Black Triangle

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

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Monday, October 13, 2003

Very small world: My friend's attempt to find a job using small world theory appears to have worked, but the reality just didn't live up to the dream. From smallworld @ netcetera:
here's what I imagined would happen: my aunty in San Francisco would forward my email to a techy friend who recently retired to Acapulco. The friend would forward it to a guy he used to work with who now works in Tokyo. The guy went to Oxford University, so Mr Acapulco figured he might know someone in Oxford who was hiring. Mr Tokyo didn't know anyone, but forwarded the mail to a colleague in the UK office. As luck would have it, Mrs UK knew of an ex-workmate who left to set up their own company in Oxford. She forwarded my mail to him, and impressed by my resourcefulness he asked me in for an interview.

Now, call me Walter Mitty if you like, but that's the way I'd imagined it might happen. Here's what actually happened: one of the recipients of my email was a woman I used to work with in the local general hospital. Her husband owns Tiab Ltd. And, erm, that's it. Good eh?"

posted by Anthony Cox at 4:58 PM | permalink


Ask about your medicines: This is Ask About your Medicines week. Ask your pharmacist:
What does this medicine do?

How long will I need to use it?

How and when should I take it?

Should I avoid any other medicines, drinks, foods or activities when I am taking this medicine?

What are the possible risks and side effects – and what should I do if they happen to me? "
Remember that pharmacists are experts in medicines and available to answer your questions.
posted by Anthony Cox at 4:53 PM | permalink


Marketing enantiomers: The Gruffalog discusses enantiomers:
Many drug molecules exist as stereoisomers. This means that there are two versions of the molecule that share the same chemical structure but have different spatial arrangements. Enantiomers are a subclass of stereoisomers where the isomers are mirror images of each other.
and why they are of interest:
if a company markets a single isomer of a drug that has previously been marketed as a racemic mixture, they can get a new patent on that new drug (even though it's not really a new drug at all), and can therefore enjoy another lengthy period (ten years, if I recall correctly) of patent-protected sales of their new branded product before the patent expires and third parties start churning out cheaper generic versions of the same drug.

posted by Anthony Cox at 12:02 AM | permalink

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Friday, October 10, 2003

Concordance: The BMJ has a Concordance (A process where patients and prescribers come to shared decisions on treatment, rather than the "Doctor knows best" approach.) theme issue on-line today and it is well worth having a look at the table of contents. In one editorial Dr Robin Ferner uses doctors as an example of why concordance may fail to deliver.
The practical difficulties of providing information, allowing the individual patient to make rational decisions, and translating decisions into action, stand beside the realisation that, in altering behaviour, logic counts for little. Doctors are certainly bad at altering their own behaviour in response to logic. They accept that hand washing can reduce the spread of healthcare associated infection, but they still do not wash their hands. Such failings do not encourage optimism about concordance.

posted by Anthony Cox at 12:29 PM | permalink


Nazi Euthanasia files: Files showing the appalling level of euthanasia in Nazi Germany have now been made available on-line:
For the first time, files relating to the 200 000 euthanasia crimes of the Nazi regime from 1939 to 1944 are available online in a central databank.

The German Federal Archive in Berlin has gathered information from almost 300 archives in Germany, Austria, Poland, and the former Czechoslovakia.

The research project was partly financed by the German Medical Association. Speaking at the press launch in Berlin, the association’s honorary president, Karsten Vilmar, once more admitted the guilt of German medicine, which had taken an active part in the euthanasia.

In 1990 about 70 000 previously unknown documents dating from the Nazi era, which had been preserved in the central archives of the Ministry for State Security, were found. The secret service of the former German Democratic Republic had kept them for decades without following up the crimes.

