away the pounds.

Like Fen-Phen, the trial combines two drugs already approved by the FDA where the side benefit has been weight loss. The idea is putting the two together will equal greater benefits for the patient.

One of those trying the medication says, "I don't feel as hungry. I feel like I'm more in control of when I'm eating instead of trying to eat everything in sight. I get full and I stop."

In this study, Wellbutrin, an anti-depressant, deals with seratonin, while an anti-seizure drug goes for the dopamine - another messenger that tells the brain the body's full.

Maria Lightford is one of 45 patients who will be followed for the next year. She says the early results are a boost that's helping her get on track to a healthy lifestyle.

And she welcomes whatever help she can get. "If it'll help you lose weight, why not?"

Doctors say the potential side effects of these drugs could include numbness, tingling and a feeling of fogginess.

Another phase of the trial will get underway in a matter of months.

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Non-steroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors (a newer generation of NSAIDs), both commonly used drugs to treat osteoarthritis, present similar, increased risks of heart attacks while offering about the same level of pain relief, according to a new report by HHS' Agency for Healthcare Research and Quality.

Osteoarthritis is a joint disease that causes erosion of cartilage and leads to friction between bones. Its precise cause is unknown, though it has been linked to aging, specific occupations, trauma, genetics and repetitive, small injuries over time. The rubbing causes pain, swelling, and loss of motion. Osteoarthritis is different from rheumatoid arthritis, an autoimmune disease that causes joint pain and other problems.

The study, based on a review of 360 published studies of arthritis pain medications, revealed that exception is the drug naproxen, commonly sold as Aleve or Naprosyn, a medication that scientific evidence suggests presents a lower risk of heart attack for some patients than other NSAIDs or COX-2 inhibitors.

Researchers say that all drugs pose potential harms along with benefits depending from patient to patient on how they react to drugs, how they prioritize risks, and whether risks are acceptable when compared to a drug's benefits. Patients should talk to their doctors before changing any medications.

Researchers compared the pain medications' effectiveness and health risks, including heart attack and gastric side effects, plus identified topics where more research is needed. While the review yielded important findings about the painkillers, it concluded more studies are needed about the drugs' comparative risks, the consequences of long-term use, and the impact of dosing variations. The authors also suggested that genetic research may one day predict which patients are most likely to develop cardiovascular problems when taking the analgesics.

Osteoarthritis affects mostly older people, but younger people with joint injuries also may be afflicted. About 6 percent of U.S. adults 30 or older have osteoarthritis of the knee, and about 3 percent have osteoarthritis of the hip. In 2003, Americans spent about $36.6 billion on treatments for osteoarthritis and other non-traumatic joint disorders, including hospitalizations, surgeries, diagnostic tests, drugs, home care and other interventions, according to federal estimates. Of this amount, about $5.5 billion was spent on COX-2 inhibitors and $3 billion on other NSAIDs.

The AHRQ report concludes:


All NSAIDs and COX-2 inhibitors can cause or worsen hypertension, congestive heart failure, swelling and impaired kidney function.
No clear difference has been shown in pain-relief effectiveness among NSAIDS and COX-2 inhibitors.
Most NSAIDs and COX-2 inhibitors pose similar increased risks of heart attack.
The NSAID naproxen carries a smaller risk of heart attack than other NSAIDs or COX-2 inhibitors.
The risks of serious adverse gastrointestinal events for users of Celebrex are similar to the risks for users of Motrin, Advil, Voltaren and other NSAIDs.
More scientific evidence is needed to compare the cardiac and gastrointestinal risks of aspirin at doses effective for pain relief versus other NSAIDs.
Acetaminophen (Tylenol) generally reduces pain less effectively than NSAIDs but carries a smaller risk of gastrointestinal problems. One study showed high doses posed heart attack risks similar to NSAIDs.

NSAIDs being the primary treatment for osteoarthritis for years includes prescription medications, such as sulindac (sold as Clinoril) and diclofenac (Voltaren, Cataflam), as well as over-the-counter medicines such as aspirin, and medications with both prescription and over-the counter versions, such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Aleve).

Traditional NSAIDs work by inhibiting the action of two related enzymes. One of the enzymes reduces inflammation, eases pain and prevents blood clotting. But the intervention also limits the other enzyme's ability to protect the stomach lining from digestive chemicals and help maintain kidney function. Each year, an estimated 16,500 people die due to NSAID-induced gastrointestinal problems.

Many experts initially expected that COX-2s, which target only the enzyme that stimulates inflammation, would not cause the same stomach problems as traditional NSAIDs. Unexpectedly, the drugs were linked to serious cardiovascular problems. Two COX-2 inhibitors – rofecoxib (Vioxx) and valdecoxib (Bextra) – were voluntarily withdrawn from the market because of heart attack risks. Evidence on a third COX-2 inhibitor, celecoxib (Celebrex), suggests that it does reduce the risk of bleeding and other ulcer complications in patients using the drug for less than 6 months, but it is not clear if it is safer than other NSAIDs when used for longer periods of time.  

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Whether meditating before bed or sipping a kava kava nightcap, more than 1.6 million Americans use some form of alternative medicine when they have trouble sleeping.



In analyzing data from 31,000 Americans interviewed for the 2002 National Health Interview Survey, researchers found that nearly one-fifth of adults reported difficulty sleeping in the last 12 months, and of those, about 5 percent used complementary and alternative medicine to treat their sleeplessness. The majority of those who tried the therapies said they helped, with nearly half saying they helped "a great deal."

Nearly 65 percent of people using alternative methods to help them sleep used "biological therapies," such as herbs or supplements, and 39 percent used "mind-body therapies," such as self-hypnosis, guided imagery or other relaxation techniques.

The findings also shed some light on why people turn to complementary and alternative medicine to treat their sleep problems. Forty percent of those who tried alternative therapies said they had not found conventional treatments helpful. Thirty-five percent said their doctor had suggested the approach. One-quarter thought conventional medicine was too expensive, and two-thirds thought it would be "interesting to try."

The report, published last month in the Archives of Internal Medicine, was part of a larger look at U.S. sleep habits. Researchers also found a strong connection between reports of insomnia or sleep troubles and other health conditions, such as obesity, hypertension, congestive heart failure and anxiety or depression.

"This is giving us a nice snapshot of the characteristics of people who have insomnia in general, as well as those who use complementary and alternative medicine for insomnia and sleep problems," said Richard Nahin, senior adviser for scientific coordination and research at the National Center for Complementary and Alternative Medicine.

Although the report didn't rank the popularity of specific herbal or behavioral remedies, doctors who recommend complementary and alternative medicine said some alternative therapies — such as melatonin, kava kava and valerian — can be effective in treating sleep problems and are typically safer than sleep drugs.

"People are aware that a lot of conventional therapies do have side effects, and there is a potential for a dependency to develop," said Dr. Mary Hardy, director of integrative medicine at the Ted Mann Family Resource Center at UCLA's Jonsson Comprehensive Cancer Center. "If they want to be able to take something on a regular basis, they look to natural therapies to help with that."

Dr. Jay Udani, who runs the Integrative Medicine Program at the Northridge Hospital Medical Center, said he would recommend anyone with sleep problems start with mind-body techniques such as self-hypnosis, meditation or guided imagery. If that were not sufficient, he might recommend mind-body techniques combined with an herbal remedy -- and melatonin would be his first choice. Even a low dose (1 to 5 milligrams) of melatonin can be effective, he says.

But doctors cautioned against mixing sleep-inducing herbs or supplements with sleep drugs. Consumers should talk with their physicians first, they said.

Dr. Soram Khalsa, an internist at Cedars-Sinai Medical Center who has integrated natural and conventional medicine for the last 30 years, said he often recommends tryptophan and theanine, two amino acids that can be bought over the counter. He said peri-menopausal women who have a slight hormonal imbalance -- they are low in progesterone relative to estrogen -- might benefit from natural progesterone before bed. He also recommends meditating at night.

"If you meditate for even 15 minutes with some deep breathing, that will help induce the alpha rhythm brain wave which will help you sleep," he said.

Hardy said her recommendations depend on the sleep disorder. People who have trouble falling asleep because of anxiety should consider relaxation therapies, such as meditation, or calming yoga poses before bed, she says. Aromatherapy, such as lavender or geranium oils, can also help, she added, as can a pre-bedtime snack of foods that promote the release of seratonin, such as crackers, bread, tuna or a little milk.

Hops can be helpful, but valerian is the single best herbal medicine for sleep, Hardy said, because it doesn't excessively sedate, and over time it helps restore normal "sleep architecture." She said the herb is best for those who fall into a deep sleep, but wake up not feeling rested.

The new data will help generate more interest in complementary and alternative medicine and sleep disorders, Nahin said, particularly in the realm of mind-body therapies.

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October is Breast Cancer Awareness Month and a good time to tell you how doctors are looking at the disease in a different light.

It used to be that every woman diagnosed with breast cancer received the same treatment. They now understand one diagnosis doesn't fit all.

Cancer has always been defined by which organ is affects -- breast, prostate, lung -- but doctors are no longer looking at where cancer forms. They are paying closer attention to how the cancer forms, and they're realizing that breast cancer is more than just one disease.

Linda Craig, along with other women who she was surrounded by, have something in common. All have battled breast cancer, but the similarities end there.

"When you talk to a survivor, their story is always different than yours, their treatment is different," said Craig.

Their diseases may have been different, too. For generations, women like these fell under one broad diagnosis of breast cancer, but increasingly, cancer specialists have recognized there are several different types of breast cancer and at least five different subsets.

For example, experts said one type of breast cancer might be more genetic in nature, while another type of breast cancer may have more to do with hormones. The difference is critical -- so is the treatment.

While surgery remains the base upon which all other breast cancer treatment rests, chemotherapy is no longer automatic.

Doctors look first at what type of cancer cell a woman has, her genetics and her body type. Tests can now determine whether she will benefit from chemotherapy.

We all process medicine differently, and drugs are now made accordingly, drugs such as tamoxifen, reloxifene and herceptin.

"That can also help to prevent breast cancer both in the breast from coming back and also help that metastatic breast cancer," said Dr. Kathleen Erb. "The more we learn about breast cancer and its characteristics, the better we are at tailoring a given woman's treatment."

Just as personal workout routines keep us fit, personalized drugs will be used to target specific types of breast cancer and strengthen the numbers of survivors like Craig.

Breast cancer isn't the only one known to have several subtypes , colon cancer can be defined this way as well. The bottom line is: in the not too distant future, it won't make any difference what type of cancer you have -- the one-size treatment will be gone. In its place will be a specific silver bullet that can knock out your specific cancer and hopefully keep it out for good.

