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Medication is the Mainstay of ADHD Treatment

September 30, 2008

Parents 'need lessons about ADHD | news.bbc.co.uk

The well-regarded Multimodal Treatment study (MTA Study) has shown that adjunctive, behavioral treatment alone is not as effective as treatment options which include medications. Parent input (and education), however, is critical for day-to-day management of these children, since the parents are on the front lines.

Why Not?

September 25, 2008

Lilly to Disclose Payments to Doctors | online.wsj.com

As physicians, we should have nothing to hide when we provide unbiased advice to pharmaceutical companies. Receiving a grant (or a lunch or a free pen) does not, for the vast majority, obligate us to be anything other than concerned for our patients, first and foremost.

Major Potential Benefit for Small Numbers of Patients

September 5, 2008

ACE Inhibitor May Ease Cardiac Risks in Marfan's Syndrome | www.medpagetoday.com

In this small and short-duration study, ACE inhibitors seem to provide an additional preventive benefit when used with beta blockers in patients with marfan's syndrome. This is all to the good for those patients, and if the results of this preliminary study are borne out over a longer term, this may reduce the eventual need for aortic root surgery in these patients.

Right Idea, Not Enough Incentive

August 26, 2008

Europe adopts new pediatric drug rule | www.nationalreviewofmedicine.com

Children have long been therapeutic orphans, often relying on off-label use of new drugs which have only been tested on adults. This legislation seeks to remedy that inequality, by encouraging pharmaceutical companies to do more testing in pediatric populations.

A Foot in the Pediatric Door?

August 21, 2008

Abbott signs deal to promote Crestor in U.S. | www.chicagotribune.com

With Abbott being such a major player in the infant formula market, will this lead to more promotion of statins in the pediatric office, especially given the recent (although controversial) recommendation for possible statin use in children as young as 8 years old? And since they are involved in the overall nutritional market, how will this impact the sales of their nutritional products?

A Real Answer to a Real, if Low-incidence Problem

August 21, 2008

Drug Makers’ Push Leads to Cancer Vaccines’ Fast Rise | www.nytimes.com

Cervical cancer is real, and has the potential to cause significant morbidity and mortality. Yet the incidence in developed countries is relatively small, when compared with the developing world. There is a real, although small, benefit in the US, and while the vaccine is effective, the cost per prevented death is large. If we focus on health care only, the vaccine's use is clearly warranted; once we weigh cost vs. benefit, and particularly when we consider what other services might have to be cut back to pay for the vaccine, the decision is less clear. Making the vaccine available at affordable cost in the developing world, however, would be a great thing. Right now, however, the cost is prohibitive.

Let's Try to be Selective in What we Test for and Treat

August 13, 2008

Panel Urges End to Prostate Screening at Age 75 | www.nytimes.com

Finally, a recommendation that an available test and treatment NOT be used, under circumstances where there is little to be gained and much to be lost.

Another Item Which Patients "Want", and Cost be Damned

August 13, 2008

Majority of Patients Want Doc to use EHRs: Study | www.modernhealthcare.com

Just like expensive, do-everything end-of-life care, like unlimited imaging studies, like newest drugs, patients want it all. This is one of the attitudes which causes the US to spend far more than other developed countries for far less efficient and cost-effective health care.

TANSTAAFL

August 5, 2008

Just Sitting Back to Get in Shape: Two Pills Do teh Work of Exercise | online.wsj.com

(There ain't no such thing as a free lunch.) Just like the electronic devices which claim to stimulate constant muscle contractions, these pills seem to produce increased muscle metabolic activity, making the muscle "think" that it has been exercising. The animals in the study had increased endurance for exercise following treatment, that is, a longer exercise time to fatigue.

Good Documentation of Common Knowledge

August 5, 2008

Associations Between Exposure To Traffic-Related Air Pollution And The Onset Of Allergic Diseases In Children Shown By New Research | www.medicalnewstoday.com

There is not much new here for those involved in clinical care of children, but it is good to have statistical support for what we have always taught about pollution and allergic disorders, especially asthma.

