Black Triangle

Welcome to Black Triangle, homepage of Anthony Cox.

Pharmaceutical related talk about medicines, adverse drug reactions. medication errors and marketing...

Of course you may be looking for the world famous Weapons of Mass Destruction 404 error page or the T-shirt of Mass Destruction. Did I hack Google to accomplish this feat? No, it's more interesting than that.

Want to contact me? Contact Point. What is a blacktriangle?

Blog

Wednesday, July 30, 2003

MMR - reloaded: Can't say I'm surprised, but the mothers of two girls who have been trying to prevent them having MMR have lost their appeal in the courts. In the report in the Telegraph the following is stated:
"The mothers, the sole carers of their daughters, argued that immunisation should be voluntary and it was not right to impose it against the wishes of a caring parent and it would cause them great distress. "
Whether it causes the parent distress or not is completely besides the point. The issue should be what is in the best interests of the child. Mother knows best, in this case at least, does not stand up to much scrutiny. Expect the wailing and gnashing of teeth at the JABS site message board. More from the BBC:

Lord Justice Sedley said the evidence presented by the mothers in the earlier hearing that the MMR vaccination was dangerous and untenable was "junk science" and "dangerous and unnecessary".
Quite. More on MMR, at MMR, the facts.
posted by Anthony Cox at 1:52 PM | permalink

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Tuesday, July 29, 2003

Life is a risky business: One of the most difficult things a health professional does is to communicate risk to patients. They may already be concerned about the condition they are being treated for and in the case of vaccination parents may be worried about a perfectly healthy little Jimmy getting autism from MMR, after reading misleading scare stories in the media. People are also known to overestimate risks from medication.

One problem with drugs, is that you cannot just describe a single risk. Drugs also have multiple side effects, some of which are rare and some of which are more common. Some may be severe or even life-threatening at times. And drugs have benefts, how good are we at communicating those? Where do you start? What are we to do?

Health professionals, the industry and regulators all have a role to play, but so has the public. It is going to have to come to terms with the fact that risks exist, and that life is a series of finely judged decisions that they have to decide on. No risk is not an option. Even crossing the road to the pub has risk attached to it, and that's before you breathe in the carcinogenic tobacco smoke. Mind you for some the benefits of a beer are considerable, ever seen a drunk man bounce off a car and say something like "arhfg am allrrreett, no boother" and walk away? Maybe that's just specific to Blackburn where I did my drinking in my youth.

Time magazine has a good article on risks in relation to current bugbears like mobile phone masts and GM food. I particularly liked the umbrella problem:
How worried should we be? That depends on how much uncertainty we're prepared to live with. And these days we're prepared to live with less and less. As science, medicine and technology make life safer, healthier and more comfortable, our intolerance of risk is growing. Plenty of dangers have been eliminated - childhood mortality is way down, diseases that were once common have been eradicated, food is more plentiful and nutritious than ever. But these advances have made us even more sensitive to the risks that remain. "Before the umbrella, if it started to rain you got wet," says Raffaele De Giorgi, director of the Center for the Study of Risk at Italy's University of Lecce. "With the invention of the umbrella, the risk of getting wet was born."
Reckoning with Risk If you are looking for a good book about risk and numbers, then you can't go wrong by reading Reckoning with Risk: Learning to Live with Uncertainty by Gerd Gigerenzer. An absolutely fascinating and informative read. This book really could change the way you look at things. You don't need to be a mathematician to read it either, which makes it even better in my opinion!
posted by Anthony Cox at 6:22 PM | permalink

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Monday, July 28, 2003

Crocked Aussies: Medication errors down under:
"MEDICATION mix-ups put more Australians in hospital each year than major illnesses such as diabetes or asthma, doctors have warned.

Experts estimate 140,000 hospital admissions a year are linked to medication use. University of New South Wales professor of clinical pharmacology Ric Day said drug mix-ups were in the top five causes of hospital admission, along with cardio-vascular problems.

Professor Day will address a medical conference on the issue in Melbourne next week.

"And it's probably highly likely we seriously underestimate what happens out in the community, mainly because we don't see it," he said. "

posted by Anthony Cox at 4:57 PM | permalink


Patent extension helps kids: Time Magazine:
"in 1998 the FDA ruled that companies had to conduct pediatric tests of adult drugs. That rule followed a 1997 law offering drugmakers a six-month extension on their patents if they did so voluntarily.