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Do you know that those extra pounds are bad for your health? Aren't you risking your health to future cardiovascular diseases and heart problems? Isn't it time to look after your health? Are you finding it difficult to socialise as you are becoming an object of mockery at every party because you are obese?

If you say 'yes' to any of the above questions then it is time to get rid of your obesity. Obesity is considered a disease by the medical community. It has serious health risks like heart problems, diabetes, stroke, paralysis, prostrate cancer plus a dozen of other kind of diseases. Though the definite cause of obesity is far from clear there are certain theories on it. Prominent amongst them are excess food intake, heredity, laziness and lack of physical activities.

The natural method of losing weight is physical exercises and a limited diet regimen. But the natural process takes time to get a considerable weight reduction. Other method like surgery and liposuction are good as a short term solutions, but are costly and requires re-operation. But the best available method to lose weight is a combination of exercises, diet program and diet pills.

But choosing a right diet pill is a difficult task considering the different types of diet pills one has in the market today. Importantly, one should stay away from pills which say of burning fats as the lost fats return when one discontinues it. The other diet pills require an individual to maintain a controlled diet and do physical exercises. These are the kind of diet pills one should opt for.

The diet pills suppress appetite by acting on central nervous. But there are certain side effects like nausea, stomach upset, irritability, diarrhea and oily spotting etc. These diet pills require one to maintain a restricted diet regimen and do exercises, without which the effects are not noticeable.

Pills like – Phentermine, Adipex, Bontril, Didrex, Diethylpropion, Ionamin, Meridia, Phendimetrazine, Tenuate and Xenical are some of the popular weight loss diet pills prescribed by the doctors. The latest diet pill of late is Acomplia which is approved for sale in the UK and EU but is awaiting approval from FDA for sale in the US.

Obesity is such a menace that it could kill all of us with a disease or the other. It can be termed as the root cause of all future diseases. So, it would be better for us to get rid of it in whatever possible way so that we lead a disease less healthy life.

Clarence Carter received training as a healthcare scientist. She has been working in the same field and writes informative articles, weight loss being her pet subject. To find Xenical, Weight Loss Drug, Acomplia, Cheap Diet Pills, Childhood obesity, Xenical Online

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High blood pressure, joint pains, diabetes, hyperlipidemia, heart ailments, palsy, liver ailments, menstrual abnormalities, breast cancer, female infertility, decline in libido, endometrial cancer, mental stress, blood circulation diseases like arteriosclerosis, cholelithiasis etc. These are some of the diseases which might come up with obesity. This list seems endless. But before knowing how to end obesity one must know "what is obesity?"

Whom would you consider a person to be obese? A person who has BMI (Body Mass Index) of over 30 is considered to be an obese individual. But how does one become obese? In theory causes of obesity are gene, intake of fatty foods, lacking of physical activity, food habits, laziness and endocrine problems.

What are the available remedies for getting out of obesity?

Liposuction: It is a surgical process where the fat is removed by sucking out the fat from the body by inserting a needle.

Surgery: Commonly this procedure involves surgery of stomach and intestine to lower the intake of food.

Diet Pills: Majority of the diet pills are for short-term use only. These diet pills are effective only if they are used in combination with exercises and a controlled diet.

Fat burning pills: These are short-term quick fat burning pills. But the main problem with this medication is that the results are short lived. Once the medication is stopped the fats again show up.

Exercises: It is an age old technique of obesity reduction. It is a natural process so side effects are not there.

Controlled diet program: Like exercises this too is a natural process. Here a limited amount of food is taken which controls the formation of fat in the body.

Acupressure and acupuncture: Age old technique but nothing concrete has been proved yet.

Whatever be the method of getting over obesity there is no better method than natural methods like exercises and controlled diet program. And if a diet pill like Phentermine, Adipex, Acomplia is introduced the effects would be visible within a short time period.

Apart from physical aspects obesity may also let you feel dejected, out of the world and may make an individual abstain from social gatherings. If you are obese it is time to act. Whatever remedy you choose you should always consult your doctor for his view on that remedy.

Obesity is a health risk. It may lead to a multiple of diseases in future. It is better to get out of obesity to remain away from the future diseases. Change in food habits and doing physical exercises are the cost effective and natural way of treating it.



Clarence Carter received training as a healthcare scientist. She has been working in the same field and writes informative articles, weight loss being her pet subject. To find Xenical, Weight Loss Drug, Acomplia, Cheap Diet Pills, Childhood obesity, Xenical Online

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The number of cases of fake drugs increased by 388 percent this year compared to same time last year, according to a lawmaker yesterday.

Rep. Pahk Jae-wan of the main opposition Grand National Party (GNP) said yesterday that the number of cases of unauthorized drugs such as fake Viagra, Cialis and unapproved vitamins went up to 99 in the first half of the year from last year's 51.

The number of smuggled medicines and unapproved vitamins has increased by 32 percent to mark 382 cases, which means 8.3 billion won worth of illegal drugs could have been put on the market, the Korea Customs Service said.

"There is no certain expiration date marked on fake or smuggled drugs and no compensation could be given if there were any side effects," Park said.

He urged the Korea Food & Drug Administration, police and prosecutors to crack down on illegal medicine supply routes.

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WASHINGTON It is an Achilles' heel of HIV therapy: The AIDS virus can sneak into the brain to cause dementia, despite today's best medicines.
 Now scientists are beginning to test drugs that may protect against the memory loss and other symptoms of so-called neuroAIDS, which afflicts at least one in five people with HIV and is becoming more common as patients live longer.
 With almost 1 million Americans, and almost 40 million people worldwide, living with HIV, that is a a large and underrecognized toll.
 "That means HIV is the commonest cause of cognitive dysfunction in young people worldwide," says Dr. Justin McArthur, vice chairman of neurology at Baltimore's Johns Hopkins University, who treats neuroAIDS. "There's no question it's a major public health issue."
 While today's most powerful anti-HIV drugs do help by suppressing levels of the virus in blood — so that there is less to continually bathe the brain — they cannot cure neuroAIDS. Why? HIV seeps into the brain very soon after someone is infected, and few anti-HIV drugs can penetrate the brain to chase it down.
 "Despite the best efforts of (anti-HIV) therapy, brain is failing," says Dr. Harris Gelbard, a neurologist at the University of Rochester Medical Center. He is part of a major new effort funded by the National Institutes of Health to find the first brain-protecting treatments.
 What is now called neuroAIDS is much different from the AIDS dementia of the epidemic's early years, when patients often had horrific brain symptoms similar to end-stage Alzheimer's, unable to move or talk. They would die within six months.
 Today, anti-HIV medication has resulted in a more subtle dementia that strikes four years or more before death: At first, patients forget phone numbers and their movements slow. They become less able to juggle multiple tasks.
 Some worsen until they cannot hold a job or perform other activities, but not everyone worsens — and doctors can't predict who will. In a vicious cycle, the memory loss makes many forget their anti-HIV pills, so the virus rebounds.
 Gelbard estimates that neuroAIDS reduces patients' mental function by 25 percent.
 If HIV patients live long enough, many specialists worry, nearly all of them may suffer at least some brain symptoms.
 "They're living longer with HIV in the brain," explains Kathy Kopnisky of the NIH's National Institute of Mental Health, which is spending about $60 million (€47.3 million) investigating neuroAIDS. "And they're aging, so they're going through the normal brain aging-related processes" that can make people vulnerable to Alzheimer's and other brain diseases.
 Biologically, this is a different type of dementia from any caused by Alzheimer's or Parkinson's, and drugs for those brain-degenerating diseases so far are proving disappointing against neuroAIDS.
 So the government-funded attack has two fronts:
 _First, figure out which of the powerful anti-HIV cocktails are the best bet for HIV patients with memory problems.
 A few of today's HIV-suppressing drugs, such as nevirapine, abacavir, AZT and indinavir, can penetrate the blood-brain barrier, says Dr. Ron Ellis of the University of California, San Diego.
 But no one knows if using those drugs instead of others will slow the brain damage once neuroAIDS symptoms begin. Early next year, Ellis will begin a study of 120 such patients — at UCSD, Hopkins and Washington University in St. Louis — to try to tell, by randomly assigning them to either a brain-penetrating cocktail or different drugs.
 _Second, find drugs that protect nerve cells from the inflammation-triggered toxic chain reaction that seems to be how HIV wreaks its damage.
 Topping the candidates are the epilepsy drug valproic acid and lithium, a drug long used in manic-depression. Both inhibit an enzyme, called GSK-3b. The body normally makes the enzyme, but too much is poisonous. In the brain, HIV knocks that careful balancing act out of whack, leading to death of connections key to memory and other neuronal functions.
 In a recent pilot study, Gelbard found tantalizing signs that valproic acid might increase brain connections in a few neuroAIDS patients, and improve their symptoms. He is about to begin a second-stage study to try to tell if the effect is real; a similar pilot trial with lithium is under way.
 Seeking a one-two punch, Gelbard also hopes to soon begin a human study of an experimental drug that targets a second inflammatory protein that HIV uses, this one to trigger brain cells to kill themselves. 
 

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Roche Holding AG said Monday it will produce enough doses of the drug Tamiflu to cover this year's influenza season. The Basel-based pharmaceutical giant will ramp up production to 400 million packages by the end of the year, allowing it to deliver enough Tamiflu to governments intending to stockpile the drug for influenza outbreaks. Roche increased production after the spread of bird flu led to a surge in demand for its anti-flu drug, considered the most effective treatment against the virus. Shares in Roche closed down 0.6 percent at 215.00 Swiss francs (US$173.01; €136.66) on the Zurich exchange Monday.

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The role of community pharmacist in managing minor conditions is expanding rapidly – the public are currently being encouraged to "self care" and more prescription only medicines are being deregulated to pharmacy medicines status (POM to P).

There is therefore a clear need for up-to-date, accessible reference sources to support community pharmacists in a field with an expanding product range.

This new edition includes updated material in all areas and also reflects the amendments in legal category status of many products (POM to P). Primary references are also now included to support advice being given.
- Third edition of successful book
- New primary references included to support
- advice given
- Online resources: updates available

"Non-prescription Medicines - 3rd Edition" is available from Piribo. For more information go to: http://www.piribo.com/publications/otc/nonprescription_medicines.html

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New study by prescription manager Medco Health solutions Inc. claims that parents of children who take ADHD medicine end up taking the drugs themselves. The study examined the prescriptions of 107,000 children and their parents last year.

The study also found that if one twin is taking ADHD medicine, it is more likely that the other would also take it than non-twin siblings.

Impulsiveness, hyperactivity and inattention are some of the symptoms of ADHD. Robert Epstein, chief medical officer at Medco said that although in childhood boys are more affected than girls, in adulthood the difference was not much.

