Drug Resistant Superbugs are a Serious Threat

The spread of deadly superbugs that evade even the most powerful antibiotics is no longer a prediction but is happening right now across the world, United Nations officials said on Wednesday.

Antibiotic resistance has the potential to affect anyone, of any age, in any country, the U.N.'s World Health Organisation (WHO) said in a report. It is now a major threat to public health, of which "the implications will be devastating".

"The world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill," said Keiji Fukuda, the WHO's assistant director-general for health security.

In its first global report on antibiotic resistance, with data from 114 countries, the WHO said superbugs able to evade event the hardest-hitting antibiotics - a class of drugs called carbapenems - has now been found in all regions of the world.

Drug resistance is driven by the misuse and overuse of antibiotics, which encourages bacteria to develop new ways of overcoming them.

Only a handful of new antibiotics have been developed and brought to market in the past few decades, and it is a race against time to find more as bacterial infections increasingly evolve into "superbugs" resistant to even the most powerful last-resort medicines reserved for extreme cases.

One of the best known superbugs, MRSA, is alone estimated to kill around 19,000 people every year in the United States - far more than HIV and AIDS - and a similar number in Europe.

The drugs don't work

The WHO said in some countries, because of resistance, carbapenems now do not work in more than half of people with common hospital-acquired infections caused by a bacteria called K. pneumoniae, such as pneumonia, blood infections, and infections in newborn babies and intensive-care patients.

Resistance to one of the most widely used antibiotics for treating urinary tract infections caused by E. coli -medicines called fluoroquinolones - is also very widespread, it said.

In the 1980s, when these drugs were first introduced, resistance was virtually zero, according to the WHO report. But now there are countries in many parts of the world where the drugs are ineffective in more than half of patients.

To continue reading this visit http://www.foxnews.com/health/2014/04/30/who-drug-resistant-superbugs-serious-threat-worldwide/

High Dose of Antidepressants Linked to Suicidal Behavior

Children and young adults who start taking antidepressants at high doses are more likely to think about or attempt suicide than those who start at the doses of antidepressants that are typically prescribed, according to a new study.

Researchers found that young people between ages 10 and 24 who started antidepressant therapy at high doses were twice as likely to attempt or think about suicide over the first 90 days of treatment compared to those who started taking antidepressants at the doses recommended by doctors' guidelines.

This translates into about one additional event of suicidal behavior for every 150 patients who take high doses of antidepressants, the researchers said, writing April 28 in the journal JAMA Internal Medicine.

"There is no evidence that starting at a higher dose is beneficial," said Dr. David Brent, of the University of Pittsburgh, who was not involved in the research, but wrote a commentary about the study also published in the journal. 

About 18 percent of the 10- to 24-year-olds in the study were prescribed a higher dose, and although the study doesn'tmake clear why some got a higher dose, there may be differences between the young people in this group and those given the normal doses, Brent noted in his commentary. For example, those given higher doses may not have received average doses of antidepressants in the past and failed to respond.

Among young people between ages 10 to 24, suicide is the third leading cause of death, the CDC reported in January 2014. And there are many more suicide attempts than suicides that are actually completed. Each year, about 157,000 young people between ages 10 and 24 receive medical care for injuries resulting from suicidal behavior at ERs across the United States.

To continue reading this article visit: http://www.foxnews.com/health/2014/04/29/high-doses-antidepressants-linked-to-suicide-behavior-in-younger-patients/

Zohydro and Addiction

A new, highly potent painkiller is out on the market – and many health experts want it gone.

The controversial drug is Zohydro, an extended-release painkiller containing the already widely used opioid, hydrocodone.  Designed to release painkilling medication into the body slowly over a 12-hour period, Zohydro is available in doses as high as 50 milligrams – five times the amount found in similar immediate-release hydrocodone pills.

According to Zohydro’s manufacturer Zogenix Inc., the drug’s hallmark is its simplicity.  Zohydro is the first painkiller to contain only hydrocodone, while other comparable drugs, such as Vicodin and Lortab, contain hydrocodone plus acetaminophen.   The company claims that acetaminophen overdose is the leading cause of acute liver failure in the United States, and 63 percent of these cases are caused by hydrocodone-acetaminophen combination drugs.  Zohydro is meant to provide pain relief without this threat of liver toxicity.

But addiction experts claim this argument isn’t enough to outweigh the potential dangers posed by the painkiller.  Because of its extremely high dosage and lack of abuse deterrents, many believe Zohydro could easily ignite another addiction epidemic – as well as a new wave of overdose deaths.