Good thing. Turns out kids aren't little adults, after all. New studies show that young children need to take the epilepsy drug Neurontin in higher doses than adults because they excrete it faster. And Prozac, the drug that carried bewildered Gen X-ers through the '90s, can retard growth in kids and adolescents."
The Time article also notes that this initiative was successfully opposed until the Senate revisited it.
posted by Anthony Cox at 4:31 PM | permalink

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Sunday, July 27, 2003

The German NICE: As the National Institute for Clinical Excellence gets a hammering in the media, Stephen Pollard writes about the new German Center for Quality Medicine.
"Its proponents argue, as did NICE's creators, that its concern will be to ensure that all Germans receive access to the best medicines. By examining the effectiveness of different treatments, the members of the Center for Quality Medicine will be able to issue guidance to doctors across all of Germany, ensuring up to date knowledge of the latest research and that the most effective medicines are used on patients.

It sounds wonderful in theory. But the practice, as NICE shows, is rather different. In reality these decisions are about not widening the range of treatments but narrowing them; not increasing the options but restricting them. They are, in short, designed to ration health care, and to do so in the most misleading manner possible - on the pretext of rationality. "

posted by Anthony Cox at 7:09 PM | permalink


It's a small world afterall: My friend Simon Whittaker, who had 15 minutes of fame with an ebay pound coin , has started a netcetera blog which you might find more fun that this one. Interestingly, he is applying Small World Theory in attempt to find a new job.
posted by Anthony Cox at 5:14 PM | permalink

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Saturday, July 26, 2003

Pharmaceutical Lobbying: The large pharmaceutical lobby in Washington managed to split the US congress along Pharma donation lines rather than along party lines. Although the bill allowing the reimportation of cheap pharmaceuticals from Canada was passed, it does show the influence the pharmaceutical industry can wield.
Campaign contribution figures show that lawmakers who sided with pharmaceutical interests (voting "no" on the bill) raised an average of nearly three times as much from drug firms as those who took the alternate position (voting "yes"). Members who voted against the bill raised an average of $39,813 in individual and PAC contributions from pharmaceutical manufacturers between 1989 and 2002. Members who voted for the bill raised an average of $13,917 from the industry during that time.
More discussion on this at Harry's Place. Andrew Sullivan recently bemoaned the attacks on the pharmaceutical industry and suggested that they would lead to the death of the pharmaceutical industry in the US, citing the failure of the German Pharmaceutical industry. I'm not convinced, the pharmaceutical industry is still very strong and on occassion the industry does not cover itself in glory. On the other hand some of the attacks from pressure groups are hardly evidence based and in the case of vaccines harmful to public health.

Sullivan also recently commented a while back on Propecia's (finesteride) potential to reduce the risk of prostate cancer:
"Another little coup for the big drug companies who, more than any other industry, have improved and saved the lives of countless people. You can now stop baldness and reduce your risk of prostate cancer. "
Of course it isn't that that simple, the cancers that did occur were more aggressive. There is a balance to be struck in the way we view the pharmaceutical industry, who do serve a valuable role in society, but we appear to be someway from it yet.
posted by Anthony Cox at 9:26 PM | permalink

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Friday, July 25, 2003

Growth Hormone deaths:
The world's largest drugmaker, Pfizer Inc., has notified doctors of seven deaths around the world linked to use of its Genotropin growth hormone, all of whom were pediatric patients with a rare genetic disease called Prader-Willi syndrome.

posted by Anthony Cox at 10:34 PM | permalink

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Thursday, July 24, 2003

Information is power: But do we know how to put it across?
posted by Anthony Cox at 10:02 PM | permalink

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Wednesday, July 23, 2003

Tainted Drugs: More on counterfeit drugs. A Guardian report details a recent sting:
Mann said investigators had seized $18 million worth of tainted drugs during the probe - in one particular sting, authorities bought $500,000 worth of counterfeit drugs. He said any tainted drugs were immediately seized once they were discovered.

"Every time we identified drugs that were adulterated or counterfeited we immediately removed them from the mainstream. Even at the expense of our investigation, we weren't about to allow tainted or adulterated drugs to get to one patient,'" Mann said.

Dr. Margaret Fischl, director of the AIDS Clinical Research Unit at the University of Miami School of Medicine, said her office planned to discuss the case with patients in the coming days. She said the faulty medications could drastically affect their health, forcing unwarranted changes in their treatment or unnecessary procedures.

