Online pharmacy weblog

FOR many Americans, a doctor’s decision to prescribe medication is
something of a sacred transaction. A physician considers the patient
and symptoms and chooses the best drug for the job, drawing upon years
of training and clinical experience. It is an exchange conducted in a
hushed sanctuary, far from the heat and noise of the marketplace — a
place where cool judgment reigns.

That sanctuary has been breached. Today, drug manufacturers do
everything in their considerable power to ensure that their brand-name
prescription medications are on the lips of patients and in the minds
of physicians every time the two meet across an exam table. A growing
chorus of critics says their efforts have begun to rewrite the
dialogue between patient and doctor, influence physicians’ judgments
and open the act of prescribing to forces more profit-minded than sacred.

In 2006, drug-makers spent almost $5 billion to reach out to consumers
with direct advertising. But the glossy magazine ads and
buzz-generating TV spots are just the most visible parts of a campaign
to build and nourish markets for brand-name prescription products. The
world’s pharmaceutical companies spend an estimated $19 billion
annually to woo doctors. They sponsor teaching programs and research
at universities across the country, gaining goodwill along the way.
They give money to patient groups. They hire public relations firms to
share patient stories of illness and triumph.

In a nation that consumed $279-billion worth of prescription
medications in 2006 — spending 80% of that on brand-name products –
their efforts appear to be paying off. Americans filling a
prescription choose brand-name products 37% of the time, even though
three-quarters of all prescription drugs in the U.S. are available in
cheaper generics.

“The most effective marketing is the marketing you’re not aware of,”
says Dr. Peter Rost, a one-time pharmaceutical company marketing
executive who has become an Internet-based industry watchdog. “If you
see an ad, you know it’s marketing. But if a friend or your doctor
talks to you about a drug, you don’t.”

Now the size, scope and apparent effectiveness of drug companies’
marketing efforts has begun to prompt cries of foul even from within
the medical establishment, which has long been silent about its
growth. In a handful of state legislatures across the country,
lawmakers already have acted to blunt drug-company marketing, and many
more are considering similar measures. Lawmakers on Capitol Hill have
suggested that federal legislation may come next.

At stake, critics say, are patients’ health, the nation’s healthcare
budget and, ultimately, the trust and esteem in which Americans hold
their physicians. Costs rise as more doctors prescribe brand-name
drugs when cheaper, older or more effective drugs might be available.

Under-treated conditions that threaten the lives and wellness of large
swaths of the population — illnesses such as diabetes and high blood
pressure — may get less attention than conditions such as erectile
dysfunction or insomnia, for which pharmaceutical firms have new and
potentially more profitable offerings. And patients may be steered
toward newer drugs with risks and side effects that are less
well-known, in lieu of medications with a longer history of safe use.

“There is nothing fundamentally wrong with advertising products,” Dr.
Jerome P. Kassirer, a former editor of the New England Journal of
Medicine, told a Senate committee recently. “But when financial
incentives yield inappropriate or dangerous care, when they
inordinately raise the cost of care, when they risk patients’ lives in
clinical trials, and when they damage the profession, they have gone
too far.”

The pharmaceutical industry counters by arguing that its marketing
efforts are needed to recoup the cost of drug development and that
they introduce Americans to medicines that can save lives and improve
well-being. The industry’s sponsorship of research and education
pushes the process of drug discovery and development forward,
drug-makers say. Companies’ marketing to physicians keeps busy
clinicians abreast of new therapies and scientific advances in a
fast-changing landscape. And their advertising of drugs in mass-media
outlets educates patients and improves their communication with
doctors, they add.

And drug marketing improves the economic vitality of the nation, a
representative of the drug industry’s largest trade group, PhRMA, said
at a recent Senate hearing. Prompted by drug industry marketing, more
patients in recent years have sought out a doctor, and more doctors
have looked for signs of under-treated conditions such as depression,
diabetes and asthma among patients, Marjorie E. Powell, an attorney
for PhRMA, said to the Senate Select Committee on Aging in late June.
Citing a pair of studies published in 2003, Powell said that in the
long run, increasing treatment of such chronic conditions should drive
down the nation’s healthcare bill.