“I treat addiction, and see countless young people come in – a lot of guys in their late 20s, early 30s – who had a sports injury and were given an opiate.  I’m seeing them years later, and it’s devastated their lives,” Dr. Dana Jane Saltzman, a licensed acupuncturist and addiction specialist in New York City, told FoxNews.com. “...It’s really a lifelong struggle, and a lot of these kids wouldn’t be addicted if [opioids] weren’t so readily available.”

Opioids and the brain

Derived from the opium poppy plant, opioids work by binding to receptor sights in the brain called opioid receptors.  Normally, when the body experiences pain, naturally occurring peptides, such as endorphins and other chemicals, will bind to these receptor sites in order to reduce discomfort.  

Opioids, on the other hand, greatly enhance this process.  Not only do they help to diminish pain, but they also stimulate the brain’s reward pathways, increasing the activity of the neurotransmitter dopamine.

This causes an overall sense of euphoria – which ultimately gets users hooked.

“When the brain receives a reward message that feels good, we tend to want to do it again,” Ray Isackila, a licensed professional counselor and team lead of addiction recovery services at UH Case Medical Center in Cleveland, Ohio, told FoxNews.com. “…And when the brain receives a message over and over from these opiate medications, the brain changes to adapt to that reward and that drug.  So the first change in the brain is tolerance.”

For individuals who start using opioids day after day, it may take only a few weeks before their brains build up a tolerance to the medication.  This means users will need higher and higher doses to get the desired euphoric effect – and as they take more pills, their bodies begin to develop a physical dependence on the drug.  Then, if they are ever deprived of medication, the withdrawal period can be very intense.

To continue reading visit: http://www.foxnews.com/health/2014/04/28/zohydro-why-this-new-painkiller-could-spark-new-addiction-epidemic/

Powdered Alcohol--What's the Rage?

Palcohol could give new meaning to the phrase “dry martini"

DRY UP: Image of a Booz2go packet, a powdered alcoholic beverage developed at Helicon Vocational Institute in Boxtel, the Netherlands (via YouTube).

Just add water. It works for instant coffee, tea and juice mix. Might it also work for your favorite cocktail? Powdered alcohol hasn’t gotten much of a foothold in the U.S. even though the idea has been around for decades. An Arizona company thinks that Americans are ready for the convenience of mojitos and margaritas that come from a small foil packet. The U.S. government thought so, too, at least for a couple of weeks earlier this month.

Makers of the new powdered alcohol drink mix Palcohol have to put the cork back in their champagne, for now anyway. The Alcohol and Tobacco Tax and Trade Bureau (TTB), part of the Department of the Treasury, earlier this week told the Associated Press that it had on April 8 issued “in error” the federal approvals necessary for Palcohol maker Lipsmark to make and sell its product. The agency has not elaborated on its comments since, and Lipsmark claims to have resubmitted its product labels after a “minor change,” according to the Palcohol Web site. The issue is a discrepancy over how much powder each product packet contains, the company says.

Adding to the controversy, “the government has no authority to simply cancel the approvals,” according to Bevlaw.com, a Web site run by Lehrman Beverage Law, which specializes in the federal regulation of alcohol beverages. This means Palcohol may yet show up on liquor store shelves in the U.S.

The TTB approved labels for several Palcohol flavors: two beverages resembling rum and two vodkalike drinks as well as those simulating a cosmopolitan, a lemon drop and a margarita. Companies in Japan, Germany and the Netherlands already sell powdered alcohol products. In fact, Japan’s Sato Foods Industries had patented a process that encapsulated alcohol in powder form and since the 1970s has been selling its product to be used as an additive to jelly, chocolate and other foods, according to a 1977 Seattle Times article (pdf). At the time, a U.S. company tried unsuccessfully to bring to market a beverage in the States called SureShot and based on Sato’s product.

Lipsmark is, not surprisingly, tight-lipped about how it makes Palcohol. To find out more about how powdered alcohol works and its potential impact on those partaking in it, Scientific American interviewed “Food Matters” blogger See Arr Oh, a PhD scientist with experience in organic, inorganic and medicinal chemistry as well as biology.

[An edited transcript of the interview follows.]


When did you first become aware of powdered alcohol?
I've heard of various "liquids in powder form" for quite some time: instant coffee, tea, powdered milk, etcetera. "Powdered alcohol" is a great example of nothing new under the sun—there's patents for this that go back to the early 1970s.

How does powdered alcohol work?
First things first: "Powdered" is a misnomer. Unlike CBS News’s account, this powder is not "freeze-dried alcohol." Rather, it appears to be ethyl alcohol encapsulated by a fancy sugar container. Most powdered forms of liquids rely on cyclodextrins—literally small rings of sugars—to carry "guest" molecules in their inner cavities. To make the powder, you suck all the moisture out of the carrier and then just mix with ethanol. When you add warm water it dissolves the molecular container, springs loose the "cargo" (alcohol) and you get a martini.