"You could be doing tests that are absolutely not necessary. You could be exposing patients to other interventions that are not needed,'' Fischl said. ``To me ... you're playing with people's well-beings and their lives.'"

Authorities said the 19 people indicted this week represented some of the most egregious cases involved in a sophisticated scheme to substitute genuine medications with weaker or bogus drugs. More indictments were expected.

posted by Anthony Cox at 12:03 PM | permalink


France declare "War on polypharmacy": The French health minister has announced that the number of drugs available on prescription will be reduced in future by 84. The French are apparently the biggest user of prescription medicines in the European Union, and the overspend of 4 billion pounds on health is not helping them match their euro deficit targets.

"The French are the world's leading consumers of medicine: three billion boxes a year," said Jean-François Mattei. "It's absolutely incredible! Our prescriptions are the longest of all the industrialised countries surrounding us."

M Mattei said the state would still reimburse patients for some 4,500 medicines, but the 84 struck off the list would save the country around £30 million a year. "We must hunt down waste, excess and abuses of the system," he said. "We must correct our practices, because in terms of prescriptions France is not setting a good example."

Daily Telegraph [free registration may be required]

Those of you who can read French, can read the offical Government documents and the PDF list of blacklisted medication [32kb]. Not much of it looks a great loss to the health of France.
posted by Anthony Cox at 7:25 AM | permalink

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Tuesday, July 22, 2003

Penicillin error claims a life: The sad story of a lady who only wanted an infected insect bite treated, but unfortunately was given penicillin. This was despite staff being aware she was allergic. Now having been in a permanent vegetative state for 18 months it has been ruled that she can be allowed to die.
posted by Anthony Cox at 8:46 PM | permalink


Autism and MMR: Autism cases are levelling off, meaning that MMR is not likely to be cause of autism. Not that those with a fixed view on this subject will change their opinions. The MMR debate has gone way past the point where facts would make any difference to some people.

The researchers said that if autism was caused by the MMR vaccine then figures would have jumped sharply throughout the early 1990s. The MMR vaccine was introduced in Britain in 1988.

But writing in the journal Archives of Disease of Childhood, the researchers said: "The appearance of autism appears to have stabilised."

They researchers also dismissed claims that the vaccine can cause developmental or bowel problems in children.

"The claims that MMR vaccine is involved in the initiation of autism, and/or with regression, and/or with bowel problems associated with autism are not supported by any credible scientific evidence, while there is compelling and increasing evidence showing no association."


posted by Anthony Cox at 8:17 AM | permalink

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Monday, July 21, 2003

Yellow Card Scheme review: The BBC reports that A review is to be carried out into the NHS scheme for reporting adverse drug reactions. The review into the "yellow card scheme" will examine if people, including pharmaceutical companies, should have access to the data collected under the scheme.

Inaccuracies in the BBC report:

1. A review is to be carried out into the NHS scheme for reporting adverse drug reactions." In fact the Yellow Card Scheme is not an NHS scheme. The Medicines and Healthcare Regulatory agency is an executive agency of the Department of Health. It could be described as a Department of Health Scheme.

2. Doctors and all other NHS staff are encouraged to report serious side effects of drugs. Firstly, the scheme is not restricted to NHS staff. As an example, pharmacists who work for private companies or own their own pharmacy can also report. In addition, it is not all NHS staff but specific groups of professionals. Doctors, dentists, pharmacists, nurses and coroners can report. Hospital cleaners cannot. In addition, reporters are encouraged to report serious side effects to established drugs and any reaction, no matter how trivial, to new drugs under intense surveillance.

3. Patients can also report adverse reactions through the telephone helpline NHS Direct. Yes, they can, but currently only in a pilot scheme in one part of the country.
posted by Anthony Cox at 3:55 PM | permalink

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Friday, July 18, 2003

Counterfeit drugs: The FDA have launched a new campaign. Such counterfeits are a serious public health risk:

Toxic Effects: Some fake drugs contain ingredients that, if ingested or injected, can cause health problems. For example, the recently counterfeited Procrit, an important drug for cancer and AIDS patients, contained nonsterile tap water, which can cause an infection in the bloodstream.

