Patients of the new millennium have a strong desire for quick information and the Internet has made this incredibly convenient. One no longer needs to be on a desktop computer with increasingly popular wireless access via cell phones or the more common iPhone available. According to the Pew Internet & American Life Project, 83 percent of Internet users have looked online for health information. Any patient is now empowered to search online anytime, from anywhere, for valuable and sometimes critical information to help them learn about a medical condition or symptom and to search for viable options. The health concern may or may not be life-changing, but patients quickly want to learn their choices to help them reduce anxiety or allow them to plan ahead. They no longer have to wait for a medical appointment to obtain complex answers from their doctor rather they can quickly gain the necessary knowledge online to help them make an informed decision. The fact is that the Internet provides instant answers with options to empower the patient so that the least to the most educated patient can readily weigh the information. The question may not always be convenient, but the Internet sure is. This is a powerful pill.
Although the Internet is certainly convenient for the most sought after medical information such as herpes, pregnancy, depression, heart disease and breast cancer, many useful websites offer information only in English. Globally, millions of Internet users who seek health information are non-English speaking and speak an array of other languages. English-only sites that are well-intended may be counter-productive for those who speak other languages and could result in frustration, anxiety and fear. Language barriers pose challenges, prevent effective communication and remove the possibility of learning. This is the opposite of empowerment. People who speak other languages should be able to access valuable health information in their native language and gain the capacity to explore options. Why not give everyone a shot at this pill? Why not make it convenient for all?
(MUR)
Friday, November 12, 2010
Tuesday, September 28, 2010
Is a signature enough?
GlaxoSmithKline’s diabetes drug, Avandia has been under intense scrutiny recently. According to a study by cardiologist, Dr. Steven Nissen and Kathy Wolski, published in the New England Journal of Medicine, the drug increases the risk of heart attack by 43% and increases the risk of dying from cardiovascular causes by 64%.
In Europe, the European Medicines Agency has banned its use. In the US, however, the FDA has decided to keep Avandia available to patients. The FDA argues study data is not strong enough to remove it from the market. It currently requires restricted access under a risk evaluation and mitigation strategy (REMS). As such, patients currently taking Avandia who feel they are benefiting from the drug may continue taking it upon signing a consent form acknowledging the potential risks associated with the drug. The strategy only allows new patients to take the medication if it is truly the only option available to them to control their glucose levels, and again, upon signing a consent form.
"Patients will only be allowed to use [Avandia] if they acknowledge and document the risk of this drug," said Dr. Joshua Sharfstein, FDA principal deputy commissioner.
In essence, the FDA has pushed the responsibility of determining if risk outweighs reward to the patient and their doctor. We would argue the signing of the consent form shifts much of this responsibility to the patient, relinquishing the doctor and the manufacturer of liability. They were told the risks, they signed the form, what happens next is on the patient.
In a case where your risks include heart attack, stroke or even death, is simply signing a written consent enough? Shouldn’t there also be a check for actual understanding? A panelist on the FDA advisory committee, a researcher from Duke, Ruth Day, suggested patients should be required to take a quiz to check for understanding.
We would agree. Here is the reality: A patient sits in an exam room as a doctor rattles off a laundry list of “potential risks.” The eyes glaze over a little, there is a lot of nodding and affirmative responses. A doctor whom they trust implicitly says “sign here” and voila, consent is given. Is that true understanding? Especially in patients for whom English is not their first language, how do you know they really understand? Would it be wrong to make the patient run it back?
Taking this medication can cause which of the following side effects?
a) purple fingernails
b) bulging eyeballs
c) heart attack, stroke or possibly death
d) all of the above?
If doctors and the FDA are going to put the responsibility of the risk of death onto the patient, shouldn’t they be responsible for ensuring patients fully and clearly understand that responsibility?
Tuesday, May 18, 2010
Cuidado! Do you know?
On or about the first of May a warning went out to medicating parents everywhere: put down the children’s liquid medications. Cries of “but how will I get my kids to sleep tonight!” were heard across the country as viewers saw the warning on the CBS Evening News Bloomberg News and CNN, online over MedPage Today, HealthDay and WebMD and read about it in publications like the NY Times, Wall Street Journal, Chicago Tribune and the Washington Post.
The recall of pediatric formulations of children’s Tylenol, Motrin, Zyrtec and Benadryl was voluntary and mandated because of manufacturing deficiencies in the plant where the medicines were made. Consumers were advised “to stop using the medicine as a precaution.” Any children taking the recalled medicines and exhibiting “unexpected symptoms” were urged to contact a healthcare professional.
