Sunday, August 31, 2014
News that the Federal government is tightening restrictions on hydrocodone combination painkillers in an effort to curb widespread abuse received wide coverage, with several major newspapers and news agencies reporting. Some news outlets noted that the rule change was welcomed by many, including lawmakers from states that have been plagued by opioid abuse. Others quoted sources who were skeptical whether the rule change would help curb abuse of the painkillers.
USA Today (8/21, Leger) reports the change, for instance, will “sharply reduce how many pills a doctor can prescribe for them at one time.” Also, manufacturers and pharmacies will now have to keep hydrocodone combination products such as Vicodin (acetaminophen and hydrocodone) under tighter security, along with “more extensive records.” The new rule, which takes effect from mid-October, elevates the painkillers to Schedule II from Schedule III under the Controlled Substances Act.
Highlighting the importance of the rule change, theNew York Times (8/22, A12, Tavernise, Subscription Publication) notes that it is “one of the most far-reaching efforts to stop the growing epidemic of prescription drug abuse.” The paper points to a grim statistic, noting that “more than 20,000 Americans die every year because of prescription drug abuse,” citing Federal data. Still, the Times notes, the change is expected to “draw strong criticism from some pain management experts,” who argue that the new restrictions impose “unfair obstacles for patients in chronic pain, making it harder, for example, on those who cannot easily make a trip to the doctor.”
The Wall Street Journal (8/22, A3, Radnofsky, Walker, Subscription Publication) examines both sides of the debate, citing sources who are against tighter restrictions and those who seek tougher rules. The paper notes that Linden Barber, a former DEA attorney, who now works with the law firm Quarles & Brady LLP in Indianapolis, pointed out the rule change may not have a major impact because painkillers such as OxyContin (oxycodone), which already have tough safeguards in place, continue to be abused. The AP (8/22, Perrone) also covers the story.
In a 5-year study of more than 10,000 type 2 diabetics with an elevated risk of cardiovascular disease (high levels of triglycerides and low levels of HDL), the cholesterol-lowering drug fenofibrate cut adverse cardiovascular outcomes by 30% in women and 24% in men. The results, which come from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study, are published in Diabetologia. Fenofibrate stimulates the action of an enzyme that breaks down triglycerides and low-density lipoproteins.
Wednesday, August 20, 2014
HealthDay (8/20, Haelle) reports that according to a study(8/20) published Aug. 19 in the Annals of Internal Medicine, acute “kidney injury can be added to the list of possible harms related to use of three antipsychotic medications often prescribed to treat behavioral symptoms of dementia in older adults.” For the study, researchers examined health records of some 97,000 seniors over the age of 64 in Ontario, Canada, who were taking the atypical antipsychotics Seroquel (quetiapine), Zyprexa (olanzapine) or Risperdal (risperidone), medicines which are often used “off-label” to treat agitation in people with dementia.
MedPage Today (8/20, Fiore) points out that use of atypical antipsychotics in this population was also tied to “an increased risk of hospitalization for: hypotension: RR 1.91 (95% CI 1.60-2.28), acute urinary retention: RR 1.98 (95% CI 1.63-2.40),” and “all-cause mortality: RR 2.39 (95% CI 2.28-2.50).”
Medscape (8/20, Brauser) reports that the study authors “note that the US Food and Drug Administration issued a black-box warning in 2005 on the basis of 17 randomized controlled trials showing that elderly patients with dementia who received an atypical antipsychotic had a 1.6 to 1.7 times’ greater mortality risk than those who received placebo.” The study’s lead author expressed his surprise “that so many patients were still receiving these prescriptions.”
Bloomberg News (8/19, Ostrow) reports that researchers found that “more than half of men 65 and older who had a very high risk of dying in nine years were screened for prostate cancer, a slow-moving disease.” Nearly “38 percent of older women with a similar life expectancy were screened for breast cancer and 31 percent were screened for cervical cancer despite some having undergone a hysterectomy.”
Vox (8/19) reports, “Among patients with the shortest life expectancies (about five years), 40 percent had been screened for colorectal cancer.”
HealthDay (8/19, Reinberg) reports that the researchers did find that “fewer men were screened for prostate cancer and fewer women for cervical cancer in more recent years, compared with 2000.”
MedPage Today (8/19, Bankhead) reports that a “second study” published in JAMA Internal Medicine “showed that reducing the screening colonoscopy interval from 10 to 5 years would lead to a minimal gain in quality-adjusted life years (QALYs) at a cost exceeding $700,000 per QALY.” Medscape (8/19, Nelson) also covers the story.
Thursday, August 14, 2014
On its front page, the Wall Street Journal (8/14, A1, Winslow, Subscription Publication) reports that according toresearch published in the New England Journal of Medicine, the consumption of less than 3,000 milligrams of sodium daily may increase the risk for death, stroke or heart attack. Researchers arrived at this conclusion after following for three years some 100,000 people in 17 countries. The Food and Drug Administration has announced its intention to review the research. Currently, the FDA is putting together voluntary guidelines which will ask the food industry to reduce the amount of sodium in processed foods.
The Los Angeles Times (8/14, Healy) “Science Now” blog reports that another study published in the NEJM “concludes that one in 10 cardiovascular deaths can be attributed to excessive sodium consumption, and one in five of those among people younger than 70.” Meanwhile, “an invited editorial touted the study as a ‘herculean effort’ to glean the effects of excess salt consumption in a broad population.” Nevertheless, “citing the findings of two studies published alongside the global assessment, University of Alabama vascular expert Dr. Suzanne Oparil declared it too early for public health officials to take up the cudgels against dietary sodium.”
The AP (8/14, Marchione) points out that “guidelines from various groups for heart disease prevention recommend 1.5 to 2.4 grams of sodium a day.” For example, “the American Heart Association advises no more than 1.5 grams.” In any case, “limiting salt is still important for people with” hypertension.
Bloomberg News (8/14, Cortez) reports that experts are in agreement that “too much sodium is dangerous and it comes mainly from packaged foods and restaurant meals” and that just “a small proportion stems from salt added to a homemade meal or shaken on food at the kitchen table.” Experts also stress the importance of reading “food labels to get a good sense of how much salt” is consumed on a daily basis.
MedPage Today (8/13, Yurkiewicz) reports that a third paper, “a meta-analysis of 107 randomized interventions in 103 trials,” revealed “a linear dose-response relationship between reduced sodium intake and blood pressure.” Its authors concluded, “Globally, 1.65 million annual deaths from cardiovascular causes (95% uncertainty interval [confidence interval], 1.10 million-2.22 million) were attributed to sodium intake above the reference level.” In discussing all the studies, some experts, including editorialist Dr. Oparil, are of the opinion that “encouraging diets high in potassium may be an alternative approach to reducing blood pressure and cardiovascular events.”
Also covering the studies are Reuters (8/13, Emery), the NBC News (8/13, Silverman, Tolin) website, the NPR(8/13, Aubrey) “Goats and Soda” blog, Forbes (8/13, Husten), HealthDay (8/13, Thompson) and Medscape(8/13, Busko).