A Good Intermittent and Intermediate Treatment

July 28, 2008

Intermittent tacrolimus Ointment therapy Helps Prevent Relapse Of Stabilized Atpoic Dermatitis | www.medscape.com

Treatment of atopic dermatitis has always been frustrating. Flare-ups, which are all too common, can be treated with topical steroids, but these cannot be used for prolonged periods without significant downside. And lubrication of the skin, the mainstay of maintenance therapy, is not always effective in controlling the flare-ups.

Poor Economic Conditions Affect All Sectors

July 24, 2008

Patients Curb Prescription Spending | online.wsj.com

While the need for urgent care does not disappear during tough economic times, patients are far more selective about when they consider themselves sick enough to require medical care. With higher copayments, often $25-50, patients think twice before going to a physician for minor complaints--they might try self-care, which often works (even if only because many conditions are self-limited), or they might wait til the condition becomes more serious.

Potential Side Effects May Take Years to Become Visible

July 21, 2008

Drugs to Build Bones May Weaken Them | www.nytimes.com

As in so many other instances, some potential side effects will only show up once the number of patients has grown far beyond the number studied in pre-marketing studies.

Starting Younger Every Day

July 18, 2008

8-Year-Olds on Statins? A New Plan Quickly Bites Back | www.nytimes.com

While I am sure that there are a few children with hereditary lipid disorders which should be treated aggressively and early with statins, the data is certainly not available to support routine treatment of every child with elevated lipid values.

No Point to This at All

July 1, 2008

Taro Receives Final FDA Approval For RX Cetirizine Hydrochloride Syrup ANDA | www.medicalnewstoday.com

If the same drug is available OTC, insurances won't cover the rx form, and patients will (continue to) self-treat with OTC meds, without even needing to see their doctor.

Who Will Benefit Most?

June 23, 2008

Most Doctors Aren’t Using Electronic Health Records | www.nytimes.com

While all can agree that universal use of EMR/EHR would be beneficial, the cost burden of implementing these systems generally rests with the physician, who will generally see the least benefit (as opposed to insurance companies, Medicare, patients, etc.)

The Extent is More Troubling that the Fact

June 18, 2008

Researchers Fail to Reveal Full Drug Pay | www.nytimes.com

While I knew (from the required disclosures) that these researchers receive income from speaking for the pharmaceutical companies about their products, I am troubled more by the amounts involved. A speaker who is acting as a paid spokesman for ANY product deserves to be paid for his/her time, and physicians with expertise are no different. However, this should not constitute such a significant source of the physician's income if he/she is to be able to maintain an honest approach to the product involved.

More Study is Certainly a Good Thing

June 11, 2008

FDA's Chief Scientist Asks Science Board Subcommittee To Review Research On Bisphenol-A | www.medicalnewstoday.com

Gee, remember when Nalgene was the way to go, because it was safer/healthier than phthalates? Now Nalgene is suspect, since it may contain BPA. Metal is no good, especially aluminum. And if the inner lining is some epoxy coating, there are yet other things to worry about. I THINK glass is still safe to drink from, but the shards when it breaks are a hazard to one's feet.

A Big Win for Glaxo

June 6, 2008

GlaxoSmithKline given OK to sell bird-flu vaccine in Europe | www.bizjournals.com

Whether or not the bird flu ever becomes a threat to humans, Glaxo has won here. Since it will be impossible to rule out a serious risk of epidemics, an effective vaccine will have to be purchased and stockpiled by governments and other health care systems.

Another Good Agent for the Pediatric Age Group

June 6, 2008

AstraZeneca Submits an sNDA for SYMBICORT(R) for the Treatment of Asthma in Children as Young as Age Six | www.pipelinereview.com

Symbicort has proven safe and effective in ages 12 and up, and should confer its benefits on younger patients as well.    

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This author consults with leading institutions through GLG