Depression drugs ‘causing falls’

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19 January 2012 Last updated at 01:21 GMT Falls are the leading cause of accidental death in the over-65s Elderly people with dementia are more likely to suffer falls if they are given anti-depressants by care home staff, a study claims.

Many dementia patients also suffer from depression and drugs known as selective serotonin uptake inhibitors (SSRIs) are frequently prescribed.

But the British Journal of Clinical Pharmacology reports that the risk of injuries from falls was tripled.

The Alzheimer's Society called for more research into alternative treatments.

The risk of falls following treatment with older anti-depressants is well established, as the medication can cause side effects such as dizziness and unsteadiness.

It had been hoped that a move to newer SSRI-type drugs would reduce this problems, but the latest research, from the Erasmus University Medical Center in Rotterdam, appears to show the reverse.

'Worrying'

Dr Carolyn Sterke recorded the daily drug use and records of falls in 248 nursing home residents over a two-year period.

The average age of the residents was 82, and the records suggested that 152 of them had suffered a total of 683 falls.

The consequences of falls were relatively high, with 220 resulting in injuries including hip fractures and other broken bones - and one resident died following a fall.

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More research is now needed to understand why this anti-depressant is having this effect on people with dementia and if there is an alternative treatment for depression that they could be prescribed”

End Quote Professor Clive Ballard Alzheimer's Society The risk of having an injury-causing fall was three times higher in residents taking SSRIs compared with those not taking the drug, and this risk rose further if the patient was being given sedative drugs as well.

Dr Sterke said that these risks needed to be taken into account when assessing whether anti-depressants were required.

She said: "Physicians should be cautious in prescribing SSRIs to older people with dementia, even at low doses."

Professor Clive Ballard, from the Alzheimer's Society, said it was "worrying" that such a commonly prescribed anti-depressant was causing increased risk.

He said: "It is important to highlight any aspect of care that might be causing risk to a person with dementia. We want to ensure that people with the condition are always receiving the best care possible.

"More research is now needed to understand why this anti-depressant is having this effect on people with dementia and if there is an alternative treatment for depression that they could be prescribed.

"One in three people over 65 will die with dementia yet research into the condition continues to be drastically underfunded. We must invest now.'

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NYC recommends AIDS drugs for any person with HIV

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NEW YORK (AP) — Health officials in the nation's largest city are recommending that any residents living with HIV be offered AIDS drugs as soon as the virus is diagnosed, an aggressive move that has been shown to prolong life and stem the spread of the disease.

Standard practice has been to have patients put off the expensive pill regimen — which can cost up to $15,000 a year in the United States — until the immune system weakens.

But New York City Health Commissioner Thomas Farley said recent studies have shown that the benefits of early treatment, combined with education and testing, appear to be a promising strategy for countering the epidemic.

"I'm more optimistic now than I've ever been about this epidemic that we can drive our new rates down to zero or close to it — eventually. I don't know how soon. But I'm very optimistic of the direction that it's going to take the epidemic to," Farley said Wednesday.

More than 110,000 people in New York City are infected with HIV, more than in any other U.S. city and about 75 percent of all cases in the state. San Francisco, which had more than 18,000 people living with HIV, is believed to be the only other major city to have made a similar recommendation, in 2010.

City health officials said the new recommendation could initially help about 3,000 people get on medications. About 66,000 New Yorkers living with HIV that the Health Department tracks are being effectively treated with AIDS drugs, they said. But they said it was difficult to estimate how many people would eventually need the medications.

Some doctors agree with the Department of Health that it is time to update the guidelines for initiating AIDS drug treatment.

"The New York City health department is a little bit ahead of the curve. In my opinion, the rest of the country will follow, and I think it will be pretty quick," said Dr. Michael Saag of the University of Alabama at Birmingham and past chairman of the HIV Medicine Association.

The standard measure of the CD4 count — a way to measure the strength of the immune system — is an outdated trigger for therapy, a relic from research on early antiretroviral drugs, Saag said.

"It's an anachronism. It's old school. It's yesterday," Saag said. "I agree completely with the New York City health department."

Dr. Joel Gallant of Johns Hopkins University School of Medicine and vice chair of the HIV Medicine Association also agrees with the New York recommendation for offering early treatment. He recommends early treatment for his own patients.

"Nobody I know who is an HIV expert feels that it's a bad idea to treat HIV at high CD4 counts from a medical or scientific standpoint," Gallant said. "If there are objections, they'd usually be based on cost or feasibility."

Saag said the cost questions are very important because brand-name drugs can retail for $1,200 to $1,600 per month.

"For sure, they're very expensive drugs and we should be careful about that," he said, though he added that the medications are going generic so costs should come down.

City health officials said they anticipated that the cost for expanding the use of AIDS drugs would be covered by private insurance or by the AIDS Drug Assistance Program, a $270 million program for the uninsured or underinsured that is partially funded through federal dollars. The health officials said they expect the benefits over the long term would far outweigh the initial costs because there would be fewer hospitalizations and new HIV cases.

"There will be some increasing costs over the short term," Farley said. "But over the long term, it's absolutely the right thing for the epidemic."

HIV experts are split about whether early therapy should be recommended or optional. Besides the high costs, the pills have side effects from nausea to liver damage. Patients unwilling to take them religiously for life could develop drug resistance.

A panel that recently updated U.S. guidelines was divided evenly, with half favoring starting therapy early for everyone and half regarding an early start as elective.

But there's growing evidence that untreated HIV can lead to cancers and heart disease. What's more, antiretroviral drugs are safer, have fewer side effects and work better than they did in the past. New research also indicates that people live better, healthier lives and their sex partners are less likely to get infected.