How does creating a powdered alcoholic drink impact its alcohol content?
According to one patent [for “alcohol-containing powder,” filed in 1972 (US 3,795,747)], the dextrin carrier tops out at 60 percent, even in pure alcohol. Part of that has to do with space: Each carrier molecule only has so much room to adsorb [adhere to] ethanol, and this is dependent on size, shape, number of sugars and how dry it was to start.

To continue reading visit http://www.scientificamerican.com/article/what-is-the-big-deal-about-powdered-alcohol/

Whooping Cough on the Rise in California

A Southern California city has seen a spike in reported whooping cough cases so far this year, with the number of infections nearly tripling compared to all of last year, possibly due to a less potent vaccine or lower vaccination rates, officials said on Wednesday.

Some 43 cases of whooping cough, or pertussis, have been documented since January in Long Beach, a city of about 470,000, up from 15 cases reported in all of 2013 and four cases reported in 2012, Long Beach Health Officer Michael Kushner said.

"We've never had so many cases in such a short amount of time," Kushner said.

Whooping cough is a highly contagious bacterial infection that often begins with cold-like symptoms and a mild cough, followed by severe coughing that can last for several weeks.

The infection, which can be treated with antibiotics, is spread through the coughing or sneezing of an infected person. It is especially dangerous for young babies, who can develop pneumonia and other sometimes fatal complications.

Kushner said the rise in whooping cough cases in Long Beach was likely due to a drop in vaccinations or booster shots, a weakened vaccine or infections that are left untreated.

Across the nation, the number of reported whooping cough cases has ballooned since the 1990s, when there were fewer than 10,000 reported infections each year, according to the U.S. Centers for Disease Control and Prevention.

To continue reading this article vist: http://www.foxnews.com/health/2014/04/24/california-city-sees-spike-in-whooping-cough-cases/

Ebola Breakout in Africa

Check out this video below. There are so many amazing volunteers willing to sacrifice their time and risk their lives to serve those infected with the deadly Ebola virus that has infected 112 people in Africa so far. 

Children and Codeine in the ER

Despite recommended limits on codeine use in children, the potent painkiller is prescribed for children in at least half a million emergency room visits each year, a study suggests.

Use of the drug in that setting is hardly rampant — just 3 percent of kids' ER visits resulted in a codeine prescription in 2010, the 10-year study found. But with more than 25 million ER visits by children each year, the authors say far too many kids are getting the drug when better options are available.

THE CONCERNS

Codeine is an opiate drug and a genetic variation makes some people metabolize it too quickly, potentially resulting in dangerous side effects including excessive sleepiness and difficulty breathing. The Food and Drug Administration issued its strictest warning last year about a rare risk for life-threatening complications or death in children given the drug after certain surgeries. It advises using codeine for children's pain only if anticipated benefits outweigh the risks.

Another genetic variation makes the drug ineffective for pain relief in as many as a third of patients. Codeine was once commonly used for coughs, but the American Academy of Pediatrics recommends against that use because of the risks and no evidence it relieves coughs.

THE FINE PRINT

Injuries and respiratory symptoms are the top reasons for children's ER visits. The study authors analyzed 2001-10 national data on ER visits for kids aged 3 to 17. The portion of visits where codeine was prescribed dipped slightly during the study. But the authors estimated the yearly number of codeine visits ranged from almost 560,000 to 877,000. Information on any side effects was not included in the data.

The study was published online Monday in Pediatrics.

WHAT DO DOCTORS SAY?

Dr. Kathleen Neville, a pediatric drug expert at Children's Mercy Hospitals and Clinics in Kansas City, said it's likely the numbers have declined since the study ended, given the FDA's black box warning.

Dr. Bradley Berg, medical director of McLane Children's Clinic in Round Rock, Texas, said some ER doctors may have been unaware of pediatricians' guidelines on limiting codeine's use, or recalled getting the drug themselves as children, when its use was more common, with no ill effects.

Dr. Alfred Sacchetti, a spokesman for the American College of Emergency Physicians, says codeine can be safely used in many children, especially older kids. Children typically are monitored in the ER after getting codeine and would not be sent home with a prescription if they had a bad reaction or it didn't work, he said.

To continue reading visit: http://abcnews.go.com/Health/wireStory/kids-codeine-er-risks-guidelines-23402822

Should We REALLY Eat Those Easter Treats?

Cadbury Creme Eggs, Peeps, Robin's Eggs: We love you. But you pack quite the caloric punch. Figure out what it'll take to burn off those Easter season indulgences before you hit the candy aisle. 

*Calories burned based on a 135-pound woman. 

