Drug Makers Agree to Voluntary Ban on Doctor 'Freebies'
The pharmaceutical industry has agreed to a voluntary moratorium on giving doctors branded items that advertise some of the country's most prescribed drugs, The New York Times reported.
Starting Jan. 1, doctors will see supplies of trinkets such as Viagra pens, Zoloft soap dispensers and Lipitor mugs cut off in a move that proponents of the moratorium say is a step toward eliminating influencing doctors' prescribing habits. But skeptics say the move is only a superficial measure, doing little to curb the far larger amounts of money that big drug companies spend to try to influence physicians.
About 40 drug makers, including Eli Lilly & Company, Johnson & Johnson, and Pfizer have signed on to the code, the Times reported.
Drawn up by the Pharmaceutical Research and Manufacturers of America, the new code bars companies from giving doctors branded pens, staplers, flash drives, paperweights, calculators and the like, the Times said. The new guidelines reiterate the group's 2002 code, which prohibited firms from giving physicians expensive gifts such as tickets to sporting events or resort stays, and asked drug companies that finance medical courses, conferences or scholarships to let independent experts choose study materials and scholarship recipients.
In a statement, Diane Bieri, executive vice president of the manufacturers' group, said the updated guidelines were not an admission that gifts could influence doctors, but were meant to emphasize the educational nature of the industry-doctor relationship, the newspaper said.
The drug that turned around the sex lives of many older men has proven in a small trial to also help women on antidepressants who experience sexual dysfunction.
The eight-week study found that Viagra, also known as sildenafil, helped women achieve orgasm.
"In this study population, sildenafil treatment of sexual dysfunction in women taking SRIs was associated with a reduction in adverse sexual effects," the study's authors wrote.
Results of the study are in the July 23/30 issue of the Journal of the American Medical Association. The lead author of the study, Dr. H. George Nurnberg, of the University of New Mexico School of Medicine, in Albuquerque, declined to be interviewed for this article.
Selective and nonselective serotonin reuptake inhibitors, such as Prozac, Paxil, Zoloft and Effexor, comprise up to 90 percent of the 180 million antidepressant prescriptions filled in the United States each year, according to the study. But while these medications are very effective at treating clinical depression, one of their known drawbacks are sexual side effects.
Nurnberg and his colleagues previously reported in the Journal of Clinical Psychiatry, that Viagra was helpful for men who suffered from erectile dysfunction associated with the use of antidepressant medications.
In the current study, undertaken at seven research centers, they turned their attention to women. The study included 98 women -- half of whom received Viagra and half who received a placebo -- who were told to take the pills before sexual activity.
Women taking Viagra reported an improved ability to reach orgasm and increased orgasm satisfaction, according to the study authors.
But 43 percent of the women taking Viagra also reported headaches, versus 27 percent of those on placebo. Almost one-quarter of those using Viagra reporting flushing, while none of the women on placebo did. And 37 percent of women taking Viagra reported nasal congestion compared to 6 percent of women on placebo. Nausea and anxiousness were reported more often in the group taking placebo.
"The libido response in women is such a complex problem. If women are unhappy in a relationship, it can affect libido. If it hurts, it can affect libido. If she doesn't feel good about herself, it can affect libido. It's hard to tease all of those factors out," said Dr. Judi Chervenak, a reproductive endocrinologist at Montefiore Medical Center in New York City.
When it comes to sex, grandma and grandpa are having more of it these days, new Swedish research suggests.
According to the study, the last quarter century has seen a dramatic rise in the frequency of sex among the 70-year-old set, whether married or unmarried. And as an added bonus, seniors today (particularly women) say they're much more satisfied with their liaisons than the previous generation -- facing less sexual dysfunction and feeling more positive about the experience.
"Our study shows that a large majority of elderly consider sexual activity and sexual feelings a natural part of late life," said study author Nils Beckman, a doctoral candidate with the neuropsychiatric epidemiology unit at the Institute of Neuroscience and Physiology at Gothenburg University. "It is thus important that health professionals and others take sexuality into consideration, irrespective of age."
The findings are reported online in the British Medical Journal.
Beckman and his team reviewed surveys concerning sexual behavior and attitudes that had been completed by more than 1,500 healthy 70-year-old Gothenburg residents over a 30-year period.