The new research cited by the city's Health Department in making its recommendations includes a nine-nation study whose preliminary results were announced earlier this year and showed that earlier treatment meant patients were 96 percent less likely to spread the virus to their uninfected partners.

Dr. Moupali Das, the director of research at the San Francisco Department of Health HIV Prevention Section, said its surveillance data indicated that physicians were treating their HIV patients early even before the city recommended doing so. She said the average amount of time from diagnosis to having no virus in the blood went from 32 months in 2004 to eight months in 2008.

"That reflects that the newer medications are more potent and efficacious, and the doctors were likely initiating them earlier," she said.

She said they are currently analyzing what has happened since the recommendations went into effect. But, anecdotally, she said that there has been a change among patients seeking treatment. "It's changed the dialogue and empowered our patient population," she said.

Public health experts predict the guidelines for starting AIDS drugs treatment will shift toward a clear recommendation for early treatment.

But New York City's health commissioner said officials there could not wait to respond.

"What we're doing here is we're making a really clear and unequivocal statement that we think this is good for the health of the patient, good for the health of the entire population, good for the response to the epidemic," Farley said.

___

AP Medical Writer Carla K. Johnson in Chicago contributed to this report.

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Study: Whites More Likely to Abuse Drugs Than Blacks

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Black youth are arrested for drug crimes at a rate ten times higher than that of whites. But new research shows that young African Americans are actually less likely to use drugs and less likely to develop substance use disorders, compared to whites, Native Americans, Hispanics and people of mixed race.

“Our goal is to alert people to the burden of drug problems and also to how some of our concern about who has these problems may not be true,” says Dr. Dan Blazer, senior author of the study and a professor of psychiatry at Duke University. “There's a perception among many individuals that African Americans as a group — regardless of socioeconomic status — tend to abuse or use drugs at higher rate and this [does not support] that."

Using data from 72,561 youth interviewed for the National Survey on Drug Use and Health, researchers found that 37% of those aged between 12 and 17 had used alcohol or other drugs at least once in the past year. Nearly 8% met criteria for a substance use disorder — either the less severe “substance abuse” diagnosis or the more problematic “substance dependence,” which is more commonly known as addiction.

The study, which was published Monday in the Archives of General Psychiatry, controlled for variables like socioeconomic status because rates of severe drug problems tend to be greater amongst the poor. Despite this, Native American youth fared worst, with 15% having a substance use disorder, compared to 9.2% for people of mixed racial heritage, 9.0% for whites, 7.7% for Hispanics, 5% for African Americans and 3.5% for Asians and Pacific Islanders.

It is not known why rates for Native Americans were so elevated, but the category of substance use disorders does include alcoholism, a disorder for which this group is known to be at high risk.  Marijuana and prescription opioid problems also occurred at higher rates in Native Americans.

MORE: How to Find the Best Drug Treatment for Teens: A Guide for Parents

The authors considered abuse and dependence together rather than separating them because the next edition of psychiatry's diagnostic manual, the DSM-V, will combine them into one diagnosis, with different levels of severity.

“It's really difficult when you look at the data to actually separate out abuse and dependence,” says Blazer, while acknowledging that merging the categories could pose different problems.

For example, a large proportion of youth with drug problems recover without treatment. While rates of substance use disorders tend to be around 8% in the teen years, these rates dip to less than 2% for those over 26; the number of people who've gotten better far exceeds that which could have possibly attended treatment or even self-help groups.

That poses a problem: addiction treatment centers tend to focus on getting youth to acknowledge that they have a chronic, relapsing disease, but this — in combination with surrounding youth with peers who are also in trouble — could create a self-fulfilling prophecy.

MORE: Does Teen Rehab Cure Addiction or Create It?

“Labeling can be problematic,” says Blazer, “but also, treating these individuals is not easy. Most programs have modest success at best and with ongoing use over time the ability to actually reverse [the disorder] declines. Therefore, by identifying these individuals early and intervening early, they have a much better chance.”

That is, of course, if the treatment is effective and doesn't use tactics that can backfire. “I would hope we get a little more enlightened in the way we treat adolescents,” Blazer says, explaining that treatment must be culturally sensitive if it is to help all types of youth resolve drug problems.

MORE: The Authentic Self: How Do You Know If You're 'Really' Racist or Sexist?

Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland's Facebook page and on Twitter at @TIMEHealthland.

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Psoriasis, RA drugs don't raise infection risk

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TNF inhibitors, which include Humira and Enbrel, pose no additional infection risk is a "very new and heretical idea."The research contradicts numerous earlier studies that did find an increased risk Felson, however, says the new findings aren't sufficient to quell the concernsPrevious studies have found that TNF inhibitors as much as double the risk

(Health.com) -- A class of injectable drugs used to treat autoimmune disorders such as rheumatoid arthritis doesn't raise the risk of serious infection when compared with more conventional treatments, according to a new analysis in the Journal of the American Medical Association.

The research, which was funded by the Food and Drug Administration and other federal health agencies, contradicts numerous earlier studies that did find an increased risk of infection associated with the drugs, known as tumor necrosis factor (TNF) inhibitors.

The possibility that TNF inhibitors -- which include popular drugs such as Humira and Enbrel -- pose no additional infection risk is a "very new and heretical idea," says David T. Felson, M.D., a professor of medicine and epidemiology at the Boston University School of Medicine, who cowrote an editorial accompanying the study. "Up until now there has been considerable evidence that anti-TNFs heightened the risk of serious infection compared to other treatments."

Health.com: Signs and symptoms of rheumatoid arthritis

The lead author of the study, Carlos G. Grijalva, M.D., a professor of preventive medicine at Vanderbilt University, in Nashville, Tennessee, says the findings "should be reassuring for patients and providers."

Felson, however, says the new findings aren't sufficient to quell the concerns raised by previous studies. "We still need to be concerned about serious infection risk among patients starting these medicines," he says.

