Drug reps form a huge part of the industry’s marketing strategy…
a GP’s take on Big Pharma spruiking
I’m one of several doctors throwing their weight behind the new No Advertising Please campaign, vowing to avoid drug reps for a year. This should be reasonably easy for me, as I’ve been trying to avoid them for years – though no doubt I’ll be occasionally ambushed in tea rooms and corridors. Meanwhile, I’ll keep buying my own lunch, and relying on independent sources of medicines information.
What is antibiotic resistance, and why should we care? Video published on 18 Sep 2014 by Public Health England.
Make your pledge today and become an antibiotic guardian
Antibiotic Guardian, an initiative developed by Public Health England (PHE) is urging members of the public and healthcare professionals to join in the campaign and take action and help make sure antibiotics work now and in the future.
To become an Antibiotic Guardian people choose and enact a pledge about how they will make better use of antibiotics. This campaign forms part of activities that support European Antibiotic Awareness Day (EAAD).
The website asks users to choose which category they would like to make a pledge in. For healthcare professionals and leaders, there are 10 categories from GPs, nurses, vets, commissioners, government officials and public health specialists. For members of the public there are 4 choices including parents of small children, pet owners and farmers. The available pledges change per category and those responding will be asked if PHE can follow-up to confirm they did keep their pledge.
For example, members of the public can choose from a range of pledges, including the following:
the next time I have a cold or flu I pledge to try treating the symptoms for 5 days rather than going to the GP
the next time I have a cold or flu I will talk to the pharmacist first about how I can treat their symptoms rather than making a GP appointment
It is vital we prevent antibiotics from getting into the environment. I pledge to always take any unused antibiotics to my pharmacy for safe disposal
And GPs can choose, among others:
when I see a patient with a self-limiting illness, I will discuss methods of controlling symptoms rather than prescribing antibiotics
when I see a child with a respiratory tract infection (coughs, colds, sore throats, and ear aches) I will use the TARGET guide to treat your infection booklet rather than prescribe antibiotics
the next time I intend to prescribe antibiotics for a self-limiting infection to a patient with high expectations of antibiotic treatment, I will use a delayed/backup prescription
Healthcare leaders can choose; among others:
I will visit my local hospital, community pharmacy or general practice surgery to show support for European Antibiotics Awareness Day during EAAD week (18 to 22 November 2014)
I will ensure that the executive team and board are regularly informed about Antimicrobial Stewardship and AMR in my Trust
I pledge to incorporate Antimicrobial Stewardship and Resistance as a quality measure within my commissioning pathways (including out of hours)
Dr Diane Ashiru-Oredope,
Lead for EAAD 2014 at Public Health England, said:
” Everybody can help to tackle antibiotic resistance and we really urge people to help us do this. There is a lot to be done but we can start by making inroads into inappropriate prescribing.
There are 2 elements to this. One is that we need patients to not always expect to receive an antibiotic for those self-limiting illnesses which are typically caused by viruses. This generally includes those where the symptoms include coughs, runny noses, muscle aches and fever. And the other is for GPs not to feel pressurised into prescribing antibiotics when they aren’t really necessary.
Community pharmacists and their teams also have a key role and should be seen as the first port of call for many winter illnesses caused by viruses. They can also help to manage patients’ expectations by explaining the normal duration of these symptoms, what warning signs to look out for and providing effective over the counter treatments that will help relieve the symptoms. “
President at the British Society for Antimicrobial Chemotherapy (BSAC), said:
” Recently published research in BSAC’s Journal, Journal of Antimicrobial Chemotherapy, confirms that despite government recommendations to reduce prescribing for viral illnesses there are still many GPs who do this. Of course GPs don’t want their patients to feel unwell but there are many medicines which are available over-the-counter which can really help to reduce symptoms and make people feel better.
We want to encourage everyone to self-treat as much as possible when it is safe and appropriate to do so. By using antibiotics only when they are needed we can all help to make sure that we keep our antibiotics working for everyone in the future.
Antibiotic resistance is one the biggest threats to public health and PHE is delivering 4 key aspects of the 5-year UK strategy to help combat antibiotic resistance. These are improving infection prevention and control practices to reduce the number of infections in patients; optimising prescribing practice, improving professional education, training and public engagement and enabling better access to and use of surveillance data. “
Public Health England Reports:
Join over 1,500 antibiotic guardians: choose a pledge today to help tackle antibiotic resistance, press release, 10 October 2014.