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based internet pharmacy RxNorth.com is shutting down its distribution operation there and moving it to a Winnipeg company, due to American concerns over drug safety.

RxNorth.com, which is operated by Mediplan Global Health Inc., will transfer its operation to another company, CanadaDrugs.com, which is based in Winnipeg.

About 20 pharmacists and support staff are affected by the move, which does not affect the pharmacy's call centre in Minnedosa. At one point, the operation employed up to 200 people in Minnedosa.

Minnedosa Mayor Duane Lacoste said Wednesday he was sorry to see the company scale back its presence in the town, which is located 45 kilometres north of Brandon.

"They certainly were an excellent corporate citizen to our community," Lacoste said.

"They provided, of course, employment opportunities for all of these people. They provided funding for amateur sports, provided a large cash grant to our golf course."

The company says the latest move is being made to satisfy safety concerns of American regulators.

In late August, the U.S. Food and Drug Administration advised American consumers not to purchase several popular prescription drugs from RxNorth.com and other websites that have their orders filled by Mediplan Global Health, also known as Mediplan Prescription Plus Pharmacy.

The USDA claims the drugs shipped by Mediplan, including Celebrex, Lipitor and Propecia, are counterfeit. A Mediplan official called the allegations "completely false."

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Over-the-counter antihistamine drugs used to treat heartburn and acid reflux might be useful against chronic heart failure, a Japanese study suggests.

It's a small study, including only 50 patients. But the results point to possible benefits for many of the 23 million Americans with heart failure, a potentially fatal condition in which the heart cannot pump blood effectively, said a report in the Oct. 3 issue of the Journal of the American College of Cardiology.

"It's still very early, because we know very little about who might benefit from it or what drugs might be best," said Dr. W.H. Wilson Tang, an assistant professor of medicine at the Cleveland Clinic and co-author of an accompanying editorial in the journal. "It is an important thing to validate this data."

The initial work focused on the drug Pepcid, because a major study of medical databases by a group led by Dr. Masafumi Kitakaze of Japan's National Cardiovascular Center found that people with heart failure who were also taking the antihistamine appeared to have fewer heart failure symptoms.

The researchers were looking for such a relationship because previous research pointed to a role of histamine in heart failure. The same type of chemical reaction that allows stomach acid to cause heartburn and ulcers also seems to damage and weaken diseased hearts. Blocking this process with Pepcid might help to slow the progression of chronic heart failure, the researchers theorized.

The biological chemistry is complex, but the basic idea is that one kind of histamine can accelerate the damage done to heart cells, so that blocking the activity of histamine can protect those cells.

Half the patients in the Japanese trial were given Pepcid along with regular therapy. The other half got an alternative heartburn medicine called teprenone, whose protective effect does not involve histamine. Examinations by three cardiologists after 24 weeks found less-severe symptoms in those getting Pepcid.

"Now we need to conduct a large-scale trial to confirm the present findings," Kitakaze said in a statement. "The large-scale trial based on the results of our present research may not help current heart-failure patients because it takes time, but we hope it helps our children and grandchildren and others in the future."

The key point, Tang said, is that the Japanese researchers "found some objective benefit of using this histamine blocker versus another reflux drug that doesn't act on this mechanism."

Further studies are essential not only to determine whether all antihistamine drugs might have some value against heart failure but also to identify drugs that might work best for specific patients, he said.

"It is intriguing because this work indicates that an inflammatory cell mechanism may be pertinent in heart failure," Tang said.

But it's much too early for people with heart failure to take antihistamines because of the many uncertainties that exist, he said.

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Pfizer claims it is the first pharmaceutical company with a program of this type, focused on EPC authentication as a means of deterring counterfeiting. However, Wal-Mart now requires its top 300 suppliers to tag cases and pallets of select goods, and over 24 drug providers tag bulk containers of Schedule II drugs, prescription painkillers and drugs of abuse.


A pharmaceutical giant has announced it is using radio frequency identification (RFID) to fight pharmaceutical fakes.

Pfizer (NYSE: PFE) has initiated a tag application-verification process for Viagra sold in the United States. As each bottle is packaged, a label with an integrated passive high-frequency tag is applied. An RFID interrogator encodes an electronic product code (EPC) to each label, after which a second interrogator verifies the tag has been successfully encoded. It also reads the unique ID stored on the tag's chip, enabling Pfizer to record chip ID and EPC in a database.


Authenticity Checked

Pfizer sells five different stock-keeping units (SKUs) of Viagra -- several million units per year in the U.S. The company is also tagging the SKUs at the case and pallet levels.

Upon receipt, wholesalers and pharmacies will use an RFID interrogator linked to the pharmaceutical company's RxAuthentication Service over a secure Internet connection to verify the authenticity of each tag's unique EPC and chip ID.

If the EPC was not issued by Pfizer, or if the chip ID does not match Pfizer's records, the service sends a notice to quarantine the product, and to Pfizer's Medical Information Services employees, who process suspected cases of counterfeit drugs. The MIS employees then ask the druggist or wholesaler to send the suspected bottle to Pfizer for investigation.

There is also a version of the RxAuthentication process that allows wholesalers processing cases or pallets to verify the EPCs encoded to the case and pallet tags.

Pfizer claims it is the first pharmaceutical company with a program of this type, focused on EPC authentication as a means of deterring counterfeiting. However, Wal-Mart (NYSE: WMT)  now requires its top 300 suppliers to tag cases and pallets of select goods. Over 24 drug providers tag bulk containers of Schedule II drugs, prescription painkillers and drugs of abuse shipped to the retailer's pharmaceutical distribution centers.
FDA Approved

The U.S. Food and Drug Administration  (FDA) has endorsed the use of RFID as a means of authenticating and tracking individual containers of drugs throughout the supply chain, in order to create an e-pedigree showing each bottle's chain of custody. But Pfizer says it, and its distributors, wholesalers, and other supply chain partners, are not yet prepared to roll out an e-pedigree system.

Systech, a provider of automated packaging and data collection systems, worked with Tagsys and Pfizer to design the automated tagging process. Pfizer worked with SupplyScape, a creator of pharmaceutical supply chain software, to deploy the RxAuthentication Service.

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Newly approved drugs in the U.S. should carry a warning that their safety isn't guaranteed, the medications should be reviewed in five years, and they shouldn't be advertised for two years, according to a report released Friday.

The report, released by the U.S. Institute of Medicine, said the Food and Drug Administration hasn't done enough to oversee new drug safety. The institute said the medications should carry a symbol, such as a black triangle, indicating they might not be safe. It also suggests agency rules be enforceable with fines.

The FDA asked the institute for the study in 2004 after Merck & Co. withdrew its painkiller Vioxx, linked with higher risks of heart attack and stroke. Sen. Charles Grassley (R-Iowa), other members of Congress and consumer groups criticized the FDA for its oversight of Vioxx after the drug was approved.

"This report should be a watershed moment for FDA reform," said Grassley. "Public safety is at stake, along with the credibility of our nation's drug-safety agency."

FDA spokeswoman Susan Bro said the agency has "done a lot of work over the past two years to improve the drug-safety enterprise at FDA." The agency recognizes that more needs to be done, she said.

The study was completed by a panel of 15 independent doctors, scientists and other advisers assembled by the Institute of Medicine, which is part of the congressionally chartered National Academy of Sciences.

The FDA and several other government agencies contributed $1.8 million to cover costs associated with the study, said Christine Stencel, a spokeswoman for the Institute of Medicine.

The report takes a wide-ranging look at the FDA's oversight and says the agency needs more regulatory authority, including the ability to impose fines to ensure companies comply with labeling changes and conditions imposed on new products.

Although the report urges that drugmakers not be allowed to advertise their products to consumers in their first two years on the market, it said there might be legal questions that would limit such a move.

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Republicans in the U.S. House of Representatives tentatively agreed Thursday to prohibit Customs agents from seizing prescription drugs Americans buy in Canada and take back into the United States.

The deal would let Americans carry up to a 90-day supply of medication back to the United States from Canada without being stopped by Customs agents, House and Senate Republicans said. But it would not let Americans purchase cheaper prescriptions over the Internet or by mail-order, officials said.

"This really breaks the dam and it shows that it's only a matter of time before we pass a full-blown reimportation bill," said Senator David Vitter, a Louisiana Republican, who led the fight in the Senate to prohibit the Homeland Security Department from seizing prescription drugs being carried over the border. U.S. Customs and Border Protection is an arm of the Homeland Security Department.

Vitter acknowledged sales of drugs though mail order or through the Internet are significant.

But he added: "I think support for that is going to continue and going to continue to grow, no matter what this bill says or doesn't say."

President George W. Bush has rejected repeated congressional efforts to lift the ban on prescription imports. Medications are generally cheaper in Canada because of government price controls.

While importing drugs into the United States is illegal, the U.S. Food and Drug Administration generally has not stopped small amounts of medicine purchased for personal use. But U.S. Customs officials began intercepting imported prescription drugs two years ago and has seized more than 34,000 packages of drugs over the last year.

The pre-election controversy over the new rule threatened to split House Republican leadership who oppose lifting the import ban and rank-and-file Republican legislators who want to help elderly voters buy cheaper drugs.

However, many Customs agents already allow prescription drugs into the U.S. from Canada because they don't rigorously search people and cars for them.

Opponents said importing drugs that do not have FDA approval could be unsafe for consumers. The FDA says it cannot guarantee the safety of imported drugs.

Representatives for the pharmaceutical industry claimed Canadian Internet pharmacies, for example, have been known to sell fake and potentially unsafe medicines to unknowing American consumers through other countries.

"Americans should look at much safer alternatives that already exist and are proving to be incredibly effective here at home," said Ken Johnson, senior vice-president for the Pharmaceutical Research and Manufacturers of America, or PhRMA.

According to the Congressional Budget Office, brand-name drugs cost, on average, 35 to 55 per cent less in other industrialized countries than they do in the United States. Supporters of importing drugs contend that the U.S. is subsidizing the cost of medicine for the rest of the world.

The prescription drug policy shift would be included in a US$33.7 billion bill to fund the Homeland Security Department next year. Legislators who control the department's spending levels will meet Monday to debate other last-minute changes to the legislation, which has also been stymied by proposals to give Homeland Security regulatory oversight of security measures at chemical plants.

Legislators were negotiating whether to let the department require some high-risk chemical facilities to use nontoxic materials that would be more expensive but safer to the public if there is a release. The chemical industry strongly opposes such a requirement, and environmentalists have been pushing for it just as vociferously.

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Hong Kong customs officers have arrested an alleged mastermind in a massive international fake pharmaceutical drug-smuggling syndicate in the first joint operation with US customs and the US Food and Drug Administration.