Autoimmune conditions, including rheumatoid arthritis, psoriasis, and inflammatory bowel disease, arise when the body's immune system goes awry and begins attacking healthy cells and tissue. TNF inhibitors -- known as biologic drugs, because they're derived from substances that occur naturally in humans and animals -- work by blocking the action of TNF, an important immune-system molecule.

Health.com: 10 risk factors for inflammatory bowel disease

This class of drugs drastically improved the treatment of these conditions when first introduced in the late 1990s, but because they suppress the immune system they are believed to open the door to opportunistic infections. Some patients taking the drugs have died from these infections, and the FDA has been closely watching the drugs' safety profile as more and more people use them.

Previous studies have found that TNF inhibitors as much as double the risk of serious infection compared with other treatment options. Those trials tended to be relatively small, however. The new study, which was presented this weekend at an annual meeting of the American College of Rheumatology, sought to address that weakness.

Grijalva and his colleagues combined data on more than 32,000 mostly low-income people from four large health-care databases, including those for Medicaid and Medicare. About half of the people took TNF-inhibitors for their conditions, and the other half took older, non-biologic drugs -- such as leflunomide, hydroxychloroquine, and sulfasalazine.

Health.com: Got psoriasis? 7 signs you may have arthritis too

The authors identified 1,172 infections requiring hospitalization during the study period. (The most common infections were pneumonia and skin and soft-tissue infections.) After one year of treatment, people taking TNF inhibitors had no higher risk of serious infections than those taking other types of drugs.

The researchers did find, however, that among patients with rheumatoid arthritis, the TNF inhibitor Remicade carried an approximately 25% higher risk of infection than Enbrel or Humira.

How well are you managing your rheumatoid arthritis? Take a health test

It's not clear why Remicade might be riskier than other TNF inhibitors, but it's possible that the higher initial doses the drug requires might be partly responsible, Grijalva says. The mechanism of action may also be slightly different than that of other TNF inhibitors, he adds.

The study does have an important limitation that detracts from the findings, Felson says. As he notes in his editorial, some 40% of participants taking TNF inhibitors dropped out within the first month, compared with only 15% in the comparison group.

In previous trials and in clinical practice, people who stop taking TNF blockers "tend to be older and at a higher risk of serious infections," Felson says. That pattern, he adds, may have skewed the study results and made TNF inhibitors look safer than they perhaps really are.

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FDA links new blood clots birth control drugs

WASHINGTON (AP) - concerns of security with the popular birth control pill as yaz increased federal Thursday that scientists of Health reported that the drug from Bayer and other newer birth control treatment appear to increase the risk of dangerous blood clots more older drugs.

A new study published by the Food and Drug Administration reviewed the medical history over 800,000 women U.S. takes different forms of control of births between 2001 and 2007. On average, women taking Yaz had 75% more likely to end up with a blood clot than women older birth control medications.

YAZ contains estrogen with a synthetic hormone of next generation called drospirenone, who is known to increase the level of potassium in the blood. FDA compared the medical records of women taking the drug with those who take the old drug levonorgestrel.

YAZ, Yasmin and related pills containing drospirenone of were free of second-best-selling Bayer to $ 1.6 billion in global sales last year.

In 2009, the FDA has taken an unusual step order Bayer to run corrective on Yaz TV advertisements, stating that the ability of drugs exaggerated the drugmaker marketing campaign to prevent acne and premenstrual syndrome.

Bayer Healthcare, a division of the German conglomerate, it says "currently assessing this publication and cannot comment on at this time."

The Agency also reported complications higher in women using the Ortho Evra of Johnson & Johnson and ring patch vaginal Nuvaring of Merck & Co. Inc. These drugs combine estrogen, which is present in all birth control pills, with two other synthetic hormones in the last decade.

The FDA said it has not reached a final conclusion on the safety of the drugs but will hold a meeting with scientific advisors on 8 December.

The consumer safety advocates have criticized the Agency of the latest and most expensive birth control drug approval when cheaper, generic medicines with established security records are widely available.

"At some point we must ask why the FDA continues to approve drugs that are less safe and have no advantage over drugs already on the market," said Dr. Diana Zuckerman, President of the National Centre for women and families, a group of consumers for women's health issues. "With all these different birth control options, why take the more expensive that can kill you?"

Recent studies have reached different conclusions about the risks of contraceptive pills more recent.

A study published earlier this week on more than 1 million Danish women found that women taking Yaz and other newer drugs have twice the risk of blood clots as women taking the hormone levonorgestrel older. The findings published Tuesday in the British Medical Journal.

However, two studies published in 2007, conducted as part of the regulators FDA postmarketing requirements or European, have not found any difference in clotting between comparable groups.

Pills of birth control containing drospirenone include Yaz, Yasmin, Bayer's Beyaz, Safyral; Sandoz Syeda and Loryna; as well as Ocella Barr, Watson Pharmaceuticals Zarah and Loryna of Teva Pharmaceuticals laboratories.

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Asthma drugs may increase attacks in kids: report

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By Genevra Pittman

NEW YORK | Tue Oct 25, 2011 5:19pm EDT

NEW YORK (Reuters Health) - One class of drugs used to prevent wheezing and shortness of breath in people with asthma may increase kids' risk of being hospitalized for an asthma attack, according to a new analysis from the U.S. Food and Drug Administration.

However, researchers said, it's possible that when the drugs, called long-acting beta-agonists or LABAs, are used in combination with inhaled corticosteroid medications, that extra risk disappears.

"These studies confirm our recommendations at the FDA that are already (on drug labels) for children and adolescents to use inhaled corticosteroids and LABAs together in one asthma product," said Dr. Ann McMahon, who led the study.