Unintended Effects: Some counterfeits substitute one drug for another. For example, insulin has been substituted for a more expensive injectable drug. And last year, counterfeiters emptied bottles of Zyprexa, a drug used for schizophrenia and acute bipolar mania, and replaced them with white tablets imprinted with the word "aspirin."

Ineffective Treatments: Some fake drugs contain some active ingredient, but are subpotent. Others attempt to accurately copy the real drug, but still pose safety risks because they are not formulated in a way that achieves the right therapeutic levels in the patient’s blood.

No active ingredients: Some counterfeit drugs have no active ingredients. For example, a counterfeit version of Serostim, a growth hormone used in AIDS patients, was found to have no active ingredient.

posted by Anthony Cox at 3:29 PM | permalink


Big things in small spaces: "MHRA is aware of a number of cases where the use of expanding haemostatic agents, when used in cavities or closed tissue spaces, has resulted in serious patient consequences. One case involved the use of a gelatin sponge to achieve haemostasis in the lumbar spine after routine surgery. Initially the patient appeared to be neurologically intact but over the next 24 hours developed a complete cauda equina lesion with bilateral foot drop and loss of all movement in the feet. It is likely that these symptoms were caused by compression of the spinal cord by the expanding sponge. "
posted by Anthony Cox at 12:17 PM | permalink


Hip Fractures and anti-depressants: "The clinical implication is that older patients starting treatment with either tricyclic antidepressants or SSRIs will have a transient doubling in their risk of hip fracture and that patients should be aware of this increased risk so that they can take appropriate precautions."
Clinnex.net reporting on an American Journal of Epidemiology paper.
posted by Anthony Cox at 8:53 AM | permalink


Are you a healthcare professional? Then tell everybody you know to stop abbreviating:

"Use of abbreviations is risky and should be avoided. Abbreviations are forms of code, and codes only work when both sender and recipient have agreed on the code and its meaning and have agreed to use it for a particular communication."

Indeed.
posted by Anthony Cox at 8:45 AM | permalink


Celebrity Deathmatch: Cigarettes vs the oral contraceptive pill. The pill does not increase overall mortality, smoking doubles the risk of death from all causes. Why don't you stop smoking today?
posted by Anthony Cox at 8:40 AM | permalink


Spironolactone and hyperkalaemia: "Beware severe hyperkalaemia in patients taking spironolactone plus ACE inhibitors or AT1 receptor blockers. " Special care needs to be taken diabetic patients and this is borne out in a study of around 100 patients I have been involved in which is due to be published later this year.
posted by Anthony Cox at 8:28 AM | permalink


Rhabdomyolysis: Has many causes, including statins, and may be fatal, however:

"Statins are of particular concern because of their widespread and increasing use. Myotoxicity occurs in about 0.1% of cases, although cerivastatin was withdrawn in 2001 because the incidence of myotoxicity with this drug was some 10 times greater. Drug interactions particularly with fibrates or drugs that interfere with cytochrome p450, the main isoenzyme involved in the metabolism of statins, seem to account for most instances. Reassuringly, fatal rhabdomyolysis due to statins is now rare and occurs in less than one per million prescriptions."
posted by Anthony Cox at 8:21 AM | permalink

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Thursday, July 17, 2003

Bumper crop of error articles: A sort of theme-issue in Pharmacy World and Science. Risk and the sense of safety, computerisation and information technology's role in improving prescribing, implementating computerized physician medication orders, drug interaction management, risk assessment in clinical pharmacy, more on intravenous medication errors and other bits and pieces of interest.
posted by Anthony Cox at 3:09 PM | permalink

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Wednesday, July 16, 2003

Autism: Autism may be caused by unusually rapid brain growth during the first year of life, according to this BBC report. The original article is at JAMA.

"there is aberrantly rapid and disordered growth without guidance that produces in too short a time too many connections that may not be adaptive. Faced with the neural noise that would be the result of such rapidly changing aberrant connections, the infant would lose the ability to make sense of its world and withdraw. Not until later, when the excessive growth rate slows, would the now autistic child have a chance to use experience-guided processes to select whatever connections might still be useful and to eliminate those that are not. By that time, however, the extended period of plasticity that allows the exquisite and graceful complexity of the human brain to emerge will have passed. "
posted by Anthony Cox at 4:23 PM | permalink

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Tuesday, July 15, 2003

Dispensing errors: An interesting study on the accuracy of pharmacists when dispensing prescriptions. They looked at 50 pharmacies across 6 US states for 1 day and looked for dispensing errors.