Cadbury Creme Egg: 150 calories (1 egg) 
This classic Easter treat packs 6 grams of fat and 20 grams of sugar into one little egg. (Thanks, irresistible cream filling!). Indulge, then grab a partner and burn off those cals with a 30-minute game of doubles tennis.

Related: 20 Superfoods For Weight Loss

Original Peeps: 140 calories (5 yellow chicks) The good news here is that Peeps have no fat content —but five of the little guys (a serving size) have 34 grams of sugar (ouch). If you're headed to the gym, hop on the rower — 20 minutes of moderate rowing will burn those cals off.

Milk Chocolate-Covered Peeps: 110 calories (1 chick) These individually wrapped candies get a plus for built-in serving size. And 3 grams of fat and 14 grams of sugar isn't SO bad. Burn off the cals with a 30-minute brisk walk (hey, you can do that during your lunch break).

Related: 6 Moves To Resize Your Butt and Thighs

Cadbury Mini Eggs: 190 calories (12 pieces)
With that coated hard-candy shell and creamy milk chocolate inside, there's really no way to say no to these gems. A dozen pieces is a satisfying serving size, but it packs in 8 grams of fat and 27 grams of sugar. Burn off the calories with a 30-minute run/walk, like one of these non-boring treadmill workouts.

Sweetarts Chicks, Ducks and Bunnies: 50 calories (10 pieces)
Like most fruity candies, these cuties have no fat, although a serving does have 12 grams of sugar. The good news? About 30 minutes of gentle yoga burns nearly 80 calories, so if you have a few more pieces than the serving size (those bunnies are so friggin' adorable!), you're still good.

Related: Look Better Naked

M&Ms Bunny Mix: 210 calories (1.5 ounces or about 1/4 cup) 
Gotta love those pastel colors and bunny ears on these special-edition candies. A small handful has 9 grams of fat and 26 grams of sugar, so put on those running shoes: A 25-minute run at a 12-minute mile pace should burn off those cals.

Hershey's Milk Chocolate Eggs: 200 calories (7 pieces)
There's something so fun about peeling off the pretty foil on these little guys. (We remain hopeful that this action also burns cals, but it's doubtful). Hide seven pieces in an Easter egg and get a surprise that includes 12 grams of fat and 22 grams of sugar. A 30-minute elliptical workout at a moderate pace should burn the cals off.

Whoppers Mini Robin Eggs: 190 calories (24 pieces)
Buy these in handy little milk-carton servings (rather than the grab-all-you-can bags) and you get a bonus for automatic portion control. There are 5 grams of fat and 30 grams of sugar in each box; burn off the cals with a 30-minute cross-country hike.

Snickers Egg: 160 calories (1 egg)
Eating one of these takes you straight back to childhood. Burn off the cals (plus 9 grams of fat and 17 grams of sugar) by taking your exercise regimen back to basics, too: 15 minutes of moderate jumping rope should do the trick.

Reese's Peanut Butter Egg: 170 calories (1 egg) 
Get your peanut butter fix with these individually wrapped eggs; there's 10 grams of fat and 16 grams of sugar in each one (but yay for portion control). It'll take about 35 minutes of moderate aerobics to burn those cals off.

Lifesavers Gummies Bunnies and Eggs: 130 calories (20 pieces) 
Chewy and sweet, these have no fat but 25 grams of sugar per 20-piece serving. Use the opportunity to do some springtime yard work: 25 minutes of it will burn off those cals.

Russell Stover Marshmallow Egg: 110 calories (1 egg)
Remember finding these during Easter Egg hunts? Thanks to the light'n'fluffy 'mallow, each egg has just three grams of fat and 14 grams of sugar. Burn off the cals with 30 minutes of beginner Pilates.

Russell Stover Solid Milk Chocolate Bunny: 240 calories (1 bunny)
We're pretty sure sharing these treats has initiated plenty of sibling rivalry over the years. (Who gets the ears??) Each one has 14 grams of fat and 23 grams of sugar in addition to the 240 calories. Mend fences with said sibling and go on a 30-minute moderate bike ride to burn those cals off.

http://www.foxnews.com/health/2014/04/18/your-favorite-easter-candy-what-will-it-take-to-work-it-off/

12 Million Misdiagnoses?

At least 1 in 20 adults is misdiagnosed in outpatient clinics in the U.S. every year, a new study published in the journal BMJ Quality & Safety indicates.

The research, which analyzed data from three earlier studies, indicated that the misdiagnosis rate among outpatients - patients who receive treatment without being admitted to a hospital - is approximately 5 percent. When translated to the entire population, the researchers estimate that 1 in 20 adults, or 12 million people nationwide are misdiagnosed every year.