But, she added, the researchers weren't completely convinced from the data they had that inhaled corticosteroids take away all extra risk.

According to the Centers for Disease Control and Prevention, seven million children in the U.S. have asthma (about nine percent), and the rate has been climbing steadily in recent years.

Some kids and adults with asthma are prescribed LABAs to relax muscles around the airway and prevent symptoms like wheezing. But there's also evidence that long-term use of the drugs may slightly increase the risk of sudden serious symptoms.

LABAs are also used by people with chronic obstructive pulmonary disorder, or COPD.

The FDA report combines safety data from over 100 studies including about 60,000 people with asthma. The original trials were done by companies that market LABAs.

The drugs include Merck's Foradil and GlaxoSmithKline's Serevent.

Compared to all patients who didn't take LABAs, adults and kids who were prescribed the drugs were 27 percent more likely to end up in the hospital, or in rare cases die or require intubation, because of an asthma attack.

That extra risk was greatest in the youngest study participants. Kids between age four and 11 who were taking a LABA were 67 percent more likely to have an asthma-related hospitalization than those who weren't getting the medication.

That means that over a one-year period, there would be an extra three hospitalizations for every 100 kids taking LABAs.

A small number of people of all ages who were regularly taking an inhaled corticosteroid together with a LABA didn't seem to have any extra risk of hospitalization, according to the report published in Pediatrics.

"Although we were able to be somewhat reassured... it was a small enough sample that we didn't feel entirely confident, and we need to have further analysis," McMahon told Reuters Health.

The finding of an extra hospitalization risk in people taking LABAs alone isn't new. Last year, after other research suggested that risk, the FDA began requiring drugmakers to write on LABA labels that the drugs should not be used without a long-term asthma control medication like an inhaled corticosteroid.

Some asthma medications, including GlaxoSmithKline's Advair and AstraZeneca's Symbicort, contain both a LABA and corticosteroid. The FDA recommends such combined products for kids with asthma.

"The thing that's new in this paper... is they've highlighted the fact that younger-age children may have a higher risk" when taking a LABA alone, said Dr. Scott Weiss, as asthma researcher from Harvard Medical School in Boston who was not involved in the report.

Weiss reported financial ties to the drug company Novartis, and was formerly linked to GlaxoSmithKline and AstraZeneca.

McMahon said the analysis wasn't designed to examine the reason for extra risks due to LABA use in kids, and didn't want to speculate. But Weiss said it could be related to their smaller airways.

He agreed that it's important for future studies to look directly at the issue of serious attacks in LABA users to determine the underlying cause behind those attacks -- and whether they're directly due to the medications themselves.

Still, he told Reuters Health, "Nobody is really prescribing a LABA on its own -- that's basically off the market."

SOURCE: bit.ly/txNP6y Pediatrics, online October 24, 2011.

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CDC: 1 in 25 adolescents take drugs for depression

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ATLANTA (AP) — Roughly 1 in 25 adolescents in the United States are taking antidepressants, according to a new government study billed as the first to offer such statistics on that age group.

The Centers for Disease Control and Prevention on Wednesday reported the figure for kids ages 12 to 17. It's based on surveys and depression screenings of about 12,000 U.S. adolescents and adults during the years 2005 through 2008.

The study found about 1 in 10 adults take antidepressants. And perhaps more should: The researchers said only one third of people in the study with symptoms of depression were taking medication.

The finding suggests that "there's a lot of people who are seriously ill who aren't getting treated," said Laura Pratt, the CDC epidemiologist who led the research.

Curiously, rates of antidepressant use were about the same in different income groups, even though earlier research had shown higher rates of depression among the poor, Pratt noted.

The researchers don't know why that is, but other experts have noted that poor people may have less access to medical services and doctors who prescribe the drugs. Also, some people may think they can get over depression themselves or don't want to be labeled as depressed.

Women take antidepressants more than men, and whites use them more than blacks or Mexican-Americans, the study also found.

Also, more than 60 percent of Americans taking antidepressants have been taking a medication two years or longer, and 14 percent have been taking such a drug for 10 years or more.

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CDC: 1 in 25 adolescents take drugs for depression

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ATLANTA (AP) — Roughly 1 in 25 adolescents in the United States are taking antidepressants, according to a new government study billed as the first to offer such statistics on that age group.

The Centers for Disease Control and Prevention on Wednesday reported the figure for kids ages 12 to 17. It's based on surveys and depression screenings of about 12,000 U.S. adolescents and adults during the years 2005 through 2008.

The study found about 1 in 10 adults take antidepressants. And perhaps more should: The researchers said only one third of people in the study with symptoms of depression were taking medication.

The finding suggests that "there's a lot of people who are seriously ill who aren't getting treated," said Laura Pratt, the CDC epidemiologist who led the research.

Curiously, rates of antidepressant use were about the same in different income groups, even though earlier research had shown higher rates of depression among the poor, Pratt noted.

The researchers don't know why that is, but other experts have noted that poor people may have less access to medical services and doctors who prescribe the drugs. Also, some people may think they can get over depression themselves or don't want to be labeled as depressed.

Women take antidepressants more than men, and whites use them more than blacks or Mexican-Americans, the study also found.

Also, more than 60 percent of Americans taking antidepressants have been taking a medication two years or longer, and 14 percent have been taking such a drug for 10 years or more.

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Counterfeit drugs targeted by technology in India

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11 October 2011 Last updated at 05:47 GMT By Shilpa Kannan BBC News, Delhi WATCH: Fake drugs like these counterfeit Viagra pose a huge health risk to patients - and destroy confidence in genuine pharmaceuticals

Making pills that could save lives both in India and abroad, Indian pharmaceutical companies are growing faster than ever before.

