Archive for July, 2011

2011 Flu Vaccine/ Vegetarians and Diverticulitis

Wednesday, July 20, 2011 // Uncategorized

The components of the 2011 flu vaccine have been chosen and are the same as last year.  This is a summary from Journal Watch.

Influenza Vaccine Components Unchanged from Last Season
The components of influenza vaccine for the 2011-2012 season will be the same as those in the previous season’s vaccine, the FDA announced on Monday. The vaccine will include:
A/California/7/09 (H1N1)-like virus (the 2009 pandemic virus);
A/Perth /16/2009 (H3N2)-like virus; and
B/Brisbane/60/2008-like virus.
In addition, a new vaccine formulation will be available this year. In May, the FDA approved Fluzone Intradermal for patients aged 18 to 64 years. This vaccine will be administered under the skin with a smaller needle.
Patients may ask whether, having been vaccinated with these same strains last year, another round of shots is necessary. The answer is yes. The FDA’s Dr. Karen Midthun explains: “It is important to get vaccinated every year, even if the strains in the vaccine do not change, because the protection received the previous year will diminish over time and may be too low to provide protection into the next year.”

Diverticuli are basically hernias on the colon which are common in developed countries.  This is thought to be due to the low fiber in the diet.  Sometimes diverticuli become inflamed.  This is called diverticulitis.  these are small abscesses which can cause serious abdominal infections if left untreated.  This summary of an article in the British Medical Journal suggests that vegetarians who likely take in more fiber in their diets are less likely to develop diverticular disease.  It stands to reason that even non vegetarians could improve their colon health by adding more high fiber food to their diets.  A list of high fiber foods follows the summary from Journal Watch.
Physician’s First Watch for July 20, 2011
David G. Fairchild, MD, MPH, Editor-in-Chief
Vegetarian, High-Fiber Diets Linked to Lower Risk for Diverticular Disease
 Vegetarian, High-Fiber Diets Linked to Lower Risk for Diverticular Disease
Vegetarian and high-fiber diets are each associated with lower risk for hospitalization or death from diverticular disease, according to a prospective study in BMJ.
Some 47,000 “generally health conscious” adults in the U.K. completed dietary and lifestyle questionnaires and then were followed for nearly 12 years. About one third of participants said they were vegetarian.
During follow-up, there were 806 hospital admissions and 6 deaths from diverticular disease. After multivariable adjustment, vegetarians had a roughly 30% lower risk for diverticular disease compared with meat eaters, and participants in the highest quintile of fiber intake had about a 40% reduced risk compared with those in the lowest quintile.
The authors note that vegetarianism and high fiber intake are “correlated with rapid bowel transit times and increased frequency of bowel movements, which could be the biological mechanism” underlying the lower risk for diverticular disease observed here.

Amount of fiber in different foods
Food Serving Grams of fiber
Fruits
Apple (with skin) 1 medium apple 4.4
Banana 1 medium banana 3.1
Oranges 1 orange 3.1
Prunes 1 cup, pitted 12.4
Juices
Apple, unsweetened, w/ added ascorbic acid 1 cup 0.5
Grapefruit, white, canned, sweetened 1 cup 0.2
Grape, unsweetened, w/added ascorbic acid 1 cup 0.5
Orange 1 cup 0.7
Vegetables
Cooked
Green beans 1 cup 4.0
Carrots .5 cups sliced 2.3
Peas 1 cup 8.8
Potato (baked, with skin) 1 medium potato 3.8
Raw
Cucumber (with peel) 1 cucumber 1.5
Lettuce 1 cup shredded 0.5
Tomato 1 medium tomato 1.5
Spinach 1 cup 0.7
Legumes
Baked beans, canned, no salt added 1 cup 13.9
Kidney beans, canned 1 cup 13.6
Lima beans, canned 1 cup 11.6
Lentils, boiled 1 cup 15.6
Breads, pastas, flours
Bran muffins 1 medium muffin 5.2
Oatmeal, cooked 1 cup 4.0
White bread 1 slice 0.6
Whole-wheat bread 1 slice 1.9
Pasta and rice, cooked
Macaroni 1 cup 2.5
Rice, brown 1 cup 3.5
Rice, white 1 cup 0.6
Spaghetti (regular) 1 cup 2.5
Nuts
Almonds 1 cup 17.4
Peanuts 1 cup 12.4
To learn how much fiber and other nutrients are in different foods, visit the United States Department of Agriculture (USDA) National Nutrient Database at: http://www.nal.usda.gov/fnic/foodcomp/search/.