The polls had been conducted in 1971-1972, 1976-1977, 1992-1993, and 2000-2001.
Between the first survey and the last, the frequency of sexual intercourse was found to have increased among all groups. Among married men, 68 percent said they were engaging in the practice in the latest poll, compared with 52 percent in 1971, while among married women the number had risen from 38 percent to 56 percent.
Among unmarried men, the jump went from 30 percent to 54 percent in the same 30-year span, while among unmarried women the observed bump was from just under 1 percent to 12 percent.
Women seemed to make the most headway in terms of increasing their sexual satisfaction. While men expressed more positive attitudes about sex in 1971, by 2001 the gender difference had evaporated.
As well, more 21st-century women said they were highly satisfied with their sex; fewer said they had low satisfaction; more said they experienced an orgasm during sex; and fewer said they had never had an orgasm.
Regarding the degree to which the respondents said they felt "very happy" about their relationship, the three-decade trend also moved in a similarly positive direction for both genders: rising from 40 percent to 57 percent among men, and from 35 percent to 52 percent among women.
Beckman and his colleagues speculated that, in part, the findings might simply reflect the degree to which Western societies have become more comfortable in dealing with sexual matters frankly and openly -- perhaps leading to a greater willingness to honestly report sexual encounters.
"(And) maybe it has become more permissible to leave an unhappy marriage today," suggested Beckman. "And even for widows [and] widowers to establish new relations."
Whatever the explanation, S. Jay Olshansky, a professor of public health and senior research scientist at the Center on Aging at the University of Illinois at Chicago (UIC), said the findings closely mirror the results of similar research conducted at UIC and elsewhere.
"Probably the addressing of physiological problems with the development of medications like Viagra explain some -- but not all -- of the upward sexual activity trend," he said. "But the most important point being made here is that when it comes to sex, clearly it doesn't matter what age you are. At least most men and many women still have a desire to have it as they age."
Weight Loss After Diabetes Diagnosis Offers Big Benefits: Study
Newly diagnosed type 2 diabetics who lose weight soon after their diagnosis gain better control of their blood pressure and blood sugar, a benefit that lasts even if they regain that weight.
"If you lose weight after diagnosis, you can achieve some long-term benefits in terms of blood pressure and glycemic control that extend even beyond the point at which you regain weight," said Gregory A. Nichols, co-author of new research published online Aug. 12 in the journal Diabetes Care.
Added Dr. Spyros Mezitis, an endocrinologist with Lenox Hill Hospital in New York City: "We haven't had results like this before. This is telling us that with a significant mean weight loss of 10.7 kilograms [23.5 pounds] in 18 months, there's an improvement despite weight regain after 36 months."
More than 20 million Americans now have type 2 diabetes, and the majority are either overweight or obese.
Studies have shown that weight loss is important to maintain blood-sugar and blood-pressure control, as well as to keep cholesterol levels in check. These parameters, in turn, are critical for avoiding the long-term complications of diabetes, such as heart disease, blindness, kidney damage, amputations and even death.
Nichols, an investigator with the Kaiser Permanente Center for Health Research in Portland, Ore., and his team looked at electronic medical records, spanning 1997 to 2002, for 2,574 patients aged 21 through 75 who had been recently diagnosed with type 2 diabetes. The participants were grouped into weight loss categories and followed for four years.
Just over 12 percent of the participants were in the "weight loss" group, with a mean weight loss of more than 25 pounds. Almost all of those pounds were regained by 36 months. The other groups were labeled as "higher stable weight," "lower stable weight" or "weight gain."
Patients who lost weight were more likely to reach blood pressure and blood sugar targets during the fourth year, although, by then, they had regained the weight.
The researchers acknowledged, however, that they don't know what happens after the four-year mark, and they don't know why the benefit was sustained. "It's entirely possible that one of the explanations here is that if we looked at 15 years, we wouldn't find that benefit continuing," Nichols said.
Nichols and his colleagues hope to explore a number of other questions, including whether there was a difference in benefit between people who regained weight and those who kept it off.
Whatever the final answers, "losing weight is a good idea, even if you regain it," Nichols said.