Worth over $12bn, the industry is expected to grow more than four-fold in the coming decade.

But even as global attention is focused on the healthy growth in India, it is threatened by a serious malaise - counterfeiting. Fake drugs in the system risk not just lives of patients, but also the reputation of drug makers.

Faking it

There are varying estimates of how big the problem is. Up to 25% of the medicines consumed in poor countries could be counterfeit or substandard, according to the World Health Organisation. They define a counterfeit as "a medicine, which is deliberately and fraudulently mislabelled with respect to identity and/or source".

Counterfeit drugs are a $200bn (£128bn) industry worldwide. Producers need very little investment to set up the manufacturing process and can make huge profits.

With manufacturing costs nearly 40% cheaper than other countries, the authorities are worried India could become an easy target for counterfeiters.

This is why the government has launched a campaign against counterfeit medicines. The drug controller of India says while they have task forces that regularly raid producers, it is increasingly difficult to spot fakes.

Fake drugs like these, destined for Africa, can kill

Very often consumers cannot work out if they have been treated with a counterfeit product, which may contain non-active or even toxic ingredients.

Deputy drug controller general of India, Dr D Roy, says counterfeit medicines often resemble the originals in chemical composition. But he thinks the biggest problem is the packaging.

Holding up two strips of a medicine for the common cold, he points out that its nearly impossible to find any differences in them.

"This is how consumers are deceived," he says.

"Retailers too would find it difficult to identify a fake. The packaging industry is not regulated by us. The need of the hour is to evolve a more holistic approach that ensures involvement of all stakeholders in the supply chain."

The deputy drug controller for India, Dr D Roy, shows how difficult it is to tell the fakes from the real things

Currently, when a company suspects that its drugs are being counterfeited in a particular area, they alert the local office of the drug controller to take action.

The authorities then conduct a raid and seize any fake products found.

Testing times

When a consumer suspects that a drug is counterfeit, the process to get it tested in a government laboratory is slow and expensive.

Technology is now being used to speed up the process.

A committee set up by the Indian Ministry of Health has approved a proposal to put 2D barcodes and scratch-off labels on medicines.

The label works like a telephone recharge coupon. The user scratches off the cover and texts what is underneath to a freephone number, to find out if a pill is real.

Quick response (QR) codes are also being tested. These printed squares are an advanced version of the 2D barcodes. Anyone with a camera-enabled phone and web access can scan the code and be taken instantly to the pharma company website to authenticate the drug.

Leveraging the extensive mobile usage in the country and cloud computing, the pharma industry hopes to increase their credibility. Computer companies see a huge business potential in offering technology solutions to the whole industry.

Hewlett-Packard is one of the companies offering a solution, a cloud-based platform called Global Authentication Service.

This barcode lets pharma companies track drugs through the supply chain

Pharma companies can buy two-dimensional bar codes which will be printed on the packaging material.

The companies can then use the cloud service to monitor the movement of products through their global supply chains. The system is used to trace and authenticate medicines in Nigeria and Ghana.

A Appadurai of HP India says they have used the system in Africa with non-profit social enterprise mPedigree. In India, they are in talks with pharma manufacturers like Cipla, Tablet India and the Chemical & Alkeli Merchants Association (CAMA).

Mr Appadurai says the technology would not be very expensive.

"The two dimensional barcodes would cost around one rupee each. This may mean a firm's expenditure may rise marginally. However, compared to the litigation costs some pharma companies face, this cost is nothing."

Bonding moment

In an effort measure the amount of fake drugs in the market, the pharma industry and the authorities have come together.

Measures under consideration include a certification system for pharmacists, and an open source website where consumers and companies can access data on fake drugs.

Bilcare Technologies makes anti-counterfeiting, security and brand protection technologies. These include a handheld scanner to track their security technology nonClonableIDT.

This scanner can check the authenticity of packets of pills

It's almost like a fingerprint that can be put on any product. The company claims it provides a reliable means to track and trace products across the supply chain - from manufacturer to consumer.

Another company, PharmaSecure, has come up with a technology called UIMV - unique identification mobile verification. It is a unique code for each product which can be verified by sending texts to the number given.

Manufacturers print these codes on packaging, and monitoring begins the minute the product leaves the factory. This way consignments are protected while in transit until they reach their destination.

Profits warning

Bejon Misra of the Partnership for Safe Medicines says counterfeiting eats into profits and affects the development of new formulations for medicines.

Consumers can text this number to a freephone number to find out if their medicine is real or fake

"In the perennial search for new drugs to tackle viruses and bacteria that are constantly mutating and developing resistance to current medications, the pharmaceutical industry spends billions of dollars every year towards research and development.

"If we fail to reduce the menace of spurious medicines, the cost towards health care can increase phenomenally."

Prafull D Sheth of the South East Asian Regional Pharmacy Forum says that even if a small percentage of the overall market is found to be counterfeit, it has a big impact financially.

According to the WHO the most frequently counterfeited medicines in wealthier countries are new, expensive lifestyle medicines, such as hormones, steroids and antihistamines.

Government regulations mean drug manufacturers will have to bar code their products

While in developing countries it is those used to treat life-threatening conditions such as malaria, tuberculosis and HIV/AIDS.

The majority of fake drugs available are said to originate in India and China.

India is also one the world's fastest-growing hubs for generic drug production. A majority of the medicines available in Africa come from Indian generic drug laboratories.

Meanwhile the World Trade Organization says fake anti-malaria drugs kill 100,000 Africans a year and the black market deprives governments of 2.5-5% of revenue.

The government hopes barcoding will give credibility to the generics leaving the country. From 1 October 2011, it will be mandatory for all pharmaceutical exporters to print bar-codes on their tertiary or outer-most packaging.