The United States is seeking a warrant to extradite the 27-year-old Chinese suspect, and he could face up to 10 years in jail and a US$2 million (HK$15.6 million) fine if he is convicted of smuggling and conspiracy to defraud, according to Ben Leung Lun- cheung of the Customs Drug Investigation Bureau.

Millions of fake Viagra and Cialis tablets were seized in the United States in the past few months, where other arrests were made, Leung said.

US and Hong Kong authorities tracked down the suspect who was distributing the drugs via the Internet.

In an undercover operation, an officer posing as a potential buyer met with the distributor in Hong Kong.

Leung said the man offered 400,000 tablets at a price of US$100,000 even though the market value would have been worth US$4.4 million. One tablet of Viagra is worth about US$11.

The Chinese national, believed to be surnamed Xu, claimed to be a businessman. He was arrested at 1.40pm in a hotel Thursday.

The undercover officer found the man articulate and fluent in English, Leung said.

Four tablets of fake Cialis and 24 tablets of fake Viagra were seized.

Leung said he believed the man had been distributing two types of pharmaceuticals: counterfeit tablets, which masquerade under a more respectable brand name; and totally fake tablets which have no pharmaceutical effect at all.

"The appearance of the tablets, and the overall packaging of the products are very similar to the real thing," Leung said.

The arrested man "is a very, very key player," distributing the fake drugs to Europe, the United States, and Southeast Asia, he said.

However, local authorities are still investigating the manufacturing base of the syndicate and Leung said there may be more operations in the future in relation to this case.

Leung said the arrest was a landmark operation for Hong Kong in combating the smuggling of counterfeit pharmaceuticals, but denied it was an indication of a growing problem in Hong Kong.

He pointed to figures which showed in 2004 that 16,000 fake Viagra tablets were seized, while only 4,600 were seized last year. In the first eight months of this year 16,000 fake Viagra tablets had been seized, but Leung said this was still no indication of an increasing trend.

Accompanying Leung at the press briefing Friday were representatives from the US Immigration and Customs Enforcement and Food and Drug Administration, who praised the Hong Kong officers for their dedication and professionalism. FDA special agent Daniel Burke said they approached the investigation with a "sincere desire to protect public health and to ensure the safety and integrity of the world's pharmaceutical supply chain."

Leung said the sharing of intelligence and the cooperation in the operation showed the level of trust between the authorities on either side of the Pacific Ocean.

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The 'postcode lottery' effect seems to be diminishing, with medicines becoming widely available

THE use of cancer drugs in England has grown rapidly, and there is less evidence of "postcode prescribing", according to a new report.

The figures, to be announced today in a speech by Mike Richards, the National Cancer Director, show great changes in prescribing over quite a short period, between the second half of 2003 and the first half of 2005. Professor Richards's investigation stemmed from criticism from charities and drug companies that, even when approved by the National Institute for Health and Clinical Excellence (NICE), cancer drugs were not being used widely enough to make a difference.


The NHS is traditionally slow to adopt new drugs, something that NICE was set up to correct. But the evidence was that the system was not working. Professor Richards found, in a report in June 2004, that there was considerable variation in the uptake of drugs between different regional cancer networks.

A lack of money did not explain the differences, which appeared to be attributable to the way that services were organised, and different opinions between cancer specialists on prescription. The professor made recommendations aimed at reducing this variation and ensuring that good drugs were used more widely.

Today, in a speech at a Health Service Journal conference, he will announce that a second study has shown considerable improvements.

The use of cancer drugs increased sharply in the 18 months between the two surveys, by an average of just under 50 per cent. For some drugs, such as rituximab (MabThera), for lymphoma, and temozolomide (Temodal), for the brain cancer glioma, usage roughly doubled in that time.

The use of trastuzumab (Herceptin), for breast cancer, rose by 55 per cent, and imatinib (Glivec), for chronic myeloid leukaemia, by 70 per cent. Both drugs are well known and highly effective.

The report also includes encouraging signs that where patients live now matters rather less than it did in terms of cancer drug prescription.

Professor Richards compared the networks that use the most cancer drugs with those that use the least. In 2003 those at the top of the scale were typically using three or four times as much of the cancer drugs as those at the bottom. By last year the gap had narrowed to between two and three times as much — about twice as much for the most common and widely used.

In the case of Herceptin, for example, ratio fell from just over 4:1 to just under 3:1.

"For every single cancer drug, we are seeing a reduction in the variation," Professor Richards said. "We haven't eliminated all variation but we are moving in the right direction and the recommendations of the first report are beginning to pay off."

He does not expect to see such variations disappear. Some are due to individual clinicians' judgments, some to the patient mix in an area, or the sending of particular types of patient to a different area for treatment. There are also un- certainties about the data.

"But taking all that into account, this is good news," he said. "We are moving in the right direction."

Rosie Winterton, the Health Minister, welcomed the report. "It is fundamental that all cancer patients should have the same access to cancer drugs that have been approved by NICE, no matter where they live," she said. "I am delighted that the cancer director's report shows that considerable progress has been made.

"However, that does not mean we will be complacent — we recognise that there is still more to do. As more people are diagnosed with cancer each year, the NHS must keep improving cancer services so each and every patient receives the best treatment possible."

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Medicare prescription drug plans cover 75% of cancer drugs, according to study conducted by Avalere Health and published in the September/October issue of Health Affairs, Dow Jones reports. The study examines CMS data from January and February on 3,000 Medicare PDPs (Gerencher, Dow Jones, 9/18). Researchers focused on two classes of cancer drugs called anti-neoplastics and hormonal agents. They did not examine data on infused chemotherapy drugs, drugs used mainly for cancer supportive care or oral cancer drugs covered by Medicare Part B (Bowman et al., Health Affairs, September/October 2006). Under the 2003 Medicare law, Medicare PDPs are required to cover "all or substantially all" anti-neoplastics. Lead author Jennifer Bowman, director in the Medicare practice at Avalere Health, said the study finds that the drug plans cover 99% to 100% of generic cancer drugs and about 70% of brand-name cancer drugs. She added, "Brands are covered less frequently than generics, but it turns out brands that were not covered almost always had a generic equivalent available." For example generic tamoxifen is covered by 100% of stand-alone prescription drug plans and nearly 100% of integrated drug plans, but Nolvadex -- the brand-name for tamoxifen -- is covered by 29% of plans, Bowman said. In addition, the study finds that copayments for 30-day supplies of cancer drugs range from $5 to $40. Tarceva has a $40 copay, the highest median copay of the drugs studied. Bowman said. The study also finds that 10% of drugs require prior authorization, 5% of all PDPs limit quantities of medications and no plans require step therapy, in which patients must first try lower-priced drugs before receiving coverage for more expensive treatment, Bowman said. The study did not examine beneficiaries' access to drugs during the so-called "doughnut hole" coverage gap (Dow Jones, 9/19). An abstract of the study is available online.

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Using bar coding in the hospital pharmacy may help prevent dangerous prescription errors, according to a new study.


Reporting in the Sept. 19 issue of the Annals of Internal Medicine, researchers at Brigham and Women's Hospital in Boston compared the rates of medication dispensing errors before and after bar coding technology was implemented at the hospital pharmacy.

With the new technology, every dose of medication was affixed with a bar code, and these codes were scanned in as an additional step to ensure that the right medications were being dispensed. Without the bar coding, the pharmacists relied on visual inspections alone to make sure they were dispensing the right medication.

After implementing the bar coding technology, the rate of dispensing errors fell by 85 percent, and the rate of dispensing errors with the potential to harm patients fell by 63 percent.

The bar coding technology was most effective when it required the pharmacy staff to scan all doses of medications.

"Overall, the use of bar code scanning technology appears to have a significant impact on the rate of dispensing errors that were serious enough to potentially harm patients," lead author Eric Poon, an associate physician in the hospital's department of general medicine, said in a prepared statement.

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Cancer medications can cost several thousand dollars a month. Knowing the tough decision some patients have to make about their medication, one Austin-based pharmacist decided not to profit from cancer medicine anymore.

CBS 42 Medical Watch reporter Seema Mathur looked into the cost of cancer medication.

The online www.smartchoicedrugstore.com based in Austin has been filling prescriptions for about a year.

Then, a recent phone call from a cancer patient prompted the founder to rethink how they sell cancer medications.

"Should we be making a profit at all on cancer medications and the bottom line was no," said Chatrick Clark, CEO of www.smartchoicedrugstore.com. "We shouldn't be doing that and that's how the program started."

At the pharmacy, a pharmacy technician lets a caller from Iowa know they are selling all cancer drugs at cost, with zero profit.

"We'd be saving her about $160 every three months so she was very excited," said pharmacy tech Kara Perez with smartchoicedrugstore.com.

An example of the savings www.smartchoicedrugstore.com says they can offer on cancer medications: 30 pills of tamoxifin is sold for $71.99 at Walgreens...
Smart choice offers it for $9.79. Thirty tablets of tarceva costs $3, 176.19 cents at Walgreens, compared to $2,602.

The same quantity of arimidex is sold for $275.99 at Walgreens; smartchoicedrugstore.com sells it at $212.16.

"They need those drugs to live and why should they decide between staying alive and making an electric bill payment," pharmacist Judy Welch said.

This online drug store still plans to be successful, but not at the expense of cancer patients.

Experts say in the last year the cost of cancer drugs climbed 15-percent, five times more than other prescriptions.

The pharmacist at smartchoicedrugstore.com says that even for people who have insurance, often the insurance won't pay for all cancer medications. And that was one of the reasons smartchoicedrugstore.com singled out cancer medicine to not make a profit on.

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A recent report from the Institute of Medicine states that at least 1.5 million Americans are injured every year by medication errors that could have been prevented. Nothing disturbs me — and my fellow pharmacists — more than medication errors in hospitals. It's a significant problem that needs to be fixed and I have good reason to hope that it will be. I firmly believe we will see a significant reduction in medication errors as new systems are put in place and proactive education takes hold in our region and nationwide.

Why am I hopeful? We are in the midst of several major movements in patient safety and quality, driven by health-care powerhouses. The Joint Commission on Accreditation of Healthcare Organizations, the nation's predominant standards-setting and accrediting body in health care, has taken on this problem rigorously. In one small but dramatic example, this agency now requires hospitals to stop using certain abbreviations in patient orders that previously caused a host of problems.

Here's one example to illustrate the problem: The abbreviation "QD" is Latin and short for "daily." It could be misread as the abbreviation "QID," which is short for "four times daily." You can see how one letter makes a world of difference. By eliminating potentially confusing abbreviations in patient charts, lives can be saved and harm prevented.

Drugs that have similar names can have seriously different consequences when they are prescribed. For this reason, many hospitals have adopted "Tall Man Lettering," which graphically emphasizes the differences between two look-alike, sound-alike drugs by using capitalizations to point out the variance ( e.g., epHEDrine and epINEPHrine).