People in the healthcare industry love a good study, both clinical and academic. Here’s a suggestion for a study we’d like to see. In the United States, packaging for over the counter medicines is mostly printed in English. That’s fine. English is official language of the United States and most non-English speaking parents can probably go to the drug store and piece together the English they know to pick out pain relief medicine for their children.
What about this recall? Was information about the recall presented in other languages and to what degree?
How many non-English speakers are purchasers of these liquid children’s medications and what was the customer service rate of inquiry for non-English speakers for the recall? Do non-English speakers even realize there was a recall? Is the Russian mother of three who buses tables at the restaurant around the corner reading the NY Times and watching CNN? How do non-English speakers know to stop taking these medicines?
The recall of pediatric formulations of children’s Tylenol, Motrin, Zyrtec and Benadryl was voluntary and mandated because of manufacturing deficiencies in the plant where the medicines were made. Consumers were advised “to stop using the medicine as a precaution.” Any children taking the recalled medicines and exhibiting “unexpected symptoms” were urged to contact a healthcare professional.
People in the healthcare industry love a good study, both clinical and academic. Here’s a suggestion for a study we’d like to see. In the United States, packaging for over the counter medicines is mostly printed in English. That’s fine. English is official language of the United States and most non-English speaking parents can probably go to the drug store and piece together the English they know to pick out pain relief medicine for their children.
What about this recall? Was information about the recall presented in other languages and to what degree?
How many non-English speakers are purchasers of these liquid children’s medications and what was the customer service rate of inquiry for non-English speakers for the recall? Do non-English speakers even realize there was a recall? Is the Russian mother of three who buses tables at the restaurant around the corner reading the NY Times and watching CNN? How do non-English speakers know to stop taking these medicines?
Wednesday, April 21, 2010
More Than a Hangover
January’s post, I Know Not What I Pour, noted how excessive alcohol consumption may not be a conscious decision and can affect your health. There is further evidence that heavy alcohol consumption yields more than a hangover the next morning. An NHS Confederation report from this year states hospital and ambulance costs associated with treating heavy drinkers in the UK have doubled over the past five years.
According to Professor Ian Gilmore, President of the Royal College of Physicians, “The nation’s growing addiction to alcohol is putting an immense strain on health services, especially in hospitals, costing the NHS over ₤2.7 billion each year. This burden is no longer sustainable.”
According to Steve Barnett, chief executive of the NHS Confederation, “This report shows that not only are we drinking too much but that the cost to our health services is increasing.” He notes that of 18 people, who are addicted to alcohol, only 1 receives treatment. He believes more needs to be done to effectively identify, assess, and treat patients and calls for a “reappraisal” of social and cultural attitudes towards drinking.
The International Center for Alcohol Policies (ICAP) would agree. In 2008, they sponsored a focus group centered study on alcohol consumption in Europe, Brazil, China, Nigeria, Russia, and South Africa. As reported in the September 23, 2008 issue of Science Daily, they found “cultural influences are a dominant factor in youth attitudes about drinking and drunkenness.”
Attitudes towards drinking varied by country and the lower rates of heavy drinking were found in Mediterranean countries versus heavy drinking rates in Northern Europe (including the UK.) For some countries, Spain, Italy and France for example, drinking moderately on a daily basis is a way of life.
It will take a little more than a Bloody Mary and a bottle of Advil to cure this hangover. Whether you drink or not, the increasing costs associated with caring for those who do will be passed on to everyone. The answer will lie in doing more than simply identifying and treating patients addicted to alcohol. To be effective, preventative measures able to change attitudes towards drinking need to be implemented. These preventative measures can only be effective if they are based on an awareness of the cultural factors contributing to the high levels of alcohol consumption in the first place.
Want to know more about the ICAP study? No sweat! They wrote a book about it: Swimming with Crocodiles: The Culture of Extreme Drinking.
According to Professor Ian Gilmore, President of the Royal College of Physicians, “The nation’s growing addiction to alcohol is putting an immense strain on health services, especially in hospitals, costing the NHS over ₤2.7 billion each year. This burden is no longer sustainable.”