Continue reading the main story

It's important for India to reassure consumers worldwide of the safety and credibility of drugs made here”

End Quote Paul Lalvani Empower School of Health The order also stipulates the compulsory implementation of a track and trace system will also include secondary-level packaging from 1 January, 2012 and primary packing from 1 July, 2012.

Paul Lalvani is dean of Empower School of Health.

He says around $5bn is invested by the big donor funds in anti-malarial and anti-retro viral drugs.

"80-90% of this comes from India. Drug makers impact the lives of over 6m people around the world who are on anti-retro viral drugs and 200m people on anti-malarials."

"So it's important for India to reassure consumers worldwide of the safety and credibility of drugs made here."

Ensuring that poor people get access to quality drugs is a top priority says the government. But counterfeiting is seriously impacting the growth the pharmaceutical sector has so far been enjoying.

Until the government is able to crack down on fake products in the marketplace, popping a pill could be life threatening.

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Warning over heart patient drugs

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28 September 2011 Last updated at 13:44 GMT The report reviewed cardiology services across Scotland More than half of heart patients in Scotland at high risk of stroke are not receiving the most appropriate treatment, according to a new report.

Scrutiny body Healthcare Improvement Scotland has published the "most comprehensive picture yet" of cardiology services across the country.

It found 53% of patients who should be getting a blood thinning drug were not.

Meanwhile low-risk patients are being given more powerful medication when they should just be taking aspirin.

The report paints an in-depth picture of the strengths and weaknesses of heart disease services in Scotland, and includes detailed plans for how improvements to services can be made.

Cardiovascular disease is the leading cause of death in the UK and coronary heart disease results in nearly 10,000 deaths every year in Scotland.

The report raised concerns about treatments prescribed to people with atrial fibrillation, a common heart rhythm disorder with a high risk of stroke.

While nearly 80% of people with this diagnosis receive some form of blood-thinning drug, less than half (47%) of higher risk patients are receiving the most appropriate treatment, Warfarin.

At the same time 31% of low-risk patients, who should be treated with aspirin alone, are receiving a blood-thinning drug which exposes them unnecessarily to a higher risk of bleeding complications.

Vital services

Dr Martin Denvir, clinical lead for the heart disease improvement programme, said: "Within three years of starting this improvement programme we are now publishing a groundbreaking report which sets out in detail just what has been achieved in Scotland - and what is still to be done.

"This is the most comprehensive picture yet of heart disease services in Scotland.

Continue reading the main story

There is some way to go until every patient has the correct treatment every time”

End Quote David Clark Chest Heart & Stroke Scotland "The journey towards perfect care for all patients is by no means over, but our findings clearly identify what is already being done well, what needs improvement and how we can measure our improvement and progress towards best quality of care."

The report also found that although all health boards have risk assessment programmes in place to identify people at high risk of heart disease and stroke, these programmes are not provided comprehensively for all high-risk groups in the general population.

It also said the Scottish Ambulance Service provides a well-trained and rapid response to emergency calls and reaches 71% of patients with suspected heart disease within eight minutes.

The report makes a number of key recommendations to improve patient care, including a review of the prescribing of blood-thinning drugs.

It said patients at low risk of stroke should not routinely be prescribed Warfarin.

Andy Carver from the British Heart Foundation (BHF) welcomed the report and said: "It is an important step in improving the accountability of NHS boards for the delivery of vital services for heart patients.

"We will continue to watch closely and help ensure that these standards are implemented to help people prevent heart disease and make sure services for heart patients are the best possible in all parts of the country."

Chest Heart & Stroke Scotland's chief executive David Clark said "We recognise that there has been real progress as a result of the Heart Disease Improvement Programme and that Scotland has some world-class centres for the treatment of heart disease.

"However, we also have to recognise that there is some way to go until every patient has the correct treatment every time."

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Study: College-Age Youths Increasingly Overdose on Alcohol and Drugs

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College-age youth are increasingly overdosing on drugs and alcohol, according to 1999–2008 data on hospitalizations in this age group.

The rate of hospitalizations following overdose skyrocketed in people aged 18 to 24, the new study found: overdoses involving alcohol in combination with other drugs increased 76%; overdoses involving drugs other than alcohol rose 55%; and those involving alcohol alone went up 25%. The most striking rise was seen in overdoses involving prescription painkillers, which leapt 122% over the same period.

In 2008, researchers estimated that there were 114,000 hospitalizations for single or multiple drug overdoses, 29,000 for combination alcohol and other drug overdoses and 29,000 for alcohol-only ODs.

Adults over age 25 saw similar increases in overdose rates, except in those involving both alcohol and other drugs — that increase was less steep. Although alcohol is much more commonly used than other drugs, it was responsible for a smaller proportion of overall overdose-related admissions to the hospital.

MORE: On Overdose Awareness Day, a Mother's Plea for Compassion

The costs of such hospitalizations total a whopping $1.2 billion per year, just for 18-to-24-year-olds alone, according to the study published in Journal of Studies on Alcohol and Drugs. Overall, 1.8 million people were hospitalized for overdose in 2008, at a cost of $15.5 billion.

Researchers used data from a sample of 20% of community hospitals in the U.S. to estimate national statistics and costs. The study did not look at drug-related death rates, but according to federal statistics, 37,485 people died from overdose, largely driven by prescription drug misuse, in 2009 — the first year that overdose deaths outpaced the number of people killed in traffic accidents.

How can we cut the death toll? I wrote about one potential solution for the New York Times' "Fixes" section on Friday, telling the story of a remarkable man who saved 14 lives with the overdose antidote naloxone. He saved 10 of those people after being brought back from overdose himself, with naloxone. If this drug were made available over the counter, half of all people who die from the most dangerous combinations of drugs in the U.S. could be spared. (For more on naloxone, I've written about it for TIME here and here.)