The Institute for Safe Medication Practices has published a recommended list of high-risk drugs that look alike and sound alike for hospitals to post in the medication-dispensing areas. Other medications that don't have similar names — but are considered high-risk — have special labels or alerts for the health-care provider. These alerts can be in the form of colored labeling or bold lettering that is twice the size of normal print on labels.

Many hospitals are starting medication-reconciliation projects. This is designed to correct a complex process, but here is the essence. Patients are asked to take responsibility for providing key medication information. For any planned hospitalization, patients bring a comprehensive list of everything they are taking, including supplements and natural therapies. We then compare this regime with the medications provided during hospitalization. Finally, this complete list is communicated through the next phase of care, which might mean going home or on to another facility.

This project has been widely promoted nationwide through the Institute for Healthcare Improvement's "100K Lives Campaign," which recently announced great success in its patient safety and quality efforts.

In Washington state, a law was passed this year that prohibits physicians from writing prescription orders using cursive handwriting. Instead, they need to print, type or computer-generate medication orders.

It's a stereotype that physicians have illegible handwriting, but the unfortunate reality for us pharmacists is that too many prescription orders are difficult to read. Even under the considerable pressures of time constraints and multiple demands, physicians will now need to use more care in writing prescriptions. Electronic prescribing (computerized physician order entry) is being promoted to help with this problem; however, full acceptance and implementation in this area will take a significant amount of time.

Technology is truly our friend in the pharmacy world. A few innovations and emerging systems are causing tremendous improvements. There are now automated medication-dispensing cabinets that nurses use to obtain medications. Much like a banking ATM machine, a nurse enters his or her code, along with the patient's code, and only the selected medication and dose can be obtained. Special dosing alerts are built into the system to help avoid potential dosing errors.

Other examples include the use of smart IV-pump technology, whereby abnormal dosing parameters and rates can alert the nurse.

Also, a small but growing percentage of hospitals nationwide are using bedside bar-coding technology to scan an I.D. bracelet worn by the patient, along with the corresponding bar-coded medication before it is administered. This is to help make sure the right drug, at the right dose, is given to the right patient (via the right route) — all at the right time.

These technological tools are excellent and are sure to reduce the occurrence of medication errors in hospitals. But good technology and improved systems are only part of the solution. Every family member, nurse, physician, pharmacist and caregiver needs to be attentive and handle with thoughtfulness the medications given to our patients.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

For the first time since starting publication, "Obesity Meds and Research News" has something to smile about. This month the magazine is reporting the phase IIb results of a compound that actually works better than phen/fen. Phentermine and fenfluramine (phen/fen), when taken together, were the most successful weight loss medications ever, until fenfluramine was taken of the market in 1997. None of the new medications approved so far, and none in late stage clinical trials, has been as successful . . . until now.

Obesity Meds and Research News  So what's different now? The success of phen/fen has sparked a few innovative pharmaceutical companies to begin experimenting with existing medications and combining them into a single dose formulations for the treatment of obesity. Doing this provides several benefits over simply prescribing two medications off-label. First, primary care physicians are more likely to prescribe a single agent, already approved for long-term use. Second, with the safety and efficacy already established in one- and two-year trials, it is unlikely that the public will see the type of rare, but severe, adverse events as seen with phen/fen. Third, these compounds are being developed for once-a-day use, which makes compliance -- and successful weight loss -- more likely. Fourth, since the compound is approved for the long-term treatment of obesity, insurance company formularies are more likely to cover them.

On-line today the site has detailed results of a phase II trial on one of these combination therapies. And the good part is that it produces significantly more weight loss than phen/fen, remains useful for weight loss over multiple years, can maintain patients at goal weight in a reduced maintenance dose, and has almost no side-effects.

"Obesity Meds and Research News" is a subscriber-supported advertisement-free newsletter with the latest information on obesity medications, weight loss and diet studies written for professionals and patients. In addition to the monthly newsletter, OMR maintains an investigational drug database, and features two subscriber bonuses, Obesity 101, a primer on obesity basics, and OMR Obesity Update, a monthly literature overview. The OMR pages contain in-depth information on medications coming out within the next few years and others in earlier stages of development.

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Adults 18 years and older are able to buy hypodermic needles without a prescription for the first time in Massachusetts under a controversial state law that went into effect Monday.

Massachusetts becomes one of 48 states in the nation to decriminalize needle possession in an attempt to reduce the spread of HIV and hepatitis C. It took nearly two decades for the Legislature to pass the law, and supporters had to override a veto from Gov. Mitt Romney.

Donna Rheaume, a spokeswoman for the state Department of Public Health, said pharmacies had received educational material over the weekend that described how to safely dispose of needles. It also contains information on where to seek help for drug addiction, AIDS, diabetes and other diseases.

The educational material was required under the law. A copy of the pamphlet was posted on the state's web site on Friday.

"The law went into effect today," Rheaume said. "The information, the pamphlets that DPH was required to provide to the pharmacies has been sent to the pharmacies."

The law is optional for pharmacies. They can still choose to require a prescription. Rheaume did not know how many were opting out, but CVS will sell needles without a prescription, as it does in other states with the same law, a spokesman said last week.

Rick Gregg, proprietor of the Medicine Store in Hyannis, said he hadn't sold any hypodermic needles over the counter yesterday.

"I'm not sure I will, either," he said. His clients have insurance and get reimbursed for prescription needles, so they would have no need to buy over the counter unless they forgot to pack needles on vacation.

But Gregg, one of the last independent pharmacists on Cape Cod, said he thinks the new law is a good idea if it encourages drug addicts to use new, clean needles.

Otherwise they're at increased risk of getting hepatitis C or HIV, and treating those diseases costs a lot more than a box of needles, Gregg said.

Opponents of the measure, including Lt. Gov. Kerry Healey, the Republican nominee for governor, warned it would lead to more drug addiction and larger numbers of discarded needles in beaches, parks and other public areas.

But people who argued for the law, including Sen. Robert O'Leary, D-Barnstable, who filed the legislation in the Senate, said it would prevent the spread of disease, without condoning drug use.

The state pamphlet warns people that they cannot dispose of needles in household trash or recycling bins. Needles must be thrown away at a drop off site or through a medical mail back service.

The law has a penalty of up to $25,000 or two years in jail for improper disposal of hypodermic needles.

The issue was used against Democrats in the 2004 elections, and Healey quickly made it a centerpiece of her platform in the race for governor.

"Imagine your children not only coming upon dirty needles in the park, but standing next to a drug addict in the checkout line at CVS who is there to buy more needles to feed his or her addition," Healey said earlier this summer.

The pamphlet lists needle disposal sites that already exist locally in Barnstable County, Franklin County and the City of Haverhill, leading some supporters of the law to accuse the DPH of not doing enough to promote safe disposal.

The law allows collection centers in such places as health facilities and municipal buildings, if they chose to offer them.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

Filling a prescription from your doctor's clinic may soon get a lot easier, faster and possibly safer.
PatientCare Family Clinic was among the first in Missouri to send prescriptions electronically to participating pharmacies, but more area clinics will have the ability in the near future, said clinic medical director Dr. Tom Landholt.
Electronic prescribing eliminates time-consuming paperwork and phone calling between the doctor's office and pharmacist, it prevents mistakes that occur in deciphering handwriting or retyping drug data at the pharmacy. And it can streamline the time it takes for a patient to get a prescription filled or refilled, Landholt said.

"Over half my prescriptions are going out this way" to Wal- Mart, Walgreens, Sam's, Super-D and a few participating independents, Landholt said.

"The patients have been excited about this because everybody's time is important," he added.

On Monday, it made a difference for Alex Kintner, 16, who saw Landholt's physician assistant Dawn Zabinski for a sinus infection.

She called up Kintner's records on a computer in the exam room, chose an antibiotic from a menu on the screen, clicked on the name of his pharmacy and pressed the "sign" button.

Instead of it printing out a prescription slip, the order went directly to the pharmacy. Within a minute she got a receipt that the order had been sent through SureScripts, a secure national clearinghouse for electronic prescriptions.

"As soon as we left the doctor's office, we went to the Walgreens on East Sunshine and it was ready when we got there," Kintner said. "I've never gotten a prescription that fast before," he added. "It usually takes an hour."

Speed at the pharmacy is up to the pharmacist, Landholt said. But the electronic ordering cuts down on the back-and-forth of calls, re-calls, faxes and re-faxes that add up over a day's time.

"This was a two-click procedure to get the prescription filled out and sent to the pharmacy," Landholt said. "That's pretty cool."

His was one of three clinics in Missouri, Arizona and Portland that did final testing before going live this month using SureScripts. The software could be released for sale Oct. 1, he said.

SureScripts provides an "electronic interface," or path for the doctor's and pharmacist's computers to talk.

To participate, a clinic must buy SureScripts software or have an electronic medical records system that links to SureScripts. Both CoxHealth and St. John's systems have bought or are using software that has the ability to access this service in the future, he said.

The SureScripts Web site, www.surescripts.com, says more than 40 percent of the nation's pharmacies are members. As more pharmacies and physicians participate, they will help drive down the cost of prescribing transactions and boost efficiency and safety, the Web site said.

Like an online banking system, SureScripts must meet federal standards for privacy and security of medical records, Landholt said.

The system also has built-in safeguards, and communication goes both ways.

"The pharmacist is still going to look at a prescription," he said. And he or she will still call by telephone with concerns about potential drug interactions or allergies.

If a patient calls the pharmacy for a refill, the pharmacist sends a message to the doctor that lands in the patient's chart and flags the doctor.

Landholt or Zabinski can approve or deny the refill with one click, and can send an explanation via computer. If they order a drug incorrectly, the system will immediately alert him that the order failed.

Physician assistant Zabinski sees a big difference between this method and her former job in Marshfield.

"Nurses would be there 45 minutes to one hour after closing just (calling in) refills," she said, while larger clinics hire full-time "refill nurses." Nurses at PatientCare Family Clinic go home at 4:30 p.m., she said.

"It's exciting to feel like when I send it electronically, I'm not going to get a phone call back that (the prescription fax) didn't get there," she said.

Landholt added, "It's very simple, but it takes a great deal of headache away if you can do it electronically."

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On any given Sunday afternoon you can walk into Leawood Family Care and find a buzz of activity — and it's not the cleaning crew.

Leawood Family Care, at 11301 Ash St. in Leawood, is among a limited — but maybe growing — number of doctors' offices that offer extended hours.