Despite warnings, the number of antibiotic prescriptions in the UK continues to soar, as do new cases of resistant bacteria
A new report from Public Health England (PHE) found that between 2010 and 2013 there was a 6% increase in the combined antibiotic prescribing of GPs and hospitals. There was also an increase of 12% in the number of bloodstream infections caused by E.coli with varying levels of resistance to key antibiotics for this infection of between 10 to 19%.
These data are from the first annual report of PHE’s English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR), published today (10 October 2014).
While the proportion of resistant infections remains the same as that seen in previous years, as the total number of infections has increased so the total number of resistant infections has risen. The report also shows a wide variation in both prescribing habits and antibiotic usage across England.
between 2010 and 2013 total antibiotic consumption (GPs and hospitals) rose by 6% from 25.9 to 27.4 daily defined dose* per 1,000 inhabitants per day
over the same 4-year period GP prescribing rose by 4%, prescribing to hospital inpatients rose by 12% and other community prescriptions (dentists and other non-GP prescribing) rose by 32%. This latter area is of concern and needs to be further examined
the increasing number of E.coli bloodstream infections has seen a corresponding increase in levels of resistance to a number of key antibiotics
higher rates of resistance were seen in those areas with higher rates of prescribing
there was a difference in prescribing between the north and south of the country. This is an area that needs more investigation but some of the differences may be due to deprivation, higher rates of smoking, co-morbidities, and other factors
the highest levels of GP prescribing were seen in Durham, Darlington and Tees which was over 40% higher than London (26.5 versus 18.9 daily defined dose per 1,000 inhabitants). However, this may be due to access to healthcare in London (with people attending hospitals instead of GP practices to access treatment), as London has the highest amount of hospital prescribing per population
Lead author Dr Susan Hopkins,
healthcare epidemiologist at PHE, said:
” This publication marks a real move forward in our understanding of antibiotic prescribing habits as it is the first time that both GP and hospital prescribing data have been collated in one document and prescribing trends analysed.
The aim now must be to reduce levels of prescribing back to that seen in 2010. There are already a number of different activities going ahead to support this including the development of quality measures for prescribing. This will enable local clinical commissioning groups to monitor the prescribing of hospitals and surgeries in their area and see how they compare against a benchmark. They will also be responsible for taking action against inappropriate prescribing in their area.
In addressing the issue of antibiotic resistance it is important to look at the whole healthcare economy approach. There is a lot of work going on to address the problem of antibiotic resistance but we must not underestimate how much work needs to be done to turn the tide and get levels of resistance down. ”
Professor John Watson,
deputy chief medical officer at the Department of Health, said:
” Antimicrobial resistance is one of the biggest threats to health security facing the world today and everybody must take action. We want to support all doctors and other prescribers in reducing their prescribing rates where possible. These data will play an important part in highlighting regional variations in prescribing. ”
Professor Anthony Kessel,
director of international public health at PHE, said:
” We cannot underestimate the importance of this report. Antibiotic resistance is one of the biggest threats of our time and understanding more about who is prescribing and what is being prescribed is the first step to helping us make improvements.
In England we are progressing and implementing a raft of tools to help us reduce the levels of prescribing and resistance and these include benchmarking, accountability on prescribing and quality measures. We are also asking everyone in the UK, the public and the medical community, to join our campaign and become an Antibiotic Guardian. We want everyone to choose one simple pledge about how they make better use of antibiotics and help save these vital medicines from becoming obsolete.
ESPAUR was established as a response to the UK cross government 5-year strategy to address the growing problem of antibiotic resistance. The report focuses on the use of antibiotics, stewardship and levels of resistance by NHS area team across GP practices and hospitals (primary and secondary care). ”
Public Health England Reports:
New report reveals increase in use of antibiotics linked to rising levels of antibiotic resistance, press release, 10 October 2014.
English surveillance programme antimicrobial utilisation and resistance report 2014.
UK 5 Year Antimicrobial Resistance Strategy 2013 to 2018, PDF 2013.
Infections and the rise of antimicrobial resistance report 2013.