Said Mezitis: "We do ask that those diabetics who are overweight lose weight, and that, in general, improves all the factors that affect vascular disease, and that's blood pressure, blood sugar and cholesterol."
FDA Warns Consumers About Tainted Weight Loss Pills
In April 2008 , GSK Consumer Healthcare along with the American Dietetic Association, The Obesity Society and Shaping America's Health jointly filed with the FDA a Citizen Petition asking, among other things, to require that manufacturers of dietary weight loss products submit their scientific evidence behind weight loss claims to the FDA for review prior to making those claims.
"Weight loss is one of the top New Year's resolutions for many people but it is often a difficult resolution to keep. GSK Consumer Healthcare is pleased to offer the only FDA approved over-the-counter aid to help consumers lose weight safely and improve their lives. When consumers use alli, they can rest assured that the product has been thoroughly tested and proven to be safe and effective. That's a commitment we've made to consumers and one we intend to keep," said Karen Scollick , Vice President, Behavioral Sciences Business Unit for GSK Consumer Healthcare.
alli, marketed by GSK Consumer Healthcare, is the only FDA-approved weight-loss product available to overweight adults, 18 years or older, without a prescription that has been proven to be both safe and effective. No other weight loss product sold directly to consumers has the same scientific rigor behind it as alli.
alli is proven to help people lose 50% more weight than dieting alone. alli works with any low-fat reduced calorie diet. alli is more than a pill, it is also a program that includes lifestyle changes such as physical exercise for optimal results. The program encourages gradual weight loss which experts recommend as the healthiest and most successful way to lose weight. Resources to support the user's weight loss program include the allicircles message board and website on which experts and other users share advice and experiences.
New research shows that obese people who have asthma are nearly five times more likely to be hospitalized for the problem and to have lower quality of life and worse control of the disease than those with asthma who are normal weight.
Researchers from Kaiser Permanente, Massachusetts General Hospital and Harvard Medical School evaluated 1,113 adults with asthma, all members of Kaiser, in Oregon, Washington or Colorado.
They asked the patients about their weight, height, smoking habits, other illness, asthma treatment and their quality of life associated with asthma, as well as their asthma control and any hospitalizations related to the condition. They also computed their body-mass index (BMI).
"Even accounting for all of those factors, there was a pretty dramatic difference for obese asthmatics versus non-obese asthmatics," said study authors Dr. Michael Schatz, chief of the department of allergy at Kaiser Permanente, San Diego, and a clinical professor of medicine at the University of California, San Diego, School of Medicine.
"The most severe was a nearly five times greater risk for being hospitalized for asthma in the prior year," Schatz said. Obesity was defined as having a BMI of 30 or above.
Boys may be more likely to have childhood asthma than girls, but they are also more likely to grow out of it, a new study says.
The report, published in the second August issue of the American Journal of Respiratory and Critical Care Medicine, found that boys also have fewer asthma occurrences in the post-pubertal years.
The study tracked more than 1,000 children, ages 5 to 12, with mild to moderate persistent asthma over nine years. Each child received an annual spirometric testing with methacholine challenges to quantify their airway responsiveness (AR).
After an average of 8.6 years, boys became increasingly tolerant over time to larger and larger doses of methacholine, which provokes airway constriction, suggesting a possible decrease in disease severity. By age 16, it took more than twice as much methacholine to provoke a 20 percent constriction in the boys' airway on average as it did with the girls'.
Over the years, the girls' reactivity did not change markedly. By age 18, only 14 percent of the girls showed no significant degree of airways responsiveness, compared to 27 percent of boys.
If your child gets migraine headaches, the American Academy of Family Physicians offers these suggestions to help prevent them:
Make sure your child eats meals on a regular schedule, and never skips a meal.
Keep your child on a regular sleep schedule.
Make sure your child gets daily exercise, but don't overdo it.
Figure out what triggers migraines in your child, and try to avoid those factors. Common triggers include stress, too much intense exercise, or changes in weather or altitude.
Avoid foods that are known to trigger your child's migraines. Popular culinary causes include: cheese, processed meats, chocolate, caffeine, nuts, pickles and foods high in the preservative monosodium glutamate (MSG).
Antibiotics Effective for Vaginal Injury After Childbirth
Antibiotics can make a big difference in the healing of vaginal tissues damaged during childbirth, a new study finds.