Given the enormous costs to lives and to the health-care system due to overdose, this is a fix that could do a lot of good.

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Fueled by Growing Painkiller Use, Overdose Deaths and Child Poisonings

Are on the Rise" href="http://healthland.time.com/2011/09/19/fueled-by-growing-painkiller-use-overdose-deaths-and-child-poisonings-are-on-the-rise/">Fueled by Growing Painkiller Use, Overdose Deaths and Child Poisonings Are on the Rise

Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland's Facebook page and on Twitter at @TIMEHealthland.

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More Evidence That Marijuana-Like Drugs May Help Prevent PTSD

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Could a marijuana-based medicine potentially prevent the symptoms of post-traumatic stress disorder (PTSD)? If the findings of a new study in rodents hold up, they may offer a new avenue for treatment of an illness that affects at least 7% of Americans during their lifetimes.

For the study, published in the journal Neuropsychopharmacology, researchers exposed rats to severe, Navy Seal-level stress, including restraint, forced swims and anesthetization. Luckier control rats just stayed in their cages and were handled twice by researchers.

Like humans who develop PTSD, the stress-exposed rats later became oversensitized to more moderately stressful stimuli, showing an exaggerated startle response to loud noises, for example. These rats also took longer to recognize that a once scary spot in a cage was now safe. Animals that had experienced traumatic stress also showed related changes in stress hormones.

But rats that were severely stressed, then immediately given a synthetic compound that mimics the effects of THC, the main psychoactive ingredient in marijuana, were mellower. They showed none of the stress-related changes seen in the rats receiving placebo.

The timing of the drug (known as WIN55, 212-2) mattered, though. The injections prevented symptoms of PTSD when they were given two or 24 hours after stress, but had no effect when administered 48 hours later.

The study, which involved a total of 637 male rats included in a series of 16 experiments, follows up similar previous work by the same author, this time using different tests of stress.

MORE: Marijuana Slims? Why Pot Smokers Are Less Obese

So would smoking marijuana within a day of being exposed to trauma reduce the risk of PTSD is humans?

"I would not suggest smoking marijuana after a traumatic experience until we have controlled data from human studies," says lead author Irit Akirav of the University of Haifa in Israel, noting that it's clear that some people are already doing this in an attempt to self-medicate. (An FDA-approved drug called Marinol, which includes THC, already exists, so it could potentially be used in human trials.)

She cautions also that the THC in marijuana has what's called a biphasic effect, in which it can initially have one effect and later the opposite, so it could potentially backfire.

Further, while THC and WIN55, 212-2 both act on the same receptors in the brain, they do so to varying degrees, so it's unclear whether smoking marijuana would have the same effect as taking the experimental drug. And, of course, the effect of either drug on rats doesn't necessarily translate into humans.

Some veterans say medical marijuana helps treat their PTSD symptoms, but there has been no human research on the question. Some research in the addictions field has found an association between higher levels of cannabis use and increased PTSD, but this could simply reflect use of marijuana to self-treat PTSD.

MORE: Why Pot Smokers Are Paranoid

Interestingly, another controversial class of drugs may also have potential in preventing PTSD. Studies of both soldiers injured in combat and children suffering from severe burns have found that greater use of opioid drugs like morphine to treat their pain is associated with reduced risk of PTSD.

Given that higher doses of pain relievers are more likely to be given in cases of more severe injury — which may carry an increased risk for PTSD — the connection is notable.

Unfortunately, the politics surrounding drugs that are used recreationally means that interesting and possibly important compounds may be not be appropriately studied. Synthetic cannabinoids similar to WIN55, 212-2 (which cannot be used in humans) are often sold as "legal highs," which have led to bans by the Drug Enforcement Administration. Such bans reduce pharmaceutical company interest in developing potentially useful drugs because of the expense involved in studying controlled substances.

But since PTSD affects between 10% and 30% of people exposed to traumatic experiences including combat, rape, terrorism and natural disasters, a drug that could help prevent it could be remarkably helpful.

MORE: U.S. Rules That Marijuana Has No Medical Use. What Does Science Say?

Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland's Facebook page and on Twitter at @TIMEHealthland.

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Designer drugs 'cost NHS fortune'

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22 September 2011 Last updated at 02:13 GMT By Helen Briggs Health editor, BBC News website NHS spending on insulin has been rising Doctors have "wasted" millions on "designer" diabetes drugs when cheaper ones would have been just as effective, according to a report.

The NHS could have saved £625m over 10 years if the older types of insulin recommended in guidelines had been prescribed, claim UK researchers.

The study, published online in BMJ Open, found the NHS spent £2.73bn on insulin, mainly on "designer" forms.

A diabetes charity said patients should have a choice of what insulin to use.

Researchers at Cardiff University found NHS spending on insulin prescriptions in England, Wales, Scotland and Northern Ireland rose from £156m a year in 2000 to £359m in 2009.

Over the same period, annual NHS spending on "designer" insulin increased from £18m (12% of total insulin cost) to £305m (85% of total insulin).

Continue reading the main story Patients with Type 1 diabetes need insulin injections to help their bodies use glucose from meals, as do some people with Type 2 diabetes There are a number of types of insulin available, including animal insulin, human insulin and analogue (designer) insulinsAnimal insulin comes from animals. Human insulin doesn't come from humans but is made in a laboratoryAnalogue insulin is a type of laboratory-made human insulin which is modified to affect how quickly or slowly it actsSource: Diabetes UKBased on the assumption that all patients could have been prescribed alternative forms of insulin, the NHS could have saved itself £625m, said the Cardiff University report.

Professor Craig Currie of the Department of Primary Care and Public Health told the BBC: "The regulatory agencies have to get a grip of the way that medicines are chosen and dispensed.