Results: Data were collected between July 2000 and April 2001. The overall dispensing accuracy rate was 98.3% (77 errors among 4,481 prescriptions; range, 87.2%-100.0%; 95.0% confidence interval, ± 0.4%). Accuracy rates did not differ significantly by pharmacy type or city. Of the 77 identified errors, 5 (6.5%) were judged to be clinically important.

Conclusion: Dispensing errors are a problem on a national level, at a rate of about 4 errors per day in a pharmacy filling 250 prescriptions daily. An estimated 51.5 million errors occur during the filling of 3 billion prescriptions each year. This figure includes 3.3 million errors of potential clinical importance.

Flynn EA, Barker KN, Carnahan BJ. National Observational Study of Prescription Dispensing Accuracy and Safety in 50 Pharmacies. Journal of the American Pharmaceutical Association 2003;43:191-200 [free registration required]

Bar codes have often been cited as a way of increasing safety in the way we use medicines, and I thought this part of the paper neatly showed how any safety system can with time be undermined.

"A loophole in a bar code checking system was described by an observer at one of these sites as follows: When a clerk scanned the receipt's bar code at the cash register in preparation to dispense a prescription, an error message told the clerk that a pharmacist had not yet verified the prescription; the clerk took the bag and receipt to the pharmacist verification area, scanned the bar code on the receipt and then entered the National Drug Code number for the drug from the receipt (instead of the drug stock bottle used to fill the prescription), thus bypassing the safety system."

The price of safety is eternal vigilance both on a personal level and in the systems of work we design.
posted by Anthony Cox at 9:59 AM | permalink

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Monday, July 14, 2003

EMEA on terrorism: A bit late, published in May, but I happened across this European Medicines Evaluation Agency Guidance Document [PDF 156KB] on the Use of Medicinal Products for the Treatment of Patients Exposed to Terrorist Attacks with Chemical Agents. Not pleasant reading.
posted by Anthony Cox at 9:39 PM | permalink


Health Canada: July Bulletin is out. In this issue: gatifloxacin associated hypoglycemia and hyperglycemia, a mini-review of serotonin syndrome, and a case presentation of red yeast rice and rhabdomyolysis.
posted by Anthony Cox at 9:33 PM | permalink

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Friday, July 11, 2003

Topiramate warning: The FDA have issued warnings about potentially serious reactions to topiramate (Topamax):

"Ortho-McNeil and FDA revised the WARNINGS and PRECAUTIONS sections of the prescribing information to provide updated information about oligohidrosis (decreased sweating) and hyperthermia, which have been reported in topiramate-treated patients. Oligohidrosis and hyperthermia may have potentially serious sequelae, which may be preventable by prompt recognition of symptoms and appropriate treatment."
posted by Anthony Cox at 8:32 AM | permalink

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Thursday, July 10, 2003

Pharmawatch goes into retirement: Dr Michael Lascelles has retired from his blog:

"The drug industry spends something like $22 billion a year on marketing and promotion in the US alone. This blog, of course, has cost nothing except my time and interest. And while I’m still curious about what’s happening out there in pharma nirvana, I am unfortunately no longer able to spend much time digging up the dirt. "

I can't help thinking he'll be back.
posted by Anthony Cox at 3:48 PM | permalink


Intravenous safety: A special edition of one-liners concerns itself with safety issues related to the use of intravenous devices. If you are involved in their use, read it. Of note:

"MHRA has been made aware of users repeatedly accessing single dose vials and intravenous bags. This is associated with the risk of cross infection and should be avoided."

Perhaps the best known example of this in the UK was the death of a patient from malaria in 1999, which he had received from another patient via a shared saline bottle. People have continued to use large bags of saline in areas that use lots of saline flushes for multiple patients. It would interesting to see how many wards in the country have a shared saline bag hanging up. I'd like to hope none.