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So you’re finding yourself thirsty all the time — a lot more than
usual. Or you’ve been really, really tired lately. Can’t seem to get
enough sleep.

Maybe you’ve dropped a bunch of weight — without even trying. Funny,
but these days, it seems you always have to go pee, even when you’ve
just gone.

You dismiss it all as just something you’re going through. Something
that will pass.

Well, it could be that you’ve developed something that’s going to
stick around for the rest of your life.

You could be one of the almost 250 million people around the world who
has diabetes. A third of those people aren’t even aware they have the
condition. Forty-six per cent of them are between 40 and 59 years old.
Quick facts 2007 2025
World population (billions) 6.6 7.9
Number of people aged 20-79 years with diabetes (millions) 246 380
World diabetes prevalence (%) 7.5 8.0
Source: Diabetes Atlas: International Diabetes Federation
(Read the article)

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A jury awarded $25.8 million Friday to the family of a cancer patient
who was given a wrong prescription, had a stroke and died several
years later, lawyers said.

Beth Hippely was prescribed Warfarin, a blood thinner, in 2002 to
treat breast cancer. The prescription filled at a Walgreens pharmacy
was 10 times what her doctor prescribed, court documents said.

The Polk County Circuit Court jury found the prescription error caused
a cerebral hemorrhage resulting in permanent bodily injury, disability
and physical pain. The mother of three died in January at the age of 46.

A 19-year-old pharmacy technician, with little training, misfiled the
prescription, according to court documents.

The lawsuit was filed in 2003 by Hippely, her husband Deane Hippely
and their children against the Deerfield, Ill.-based Walgreen Co. for
negligent breach of duty and wrongful death.

“Beth Hippely died unnecessarily because this tenfold overdose with
Warfarin by the pharmacy she trusted caused her cancer to come back
with a vengeance and it interrupted all of her cancer treatments,” her
lawyer Chris Searcy said. “They have been seeking justice for almost
five years and this was a case that screamed out for justice.”

A statement released by the company expressed sympathy for the Hippely
family.

“We’re truly sorry for what the Hippely family has been through, and
we’ve personally apologized to them,” Walgreens spokeswoman Carol
Hively said in a statement. “We have been, and continue to be, the
leader in pharmacy safety initiatives. We had hoped the verdict would
have been fair and reasonable.”

Hively said the company had not decided if it would appeal the decision.

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Although abbreviations in health care may be efficient, their use
comes at the expense of patient safety, according to a new study
published in the September 2007 issue of The Joint Commission Journal
on Quality and Patient Safety. The findings of this study provide
further support for The Joint Commission’s “Do Not Use” list of
abbreviations that is part of its National Patient Safety Goals. The
study also suggests the need to consider additions to the “Do Not Use”
list.

Although abbreviations are known causes of medication errors, the
study-The Impact of Abbreviations on Patient Safety-is the first to
examine the exact characterization and impact of these errors. The
study collected and analyzed data through a retrospective review of
errors resulting from abbreviations as reported to the United States
Pharmacopeia’s MEDMARX®, a national database for medication errors,
from 2004 through 2006.

The study found that nearly 5 percent of all errors reported to
MEDMARX® during this time period were attributable to abbreviations.
This analysis of nearly 30,000 medication error reports involving
abbreviations suggests that health care organizations should consider
additions to the “Do Not Use” list. Candidates for an expanded list
include drug name abbreviations (for example, PCN, DCN, TCN), stem
abbreviations (amps, nitro, succs), µg (mcg), cc (mL), and dose
scheduling (BID, TID, QID).

The authors of the study, led by Luigi Brunetti, Pharm.D., a clinical
assistant professor at the Ernest Mario School of Pharmacy at Rutgers,
The State University of New Jersey, note that communication is the
leading cause of sentinel events and that abbreviation use hinders
communication. Sentinel events are unexpected occurrences involving
death or serious physical or psychological injury, or the risk
thereof, that are tracked by The Joint Commission.