Severe vaginal tears occur during childbirth in up to 20 percent of women, but those receiving antibiotics in the study had a third as many infections or other healing complications two weeks after the tears were surgically repaired following the delivery.
"Recovery from these tears can be painful and problematic," study co-author Dr. Yasser El-Sayed, associate chief of maternal-fetal medicine at the Stanford University School of Medicine, said in a prepared statement. "If you add an infection, or a breakdown of the surrounding tissues, it's a huge burden on the emotional and physical well-being of a new mother."
The findings were published in the June issue of Obstetrics & Gynecology.
In the study, only four of 49 patients (8.2 percent) treated with antibiotics had symptoms of infection or tissue breakdown two weeks after the repair compared with 14 of 58 patients (24.1 percent) who received a placebo.
While the study was relatively small, the researchers said a significant difference in outcome was found, and this should clear up the debate by physicians as to whether antibiotics are helpful in these instances.
Antibiotics can help you recover from a bacterial infection, but they offer no medical benefit against viruses.
Prescribing an antibiotic for an viral illness, in fact, isn't a good idea. Overuse of these medicines can make the bacteria in your body resistant to the drugs. The medicines then lose their effectiveness, making a bacterial illness harder to treat.
The American Academy of Family Physicians lists these illnesses that are often treated with an antibiotic, and a few that don't need the medication:
Colds and flu are caused by viruses, and won't respond to antibiotics.
Cough and bronchitis are usually caused by viruses. However, people with chronic lung problems or those who have a cough that lasts a long time may need antibiotics.
While a regular sore throat is caused by a virus, strep throat is a bacterial infection that requires antibiotic treatment.
Ear and sinus infections should be evaluated by a doctor, since many are caused by bacteria, while others are viral.
Rheumatoid arthritis is a chronic autoimmune disease that affects the joints. Remedies may include lifestyle changes, medication and surgery designed to help control pain and minimize joint damage.
The U.S. National Library of Medicine offers this list of possible treatments for rheumatoid arthritis:
Range-of-motion exercises and other exercise routines devised by a physical therapist can help prevent or delay joint damage.
Splints, braces and other supportive devices can help protect the joints.
Heat or cold treatments can help ease pain and inflammation.
Working with a physical therapist can help you learn how to protect your joints during daily activities and tasks, and how to use your joints when your arthritis is causing pain.
Getting at least eight hours sleep at night and taking frequent rests during strenuous activities are recommended to ease joint stress.
New recommendations for the use of disease-modifying anti-rheumatic drugs (DMARDs) in the treatment of rheumatoid arthritis (RA) have been developed by the American College of Rheumatology.
The recommendations on the use of non-biologic and biologic DMARDs in RA address five key areas: indications for use; monitoring for side effects; assessing clinical response; screening for tuberculosis (a risk factor associated with biologic DMARDs); and under certain circumstances (i.e. high disease activity) the roles of cost and patient preference in choosing biologic agents.
The recommendations, published in the June issue of the journal Arthritis Care & Research, also take into account RA disease duration, disease severity, and prognostic features.
"These recommendations were developed for specialist clinicians familiar with assessing RA disease activity and disease severity," project co-leader Dr. Kenneth Saag, professor of medicine and epidemiology at the University of Alabama at Birmingham, said in a prepared statement.
"Applying these recommendations to clinical practice requires individualized patient assessment and clinical decision-making. The recommendations developed are not intended to be used in a 'cookbook' or prescriptive manner or to limit a physician's clinical judgment, but rather to provide guidance based on clinical evidence and expert panel input," Saag said.
Preeclampsia Linked to Cardiovascular Problems After Pregnancy
Preeclampsia may change the way arteries respond to insulin, thereby increasing the risk of cardiovascular problems years after the dangerous pregnancy complication occurs, Scandinavian researchers report.
In this small study, researchers found an association between insulin sensitivity in women and a history of preeclampsia, which is high blood pressure during pregnancy.
"Although insulin sensitivity in non-obese women with previous preeclampsia is similar to that in control women, there was a significant correlation between waist-to-hip ratio and serum triglycerides and insulin sensitivity only in women with history of preeclampsia," said lead researcher Dr. Risto Kaaja, a researcher at Helsinki University Hospital in Finland.