Although vaccines are not intravenously administered, the dangers of cross contamination were also recently raised in this BBC story about single vaccines in private clinics. This is a problem that MMR does not suffer from. MMR information is available at MMR the facts.
posted by Anthony Cox at 3:34 PM | permalink


Pound coin on Ebay: Until last week I had a policy of only posting about drug safety issues in this blog, I'm just about to break that again. At the same time as my WMD 404 meme was exploding, by co-incidence my friend Simon Whitaker, [the guy on the left in this picture] was in the media for trying to sell a pound coin on ebay. Read the amusing story about how he nearly sold his coin for a million pounds. That's it. This blog is going back to my real passion, drugs!
posted by Anthony Cox at 9:19 AM | permalink

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Wednesday, July 09, 2003

Crest(or)fallen: The FDA may not license rosuvastatin (Crestor) due to concerns about proteinuria. The FDA say:

"The results from the in vitro studies with OK cells and human skeletal muscle cells support a mechanism of action consistent with the non-clinical data. However, a causal relationship between in vitro data and clinical adverse events is tenuous at best. Concern exists for the apparent increased clinical incidence of muscle and renal toxicity with rosuvastatin compared to data available from other statins." FDA paper. [PDF]

UPDATE It appears that the Independent may have got things wrong, according to DrugInfoZone the FDA have approved rosuvastatin.
posted by Anthony Cox at 1:39 PM | permalink

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Monday, July 07, 2003

T-Shirt of Mass Destruction: If you liked my 404 error page, you might like the accompanying T-shirt. Visit the Weapons of Mass Destruction Shop.
posted by Anthony Cox at 2:26 PM | permalink

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Saturday, July 05, 2003

Ask your pharmacist: Some people have emailed me for specific advice about using medicines. Much as I would like to help, I am not able to give specific advice. You may find the information you are looking for at http://www.medicines.org.uk, but better still, why not ask your pharmacist?

Pharmacists undergo five years of training in the use of medicines. They work in hospitals, general practitioners' surgeries and in community pharmacies. You may not know it but pharmacists help advise and train doctors in the safe use of medicines, helping to reduce the dangers associated with the use of medicines and they report adverse reactions to medicines. Your local community pharmacist has the advantage of knowing you, is readily accessible and should be able to give you excellent free advice about the safe use of medicines, how they work and their potential side effects. Why not use them?
posted by Anthony Cox at 8:50 PM | permalink

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Friday, July 04, 2003

Methotrexate Safety: Although unlikely to be directly related to the methotrexate paper I was involved in , the National Patient Safety Agency has announced some action on methotrexate.

"The announcement follows concerns over the safety of the drug. Over a 10-year period, the NPSA identified 25 patient deaths and 26 cases of serious harm linked to the use of oral methotrexate in a community setting in England. Key problems included patients not being informed about how to take the drug, particularly taking it on a weekly rather than daily basis, and unclear packaging."

They seem to be taking a very practical approach on this issue and involving patients. If you want to read more about the methotrexate case which led to the increased profile of this drug, you can see the report here.
posted by Anthony Cox at 2:06 PM | permalink


Mini FAQ: I will have to put up a FAQ about the 404 page at some point, but in the mean time please read this short version of events.

How did you fix Google?

I didn't . The page went up on the 12th of February 2003 and spread as a meme though email, personal pages, newsgroups and probably weblogs. It also got a mention in the Guardian some time ago, and was on the front page of the Channel 4 News page. It has been the top WMD site for some time in google on that basis, but suddenly it seems a combination of the current debate about weapons of mass destruction and the fun of the "I feel lucky button" at Google seems to have made the site very popular. Nice to think that people think I am clever enough to have cheated Google, but sadly I am not. Google people relax! My webpage statistics are showing Google as the top referrer now, whereas up until three days ago they were lower down. Having it mentioned on Radio Two by Jeremy Vine sent hits through the roof. I just worry about blueyonder's webservers!

UPDATE:Google appear to have fixed the search so the WMD 404 page does not appear when you hit the "I'm feeling lucky" button. I'm not sure what happened, but you now have to add in 404 to get the site top of the search. This is one of those times I wish I had a comments button.

UPDATE 2:It's back at the top of Google. Not sure why the change has happened.

UPDATE 3: I have written a short piece in the Guardian about the Weapons of Mass Destruction page. Possibly worth reading if you are about to send me an email calling me a "cheese eating surrender monkey".
posted by Anthony Cox at 11:30 AM | permalink


Contact point: If you wish to contact me, please email me at coxar@hotmail.com I'm taking a wild guess you are not going to email me about adverse drug reactions, but have got here via the 404 error site. However, if there are people who visit this site to read about drug safety and have found it useful in any way, I'd be pleased to find out.

