Jerry Fahrni

Category: Therapeutics

  • Surprise! Pharma says their “digital resources” are good for consumers

    Sirensong

    Reliance on pharma-sponsored digital resources among online U.S. adults is significant. The research found “51% of online U.S. adults (ages 18+) use pharma-sponsored digital resources, such as condition and treatment information, disease management tools, doctor discussion guides, or mobile apps or websites.” This validates that the interactive information and tools produced by biopharma are being utilized and appreciated.

    Use of these materials results in action: a conversation about a prescription drug. The study learned “43% of consumers using pharma-sponsored digital resources have discussed prescription drugs with a doctor, nurse, or pharmacist as a result.” This data point supports the business objective behind providing these interactive resources: generating a conversation with a healthcare professional. Note that the study was fielded online among 6,634 U.S. adults, ages 18+ during Q4 2011.

    For comparison, Prevention Magazine’s Direct to Consumer Study 2011 found that as a result of seeing an advertisement – not necessarily online – 77% of survey respondents talked to a doctor and 23% asked for a prescription.

    How scary is this! Getting consumers to talk about their medication with their physician is a good thing; talking with their pharmacist even better. However, many times this type of advertising (“digital resource”) results in consumers asking about something completely inappropriate. Which, as we all know, can lead to  a physician prescribing an unnecessary medication, using something that they’re not familiar with or prescribing something they wouldn’t consider first line.

    All you have to do is look at the top 5 “patient and caregiver groups to agree that pharma should be involved in online health consumer communities” to understand why this is such a bad idea.

    1. ADD/ADHD Caregivers
    2. Bipolar Disorder Caregivers
    3. Epilepsy Caregivers
    4. Cystic Fibrosis Patients
    5. Rheumatoid Arthritis Patients

    Yikes! Choosing drug therapy is quite a bit different than picking out a book on Amazon and it should be treated that way.

  • Impact of Anti-infective Drug Shortages [Article]

    Clinical Infectious Disease (online January 19):

    Abstract

    Anti-infective shortages pose significant logistical and clinical challenges to hospitals and may be considered a public health emergency. Anti-infectives often represent irreplaceable life-saving treatments. Furthermore, few new agents are available to treat increasingly prevalent multidrug-resistant pathogens. Frequent anti-infective shortages have substantially altered patient care and may lead to inferior patient outcomes. Because many of the shortages stem from problems with manufacturing and distribution, federal legislation has been introduced but not yet enacted to provide oversight for the adequate supply of critical medications. At the local level, hospitals should develop strategies to anticipate the impact and extent of shortages, to identify therapeutic alternatives, and to mitigate potential adverse outcomes. Here we describe the scope of recent anti-infective shortages in the United States and explore the reasons for inadequate drug supply.

    Unfortunately the abstract doesn’t say much and a subscription is required to read the full article [grrr!]. The authors of the article basically evaluate the shortage of anti-infective agents over a multi-year period (2005-2010) and conclude that “anti-infective drug shortages continue to pose significant problems for clinicians and are a rapidly evolving public health emergency.” In addition they call for further research “regarding the clinical impact of drug shortages on patient outcomes”. How would one perform such a study?

    Drug shortages have received a lot of attention lately. Shortages are certainly nothing new, but they seem to have become a bigger issue lately as the sheer number of unavailable medications is staggering. Areas like oncology and infectious disease are particularly hard hit as the number of treatment options in these specialties are limited to start with.

    While there is no doubt that the shortages have impacted healthcare, I tend to agree with the authors of a commentary piece on the article that conclude that " it is difficult to systematically measure the resulting clinical problem or draw quantitative conclusions about differences in outcomes." Sounds overly simplified, but it’s true.

    For more information on drug shortages make sure to visit the ASHP Drug Shortages Resource Center. Over 200 drugs and counting…

  • The e-patient movement, panacea or barrier to care?

    I haven’t really paid much attention to the e-patient movement, but recently it’s become a subject of interest.

    I Googled “epatient”, and here’s what I found: “e-Patients are health consumers who use the Internet to gather information about a medical condition of particular interest to them, and who use electronic communication tools in coping with medical conditions The term encompasses both those who seek online guidance for their own ailments and the friends and family members who go online on their behalf. e-Patients report two effects of their online health research: “better health information and services, and different (but not always better) relationships with their doctors.”” This definition comes from Wikipedia. I’m not a big fan of Wikipedia, but in this case it seems appropriate.
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  • Safety, privacy and UCSF Med Center’s failure to do the right thing

    I am a UCSF School of Pharmacy alum. I consider UCSF Medical Center, along with many other people, to be one of the best medical centers in the country. And, UCSF Medical Center saved my mother’s life with a liver transplant earlier this year. However, I am frustrated with UCSF Medical Center this morning.