Dr. Leonard Saltz discovers the shock and anxiety of a cancer diagnosis can be followed by a second jolt: the astronomical price of cancer drugs
Dr. Leonard Saltz, chief of gastrointestinal oncology at Memorial Sloan Kettering, discovers the shock and anxiety of a cancer diagnosis can be followed by a second jolt: the astronomical price of cancer drugs. Video published on 6 Oct 2014 by AHIPCoverage.
The Journal of Legal Medicine, Volume 4, Issue 2, 1983
An estimated 1000 individual or class action products liability lawsuits have been filed against the pharmaceutical manufacturers of diethylstilbestrol (DES). The field of potential plaintiffs is estimated at 500,000-6,000,000 and there are 150-300 potential defendant manufacturers.
This article addresses the question of whether the current system of tort liability dispenses fair, timely, and uniform justice both to DES claimants and manufacturers and presents a historical perspective on the basis for liability.
Traditional theories of tort recovery are based on negligence, breach of warranty, and strict liability. They place the burden of proof on the claimant to specifically identify the product manufacturer and establish proximate causation. Novel theories of recovery have had to be applied in DES lawsuits, including concert of action and alternative liability. Most of these theories have been unaccepted by trial and appellate courts because of the inability to identify the manufacturer. Even if DES manufacturers were to be held liable under a theory of industry-wide or market share liability, defendants would be called upon to allocate liability among themselves. Many believe that any departure from traditional tort principles should be accomplished by the legislature, not the judiciary. There is not currently a bill before the US Congress dealing specifically with compensation for damages to DES victims. Any model toxic tort legislation should aim to eliminate the benefit inequities as between claimants and the cost inequities in delivering benefits to qualified recipients by the responsible parties. The claimant’s burden of establishing fault should be eliminated in exchange for a claimant’s surrender of a right to sue a third party, and a standardization of compensatory damages. The requirements of specific product identification, duration of exposure, and degree of fault would be eliminated. Jurisdictional requirements and statues of limitation must be drafted to permit recovery for previously unknown injuries. Finally, there should be an overall goal of promptness in recovery. The most equitable solution to problems with the tort system is legislation which deals with the toxic tort problem as a whole and not just on a case-by-case basis.
Theories of recovery for DES damage. Is tort liability the answer?, NCBI, PMID: 6604118, 1983 Jun;4(2):167-200.
Full text: Journal of Legal Medicine, PDF, Volume 4, Issue 2, 1983.
Y aurait-il un super business de la maladie qui ne tiendrait pas compte des patients en souffrance?
Le docteur Nicole Delépine, Cancérologue, responsable de l’unité d’oncologie pédiatrique de l’hôpital universitaire Raymond Poincaré à Garches (APHP), pratique avec son équipe une cancérologie individualisée et sans aucun doute mieux tolérée et de surcroît plus efficace. Ses résultats parlent d’eux-mêmes : plus de 90% de réussite sur des cancers de l’os chez l’enfant si la prise en charge est immédiate contre 50% ailleurs.
Après trente ans de bons et loyaux services le Dr Delépine s’apprête à partir en retraite en juillet prochain et à cette occasion les pouvoirs publics envisagent très sérieusement la fermeture du service. La présence de la petite équipe des 8 médecins séniors pédiatres qui exercent avec elle, depuis plus de trente ans garantit la pérennité de ses méthodes et pourtant l’avenir du service reste très incertain.
“Peut-on soigner librement en France ?” manifestement la question vaut la peine d’être posée.
Après plus de 25 ans de lutte, le service existe toujours. Il est à parier que si les résultats n’avaient pas été significatifs l’unité aurait tout bonnement disparu depuis bien longtemps.
La médecine actuelle semble s’élaborer sur un fonctionnement à plusieurs vitesses. Cette médecine uniformisée, informatisée, déshumanisée n’est pas du goût du Dr Delepine et de ses collègues.
Ce qui se joue très clairement c’est la vie d’enfants et d’adultes. II semble donc évident que poursuivre la mission initiée par le Docteur Delépine est pour ainsi dire vitale.
Ses collègues pourront-ils poursuivre leurs missions ?
Cancer… Business mortel? Qui décide de notre santé?, MetaTV.
Le meilleur endroit pour financer des films ensemble! touscoprod.
Le site de Jean-Yves Bilien, Auteur/réalisateur de documentaires depuis quinze ans.