Lisa Pioli, one of the seven doctors who own the practice, said patients can come in without an appointment and be seen by a doctor within a relatively short amount of time. The walk-in portion of the practice is available until 8 p.m. Monday through Friday, on Saturdays from 10 a.m. to 4 p.m., and Sundays from noon to 4 p.m. The walk-in service is open every day except Thanksgiving, Christmas and New Year's Day.

Formerly owned by Carondelet Health, Leawood Family Care started offering extended hours several years ago because of patient requests.

"It takes a tremendous amount of work, money and staff," said Pioli, who had worked in retail walk-in clinics before coming to the Leawood practice. "You have to have doctors willing to work regular hours and after hours."

The extended hours also are expensive, Pioli said.

"We bled financially," Pioli said about the first three years of extended hours. "We had to bring in a lot of front-desk staff using both full-timers and part-timers."

But Pioli said the walk-in word spread, and eventually business began to grow.

"By keeping it busy, it made it lucrative," she said.

Charges for services are dictated largely by insurance companies, but the practice does not differentiate between walk-in and appointment patients. However, there is one thing that's distinctive between the two types of patients.

"The patient who uses walk-in (service) has a different mind-set," Pioli said. "The kiss of death to a walk-in is the wait — they want to get in and out."

Offering extended hours is one of several recommendations for improving patient care put forth by the Leawood-based American Academy of Family Physicians, whose members include 20,000 family medicine practices and 95,000 individual physicians.

The academy's Future Family Medical Report also suggested more use of technology in managing practices, such as electronic files, portability and advanced scheduling options, as well as being sensitive to ethnic and diversity issues.

"They decided (the field) needed to refocus ... to a more patient-centered focus," said Terry McGenney, chief executive of TransforMed, a subsidiary of the academy that was created to encourage members to make such a transformation.

McGenney said the academy started a two-year national demonstration project this year working with 36 practices across the United States to implement the TransforMed model. Online tools are being created for these practices to assess their progress.

McGenney said anecdotal information from those using the new model indicate a win-win situation.

"Implementing the new model not only increases patient satisfaction but increases the financial performance of the practices," he said.

James W. Hall, a primary care physician, has been offering extended hours at his office, Landmark Medical Center in Kansas City, for more than two decades.

Hall, along with another doctor and practical nurse, see walk-in patients as well as scheduled appointments beginning at 7 a.m. Hall's office is also open from 7 a.m. until noon on Saturdays and offers same-day scheduling.

"Patients love those early-morning hours," Hall said. "Medicine is to serve. We're in the personal service business, so we need to be there" when there is demand.

Hall said overhead costs are high in family practice, especially staffing.

"Forty-four cents of every dollar that comes in goes to employee salaries," Hall said. "The rest (of expenses) are fairly well fixed — utilities, rent and malpractice insurance."

Medical service providers also can benefit from extended hours.

Diagnostic Imaging Centers offers extended hours beyond the traditional business day in order to meet patient demand. The centers offer such services as mammography, ultrasound, CT and MRIs, and general radiology testing. Diana Holek, chief operating officer, said all seven locations offer early-morning or evening hours for patients, as well as Saturdays. Staffing is key in meeting the demand, she said. About 54 percent of the centers' budget goes to salaries.

"We watch our schedule closely. If you're going to open two more hours, than you have to look at your reimbursements and the other things you need — front-office staff, technologists, doctors," Holek said. "You have to do your due diligence before adding staff … but if we have to add staff to meet demand, we will."________________________________

Convenience factor


Over the past two years, drugstore health-care clinics have popped up in the Kansas City area. They are now operating in some Walgreens and CVS stores.The clinics, which are staffed by nurse practitioners, offer walk-in service without need of an appointment, quick visits and the ability to get a prescription and fill it in one stop. Terry McGenney, who leads the American Academy of Family Physicians' new TransforMed program, was not surprised by the emergence of these clinics. "They were probably more a response to the old (family practice) system," said McGenney. There has been some criticism from the physician community that the care provided by a nurse practitioner — without direct supervision by a doctor — can't be compared to what a physician provides. And the American Medical Association has expressed concerns that the clinics "cherry-pick" locations in affluent areas. The in-store clinics contend that they provide health-care services that are needed and that they offer high-quality care as well as convenience.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

According to a recent Wall Street Journal Online/Harris Interactive Health-Care Poll, four out of five (80%) U.S. adults indicate that they favor allowing people to import prescription drugs from Canada and other countries if they are much less expensive. A vast majority (84%) of the public strongly or somewhat agrees that the law banning pharmaceutical imports is intended to protect drug companies' profits, while only thirty-six percent say this law helps protect Americans from potentially harmful drugs.

These are some of the results of an online survey of 2,295 U.S. adults conducted by Harris Interactive® between August 23 and 25, 2006 for The Wall Street Journal Online's Health Industry Edition ( www.wsj.com/health).


While some pharmaceutical companies want to make it impossible for Canadian pharmacies to sell drugs over the Internet, a majority of adults (72%) state that this policy is very or somewhat unreasonable. Additionally, 83 percent agree that it should be legal to import drugs from Canada that are approved and vetted by Health Canada, Canada's equivalent of the Food and Drug Administration (FDA). Since last year, Customs has been confiscating packages mailed to U.S. consumers by Canadian pharmacies, with 37,154 packages seized as of July 2006. A majority (77%) agrees that confiscating drugs at the Canadian border jeopardizes the health of some Americans, and very few (6%) feel that those who regularly order pharmaceuticals from Canada should be fined or arrested.


Interestingly, only one out of ten (11%) adults say they have bought prescription drugs from a pharmacy in Canada or another foreign country (either by going there, on the Internet, or by mail) in order to save money, but that percentage has doubled since 2002. Adults living in the West (16%) are more likely to indicate that they have bought prescription drugs from a pharmacy in Canada or another foreign country, as compared those living in the South (11%), East (8%) or Midwest (8%). Hispanics (23%) are more likely to say they have purchased prescription drugs from a pharmacy in another country, as compared to Whites (11%) and Blacks (2%).

Labels: No Prescription, Online Pharmacy, Prescription Drugs

Buying medicine online can be easy. Just make sure you do it safely.

• Talk with your doctor and have a physical exam before you get any new medicine.

• The S.C. Board of Pharmacy — (803) 896-4700 — can tell you if a Web site is licensed and in good standing.

• Web sites that display the seal of the National Association of Boards of Pharmacy have been checked to make sure they meet state and federal rules. www.vipps.info .

A SAFE WEB SITE SHOULD

• Be licensed by the state board of pharmacy where the Web site is operating

• Have a licensed pharmacist to answer your questions

• Require a prescription from your doctor or other health care professional who is licensed in the United States to write prescriptions for medicine

• Have a way for you to talk to a person if you have problems

MORE INFORMATION

www.fda.gov/buyonline

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Actavis Group (ICEX: ACT), the international generic pharmaceuticals company, announced today that it has received a warning letter from the U.S. Food and Drug Administration (FDA), related to its inspection of the Group's solid oral dose manufacturing facility in Little Falls, New Jersey.

The Warning Letter identifies deficiencies in the way that Actavis has handled its adverse medical event reporting obligations. The Warning Letter also questions the marketing status of certain of Actavis's older products that are currently being marketed by the Group relying on pre-ANDA drug approval mechanisms ("Older Drugs").  Since the inspection, Actavis has materially revised its adverse drug event and pharmacovigilence procedures to address certain deficiencies and to establish a system that ensures continuous compliance with regulatory expectations. The Group has also complied with all previous adverse medical event-reporting obligations that were over due or deficient. Management is confident that each of the identified Older Drugs are currently being marketed in accordance with applicable regulations, but is undertaking a full review of these products to address the FDA's concerns.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

The use of antidepressants and other drugs to fight obesity has been in the news lately, so we thought we'd take a look at the prescription drugs that are currently available to fight weight loss.

As a disclaimer, this information is for dieters in the United States. Other nations have different drugs that are approved and considered effective for weight loss. As always, check with a doctor and don't just go buying drugs off the Internet.

There are two main drugs currently approved for weight loss by the Food and Drug Administration, orlistat and sibutramine. Orlistat is sold under the brand name Xenical, while sibutramine is sold as Meridia. Sibutramine is an appetite suppressant, while orlistat is known as a lipase inhibitor, which means it interferes with the body's ability to absorb fat. Both drugs are approved for long-term use.

In studies of these two drugs, patients usually lose between five and 22 pounds more than people who are just dieting and exercising, with some people losing up to 10 percent of their body weight. Peak weight loss seems to happen around the sixth month of taking the medication. They have not been studied for use of more than two years at a time.

There are also some prescription weight loss drugs approved for shorter-term use, which the FDA defines as a couple of weeks. These drugs go by several different trade names but their generic names are diethylpropion, phendimetrazine and phentermine. All three are appetite suppressants that have been on the market for decades.

Beyond the weight loss, the plus side of taking weight loss medication can include an improvement in blood pressure, lower cholesterol levels, lower triglycerides and better insulin resistance.



The risks include dependence (since all approved drugs are stimulants except orlistat are stimulants), lessening of effectiveness over time, and side effects. Side effects of orlistat can include cramping, intestinal discomfort and gas, while sibutramine can cause increases in blood pressure and heart rate.

The other approved drugs can cause nervousness, sleeplessness and euphoria. Your doctor can help you pick the right medication for you, but be sure to tell him or her if you have a history of alcohol or drug abuse, eating disorders, manic depression or have used MAO inhibitors, or if you are pregnant or nursing, have migraines, glaucoma, diabetes, high blood pressure, or heart disease. These conditions don't always rule out taking medication, but it is important for your doctor to know your history.

The FDA points out that without lifestyle change, it is likely you will gain weight back after coming off the pill, and they are not meant to be taken for a lifetime. Further, many insurance companies will not pay for drug treatments for weight loss, because it is not seen as a chronic disease. Still, if you are dangerously obese (drugs are usually only prescribed to those with a BMI of 30 and above) a weight loss drug can help you get on the road to recovery.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

Some tips for avoiding prescription drug mistakes:

_ Make a list of all drugs you are taking, including prescription, over-the-counter, nutritional and herbal supplements. List all of your doctors. Keep a copy in your wallet and give one to a family member.

_ Ask your doctor to check the list for potential bad interactions when getting a new prescription or samples of a new drug. Remind your doctor of any allergies.

_ When getting a new prescription, ask for the patient information sheet. Have the doctor write the reason for the medicine on the prescription. Learn how it should be stored and how long it may take to work.

_ If you have trouble swallowing a pill or capsule, do not chew, crush or mix it in a fluid. Ask your doctor or pharmacist if the medicine comes in a liquid.

_ In the hospital, don't let anyone give you medicine until they check your patient bracelet.

_ Flush old and expired medicines down the toilet.

_ If you use more than one pharmacy, make one your primary location and have it keep a complete list of your medications.