 
Created using data from the USDA National Nutrient Database for Standard Reference. Available at http://www.nal.usda.gov/fnic/foodcomp/search/.
For more information on what fiber is and it’s importance check out this link to UpToDate: http://www.uptodate.com/contents/patient-information-high-fiber-diet?source=search_result&selectedTitle=1%7E150
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E prescribing Errors

Thursday, July 14, 2011 // Uncategorized

E prescribing is the practice of emailing prescriptions.  It is being encouraged by the government which  increases payments to physicians who E prescribe.  The hope is that this will reduce prescribing errors.  In 2009 the government spent $150 million on additional payments to physicians.  We try many things that sound like good things without proof that they work.  This study suggests that E prescribing doesn’t  reduce prescribing errors. 

E-prescribing


.

E-prescriptions may be vulnerable to error, study finds

About 10% of electronically generated prescriptions in a recent study included at least one error, and one-third of these mistakes had potential for harm.

Researchers conducted a retrospective cohort study of 3,850 e-prescriptions received by a commercial outpatient pharmacy chain across three states over four weeks in 2008. All the prescriptions were from ambulatory care clinicians. A panel reviewed them for medication errors, potential adverse drug events, and rate of prescribing errors by type and by prescribing system. Results were published online June 29 by the Journal of the American Medical Informatics Association.

Of the 3,850 prescriptions, 452 (11.7%) contained 466 errors, of which 163 (35%) were potential adverse drug events. Of the potential adverse drug events, 95 (58.3%) were significant, 68 (41.7%) were serious and none were life-threatening.

The most common cause for error was omitted information (60.7% of total errors and 50.9% of potential adverse drug events). The most likely omissions were duration, dose, or frequency. Omitted dose was the most likely error to result in a potential adverse drug event, and accounted for 35% of all potential adverse drug events. Other types of errors were information that was unclear (16.1% of total errors, 19.6% of potential adverse drug events), conflicting (15.7% of total errors, 16.0% of potential adverse drug events), or clinically incorrect (7.5% of total errors, 13.5% of potential adverse drug events).

There was a significant variation by prescribing system in the types of prescribing errors (P<0.001) and the potential for adverse drug events (P<0.002). Prescribing error rates ranged from 5.1% (95% CI, 0.3% to 9.9%) to 37.5% (95% CI, 23.5% to 51.5%) among the different systems.

The researchers noted that the error rates seen with e-prescribing in their study were similar to those reported in the literature for handwritten prescriptions. They suggested some computer-based and clinician-based strategies to minimize the errors associated with computer-generated prescriptions. Computer-based strategies include forcing functions, specific drug decision-support systems such as maximum dose checkers, and calculators. Clinician-based strategies may include rigorous vendor selection, increased financial incentives and better training.

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The July Effect

Wednesday, July 13, 2011 // Uncategorized

For years medical personnel have said that hospital mortality increases when the new interns or first year residents begin their rotations.  Is this really  true or is it an urban myth?  This study in the most recent edition of The Annals of Internal Medicine suggests that there might be some truth to it.

  • Review

“July Effect”: Impact of the Academic Year-End Changeover on Patient Outcomes. A Systematic Review

  1. John Q. Young, MD, MPP;
  2. Sumant R. Ranji, MD;
  3. Robert M. Wachter, MD;
  4. Connie M. Lee, MD;
  5. Brian Niehaus, MD; and
  6. Andrew D. Auerbach, MD, MPH

+ Author Affiliations


  1. From the University of California, San Francisco, School of Medicine, San Francisco, California.

Abstract

Background: It is commonly believed that the quality of health care decreases during trainee academic year-end changeovers.

Purpose: To systematically review studies describing the effects of trainee changeover on patient outcomes.

Data Sources: Electronic literature search of PubMed, Educational Research Information Center (ERIC), EMBASE, and the Cochrane Library for English-language studies published between 1989 and July 2010.

Study Selection: Title and abstract review followed by full-text review to identify studies that assessed the effect of the changeover on patient outcomes and that used a control group or period as a comparator.

Data Extraction: Using a standardized form, 2 authors independently abstracted data on outcomes, study setting and design, and statistical methods. Differences between reviewers were reconciled by consensus. Studies were then categorized according to methodologic quality, sample size, and outcomes reported.