"Secondly, insulin sensitivity correlated to vasodilatation again only in the preeclamptic group," Kaaja said. "Early-onset preeclampsia correlated to impaired insulin sensitivity later in life."
Frequent sexual intercourse may cut down on a man's chances of developing erectile dysfunction, Finnish researchers report.
"This is the same as any other part of the body. It's what we in vascular surgery refer to as the 'use it or lose it' concept," said Dr. Hossein Sadeghi-Nejad, an associate professor of urology at UMDNJ New Jersey Medical School Hackensack University Medical Center. "Sexual activity will promote maintenance of normal erectile function down the line."
The report was published in the July issue of The American Journal of Medicine.
In the study, led by Dr. Juha Koskimki, from Tampere University Hospital's Department of Urology, researchers collected data on 989 Finnish men aged 55 to 75 years old.
The researchers found that men who said they had sexual intercourse less than once a week had twice the risk of developing erectile dysfunction, compared with men reporting having sexual intercourse once a week.
Among men who had sexual intercourse less than once a week, there were 79 cases of erectile dysfunction per 1,000 men. That number dropped to 32 cases per 1,000 among men who said they had sexual intercourse once a week, and it dropped even further, to 16 per 1,000, among men who said they had sexual intercourse three or more times a week, the researchers reported.
The frequency of morning erections was not associated with the incidence of moderate erectile dysfunction, the researchers noted.
Before you take a pain reliever for conditions such as headache, sinusitis, muscle or joint pain, make sure you know about the potential side effects.
The American Academy of Family Physicians says you should talk to your doctor about these potential risks of pain medications:
Liver damage can occur in people who take large quantities of acetaminophen (the active ingredient in Tylenol), or in those who already have liver problems.
Gastrointestinal problems -- such as ulcers, gastrointestinal bleeding or upset stomach -- can occur in people who take nonsteroidal anti-inflammatory drugs (NSAIDs) for long periods. NSAIDs include aspirin and ibuprofen.
Kidney damage, if NSAIDs are used frequently for long periods.
NSAIDs may interact with medicines that people take to combat high blood pressure. NSAIDs can also elevate blood pressure on their own.
In rare cases, people can be allergic to pain medications.
Foods that trigger heartburn in many people include chocolate, fatty and spicy foods, and dairy products.
Avoiding foods and beverages that trigger your symptoms is paramount, but you can also do other things to prevent the onset of heartburn, the National Digestive Diseases Information Clearinghouse says:
If you are overweight, come up with a plan to lose those extra pounds.
Don't smoke.
When you lie down, make sure your head is about 6 inches higher than your feet.
Don't lie down for at least two hours after you eat.
An experimental drug that inhibits tumor blood vessel formation slows the progression of metastatic thyroid cancer in some patients, an international study finds.
Of the 93 patients with rapidly progressing cancer, 49 had a positive response to treatment with motesanib diphosphate. Of those 49 patients, 14 percent had their tumors shrink and 35 had their tumors stabilize for more than 24 weeks. Median progression-free survival was about 40 weeks.
Genetic analysis of 25 patients revealed that drug response was better in those with a mutation known as BRAF V600E in their tumors than in those without the mutation. Further research into this genetic connection is needed, the researchers said.
"Finding that patients whose tumors bear a particular mutation were more likely to respond to the drug is an example of where we would like to head in our research," study author Dr. Steven I. Sherman, chairman and professor of the department of endocrine neoplasia and hormonal disorders at the University of Texas M.D. Anderson Cancer Center, said in a prepared statement.
"This is the first of the various thyroid cancer trials to identify specific mutations that might allow us to individualize or personalize therapy," he said.
The study, published in the July 3 issue of the New England Journal of Medicine, was funded by drug maker Amgen Inc.
Motesanib diphosphate -- a VEGF inhibitor -- targets a protein called vascular endothelial growth factor (VEGF), which plays a critical role in the formation of new blood vessels that allow tumors to grow and spread.
Currently, there are few treatment options for metastatic thyroid cancer.
"There is no standard accepted chemotherapy for advanced metastatic differentiated thyroid cancer, and response rates have typically been 25 percent or less," Sherman said. "Most patients are not treated with systemic chemotherapy, because the limited benefit rarely justifies the side effects. Treatment of thyroid cancer has been a completely unmet need."