According to Steve Barnett, chief executive of the NHS Confederation, “This report shows that not only are we drinking too much but that the cost to our health services is increasing.” He notes that of 18 people, who are addicted to alcohol, only 1 receives treatment. He believes more needs to be done to effectively identify, assess, and treat patients and calls for a “reappraisal” of social and cultural attitudes towards drinking.
The International Center for Alcohol Policies (ICAP) would agree. In 2008, they sponsored a focus group centered study on alcohol consumption in Europe, Brazil, China, Nigeria, Russia, and South Africa. As reported in the September 23, 2008 issue of Science Daily, they found “cultural influences are a dominant factor in youth attitudes about drinking and drunkenness.”
Attitudes towards drinking varied by country and the lower rates of heavy drinking were found in Mediterranean countries versus heavy drinking rates in Northern Europe (including the UK.) For some countries, Spain, Italy and France for example, drinking moderately on a daily basis is a way of life.
It will take a little more than a Bloody Mary and a bottle of Advil to cure this hangover. Whether you drink or not, the increasing costs associated with caring for those who do will be passed on to everyone. The answer will lie in doing more than simply identifying and treating patients addicted to alcohol. To be effective, preventative measures able to change attitudes towards drinking need to be implemented. These preventative measures can only be effective if they are based on an awareness of the cultural factors contributing to the high levels of alcohol consumption in the first place.
Want to know more about the ICAP study? No sweat! They wrote a book about it: Swimming with Crocodiles: The Culture of Extreme Drinking.
Tuesday, April 13, 2010
Branded Generics?
Our last blog discussed the rise in popularity of generic prescription drugs domestically without mentioning their status overseas. Since most consumers outside the US market pay for drugs out of pocket and cannot afford expensive name brands, generics are very popular internationally. With the drop in brand name drug market share domestically, pharmaceutical companies are more than willing to fill this desire for low cost drugs.
Emerging markets are set to overtake US markets in overall sales. Pharmaceutical revenue in China in particular, with its current strides towards universal health coverage and improving its healthcare infrastructure, is predicted to double by 2013. Much of the growth in emerging markets (i.e., China, Brazil, Russia and India) is driven by low-cost generic drugs.
As a result, many pharmaceutical companies are now hawking branded generic drugs in overseas markets. While the term “branded generic” may seem at odds, it is actually becoming quite a lucrative market.
Americans, because they have been “brand washed” so extensively, tend to view generic drugs as lower in quality than brand name products, despite containing the same active ingredients. Marketed to less extensively, overseas populations are less biased against lower cost, generic formulations.
Branded generics make sense. There is no additional cost for a company to attach their company name to a generic formula, instilling consumer confidence in a less expensive formulation without adding millions in cost to marketing and promoting a specific brand name.
Companies approach this tactic differently. Some associate their main brand with the generic, while others purchase local overseas generic companies to sell their products under a different name.
“We are able to create different tiers of products at prices they haven’t previously seen with our stamp of approval,” Andrew P. Witty, the chief executive of GlaxoSmithKline told the NY Times.
According to the same article, “It definitely represents a change in thinking,” said David Simmons, the president of Pfizer’s established products business unit, whose company has already added over 200 generic products to its portfolio.
Emerging markets are set to overtake US markets in overall sales. Pharmaceutical revenue in China in particular, with its current strides towards universal health coverage and improving its healthcare infrastructure, is predicted to double by 2013. Much of the growth in emerging markets (i.e., China, Brazil, Russia and India) is driven by low-cost generic drugs.
As a result, many pharmaceutical companies are now hawking branded generic drugs in overseas markets. While the term “branded generic” may seem at odds, it is actually becoming quite a lucrative market.
Americans, because they have been “brand washed” so extensively, tend to view generic drugs as lower in quality than brand name products, despite containing the same active ingredients. Marketed to less extensively, overseas populations are less biased against lower cost, generic formulations.
Branded generics make sense. There is no additional cost for a company to attach their company name to a generic formula, instilling consumer confidence in a less expensive formulation without adding millions in cost to marketing and promoting a specific brand name.
Companies approach this tactic differently. Some associate their main brand with the generic, while others purchase local overseas generic companies to sell their products under a different name.
“We are able to create different tiers of products at prices they haven’t previously seen with our stamp of approval,” Andrew P. Witty, the chief executive of GlaxoSmithKline told the NY Times.
According to the same article, “It definitely represents a change in thinking,” said David Simmons, the president of Pfizer’s established products business unit, whose company has already added over 200 generic products to its portfolio.
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