KRT Wire | 10/27/2005 | Amid signs of panic buying, drug maker halts U.S. sales of Tamiflu
BY JEREMY MANIER
Chicago Tribune
CHICAGO - In a bid to stop panic buying of flu medications based on premature fears about a pandemic, drug maker Roche Holding AG has temporarily halted distribution of Tamiflu in the United States, citing unusually large purchases as an indication some buyers are hoarding the drug.
Most public-health experts have urged consumers not to build private stores of Tamiflu, a prescription drug that can reduce the severity of ordinary flu and may help against the avian flu strain, which some experts fear could spur a pandemic. Unwarranted use of Tamiflu could help flu strains mutate into forms that are resistant to the drug, among other problems.
How effective are flu vaccines?
People are freaked out about the flu. Public-health officials have been fretting about bird flu and the possibility that it could turn into a worldwide pandemic.
There is not much anybody can do about avian flu. No vaccine has been developed, and there is not enough antiviral flu medicine to treat everyone. No one even knows yet whether the bird flu will actually morph into a real danger or if it will just remain a threatening prospect.
In the meantime, public-health pundits are urging high-risk Americans to sign up for their annual flu shots. Last year, shortages of flu vaccine created panic as people waited in long lines, only to have supplies run out.
This year, experts do not expect a shortfall of flu vaccine. But the heavy emphasis on immunization does not fit well with research on the efficacy of flu vaccine, especially for older, sicker people.
New AAAAI Guidelines Stress Flexibility in Asthma Therapy - CME Teaching Brief - MedPage Today
By Jeff Minerd, MedPage Today Staff Writer
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco
October 26, 2005
MedPage Today Action Points
* Take note that the new AAAAI asthma guidelines emphasize frequent assessment of symptoms in detail each time a patient sees a physician, with medication increased or decreased
*
Familiarize yourself with the new guidelines, available on the Journal of Allergy & Clinical Immunology web site at www.jacionline.org.
* Explain to patients that they should accept nothing but a well-controlled or completely controlled disease.
Review
MILWAUKEE, Oct. 26 - Rather than a rigid treatment regimen determined by an initial assessment of disease severity, asthma therapy should be flexible, responding to changes in symptoms.
So suggest new guidelines from the American Academy of Allergy, Asthma and Immunology (AAAAI) that emphasize the dynamic nature of the disease.
The Cochrane Library newsletter, 2005, Issue 4
People with asthma who perform regular exercise have an increased ability to take up oxygen and increase their ventilation leading to improved cardiopulmonary fitness. Physical training involved 20 to 30 minutes of aerobic exercise, taken at least 2 to 3 times a week. "Therefore, there is no reason why people with asthma should not participate in regular physical activity," says lead Cochrane Review Author Dr Felix Ram. There is no evidence to suggest that regular exercise worsens asthmatic symptoms.
Because exercise can worsen symptoms, people with asthma have often been prevented from playing sports or attempting to keep fit. But physical training programmes have been designed that enable these people to improve physical fitness, muscle coordination and confidence.
Working on this Review, the authors drew together the results of 13 studies that involved 455 participants. While the studies varied in the features they were setting out to measure, the researchers concluded that exercise can increase the total amount of oxygen a person can take in by up to 20%. It can also increase the amount of air a person can transfer in and out of their lungs each minute by up to 6L/min. Improvements in fitness were seen by a 6.27 watt increase in work capacity and an average increase in maximum heart rate of more than 3 beats per minute. All these changes are clinically important and will improve patient well-being.
One note of caution: "It is imperative to give asthmatic subjects guidance on how to prevent or treat exercise-induced asthma before encouraging them to start training," says Ram.
Review title: Ram FSF et al. Physical training for asthma. The Cochrane Database of Systematic Reviews 2005, Issue 4.
Shorter colds, milder flu may follow from newly revealed immune mechanism
Enlisted to help fight viral infections, immune cells called macrophages consume virus-infected cells to stop the spread of the disease in the body. Now researchers at Washington University School of Medicine in St. Louis have uncovered how macrophages keep from succumbing to the infection themselves. Boosting this mechanism may be a way to speed recovery from respiratory infections.
The researchers found that a specific protein produced in the course of respiratory viral infections can serve to protect macrophages from an untimely death. Their report will appear in an upcoming issue of Nature Medicine and is available at the journal's website.
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By Neil Osterweil, Senior Associate Editor, MedPage Today
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco
October 20, 2005
Review
SILVER SPRING, Md., Oct. 20 - Antibacterial soaps don't reduce the risk of illness any better than plain old soap, proclaimed an FDA advisory committee today in a unanimous vote.
Indeed, said Alastair J.J. Wood, M.D., of Vanderbilt, chairman of the FDA's Nonprescription Drugs Advisory Committee, the members of the panel were unconvinced by testimony during the day that antibacterial soaps and disposable wipes are any more effective than regular soap and water in preventing infections in the home.
Read more...medpage Today
By Jeff Minerd, MedPage Today Staff Writer
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
October 20, 2005
Review
LOS ANGELES, Oct. 20 - Elderly patients with dementia who take so-called atypical anti-psychotic drugs have an increased risk of death, according to a meta-analysis of clinical trials.
The increased risk of about 50% compared with placebo was not found for any individual drug and could not have been detected by any of the individual trials included in the analysis, according to a report published in the Oct. 19 issue of the Journal of the American Medical Association.