_ Schedule a "brown bag checkup" with your primary care physician, where you bring all of your medications and over-the-counter products in their containers. This allows an expert to look for any potential problems.

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Labels: No Prescription, Online Pharmacy, Prescription Drugs

The fear that the new Medicare drug plan would limit access to medicines hasn't come true, as least as far as cancer treatment is concerned, a new report finds.

In fact, the researchers discovered that Part D expanded access to cancer therapies and required only low co-payments.

Each year, 700,000 Medicare beneficiaries are diagnosed with some type of cancer. In 2004, Medicare spent $7.3 billion on cancer treatments, including chemotherapy drugs. Before the Part D drug plan was launched this year, Medicare did not reimburse for some outpatient therapies, including many oral and self-injectable drugs, the researchers noted.

For the study, published in the September/October issue of Health Affairs, researchers looked at the almost 3,000 drug plans involved in Part D and found that the most commonly prescribed cancer drugs were available, and that when a brand-name drug was not covered, its generic equivalent was.

"On average, 75 percent of the cancer drugs were covered by drug plans, and generic drugs were covered more frequently than brand name drugs," said lead researcher Jennifer Bowman, a director at Avalere Health, LLC, the consulting firm that conducted the study. "Ninety-eight to 99 percent of generic drugs were covered, while only 70 to 71 percent of brand name drugs were covered."

The reason that the plans are so inclusive is that Medicare mandated that all plans had to cover all drugs in certain classes, including cancer drugs, Bowman said. "We think that this policy was important," she added.

In addition, co-payments were low, Bowman said. Co-payments for the 20 cancer drugs most frequently found on plans' formularies ranged from $5 to $40. Moreover, fewer than 5 percent of the plans had quantity limits on the drug supply a patient could get at one time. No plans required patients to fail on one drug before they could be given another.

However, about 10 percent of cancer drugs, particularly brand-name drugs, require prior authorization from a physician before the pharmacist can fill the prescription. This could limit patients' access to these treatments, Bowman cautioned.

The study does not deal with access to cancer drugs when patients fall into the so-called "doughnut hole" -- the gap in Part D coverage that occurs after patients' drug consumption passes $2,250 in one year. After that threshold, patients have to pay full cost for their drugs, plus their drug plan premium, until total annual drug costs reach $5,100. This "gap" can cost Medicare beneficiaries $3,600 in out-of-pocket drug expenses.

"We don't know whether during this period patients stop taking a drug, or switch to another drug or stop therapy all together," Bowman said.

One expert thinks the study shows that Medicare Part D is working.

"This holds great news for Medicare beneficiaries and good news about the Medicare Part D prescription drug benefit," said Mary R. Grealy, chair of Medicare Today, and president of the Healthcare Leadership Council, an industry lobbing group. "It demonstrates how important a benefit this is for all Medicare beneficiaries who did not have coverage for their prescriptions, but particularly for those with cancer."

Before Plan D kicked in, Medicare only covered physician-administered medications, which required an office visit and, of course, did not cover other self-administered medications, Grealy noted.

"The study underscores the importance of the program design. Plan formularies must include all drugs in certain therapeutic classes such as anti-neoplastics [cancer]," she said.

Grealy believes that Part D is an example of a successful partnership between government and private insurance. "The study underscores the value of having private health plans participate and compete in the Medicare program to provide the best value to Medicare beneficiaries through good coverage and efficient cost," Grealy said. "It is a win-win for the Medicare program and Medicare beneficiaries."

However, another expert believes the study doesn't reflect the problems patients encounter navigating through the complexities of Part D.

"For example, prior authorization is a great bar to people without either great sophistication or an experienced advocate," said Robert M. Hayes, president of the Medicare Rights Center. "It's virtually impossible for most people on Medicare to overcome the utilization barriers the plans put in the way."

In a related study published in the same journal, researchers at the nonprofit RAND Corporation found that ratcheting up patient co-pay fees for expensive, specialty drugs won't save employers and health insurance plans money.

This strategy has worked in the past with less essential prescription medications, the researchers said. However, the new study of over 1 million patients found that they simply find ways to pay more for drugs that are crucial to treating serious illnesses such as cancer, rheumatoid arthritis, multiple sclerosis and kidney disease.

"What happens with these expensive specialty drugs is that people will use them regardless of cost, because there just aren't any other options," co-researcher Dana Goldman, chair and director of health economics at RAND, said in a prepared statement. "Given the high cost of these specialty drugs, insurers would be better off finding [other] ways to manage use," he said.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

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U.S. scientists have discovered a method of developing antibiotics that might be an important step in fighting drug-resistant infections.

The researchers at the University of Minnesota and University of Michigan say their approach, described as efficient and environmentally friendly, can help develop antibiotics that are needed to kill the increasing number of infections resistant to multiple drugs.

"We're striving to create new drugs that can have a positive impact on the growing threat of infectious diseases," said Robert Fecik, assistant professor of medicinal chemistry at the University of Minnesota College of Pharmacy and one of the lead authors of the study. "This type of research can help us make new antibiotic molecules."

The interdisciplinary team of scientists, including professors David Sherman and Janet Smith from the University of Michigan's Life Sciences Institute, is the first to crystallize an enzyme in the process of closing the antibiotic ring, which illustrates exactly how the ring is formed.

The research is described in two articles published in the current online issue of Nature Chemical Biology.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

The Drug Enforcement Agency unveiled a new proposal on Wednesday intended to make certain powerful painkillers more easily available to patients with legitimate medical needs.

The new plan would extend the maximum prescription length for some pain medications from the current 30-day supply to a 90-day supply.

Speaking at a press conference, DEA administrator Karen Tandy called the announcement "a good news day for people who are in chronic pain and need these drugs."

Experts in the field see the proposal as a long-awaited change that would update problematic regulations.

Rollin Gallagher, director of the Center for Pain Medicine, Research and Policy at the University of Pennsylvania, told ABC News, "These new rules will enable many more patients with severe pain to obtain proper treatment and prevent the consequences of pain."

Current laws do not allow prescriptions for Schedule II drugs, such as Oxycontin and Vicodin, to be refilled. This means patients must visit the doctor every month to obtain a new 30-day prescription. Such frequent visits can be a burden on patients and physicians alike, and also prove costly.

Plus, the current system doesn't indicate if doctors can issue multiple prescriptions during one office visit. This creates a potential for doctors to violate DEA regulations and possibly lose their licenses.

The new plan clarifies the rules, allowing doctors to issue multiple 90-day prescriptions for these drugs at one office visit. To prevent abuse, the new proposal controls the number of doses issued with each trip to the pharmacy. It allows for the 90-day prescription to be filled in three stages, with a month's supply available immediately, and then again after 30 days, and again after 60 days.

"The ability to prescribe a 90-day supply will greatly improve our ability to manage pain without forcing the patient to repeatedly make unnecessary doctor visits and trips to the pharmacy," Dr. Fredrick Burgess of Brown University Medical School told ABC News.

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Representatives of the British biotechnology firm GW Pharmaceuticals filed a request this week with European and UK drug regulators for approval of Sativex, an oral spray consisting of natural cannabis extracts, for the symptomatic treatment of Multiple Sclerosis (MS). Sativex is currently available by prescription in Canada and on a limited basis in Spain and Great Britain for patients suffering from neuropathic pain, Multiple Sclerosis, and other conditions.

Regulators from the United Kingdom, Denmark, Spain, and the Netherlands will review the request, which includes clinical data on the use of Sativex in nearly 700 patients with MS. In clinical trials, Sativex has been demonstrated to alleviate numerous MS-associated symptoms compared to placebo, including pain, muscle spasms, and bladder incontinence.

British drug regulators will consult with officials from each of the three countries before rendering a decision. If the UK endorses the drug, it will receive simultaneous regulatory approval from all three nations.

GW officials initially sought to gain approval for Sativex in 2003, but were told by British drug regulators that further clinical evidence of the drug's efficacy was necessary before they would consider approving it for licensing in the UK.

Separate clinical trials investigating the use of Sativex for the treatment of peripheral neuropathic pain and cancer pain are ongoing.

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Patients taking newer blood pressure drugs have a decreased risk of developing diabetes, according to an analysis of the biggest clinical trial in Europe. The study found that only 8 percent of the people on newer medicines developed diabetes as against 11.4 percent of those on older drugs.

The study involved 19,000 people. The study compared drugs like Norvasc and Coversyl with a beta-blocker and a diuretic. Norvasc is amlodipine, while Coversyl is perindopril. Professor Peter Sever of Imperial College in London, co-chairman of the study, said the findings underlined the fact that beta-blockers were no longer effecting in treating blood pressure.

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If the condom breaks, what's the plan?

Before late August, women could get the morning-after pill commonly known as "Plan B" only by prescription.

Aug. 24, however, the FDA approved the sale of Plan B over the counter to women 18 years and older. Women younger than 18 must still get a prescription from a doctor.

According to the FDA's Web site, the company Duramed will distribute Plan B with an extensive label including a toll-free number for questions about Plan B.

Duramed is also making efforts to ensure Plan B is only sold at pharmacies, licensed drug wholesalers and clinics with licensed healthcare practitioners, like the University's Student Health Center. Additionally, Plan B will only be stocked behind a pharmacy's counter and will require proof of age to purchase.

Christine Peterson, director of gynecology at Student Health, said not much will change at the University.

"For many years we've had emergency contraception very available," Peterson said. "For the last few years it's been available 24/7/365. It was a nuisance to get a prescription, but students could get it whenever they wanted."

Peterson said as of last Friday Student Health had not received the newly packaged Plan B, so it is still only available with a prescription.

Second-year College student Quinn Thomas said although the age limit quells some of her concerns, she still does not think Plan B should be available over-the-counter.

"It's not very socially responsible," Thomas said. "I feel by offering it over-the-counter and people know they have such an easily accessible backup, they will be less likely to [use other protection] that's healthier overall ... like abstinence or a condom, that prevents more than just pregnancy."

On the other hand, fourth-year Commerce student Jeff Barry said he supported the FDA's action.

"In my opinion, as long as Plan B is used as just that -- a backup plan -- I don't see any harm in selling it over the counter," Barry said. "I do think, though, that there should be some sort of education involved with it ... about basically what the morning-after pill is, the effects that it has on the body and the negative side effects [would] probably be beneficial information to have out there."

While Thomas said she believed the easier access to Plan B will increase the amount of women who engage in unprotected sex, Barry said he disagreed.

"I don't see it being a huge, nationwide, everyone's-going-to-start-having-tons-of-unprotected-sex-with-multiple-partners thing," Barry said.

Peterson said the biggest effect will be on the lower socioeconomic classes.

"This is very important for women who don't have easy access to medical care or who don't have the means to pay for prescriptions," Peterson said.