“We called it a misdiagnosis when there was a definite missed opportunity to make a timelier, correct diagnosis based on information available at that time,” Dr. Hardeep Singh, a researcher at the Michael E. DeBakey VA Medical Center in Houston, Texas, told FoxNews.com. “We would say, ‘Was that opportunity there? Was evidence there? Was it someone who presented with a red flag for colon cancer, who didn’t get a work up?’”

Singh noted that while much progress has been made in patient safety in hospital settings in recent years, few studies have focused on the outpatient experience.

“In some ways, in outpatient [care], it’s challenging; patients move between different systems of care, specialists, radiologists,” said Singh, who is also an associated professor at Baylor College of Medicine Safety. “We had done studies in integrated health care systems and thought it would be good to extrapolate that data to see how commonly these things are occurring, to see what needs to be done about them. And the numbers were quite telling.”

Utilizing data from three of his previous studies, Singh analyzed outpatient misdiagnosis rates from hundreds of medical records. The first study analyzed misdiagnoses in a primary care setting, and the second and third studies analyzed rates of misdiagnosis among lung cancer and colon cancer patients.

In each case, the researchers were characterizing misdiagnoses as times when patients presented clear symptoms that were either missed by a physician or not properly followed up on. Singh emphasized that “red flags” for disease often develop slowly, and the study only considered a patient to be misdiagnosed when clear symptoms were missed by a physician.

“Time often tells you what the diagnosis would be, and that’s natural,” Singh said.

About half of missed diagnoses have the potential to be harmful to a patient’s health, the researchers noted.

“We basically sort of made a prediction based on the cases, as to what the level of harm would be in worst case scenarios for that patient – if it’s just a minor inconvenience, or if a more severe complication, such as a disability, could have happened,” Singh said.

Though Singh’s research did not delve into the causes of the misdiagnoses, he said many factors can affect whether or not a patient receives proper medical care. Previous research indicated that in the outpatient setting, many breakdowns occur during the information-gathering portion of an appointment, when a physician is taking a patient’s medical history and observing symptoms.

With more research, Singh said he hopes systems can be developed to help doctors and patients ensure that proper diagnoses are made in the outpatient setting.

To continue reading this article visit: http://www.foxnews.com/health/2014/04/17/at-least-1-in-20-outpatients-misdiagnosed-every-year-study-shows/

New Grass Allergy Drug Approved!

Merck (NYSE:MRK), known as MSD outside the United States and Canada, today announced that the U.S. Food and Drug Administration (FDA) has approved GRASTEK^® (Timothy Grass Pollen Allergen Extract) Tablet for Sublingual Use [2800 Bioequivalent Allergy Units (BAU)]. GRASTEK is an allergen extract indicated as immunotherapy for the treatment of grass pollen-induced allergic rhinitis with or without conjunctivitis confirmed by positive skin test or in vitro testing for pollen-specific IgE antibodies for Timothy grass or cross-reactive grass pollens. GRASTEK is approved for use in persons 5 through 65 years of age. GRASTEK is not indicated for the immediate relief of allergic symptoms.

The prescribing information for GRASTEK includes a boxed warning regarding severe allergic reactions. GRASTEK is contraindicated in patients with severe, unstable or uncontrolled asthma; a history of any severe systemic allergic reaction; a history of any severe local reaction after taking any sublingual allergen immunotherapy; a history of eosinophilic esophagitis; or hypersensitivity to any of the inactive ingredients contained in the product.

“Every grass pollen season, many patients with moderate to severe allergic rhinitis experience nasal and ocular allergy symptoms at their worst while taking symptom-relieving medication,” said Dr. David Bernstein, professor of medicine and environmental health, Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine. “These patients often have multiple sensitivities. Some of these patients may be candidates for immunotherapy, but decline allergy shots. With the FDA approval of GRASTEK, allergy specialists now have a new sublingual approach to offer these patients for their grass allergies.”

Symptoms of grass pollen-induced allergic rhinitis with or without conjunctivitis may include sneezing, runny or itchy nose, stuffy or congested nose, or itchy and watery eyes, and typically intensify during the grass pollen season.

“The FDA approval of GRASTEK brings an important new sublingual tablet for allergy specialists treating adults and children with allergic rhinitis with or without conjunctivitis caused by Timothy or cross-reactive grass pollens,” said Dr. Sean Curtis, vice president, Respiratory and Immunology, Merck Research Laboratories. “This important milestone marks another opportunity for Merck to build on our respiratory heritage with allergy specialists.”

See more at: http://www.mercknewsroom.com/news-release/corporate-news/fda-approves-mercks-grastek-timothy-grass-pollen-allergen-extract-sublin#sthash.IWd26Kh5.dpuf

Specialty Drug Costs on the Rise

Even as the cost of prescription drugs has plummeted for many Americans, a small slice of the population is being asked to shoulder more and more of the cost of expensive treatments for diseases like cancer and hepatitis C,according to a report to be released on Tuesday by a major drug research firm.