Data Synthesis: Of the 39 included studies, 27 (69%) reported mortality, 19 (49%) reported efficiency (length of stay, duration of procedure, hospital charges), 23 (59%) reported morbidity, and 6 (15%) reported medical error outcomes; all studies focused on inpatient settings. Most studies were conducted in the United States. Thirteen (33%) were of higher quality. Studies with higher-quality designs and larger sample sizes more often showed increased mortality and decreased efficiency at time of changeover. Studies examining morbidity and medical error outcomes were of lower quality and produced inconsistent results.

Limitations: The review was limited to English-language reports. No study focused on the effect of changeovers in ambulatory care settings. The definition of changeover, resident role in patient care, and supervision structure varied considerably among studies. Most studies did not control for time trends or level of supervision or use methods appropriate for hierarchical data.

Conclusion: Mortality increases and efficiency decreases in hospitals because of year-end changeovers, although heterogeneity in the existing literature does not permit firm conclusions about the degree of risk posed, how changeover affects morbidity and safety, or whether particular models are more or less problematic.

Primary Funding Source: Dr. Auerbach received support from the National Heart, Lung, and Blood Institute (K24HL098372).

What does one do with this information?  If you have an elective admission to a teaching hospital you might want to avoid July.

 
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Vitamin Supplementation and Prostate Cancer

Monday, July 11, 2011 // Uncategorized

There has been a lot of interest over the years with vitamin and mineral supplementation and prostate cancer.  I took vitamin E and selenium until a study was published showing that there was no benefit.

Selenium, Vitamin E, and Prostate Cancer

Selenium and vitamin E, alone or combined, did not affect risk for prostate cancer in a healthy population.

Chemoprevention of major epithelial cancers — a major focus of clinical research during the past 10 to 15 years — has achieved some measure of success, notably regarding the activity of tamoxifen in breast cancer (JW Oncol Hematol Mar 12 2007 and J Natl Cancer Inst 1998; 90:1371). Such advances in prostate cancer have been less forthcoming, although researchers have reported hypothesis-generating data regarding the potential for selenium (S) and vitamin E (E) to lower prostate cancer incidence and overall disease-related mortality (J Natl Cancer Inst 1998; 90:1219). These data, along with epidemiologic and preclinical data, led an international group of investigators to conduct the phase III placebo-controlled Selenium and Vitamin E Cancer Prevention Trial (SELECT).

A total of 35,533 eligible participants was composed of black men aged ≥50 and men of other races aged ≥55, all of whom had prostate-specific antigen (PSA) levels ≤4, unremarkable digital rectal exams (DREs), and no prior prostate cancer diagnoses. Participants were randomized to receive E (400 IU daily), S (200 µg daily), E plus S, or placebo. All four groups were screened and followed up based on community standards at 6-month intervals; PSA and DRE tests were not mandated, given the lack of evidence of screening benefit at study initiation.

At median follow-up of 5.46 years (range, 7–12 years), no significant differences were found between groups in terms of prostate cancer incidence (the primary endpoint) as determined by routine clinical assessment. Early-stage and low-grade prostate cancers were the most common cancer types diagnosed during the trial; incidence of these types was similar for all groups. Nonsignificantly elevated risks were noted for prostate cancer in the E group and for type 2 diabetes in the S group.

Comment: These results, as well as those of a recent randomized trial of vitamins C and E (J Natl Cancer Inst 2006; 98:245), point out the limitations of chemoprevention in prostate cancer as well as the need for well-designed, adequately powered randomized trials. Patients routinely use a variety of supplements and alternative agents to try to augment the therapeutic value of prescribed treatments; others use supplements in cancer-prevention strategies. Although the current findings are disappointing, they show that patients can be readily enrolled in large prevention studies (which often is not the case for therapeutic oncology studies), setting the stage for the next series of appropriately designed trials.

Robert Dreicer, MD, MS, FACP

Published in Journal Watch Oncology and Hematology February 3, 2009

Citation(s):

Lippman SM et al. Effect of selenium and vitamin E on risk of prostate cancer and other cancers: The Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA 2009 Jan 7; 301:39.

  This is the latest article which shows that there are no benefits to vitamin supplementation. 