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  • Medscape mobile acknowledges problem with iOS 5

    Apparently some Medscape mobile users with iOS 5 have had some issues. Below is the content from an email I received earlier today. Not exactly sure what the problem is as the email didn’t actually say. I’d be leery of the application until the fix is applied, which according to the email will be sometime in the first week of January. I’d recommend using something else in the meantime.

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  • Fun with Lugol’s solution…not really

    A recent ISMP Medication Safety Alert shared various errors that have occurred with Lugol’s solution over the ages. Lugol’s solution is a concentrated liquid form of potassium iodide and iodine known for its use in the treatment of hyperthyroidism. It’s also a dangerous drug because it’s typically dosed in drops, not mL’s.

    Anyway, the ISMP alert shared several examples of oral overdoses with Lugol’s solution secondary to confusion between drops and mL’s. However, mixed in with all the “typical” errors, was the little gem below. Even though the error is more than a decade old, I can’t help but wonder “what the heck were they thinking!”. By the way, my initial read through had me thinking cursive “OS” (oculus sinister, i.e. LEFT eye). With that said, I wouldn’t have actually dispensed it because nothing else on the prescription fits.

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    One of the errors reported more than a decade ago involved an order to administer 10 drops of Lugol’s solution mixed with "OJ" (orange juice), but nurses misinterpreted "OJ" as OD (right eye). The patient received several doses of Lugol’s solution in his right eye. The error was identified when the patient complained to the physician about how painful the eye drops were.

  • National Influenza Vaccination Week December 4-10

    imageApparently National Influenza Vaccination Week (NIVW) is next week. Who knew?

    The CDC has additional information on NIVW here, and a whole lot more information on seasonal influenza (Flu) as well. Need to know more about types of influenza viruses? No problem, you can find that at the CDC site too. The most common form of influenza is Type A. For most healthy people the flu is self-limiting. Sure you feel like crap for a few days, but you get over it and truck on. With that said, influenza can be quite dangerous to elderly and those with compromised immune systems. Get vaccinated.

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  • Canada calls for national drug shortage registry [article]

    The Canadian Pharmacist Association is looking for a way to track drug shortages. They would like to get drug manufactures and hospitals to participate in a national reporting system. It’s a great idea and one that I think could provide value.

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  • Pharmacists impact on osteoporosis management (review article)

    Pharmacists are pretty good at helping people with chronic medical conditions manage their medications, hence the term Medication Therapy Managment (MTM). You can find more information about MTM at the American Pharmacists Association (APhA) website.

    Anyway, I came across an article this morning that gives the results of a literature review “to examine the impact of pharmacist interventions in improving osteoporosis management“. While I’m not a big fan of review articles in general because the information can be skewed, I found the conclusion to my liking. The articles concludes that “[d]ata support the potential role for pharmacists to help reduce gaps in osteoporosis management through improved identification of high-risk patients.” And then the article goes on to say that more research is needed. I personally think it’s time to move beyond the research stage and start integrating MTM into the care of all patients. It should be the standard.

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  • Bacteria everywhere run scared as vancomycin gets new life

    vancomycinmedGadget: “Scientists from the Scripps Research Institute have successfully reengineered vancomycin. They have reported their findings in the Journal of the American Chemical Society. This research could be a solution in the treatment of patients infected with highly resistant bacteria. Vancomycin is often considered the antiobiotic of last resort, if other antibiotics have failed to do the job. But the emergence of vancomycin-resistant bacteria is becoming a major health problem. Vancomycin works by binding the D-alanyl-D-alanine terminal dipeptide of peptidoglycan precursors, used by bacteria for constructing their cell walls. By binding it, the bacteria can not use the peptidoglycan anymore and they die. But certain bacteria have altered their peptidoglycan by replacing an amide with an ester, resulting in vacomycin resistance.

    The reengineered vancomycin can bind the altered peptidoglycan and kill the bacteria once again using the same mechanism as described above. But besides binding the altered peptidoglycan, this new antibiotic can bind the original peptidoglycan as well. It took Dale L. Boger and his team some serious chemical engineering to redesign vancomycin into this new antibiotic. In the article down below you can read the report how they managed to synthesize this altered antibiotic and exchange a single atom in the vancomycin to reinstate its antimicrobial activity.”

    Vancomycin is an oldie, but a goodie. It continues to be useful despite its age. Several drugs have been developed over the years to replace it, but for one reason or another the newer agents tend to fall out of favor. With that said, vancomycin won’t last forever as bacteria are slowing finding ways to combat its mechanism of action. So instead of finding a new drug, someone decided to alter the old one. Go figure.