Peterson maintained that she believes Plan B would be continued to be viewed as a backup, not a first line of defense, and would therefore not affect the amount of unprotected sex.

"Whatever a person's Plan A is -- abstinence, etc. -- it will be cheaper and more effective than Plan B," Peterson said. "It needs to be the backup when one's own plan A fails."

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People at risk of heart disease and stroke will have increased access to cholesterol-lowering drugs from October 1, federal Health Minister Tony Abbott has announced.

The drugs will be available to people with a family history of the conditions or with diabetes complications, regardless of their cholesterol levels.

Higher risk patients will be able to access the drugs immediately but will have to maintain a good diet as part of their eligibility.

The drugs will become more available through the Pharmaceutical Benefits Scheme (PBS) to about 250,000 patients.

The scheme is expected to cost about $150 million over four years.

Cardiovascular disease is Australia's biggest health problem and leading cause of death, affecting 3.7 million people in 2003 and causing more than 38 per cent of all deaths, Mr Abbott said in a statement.

Rising blood-cholesterol levels increase the risk of cardiovascular disease.

Diabetes is a further concern because it magnifies the effect of elevated cholesterol and other risk factors.

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BBC Scotland has learned a review of the medical guidelines used by doctors to diagnose and treat ADHD will not be available until March 2008.

Parents groups and education experts have claimed children could be prescribed the medication needlessly.

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The federal government says fake versions of Lipitor and other prescription drugs are being found in Iowa and elsewhere -- which people apparently bought over the Internet from Canada. Monty Scheele, the pharmacies director for a Midwestern drug store chain, says it's not wise to gamble with your health.

Scheele says "When you're considering your health care and medications you're taking to improve or maintain your health, you certainly don't want to jeopardize that by using medications that you can't trust." He says pharmacies large and small are joining into a nationwide program that tracks drugs.

Scheele says "We can trace the route of the medication from our pharmacy to the wholesaler to the manufacturer." He says the tracking programs are extraordinarily valuable in maintaining the integrity of the medication.

Scheele says being able to look your pharmacist in the eye and get your questions answered locally is worth every penny. He says "Developing that trust and that relationship with your local pharmacist is the key. You've got to be able to trust someone with your health care, just like your physician and your dentist, you've got to develop that relationship with your pharmacy knowing that what they do behind the counter is going to optimize your health."

Scheele says his customers often ask him about the discount drugs on-line. He says "Counterfeit medications are alive and well and they're being sold on the Internet through mail order." The F-D-A says consumers who bought drugs through ten websites should not use the medications because they may not be safe. The sites include r-x-north-dot-com, canadian-drugstore-dot-com and r-x-by-fax-dot-com.

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Prescription drugs shipped to the U.S. from Canada through certain Web sites operated by Manitoba-based Mediplan Prescription Plus Pharmacy might be counterfeit and should not be used by U.S. consumers because the medications might not be safe, FDA said on Wednesday, the Washington Times reports (Washington Times, 8/31). Mediplan, which was founded in 1999, is one of the largest Internet pharmacies in Canada and is "considered the first Internet pharmacy," according to USA Today. FDA said agency testing found that versions of 10 drugs that were ordered through Mediplan Web sites and seized by U.S. officials during the past few weeks did not contain the correct amounts of active ingredients. Some also were shipped from countries other than Canada. The drugs are considered counterfeit because they are marketed as brand-name products when they actually are not, FDA said. The drugs -- which were ordered from RxNorth.com, Canadiandrugstore.com and other Web sites -- were sold as Actonel, Arimidex, Crestor, Celebrex, Zetia, Diovan, Hyzaar, Lipitor, Nexium and Propecia, FDA said. Randall Lutter, FDA associate commissioner for policy and planning, said, "All of these products are intrinsically deceitful." Lutter did not specify the amount of active ingredients in the seized drugs or which countries they were shipped from (Appleby, USA Today, 8/31). Prescription drug reimportation is illegal under U.S. law. FDA has said it cannot guarantee the safety or efficacy of reimported drugs, but the agency generally has not stopped U.S. residents from ordering prescription drugs from abroad for personal use.

Canadian Reaction
Health Canada spokesperson Paul Duchesne said, "Health Canada is aware of the issue. We are investigating, and if there are any safety concerns, we will be sure to alert the public" (Washington Times, 8/31). Mediplan founder Andrew Strempler said, "We test our products and stand behind our products," adding that Canada, the United Kingdom and Australia are the main sources of medications sold on his company's Web sites. He said, "We were the first to do this. So we've created quite a stir with the pharmaceutical industry." Andy Troszok, immediate past president of the Canadian International Pharmacy Association, said FDA "has tended to take the evidence and skew it in a fashion to say Canadian pharmaceuticals are unsafe, which is completely contrary to the evidence." Troszok added that CIPA takes "very seriously any allegation of counterfeiting" and that Mediplan is a member in good standing with the association. He said, "We'd like to see the evidence behind the charges," adding that he could not comment further until he learns more about the allegations (USA Today, 8/31).

Poll
About two-thirds of U.S. residents believe that a federal law against the purchase of prescription drugs from Canada seeks to protect the profits of pharmaceutical companies, compared with 9% who believe that the law helps protect residents from potentially harmful medications, according to a recent WSJ.com/Harris Interactive poll, the Wall Street Journal Online reports. The online poll surveyed 2,295 U.S. adults from Aug. 23 through Aug 25. The poll finds that more than three-fourths of respondents agree that the seizure of prescription drugs purchased from Canada jeopardized the health of some U.S. residents, compared with 15% who disagree. In addition, 84% of respondents believe that the federal government should allow the purchase of prescription drugs from Canada, provided that the medication have approval from Health Canada, compared with 9% who do not, according to the poll. The poll also finds that Hispanic respondents and respondents who live in the western U.S. are most likely to have purchased prescription drugs from abroad and that black respondents and those who live in the eastern or midwestern U.S. are least likely to have purchased medications from abroad (Bright, Wall Street Journal Online, 8/31).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org , a free service of The Henry J. Kaiser Family Foundation

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Concerns that the newer rheumatoid arthritis drugs used to treat the sickest patients increase cancer risk aren't supported, according to a new study.

The findings should reassure patients who take Enbrel, Remicade, or Humira. All of these drugs are so-called biologics — meaning they are derived from living organisms. They are known as necrosis factor (TNF)-blocking biologics.

"If there is a [cancer] risk, this study supports the conclusion that it is a small one," says researcher Soko Setoguchi, M.D., DrPh, of Harvard Medical School's Brigham and Women's Hospital.

Rheumatoid arthritis patients do have a higher than normal risk for developing certain cancers, especially cancers known as lymphomas. But it has been unclear if this elevated risk is due to the disease itself or to the drugs used to treat it.

Studies examining the highly effective TNF-blocking drugs have been mixed. A widely-reported analysis by researchers from the Mayo Clinic published late last spring found a threefold increase in cancer risk among patients who took Remicade and Humira. That analysis didn't look at Enbrel.

The Mayo Clinic research weighed data from nine studies that compared biologic treatments to placebo.

In the newly published study, Setoguchi and colleagues compared the biologic drugs to the traditional rheumatoid arthritis drug, methotrexate.

Drugs like methotrexate are known as disease-modifying antirheumatic drugs. They slow down rheumatoid arthritis and improve quality of life for most people.

In the Harvard study, 1,152 patients took a TNF-blocking biologic, while 7,306 took methotrexate.
The patients were all 65 or older. They were identified through insurance databases in New Jersey, Pennsylvania, and British Columbia, Canada.

Even though the biologic users tended to have more severe rheumatoid arthritis than those who took methotrexate, the researchers found no significant difference in cancer risk between the two groups. The biologic users were followed for an average of 2.6 years, compared to 4.2 years for patients taking methotrexate. Setoguchi tells WebMD the researchers will continue to follow study subjects.

"We will need longer follow-up with a larger number of patients to provide precise answers," she says. "Until then, this issue [cancer risk] should be part of the decision-making process for patients who consider taking these drugs."

Dallas rheumatologist John J. Cush, M.D., tells WebMD that rather than increasing cancer risk, TNF-blocking drugs may actually lower it, as well as the risk for other diseases, because the drugs target inflammation.

Rheumatoid arthritis is a degenerative autoimmune disease caused by chronic inflammation. It is most commonly associated with the joints, but it can affect other areas of the body as well.

Meanwhile, inflammation has also been implicated as a possible cause of certain cancers, and even heart disease.

"A question that is just as important as 'What is the risk of this therapy?' is 'What is the risk of this disease?'" says Cush, chief of rheumatology and clinical immunology at Presbyterian Hospital in Dallas. "Depending on how you view the studies, there is either no risk or a marginally increased risk of lymphoma associated with taking these drugs. But we know that they have a dramatic impact on quality of life for many rheumatoid arthritis patients who are disabled by the disease."

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With all the prescription drugs on the market today, keeping up with medications is challenging even for the most experienced physicians. For new doctors, it may be impossible.

According to new research out of England, physicians just entering practice today are being asked to know more about all these drugs at the same time they are receiving less education on the practice of prescribing. The reason: there are not enough pharmacologists and clinical pharmacologists to provide the teaching.

The solution, write the authors, is for medical schools in the country to partner with other prescribers who can impart their knowledge to students. They also call for a national prescription form and computerized prescribing systems and guidelines and believe doctors should be routinely assessed for their competency in prescribing medications.

"Evidence of poor prescribing in the UK is abundant," write the researchers. "Effective treatments, such as angiotensin converting enzyme inhibitors for heart failure and statins for hyperlipidaemia, are often underprescribed. Prescription errors are common, especially when new doctors start work in hospitals." About 6.5 percent of hospital admissions are caused by adverse drug reactions which result in about a 0.15 percent mortality rate, report the researchers.

The authors emphasize prescribing problems are not confined to the England, citing a recent report from the Institutes of Medicine showing similar concerns in the United States.

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Non-prescription drugs will be on sale tomorrow in Carrefour hypermarkets, starting from the centre in Le Gru di Grugliasco (Turin); the hypermarkets of Assago and Limbiate (Milan) will follow, and then all the other Italian regions. Carrefour undertakes to guarantee a competitive price, offering 20-30 pct discounts, plus a further 5 pct for clients holding a special card. The non-prescription drugs to be offered will include all the ones provided for by the law, with the assistance of chemists. The opening hours will coincide with those of the hypermarket. "Since the deregulation decree was approved, we rushed to offer this service to our clients", said Didier Fleury, CEO of Carrefour Italia. "TOmorrow's opening is the result of an important team work - said Piermario Mocchi, director of the hypermarket division - we will offer about 2800 products in a specifically designed area".

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