The findings echo the conclusions of two other reports released last week by major pharmacy benefit managers, which predicted that spending on so-called specialty drugs would continue to rise.

The report, by the IMS Institute for Healthcare Informatics, also found that consumers’ use of health care — visits to the doctor, hospital admissions and prescription drug use — rose in 2013 for the first time in three years, mainly because of the improving economy, it said.

“Following several years of decline, 2013 was striking for the increased use by patients of all parts of the U.S. health care system,” Murray Aitken, executive director of the IMS Institute, said in a statement. He noted that the spike came before the Affordable Care Act, which has helped provide health insurance to millions of new customers, fully went into effect.

But even as consumers became more confident about spending money on health care last year, the report found that a divide is developing between those with medical conditions that can be treated with cheap generic drugs, and those with rare and often more serious diseases that can come with breathtaking price tags.

More than half of prescriptions cost patients, on average, less than $5 in out-of-pocket costs in 2013, and 86 percent of them were filled with generic medicines. Nearly a quarter of all prescriptions — 23 percent — required no out-of-pocket cost at all, an increase that the report’s authors attributed mainly to a requirement in the new health care law that contraceptive drugs be covered free.

On the other hand, those who need the costlier drugs paid disproportionately more. Only 2.3 percent of prescriptions accounted for 30 percent of all out-of-pocket costs, the report found.

Drug companies have increasingly turned to treatments for smaller and more complex diseases as sales of dozens of blockbuster drugs have collapsed in recent years in the face of competition by cheaper generic versions.

In 2013, drug companies debuted 36 new drugs, including 10 notable cancer treatments, the most in more than a decade, the report found. Other significant new drugs on the market included treatments for hepatitis C, multiple sclerosis and diabetes. Pharmaceutical companies began selling 17 drugs last year to treat so-called orphan diseases — those that affect fewer than 200,000 people nationwide.

To continue reading this article visit:  http://www.nytimes.com/2014/04/15/business/prices-soaring-for-specialty-drugs-researchers-find.html?_r=0

Considering Costs When Choosing Treatment Plans

THIS PATIENT could be a time bomb, Dr. Neel Shah thought. A blood test suggested that she might have an ectopic pregnancy, in which a fertilized egg remains outside the uterus. Left untreated, the condition can cause fatal hemorrhaging. But when Shah, a medical resident at the time, told the woman she needed an ultrasound to confirm the result, she refused. An earlier visit to the emergency room for a bout of stomach trouble had left her with an exorbitant bill. Until Shah could tell her how much an ultrasound would cost, she wasn’t budging.

He had no idea what an ultrasound cost, and it took him a day to find out from the hospital. “All the while I was worried she could bleed to death,” Shah says. After telling the woman the test would cost $650, she agreed to be scanned. Shah’s suspicion was confirmed and the woman was successfully treated.

Shah, now an obstetrician at Beth Israel Deaconess Medical Center, tells this story to illustrate what he sees as two entwined realities in modern medicine. One is that doctors often have no idea how much treatments cost. The other is an emerging notion with the potential to change how physicians practice medicine in the United States: that medical costs themselves can harm patients’ health. Shah is part of a growing movement of American doctors who argue that it’s time for physicians to start considering costs in their practice, weighing the toll of medical debt against the benefit of expensive treatments, and talking to their patients directly about money.

His patient was willing to forgo a potentially life-saving procedure because she worried about getting hit with another huge bill. Recent studies have started to document other ways that medical costs harm patients: People struggling with high medical debt often skip important treatments and quit taking prescribed medications. New research also shows that medical debt can lead to diminished quality of life and high levels of psychological distress for both patients and their families.

In America’s current health care debate, any mention of cost-consciousness in the doctor’s office evokes concerns about rationing, denial of care, insurance companies pushing for cheaper over better. Doctors themselves have long embraced an ethical responsibility to advocate for the best possible treatment for their patients, regardless of price, and their patients count on that philosophy to guide their decisions. But Shah and others say that ignoring cost has become a luxury doctors can no longer afford—one that not only contributes to the unsustainable growth of health care budgets, but also can end up damaging patients’ lives. They are asking their colleagues to become aware of how their treatment choices can lead to financial harm—or, as some call it, “financial toxicity,” a new term for the myriad negative effects that high medical costs can have on patients’ well-being.

To continue reading this article visit:  http://www.bostonglobe.com/ideas/2014/04/12/should-doctors-consider-medical-costs/GPJM1h30qtz6zpfzrxQGoL/story.html

Children and Seasonal Allergies

It's spring time! While that means we get to pack up our boots and scarves for the season and dust off the lawnmowers, it also means it's the start of allergy season. Allergic rhinitis, or hay fever, is estimated to affect between 10 and 30% of adults and up to 40% of all children. For this population, spring can be a miserable time. 