Stratton J, Godwin M. The effect of supplemental vitamins and minerals on the development of prostate cancer: a systematic review and meta-analysis. Fam Pract. 2011 Jun;28(3):243-52. Epub 2011 Jan 27. (Review) PMID: 21273283

BACKGROUND: Vitamin supplementation is used for many purposes with mainly alleged benefits. One of these is the use of various vitamins for the prevention of prostate cancer.
METHODS: We conducted a systematic review and meta-analysis on this topic. Pubmed, Embase and the Cochrane Database were searched; as well, we hand searched the references in key articles. Randomized controlled trials (RCTs), cohort studies and case-control studies were included. The review assessed the effect of supplemental vitamins on the risk of prostate cancer and on disease severity and death in men with prostate cancer.
RESULTS: Fourteen articles were included in the final assessment. Individually, a few of these studies showed a relationship between the ingestion of supplemental vitamins or minerals and the incidence or severity of prostate cancer, especially in smokers. However, neither the use of multivitamin supplementation nor the use of individual vitamin/mineral supplementation affected the overall occurrence of prostate cancer or the occurrence of advanced/metastatic prostate cancer or death from prostate cancer when the results of the studies were combined in a meta-analysis. We also conducted several sensitivity analyses by running meta-analysis using just the higher quality studies and just the RCTs. There were still no associations found.
CONCLUSIONS: There is no convincing evidence that the use of supplemental multivitamins or any specific vitamin affects the occurrence or severity of prostate cancer. There was high heterogeneity among the studies so it is possible that unidentified subgroups may benefit or be harmed by the use of vitamins.

Bottom line:  Another study shows that vitamins and supplements are of no benefit.  Health doesn’t come in a pill.

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Medicare and Preventive Care

Sunday, July 10, 2011 // Uncategorized

Preventive care or a waste of time for docs, patients?

  • Article by: WARREN WOLFE , Star Tribune
  • Updated: July 3, 2011 – 10:35 PM

Medicare’s new annual wellness tests are designed to catch problems early. Some say they’re not enough.

Dr. Rod Christensen, who sees patients once a week, did a wellness checkup with patient Patty Warner at Allina’s Northfield clinic.

Photo: Glen Stubbe, Star Tribune

Camera

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Dr. Patricia Lindholm thought it was a great idea this year when Medicare announced it would cover free annual wellness visits for older people.

“OK, finally we’re getting Medicare to cover preventive medicine, catch problems while they’re smaller and more treatable,” the Fergus Falls family physician said.

Then she started conducting a few — and quickly changed her mind.

What she thought would be a full physical exam turned out to be essentially a hands-off screening that was “pretty worthless for most of my patients — a waste of their time and mine,” she said.

Lindholm isn’t just any family doc. She’s president of the Minnesota Medical Association. And while there’s no full revolt among doctors against the new Medicare benefit, other physicians share Lindholm’s irritation.

The wellness screenings emerged as one of the signature benefits of the big federal health overhaul that Congress passed last year — an effort to catch problems early, keep patients healthier and cut future Medicare costs.

Some doctors, however, are having second thoughts. To get paid by Medicare, a physician and nurse must complete 15 steps during a 30- to 45-minute exam, including brief screenings for dementia and depression, an eye exam, a medical history and personalized health advice. They must also check weight, height and blood pressure — the only time the patient must be touched.

Although much touted in letters to the 46 million aged or disabled people on Medicare, the wellness visits haven’t caught fire with patients either. Since Jan. 1, about 780,000 patients have received the new service, Medicare officials say.

Last month, federal officials announced a nationwide campaign among doctors, patients and families of those on Medicare to increase awareness of the benefits under the new law. In addition to the free preventive visits, they include some free cancer screenings, immunizations and other tests and counseling.

Improve care and cut costs?

Since 2005, Medicare has offered a separate and free “Welcome to Medicare” doctor visit for the 2 million new enrollees during their first year.

A beneficiary’s first free wellness screening must come at least a year after the “welcome” visit, and subsequent screenings must be at least a year apart.

Several doctors in local clinics have chafed at the restrictions. If doctors want to go beyond the Medicare agenda — order tests or prescribe medication, for instance — they must either ask the patient to return for a separate visit or split the bill between Medicare and the patient.

“That can be confusing for patients who think Medicare is paying for a comprehensive visit,” said Suzanne Werner, manager at Allina Medical Specialties Clinic in St. Paul. “The doctor wants to treat the patient as an individual, with tests and treatment geared to that person,” she said. “Sometimes that’s hard to do.”

Medicare officials say doctors misunderstand the value of the screening tool and say there is no plan to change the process.

“The elements of this visit are defined by statute and are meant to [focus] on prevention,” said spokesman Donald McLeod. “The visit has been misperceived by a number of people due to the fact that Medicare has traditionally been focused on diagnosis and treatment of disease rather than its prevention.”