"It is only when all trials are combined that a statistically significant effect is found," said Lon S. Schneider, M.D., and colleagues at the University of Southern California, Los Angeles.
Read more at...medpage Today
No Evidence for Routine Use of Pulmonary Artery Catheter in CHF - CME Teaching Brief - MedPage Today
Review
BOSTON, Oct. 4 - Pulmonary artery catheterization does more harm than good when used in patients who are hospitalized for severe congestive heart failure, researchers here reported.
Medical therapy by itself effectively reduced volume overload, but the addition of pulmonary artery catheterization significantly increased in-hospital adverse events -- 47 versus 25 (P=0.04), according to findings reported in the Oct. 5 Journal of the American Medical Association.
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Trip J. Meine, MD; Manesh R. Patel, MD; Venita DePuy, MStat; Lesley H. Curtis, PhD; Sunil V. Rao, MD; Bernard J. Gersh, MB, ChB, DPhil; Kevin A. Schulman, MD; and James G. Jollis, MD
4 October 2005 | Volume 143 Issue 7 | Pages 481-485
Background: Previous studies suggest that patients hospitalized with acute myocardial infarction (MI) in December have poor outcomes, and some studies have hypothesized that the cause may be the infrequent use of evidence-based therapies during the December holiday season.
Objective: To compare the care and outcomes of patients with acute MI hospitalized in December and patients hospitalized during other months.
Design: Retrospective analysis of data from the Cooperative Cardiovascular Project.
Setting: Nonfederal, acute care hospitals in the United States.
Patients: 127 959 Medicare beneficiaries hospitalized between January 1994 and February 1996 with confirmed acute MI.
Measurements: Use of aspirin, ß-blockers, and reperfusion therapy (thrombolytic therapy or percutaneous coronary intervention), and 30-day mortality.
Results: When the authors controlled for patient, hospital, and physician characteristics, the use of evidence-based therapies was not significantly lower but 30-day mortality was higher (21.7% vs. 20.1%; adjusted odds ratio, 1.07 [95% CI, 1.02 to 1.12]) among patients hospitalized in December.
Limitations: This was a nonrandomized, observational study. Unmeasured characteristics may have contributed to outcome differences.
Conclusions: Thirty-day mortality rates were higher for Medicare patients hospitalized with acute MI in December than in other months, although the use of evidence-based therapies was not significantly lower.
Avian Flu Virus Showing Resistance to Tamiflu - CME Teaching Brief - MedPage Today
Review
HONG KONG, Sept. 30-Scientists here are reporting that a strain of the H5N1 avian flu virus is showing resistance to Tamiflu (oseltamivir), the antiviral many health organizations and governments are stockpiling to protect against a potential pandemic.
Tamiflu is proving less effective against the H5N1 strain that surfaced in northern Vietnam earlier this year, Hong Kong scientists reported. The greatest number of human deaths from avian flu have occurred in Vietnam since the start of the outbreak in 2003.
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Review
GIESSEN, Germany, Sept. 30-The "wonder drugs" Gleevec (imatinib) and Viagra (sildenafil) make strange bedfellows, but they both appear to improve pulmonary function in patients with pulmonary arterial hypertension (PAH), report researchers here.
They described the Gleevec case in a letter published in the Sept. 29 New England Journal of Medicine.
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QUALITY IN RESIDENCY EDUCATION -- Tenzer 3 (5): 469 -- Annals of Family Medicine
From the Association of Family Medicine Residency Directors
In discussing the concept of quality, I am reminded of the old Zenith advertisement, "quality goes in before the name goes on."1 Quality must be a requisite to be called a family doctor.
Concepts and standards of quality continue to evolve. Advances in technology, rising health care costs, increasing health disparities, and shifting population demographics will shape the future concept of health care quality. The Future of Family Medicine (FFM) project offers a template for acquiring the skills and resources needed to thrive in an ever-changing environment. The AFMRD has reformatted its strategic plan to reflect the FFM recommendations.2–4
This year’s AFMRD presidential theme is "Forging the Future of Family Medicine Through Quality and Innovation." Innovation will be a key driver and marker of health care quality in the future. Compared with health care outcomes in countries with fewer health care dollars, our expensive, high-technology health care results in poorer outcomes, and racial and socioeconomic health care disparities are increasing. Clearly, now is the time for innovation.2,4
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Some people deride them as “sugar water,” others as “liquid candy.” Never favorites with dietitians or parents, sodas are receiving more and more nutritional heat these days – and the drumbeat to run them out of schools is growing louder.
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SUNDAY, Oct. 2 (HealthDay News) -- Alcohol-based hand sanitizers, found in drug and grocery stores everywhere, do a good job of preventing gastrointestinal infections from spreading within the home, according to a new study.
As reported in the current issue of Pediatrics, the five-month study involved 292 Boston-area families, each of whom had at least one child in day care and were therefore at high risk for common respiratory and gastrointestinal infections.
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They've Got the Whole World in Their Hands: PDAs in Medicine - CME Teaching Brief - MedPage Today
Review
BERLIN, Sept. 29-You say you want a revolution? Look no further than the halls of your local teaching hospital. There you'll see a new generation of physicians who have eschewed volumes of bulky medical manuals, drug guides and charts for shirt-pocket libraries, a.k.a personal digital assistants (PDAs).
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