The new databank also contains files from many other sources. Altogether, about 200 000 people were killed in gas chambers, with drugs, or through starvation because they were considered handicapped, socially unacceptable, or mentally ill and were therefore deemed worth killing, according to Nazi ideology. The databank, which is in German, can be accessed by relatives of victims of euthanasia and historians. However, the names of victims are not listed.

posted by Anthony Cox at 12:21 PM | permalink


French heatwave: The media's role is examined in the BMJ:
"Our results speak sadly of the value that French society places on elderly people and public health policy. The adverse effects of the heat on trees and animals were emphasised much more than possible life threatening complications in old people."

posted by Anthony Cox at 12:17 PM | permalink


The MMR legal decision: A different perspective from Spiked on-line:
Some will see the halting of this court case as evidence that the authorities are banding together to hide the truth. Of course, this is X-Files stuff - but just saying that won't make it go away. In many ways, the more opportunities there are to air the facts, the better. It might be preferable that the case failed in the High Court, than campaigners and parents are left to wonder why it never got there.
The problem with this analysis is that these "opportunities" do not just air facts, but also allow the haze of falsehoods and junk science surrounding MMR to be paraded. The media give undue weight to the junk science and the personal anecdotes are hard to counter without looking like an uncaring establishment. The mere fact that the issue is in the media spotlight raises fresh doubts in the minds of parents; despite there being no new evidence that MMR is the cause of autism and accumulating evidence that it isn't.

The High Court would have eventually had to rule on the case and a decision against the anti-MMR campaigners at that point would be seen as supreme evidence that the estabishment has banded together to hide the "truth". You will never win these people over, they believe in their case regardless of the evidence. It is not open to any rational discussion. The best you can do is hope to win over those without an axe to grind and attenuate the negative effects this minority have on the vaccination rates of children.
posted by Anthony Cox at 10:01 AM | permalink


New Blog: Envirospin Watch run by Professor Emeritus Philip Stott. The blog covers environmental issues and science in the UK media. Concerned with examples of bad science in the media and the good science that is ignored for political reasons, it is well worth a read. His review of the newspaper reporting of environmental science is interesting, with The Guardian under particular attack:
The Guardian: at times hardly distinguishable from a rabid left-wing or deep green pressure group, or a less rational NGO. A once great newspaper of report that has degenerated into a tirade for the trendy and authoritarian left, which has abandonned all sense of the Enlightenment. Some of its correspondents are morally bankrupt in their quite balmy views of the world. Luckily, however, there are a precious few glorious exceptions, such as David Aaronovitch, Jonathan Freedland, Simon Hoggart, and even Polly T. when she is writing about what she knows (awful on the environment). Its main environmental science reporting is bordering on the scandalous for a serious newspaper (with a slight improvement in the new 'Life' supplement which I am monitoring).* (Section ratings: 'Life'***; 'Environment' section in 'Society Guardian' - pure unadulterated propaganda - no stars).
He says the Daily Mail is a disgrace apart from the lively Melanie Phillips. However Melanie Phillips has been so wrong with her coverage of MMR vaccine in her three part series I, II, and III and has in part been responsible for fanning the flames of the MMR controversy in the past.
posted by Anthony Cox at 8:41 AM | permalink

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Wednesday, October 08, 2003

Taking smoking companies to court, does it give out any anti-smoking message? A high profile case against cigarette companies has started in the UK. The wife of a Mr McTear, who died from lung cancer 10 years ago, is sueing Imperial Tobacco for £500,000 in damages. The basis of the claim is that the cigarette company did not warn Mr McTear of the ill-effects of smoking and advertising made smoking look "glamorous". Mr McTear was diagnosed in 1992 with lung cancer and died the next year. At the time of his diagnosis, he was smoking 60 cigarettes a day. The lawyers in the case argue that if Mr McTear had known the risks he would not have started smoking in the 1960s.