A daily dose of the erectile dysfunction drug tadalafil (Cialis) helped relieve lower urinary tract symptoms in men with signs of enlarged prostates, according to a new study.
More than 50 percent of men age 50 and older have lower urinary tract symptoms, including increased urination frequency and urgency, straining, intermittence, incomplete emptying or a weak urinary stream. Current drugs used to treat the condition can produce side effects such as dizziness, low blood pressure and sexual dysfunction.
In this study that included 1,056 men in 10 countries, the men were randomly divided into five groups that received either a placebo or tadalafil doses of 2.5, 5.0, 10.0 or 20.0 milligrams a day. All doses of the drug were superior to a placebo for relieving lower urinary tract symptoms (LUTS), with statistically significant effects at four, eight and 12 weeks.
The study, which included researchers from drug maker Lilly, is published in the October issue of The Journal of Urology.
"Since reports of erectile dysfunction (ED) incidence, pathophysiology and treatment have shown a possible link between [enlarged prostate] and ED. PDE5 inhibitors like tadalafil (Cialis) have received increased attention for treating BPH LUTS, although they are currently only approved for ED. The half-life of tadalafil is 17.5 hours, making it suitable as once daily therapy. Although the precise mechanism of action by which PDE5 inhibitors may alleviate LUTS is not completely understood, several putative mechanisms are currently under investigation." researcher Dr. Claus G. Roehrborn, professor of urology at the University of Texas Southwestern Medical Center at Dallas, said in a journal news release.
Men with sleep apnea may suffer from a treatable form of erectile dysfunction caused by regular deprivation of oxygen experienced during these episodes of obstructed breathing, a new report says.
University of Louisville researchers found that, in a study of mice, one week of chronic intermittent hypoxia (CIH) -- the lack of oxygen suffered during obstructive sleep apnea syndrome (OSAS) -- resulted in a 55 percent decline in their daily spontaneous erections. After five weeks, the length of time between mice attempts at mating increased on average by 60-fold.
The findings, published in the second September issue of the American Journal of Respiratory and Critical Care Medicine, showed that when the mice went back on standard oxygen levels for six weeks, they recovered 74 percent of their original erectile function.
A second treatment using tadalafil, which is generic Cialis and increases the availability of nitric oxide, improved erectile and sexual functioning of almost all the mice to near-normal levels.
"Even relatively short periods of CIH ... are associated with significant effects on sexual activity and erectile function," Dr. David Gozal, professor of pediatrics at the University of Louisville, wrote in the article.
Researchers found no differences in levels of testosterone or other indicators related to erectile function in mice exposed to CIH for eight weeks.
"Although this study was performed in research animals, chronic intermittent hypoxia has profound effects on multiple organ systems and a strong biologic plausibility exists that similar findings will be observed in humans," said John Heffner, past president of the American Thoracic Society, "Early identification and effective therapy of OSA is critically important, especially considering the high prevalence of this disorder."
Canadian researchers have found a whole new use for Viagra. It's for affairs of the heart, but not the bedroom kind.
A study released in the Proceedings of the National Academy of Sciences on Monday by the University of Montreal and the Montreal Heart Institute showed that sildenafil, also known as Pfizer (nyse: PFE - news - people )'s Viagra, protected against some of the cardiac complications in mice with muscular dystrophy.
Muscular dystrophy, which affects one in 6,000 people, is a disease that causes the progressive breakdown of muscle tissue, including the heart.
The study as done independently of Pfizer. The company said that it has not conducted studies of its own concerning heart protection for muscular dystrophy patients and has no current plans to try to market Viagra for that use. Shares of Pfizer were up slightly, rising to $19.97, or 6 cents, at the close of trading on Tuesday.
"Research on this disease used to focus on the degeneration of skeletal muscles," said Dr. Christine Des Rosiers, lead researcher on the study, "but it is important to take into account all muscular problems, including cardiac problems, when treating these patients so that we can improve their quality of life."
The researchers were able to decrease the levels of a molecule that breaks down the tissue by giving the dystrophic mice the drug. Sildenafil is currently prescribed for erectile dysfunction and pulmonary hypertension.