While we don't want to watch our children suffer from itch eyes, runny noses, stuffy noses and other allergy symptoms, we need to be very careful when giving them allergy medications. Watch the video below for some advice on how to give medications to your children and what age is appropriate.

There are many available allergy medicines for children such as Benadryl (diphenhydramine), Claritin (loratadine), Zytec (ceterizine) and Allegra (fexofenadine). What works for one child may not always work for another and the dosing can be very different.

These are just a few things to keep in mind as we hop into spring and this beautiful weather!

National Prescription Take Back Day

National Prescription Take Back Day is just around the corner!

The Big Day is Saturday April 26, 2014

With the warm weather many of us are itching to get outside, clean out our flowerbeds and get some spring cleaning done. Why not add one more area to clean out to your list--your medicine cabinet. Many local police departments, pharmacies and other community gathering places are participating in National Take Back day. Click on the link below to find the closest place to you.

http://www.deadiversion.usdoj.gov/drug_disposal/takeback/

Prescription and Over-the-Counter medications that are unused, old, or expired are being collected at these drop sites. You may ask, why can't I just throw them in the trash or flush them down the toilet?

1. Throwing your medicine in the trash can potentially lead to accidental poisonings of young children or pets.
2. Flushing medicines down the toilet can be potentially harmful for the environment and can lead to water contamination--not to mention if you flush enough they may clog your toilet!


Prescription drug abuse is on the rise among the teen and young adult population. The most common place they find prescription medications are family and friend's medicine cabinets. All medicines should be stored securely and in a non-conspicuous place whether they are being used or they are expired.

Accidental ingestion of prescription medication by children can also occur due to lack of proper storage or disposal of medications. The most common person a child finds medicine with is a grandparent, whether in their house, their purse, or coat pocket.


The reasons to participate in National Take Back Day are endless and they are so important! Tell your friends and family. Check the expiration date on all of your pain medicines, cold medicines, cough syrup and prescription medications. I bet you'll be surprised!

Combination Pain Medications

When it comes to the use of hydrocodone-combination products in the treatment of chronic pain, federal regulators think patients need to be protected from themselves—and the physicians who treat them.

At least that’s what some in the health care community have accused the FDA and Drug Enforcement Administration (DEA) of thinking after the agencies’ joint proposal to reclassify combination products that include the opioid analgesic from Schedule III to Schedule II controlled substances. Combination products such as hydrocodone-acetaminophen are among the most prescribed medications in the United States, despite concerns regarding the potential for abuse, misuse and addiction of opioids. Pure hydrocodone is already a Schedule II substance, as are methadone and oxycodone.

The DEA and FDA first proposed the change in October 2013, and their recommendation was endorsed by the Department of Health and Human Services in December. According to DEA spokesperson Barbara Carreno, at press time, the agency was “in the process of drafting the notice of proposed rulemaking,” which is the first step in making a schedule change for a drug under the Controlled Substances Act. The notice will then have to be published in the Federal Register, at which time the DEA will begin to collect public comments on the matter.

“DEA is concerned about the safety of how hydrocodone is used,” Ms. Carreno said. She would not “speculate on how long [the process] will take,” but the schedule change will likely not take effect for several months, if at all. In other words, those opposed still have the opportunity to have their voices heard; however, they may be swimming against the tide, given that opinion among the relevant government agencies is unified.

To continue reading visit: http://www.painmedicinenews.com/ViewArticle.aspx?d=Clinical%2BPain%2BMedicine&d_id=82&i=April+2014&i_id=1049&a_id=26198

Is Aspirin Being Recommended During Pregnancy?

A federal task force recommended Monday that some pregnant women take low-dose aspirin daily to avoid getting preeclampsia, a condition that can lead to preterm birth and other complications.

Aspirin in general isn't recommended during pregnancy because it can contribute to maternal and fetal bleeding. However, low-dose aspirin is sometimes prescribed for pregnant women with certain health conditions.

The recommendation by the U.S. Preventive Services Task Force comes after the nation's biggest obstetrics association issued similar advice last fall.

The task force said Monday that women who have had preeclampsia during previous pregnancies should take a pill of 81 milligrams—often called "baby aspirin"—each day after the 12th week of pregnancy. The recommendation applies to pregnant women whose doctors consider them at high risk for the condition, as long as they haven't had previous bad medical experiences with aspirin.

Preeclampsia affects about 4% of pregnant women in the U.S., and is most often managed with drugs and other medical therapy. Yet "it is actually one of the more common conditions that lead to complications in the mother and baby," said Michael L. LeFevre, chairman of the federal task force.