"The decisions aren't informed. The doctors aren't listening to guidelines. The system has to change to use medicines that represent the best value for money."

Pros and cons

Many patients with diabetes need to inject insulin, to help their body process glucose from food.

There are several types of insulin; including insulin made in the lab to mimic natural insulin (human insulin) and newer laboratory-made human insulins, which have been tweaked to affect the speed of action or enhance certain properties ("designer" insulin, or insulin analogues).

These newer types of insulin may have some advantages for certain patients, such as reducing weight gain and reducing the risk of low blood sugar.

But most experts believe the benefits are modest, the authors said in BMJ Open.

The medicines watchdog NICE recommends that ordinary human insulins are used as a first-line treatment, with the newer "designer" human insulins reserved for exceptional circumstances.

A spokesperson for the Department of Health said: "NICE guidance recommends that human insulin is the preferred option when insulin therapy is necessary in Type 2 diabetes.

"The National Prescribing Centre advises that newer synthetic insulins have a role in treating some patients, but people with glycaemic control problems should be properly assessed for underlying causes before these newer, more expensive insulins are considered."

Simon O'Neill, Director of Care, Information and Advocacy at Diabetes UK, said insulin analogues should be as available to all people with diabetes.

He said: "The decision of which insulin is the most appropriate for a person with diabetes should be made on an individual basis in consultation with the person with diabetes themselves."

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Prescription drugs poisonings up in kids

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By Genevra Pittman

NEW YORK | Fri Sep 16, 2011 1:27am EDT

NEW YORK (Reuters Health) - More and more kids are showing up in the emergency room after accidental poisoning from prescription drugs, according to new research.

The findings show that powerful painkillers and sedatives including sleep aids and muscle relaxants are behind much of that rise, and that the poisonings usually occur when kids get into medications themselves -- not when parents give them too much by mistake.

"This new study is a bit alarming," said Dr. Michael Rieder, a pediatrician and pharmacology researcher at the University of Western Ontario in Canada who wasn't involved in the research.

"I think people have been under the assumption that the rate of poisoning (in kids) is fairly stable," he told Reuters Health. "Our assumption is wrong."

"The big thing to take away from this is we need to do a better job of keeping children and medicines away from each other in the home," said Dr. Eric Lavonas, from the Rocky Mountain Poison and Drug Center in Denver, also not linked to the new work.

Researchers led by Dr. G. Randall Bond, from the Cincinnati Children's Hospital Medical Center in Ohio, gathered data from all calls made to U.S. poison control centers from emergency rooms after kids had accidentally swallowed a medication.

Between 2001 and 2008, they tallied about 544,000 visits in kids five and younger -- 454,000 of which could be pinned on a single drug.

Most kids who went to the ER didn't end up being sick. Still, there were 66 deaths during the study period, according to findings published in The Journal of Pediatrics.

Over that time, the number of kids landing in the ER with accidental poisoning jumped 30 percent, and hospitalizations and injuries also became more common.

That's likely because the number of prescription drugs people have at home -- including opioid painkillers, and diabetes and blood pressure medications -- has spiked recently, researchers agreed.

"Whenever you put medicines into hundreds of millions of homes, somebody's child is going to get into it," Lavonas told Reuters Health.

The most common reason for an ER visit was kids getting into a prescription medication on their own. Drugs such as sedatives and opioid painkillers, including oxycodone, as well as heart drugs caused the most visits of the prescription drugs.

The rate of hospital admission and injury after accidental poisoning was highest for long-acting diabetes drugs. Half of kids who took those drugs were kept for observation, and one in five had a moderate or serious injury as a result.

Bond said medicines that are available today are more potent than in the past, meaning a single dose could pose more of a danger to a young child.

Parents have to be extra careful about where they store their medications when kids are as young as nine months old, Rieder said.

As a society, he said, "I think we've become a bit complacent" about having drugs around and accessible.

Lavonas said a few simple rules can help prevent an accidental poisoning. "Store all medicines, including adult medicines and children's medicines, up and away," he said. "Number two, put the medicine away every time you take it out."

If a child does get into medication, "It's important to call poison control," he said.

The number for the American Association of Poison Control Centers is 1-800-222-1222.

Bond added that making that call could cut down on a lot of unnecessary trips to the ER for kids who will be fine after taking not much of a pretty safe medicine.

If your child does need medical care, Lavonas said, poison control can determine how urgent it is. They can also walk parents through emergency first aid, he added.

SOURCE: bit.ly/o3eHF5 The Journal of Pediatrics, online September 13, 2011.

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HEALTH MANAGEMENT. ' TF beacons to illuminate way to the new Oncology tests and drugs

Scientists report development a long control desired new way that the activity of genes in the way are action to detect, which bind to the DNA in genes, proteins, cells, which normally cause everything from growing cancer often. Your report is in the journal of the American Chemical Society.
Kevin Plaxco, Francesco Ricci and colleagues found that more than 10 percent of the 25,000-30,000 instructions contain genes in the human body for this so called DNA-binding proteins. Most of these proteins are known as master regulators transcription factors (TFs). You start or stop the first step in this process, in which genes statements into action are implemented. TFs bind to DNA and genes, enable or disable. Understanding and measuring the activity of TFs is important, because they are involved with many in connection with cancer, health and disease, for example. With existing possibilities the activity of TFs is slow and cumbersome to recognize scientists, stated that barrier to overcome.
The scientists describe, development and successful testing fluorescent sensors, that they term "transcription factor lighthouses." The lamps signal the activity and the concentration of TFs directly in biological samples by moving from a dark State to a fluorescent State on binding on their specific TF. With TF beacons works easier and faster than current methods, and scientists say TF beacons of various applications in cancer, the search for new cancer drugs and other areas can have.

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