MEDIA: If you are from the media, please put MEDIA in the header of your email. It would help me sort my in-tray more effectively.
posted by Anthony Cox at 8:59 AM | permalink


Liver: The risks of liver disease from non-steroidal anti-inflammatory agents like nimesulide, diclofenac, ketoprofen, piroxicam, naproxen, ibuprofen appears to be small in this paper at the BMJ. The risk seems to be higher in those over 75 and in males.
posted by Anthony Cox at 8:52 AM | permalink

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Thursday, July 03, 2003

Telling patients about adverse effects: Dr. Mansur Shomali doesn't hesitate to prescribe the osteoporosis drug Forteo, though the Food and Drug Administration has slapped it with a "black box" warning - its most severe alert about side effects.

But he doesn't tell patients about the boxed warning unless they ask. "I usually have a conversation that's appropriate to the patient in front of me," he said, explaining he doesn't want to scare patients out of taking a drug they need. "Some want to know everything about a drug, some don't."


This is important. As the article goes on to illustrate patients who suffer adverse effects they were not informed about feel cheated and tricked. Although, there is a variation in what people want to know, all should be given the opportunity to find out. Another way of preventing patients being scared off a medication is by presenting the benefits of the drug as Theo Raynor and Nikky Britten argued in the Pharmaceutical Journal.

patients need balanced information (the pros and the cons of taking the medicine) but, in their current form, leaflets present mainly negative information, ie, contraindications and side effects. The regulations permit positive information, but this generally does not appear, because companies fear it being interpreted as promotional (outlawed by the regulations) and because it would lengthen the leaflets (space is at a premium on leaflets provided as package inserts).
posted by Anthony Cox at 10:26 PM | permalink


Writing Clearly: The US state of Florida has put on the books a law requiring doctors to write clearly.

"You know the stereotype about doctors, right? That their handwriting is like chicken scratch. Well we may joke about it but it's pretty serious. In fact, studies show that up to twenty percent of medication errors happen because of doctors' illegible handwriting. Errors that cause more deaths annually than on-the-job injuries.

Pharmacists like Cathy Meier admit prescription mistakes happen because of poor handwriting. So much so, a lot of her staff training centers around deciphering handwritten prescriptions.
"
posted by Anthony Cox at 10:15 PM | permalink


The placebo effect: Appears to apply to alcohol too.
posted by Anthony Cox at 3:23 PM | permalink

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Wednesday, July 02, 2003

Not following orders: I'm in the middle of writing a review of drug-induced cardiac failure, so was interested to see this paper:"The use of metformin and thiazolidinediones is common and has increased rapidly in Medicare beneficiaries with diabetes and heart failure in direct contrast with explicit warnings against this practice by the Food and Drug Administration. Further studies to establish the safety and effectiveness of this practice are needed to ensure optimal care of patients with diabetes and heart failure."

JAMA
posted by Anthony Cox at 1:38 PM | permalink


The pen is mightier that the sword: Or at least sometimes just as fatal in its effects when applied to a prescription. This bit on remedial courses to improve handwriting caught my eye:

Cedars-Sinai Hospital offers a three-hour course that is self-instructional and emphasizes a cursive italic handwriting style, with tips on the correct position of the paper, the size of letters, the length of strokes, and how one should hold the writing instrument.

Remedial maths might be in order too.
posted by Anthony Cox at 12:43 PM | permalink


A way forward for managing error? Next to each other in the Times yesterday were two stories. The first ‘Negligent doctor killed teenager’ and the second Medical chief seeks to reform claims culture.

Liam Donaldson wants to prevent the compensation culture taking hold in the NHS and to increase the ability of Doctors to be able to hold their hands up and admit to errors:

In his report, Making Amends, Professor Donaldson said: "Legal procedings for medical injury frequently progress in an atmosphere of confrontation, acrimony, misunderstanding and bitterness. The emphasis is on revealing as little as possible about what went wrong."

Fair enough, but we also need changes at the Crown Prosecution service. Very few people go to work with the deliberate intent of murdering people, and the Crown Prosecution Service should be trying to support the changes in risk culture that the Department of Health seems to be pressing for.

Doctors would also be under a "duty of candour" to make it compulsory for them to report every mistake and "near miss". In return they would be given exemption from disciplinary hearings for negligence except where a criminal offence had been committed or it would be unsafe to let them continue to practise.

Liam Donaldson's report is on the web and he is seeking comments. Make some.
posted by Anthony Cox at 12:34 PM | permalink

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