When asked why the she was undertaking the case, one of the reasons the Mrs McTear gave was "to get it across to young people that smoking is dangerous,"

It must be pretty clear to most people that smoking is dangerous. Large warnings on fag packets, like Smoking Kills, cover up a large proportion of the pack. I can't see how this court case will get any message across to young people. Indeed, the cigarette company is expected to draw attention to the point that the risks of smoking have been known for some time and that Mr McTear chose to continue smoking even after the warnings were introduced. Cigarettes may be "evil", but smokers are making a risk-benefit decision. The fact people still start smoking despite the risks is evidence of that, though they may not be aware of the magitude of the risk due to ignorance (possibly deliberate). I can't see any benefits myself, but even Mr McTear said prior to his death:
"God forgive me but I enjoyed it. I still want to smoke even though I've got all this happening to me."
If you still smoke, go to www.givingupsmoking.co.uk and think about making a start. Giving up has some immediate health benefits and you dramatically reduce your risks of long-term diseases. After ten years of non-smoking your risk of a heart attack is back to that of a a person who has never smoked and your risk of lung cancer will be half that of a smoker.
posted by Anthony Cox at 5:04 PM | permalink


Wrong drug leads to child death: The BBC reports a case of a 18-month-old child given an injection of vecuronium, a muscle relaxant, instead of a sedative with fatal results.
posted by Anthony Cox at 4:32 PM | permalink

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Friday, October 03, 2003

Don't lose your head: I don't know why, but this has been something that has been bugging me for some time. What happens when your head is cut off?
posted by Anthony Cox at 12:52 AM | permalink

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Thursday, October 02, 2003

Lend me your ears, but don't take an anti-histamine:DrugInfoZone report that anti-histamine therapy may prolong effusions with acute otitis media:
Research published in the Journal of Paediatrics (2003; 143:1-9) suggests that as an adjunct to antibiotic therapy, treatment with antihistamines or corticosteroids does not improve acute otitis media (AOM) outcomes. The research suggests that antihistamine therapy may actually prolong the duration of middle ear effusion. The conclusions are based on a study of 179 children with AOM who were treated with one dose of ceftriaxone and then randomised to receive chlorpheniramine, prednisolone, both drugs, or placebo for 5 days.
The advice seems to be avoid using them...
posted by Anthony Cox at 11:00 PM | permalink

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Wednesday, October 01, 2003

MMR: revolutions: One can only hope that this is the start of the turning of the tides in the debate about MMR. In the United Kingdom anti-MMR campaigners have had their appeal to obtain legal overturned saving the UK taxpayer about 10 million pounds (although 15 million has been wasted already).

Much of the MMR debate in the UK has been hysterical in nature, as anybody listening to JABS (A UK pressure group opposed to MMR) spokesmen on the Radio 5 Live could testify, and getting the message across about MMR's safety will continue to be a hard job in these trust-free days.

Mavericks have been given far too much credibility by the media and the issue of autism has been presented as though it is matter of political opinion, rather than of scientific facts. Without the oxygen of public money, perhaps the voice that has drowned out rationale debate will subside and a rise in MMR uptake might be round the corner before we have what should have been an avoidable measles epidemic.

UPDATE: In the Guardian Jackie Fletcher, from JABS, called the decision to halt legal aid illogical and perverse:
"The decision to halt the cases, following the provision of new evidence, will only confirm the view that the combined powers of government and drug companies are working against vaccine victims receiving justice"
Jackie Fletcher refuses accept that there is no evidence to back up her assertion that these children are vaccine damaged, it is an article of faith. They'll carry on and on just like this lot.
posted by Anthony Cox at 8:19 PM | permalink


Risk: I missed this table in the BMJ last week about familiar risks, although I have seen similar attempts to put everyday risks in context. Something to muse over when you are buying your lottery tickets or worrying about a rare adverse effect of a drug.

Here are some of the risks you face: Bottom line. Staying in bed to avoid risks is not the panacea some think it is. Topsy and Tim would not know where to turn.
posted by Anthony Cox at 9:54 AM | permalink


There's only one Norman Geras: Some of us have suspected this for sometime, but now we have evidence to back that assertion up. According to www.yournotme.com the blogger Norman Geras "is unique like a yeti or some form of Magic Chimp.".
posted by Anthony Cox at 8:45 AM | permalink

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