Preeclampsia symptoms include high blood pressure, protein in the urine and fluid retention. It can lead to preterm birth and, in a small fraction of cases, it can progress to eclampsia, which results in seizures and coma.

Dr. LeFevre said those considered at high risk for the condition would include women with at least one experience of preeclampsia during pregnancy, and particularly any women whose previous preeclampsia led to bad medical outcomes.

The recommended amount of aspirin is the dosage often prescribed for patients at moderately increased risk of a heart attack.

To continue reading this article visit: http://online.wsj.com/news/articles/SB10001424052702304819004579487950951574012

Measles on the Rise Possibly Due to Anti-Vaccination Movement

A shocking 49 measles cases have been reported in California to date in 2014, up from only four at this same time last year.

The outbreak is reigniting public health concerns over the anti-vaccination movement; while releasing its data at the end of March, the California Department of Public Health urged residents to consider the startling outbreak’s implications.

“This dramatic jump in the number of measles cases is a reminder to get fully vaccinated,” Dr. Ron Chapman, CDPH director and state health officer, said in a statement. “Being fully vaccinated against measles does more than just protect the person who receives the vaccination -- it also protects their family and friends, including children who may be too young to be vaccinated.”

Despite it being only three months into 2014, this is the first year that the number of measles cases in California has surpassed 40 since 2000, when the highly contagious disease was declared eradicated in the U.S., KQED reports.

Affected Northern California counties include Alameda, Contra Costa, Santa Clara and San Mateo, but a staggering 21 cases have been reported in Orange County, home to many affluent communities where anti-vaccination clusters tend to flourish, OC Weekly reports. California is one of 19 states that allow personal belief exemptions from school immunization requirements, and exemptions filed for the county's incoming kindergarteners rose 20 percent from fall 2012 to fall 2013, compared to a 15 increase across the state, according to the Orange County Register.

“The fact that there is... an anti-vaccine movement questioning the importance, the utility of getting the [measles, mumps, and rubella (MMR) vaccine] dose, means that from our side, you never look forward to these events,” Dr. Matt Zahn of the county’s Health Care Agency told the Register.

“These events are the last thing you want to have happen. At the same time, it is worth mentioning to people: This is why you have to get your MMR. This is why this vaccine is important. These outbreaks can be prevented.”

According to the Centers for Disease Control and Prevention, measles is a respiratory disease that causes fever, runny nose, cough and a full-body rash. In extreme cases, it can lead to death and cause pregnant women to miscarry or deliver prematurely.

Liquid Nicotine Linked to Increasing Number of Poisonings

THURSDAY, April 3, 2014 (HealthDay News) -- The number of calls to poison control centers for nicotine poisoning from e-cigarettes has risen dramatically in recent years, U.S. health officials reported Thursday.

Calls related to poisoning from the liquid nicotine used in these devices were running at a rate of roughly one a month in 2010, but jumped to 215 in February of this year, according to the U.S. Centers for Disease Control and Prevention.

Even more troubling, more than half (51 percent) of the poison calls involved children aged 5 and younger, while 42 percent involved people aged 20 and older.

"The time has come to start thinking about what we can do to keep this from turning into an even worse public health problem," said Dr. Tim McAfee, director of the CDC's Office on Smoking and Health.

He added that many people are not aware that liquid nicotine is toxic. "We need to make sure we can avert the possibility of an unintended death from nicotine poisoning," he said.

"We have not had an unintentional poisoning death from e-cigarettes yet in the United States that we know of, but the potential is there given the amount of concentrated nicotine in these solutions -- it would not take a lot for a child death to occur," McAfee noted.

CDC director Dr. Tom Frieden noted in a news release that e-cigarettes are particularly attractive to kids because they come in candy and fruit flavors.

Dr. Vincenzo Maniaci, an emergency medicine specialist at Miami Children's Hospital, agreed that the danger to children is real.

"The concentration of nicotine in these solutions is significant and they need to be made childproof and regulated," Maniaci said. "Especially for kids under the age of 5, this amount of nicotine can be fatal."

McAfee noted that the U.S. Food and Drug Administration is planning to propose regulations for e-cigarettes. He added that he hopes these regulations will include how the product is packaged, including childproof caps and warning labels.

"These things can be hardwired into these products, rather than being left to the whim of the manufacturer," he said.

In the meantime, McAfee advised keeping these devices, and their refills, out of the reach of children.

"These should be treated with the same caution one would use for bleach. In some ways, this is more toxic than bleach," he said.

To continue reading this article visit: http://www.webmd.com/smoking-cessation/news/20140403/nicotine-in-e-cigarettes-a-growing-public-health-threat-cdc-says