The study also characterizes error-prone abbreviations as preventable
problems that are a logical area for improvement.

“Accurate communication in the health care environment is a critical
component of patient safety. Our analysis of errors reported to the
USP MEDMARX® medication error reporting system confirms that
abbreviation usage contributes to lapses in communication and may lead
to patient harm,” says Brunetti.

The notable findings in the study include:

* The most common abbreviation resulting in a medication error was
the use of “qd” in place of “once daily,” accounting for 43.1 percent
of all errors.

* The other most common abbreviations resulting in medication
errors were “U” for units, “cc” for mL, “MSO4″ or “MS” for morphine
sulfate, and decimal errors.

* Eighty-one percent of the errors occurred during prescribing,
while errors during transcribing and dispensing were much less
frequent, representing only 14 percent and 2.9 percent of errors,
respectively.

* Abbreviation errors originated more often from medical staff in
comparison to nursing, pharmacy, other health care providers, and
non-health care providers.

* The three most common types of abbreviation-related errors were
prescribing, improper dose/quantity, and incorrectly prepared medication.

The study also found that in nearly 40 percent of the errors in which
abbreviations were identified as the cause of error, the exact
abbreviation was unidentified. The authors urge individuals and
organizations reporting medication errors to include the key points
that adequately describe the error, including the cause of the error,
a brief description of the cause (in the case of abbreviations, which
abbreviation), the contributing factors, the outcome, staff involved,
and the point in the medication process when the error occurred in
order to learn from the errors and improve patient safety.

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I am instructing a Medical Asepsis class and have come up with great
information and better understanding of pathogens (disease causing
microorganisms) and infectious diseases as well. Anyways here is an
interesting blurp I came across.

Something to think about when you are making those IV’s

Joe Medina, CPhT

———–
Disgusted by Port-A-Potties? Freaked out by fast-food restrooms?
Believe it or not, picnic tables and ATMs may harbor more germs.

A new report puts our germ fears into perspective. In a nationwide
telephone survey of 1,000 adults, each adult was asked to rate the
surfaces they considered germy. Those answers were then compared with
real studies of bacteria on various surfaces.

You guessed it: The bulk of germs are hiding where you least suspect
– playground equipment, the phone receiver, ATMs, and elevator buttons.

“This survey shows that people have a false sense of security when it
comes to germs,” says Charles Gerba, a.k.a. “Dr. Germ,” a professor of
environmental microbiology at the University of Arizona, in a news
release.

It’s a real health problem, because 80% of infections are spread by
hand, Gerba says. The solution is proper hand hygiene with soap and
water or an alcohol-based sanitizer, he says.

Among his survey’s findings:

* 64% think public restroom doorknobs have more germs than a
typical ATM but a typical ATM has been proven to have more germs
because of the number of dirty hands that touch each of these items.
* 75% think the toilet seats in fast food restaurants have the
most germs — but airplane toilet seats are worse.
* 76% assumed that Port-A-Potties were off-the-chart germ wise –
but picnic tables actually have more germs.

The germ facts:

* At home, the kitchen sink is one of the places with the most
germs — harboring more germs than the bathroom. The most contaminated
sites are those that tend to remain moist. The dishcloth, toilet bowl,
garbage can, refrigerator, and bathroom doorknob are also high on the
list.
* At work, phone receivers harbor more germs than any surface –
even more than the toilet seats. Desktops, keyboards, and elevator
buttons are also on the workplace top germ-covered list.
* In public places, playground equipment, escalator handrails,
shopping cart handles, picnic tables, and Port-A-Potties are top germ
carriers.

Also, only 17% of Americans wash their hands after shaking hands –
yet 51% wash them after sneezing or coughing. It’s part of the
misconception that germs are spread in the air rather than by hand
contact.

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