The American Medical Association agrees the wellness visits can help, though it would like more flexibility.

Probing for problems

Some doctors say mastering the “somewhat clunky” regulations is worthwhile.

“It’s helping me do a good job of screening for health and safety issues,” said Dr. Rod Christensen, a family practice physician in Northfield and chief medical officer for Allina’s 45 clinics.

Last month, he and nurse Renee Estrem spent 45 minutes on a wellness visit with a long-term patient, Patty Warner, 69, of rural Northfield. But they did more than that. Warner had been treated earlier in the week at a hospital for a fast heart rhythm, a condition that in the past had sent her to the hospital emergency department. Christensen wanted to go over her health in more depth than the wellness visit would pay for.

“This is a perfect example of what we should do,” he said afterward. “With all my Medicare patients, even those I think I know well, I want to assess their risk of falls, of driving problems, of abusive relationships. I want to know how they’re doing overall.”

In the end, Warner also received a new prescription to control blood pressure, a tetanus booster shot and a physical exam — with the costs split off and billed to her Blue Cross Blue Shield Medicare plan.

“Doctors are too afraid to talk about costs, about what’s covered by Medicare and what the patient or insurance may have to pay,” Christensen said. “Our patients aren’t stupid. If I bring it up, they don’t have to wonder or worry.”

Still, his clinic sends a brochure to patients before they come, noting what services might not be covered by a prevetive visit.

While Christensen encourages the visits, in Fergus Falls, Lindholm is on the brink of forgoing them.

“I know my patients,” she said. “If I’m doing my job, neither my patients nor I usually learn anything new from this.”

Warren Wolfe • 612-673-7253

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    Chantix and Heart Disease

    Wednesday, July 6, 2011 // Uncategorized

    There is a recent article in the Canadian Journal of Medicine that was done at Johns Hopkins University that was recently reported in The New York Times linking Chantix with cardiovascular risk.  The Canadian Journal of Medicine is not one of the world’s leading medical journal and not one of the journals to which I subscribe.   It would be ironic if the treatment to end a cardiovascular risk factor actually was a cardiovscular risk factor.  There was a recent FDA warning about the use of Chantix is patients with cardiovascular risk factors.

    Chantix (varenicline): Label Change – Risk of Certain Cardiovascular Adverse Events

    [Posted 06/16/2011]

    AUDIENCE: Family Medicine, Cardiology

    ISSUE: FDA notified healthcare professionals and patients that the Prescribing Information for this drug product will be strengthened to inform the public that use of varenicline may be associated with a small, increased risk of certain cardiovascular adverse events in patients who have cardiovascular disease. This safety information will be added to the Warnings and Precautions section and the patient Medication Guide.

    BACKGROUND: FDA reviewed a randomized, double-blind, placebo-controlled clinical trial of 700 smokers with cardiovascular disease who were treated with Chantix or placebo. While cardiovascular adverse events were infrequent overall, certain events, including heart attack, were reported more frequently in patients treated with Chantix than in patients treated with placebo. The events included angina pectoris, nonfatal myocardial infarction, need for coronary revascularization, and new diagnosis of peripheral vascular disease or admission for a procedure for the treatment of peripheral vascular disease. FDA is continuing to evaluate the cardiovascular safety of Chantix and is requiring the manufacturer to conduct a large, combined analysis (meta-analysis) of randomized, placebo-controlled trials. FDA will update the public when additional information is available.

    RECOMMENDATION: See the Data Summary section of the Drug Safety Communication for additional information.

    Healthcare professionals should be aware that smoking is an independent and major risk factor for cardiovascular disease, and smoking cessation is of particular importance in this patient population. The known benefits of Chantix should be weighed against its potential risks when deciding to use the drug in smokers with cardiovascular disease.

    Patients are encouraged to read the Medication Guide they receive along with their Chantix prescription.

    Healthcare professionals and patients are encouraged to report adverse events, side effects, or product quality problems related to the use of these products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program:

    • Complete and submit the report Online: www.fda.gov/MedWatch/report.htm1
    • Download form2 or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178

    [06/16/2011 – Drug Safety Communication3 – FDA]

    Previous MedWatch Alert:

    [11/20/20074]

      The Times article is a meta analysis which is a compilation of a number of studies and this technique has some limitiations.  Another problem is that the patients in the different studies took Chantix for different times.  Here is the New York Times article:

    July 4, 2011

    Study Links Smoking Drug to Cardiovascular Problems

    By DUFF WILSON

    Chantix, the best-selling prescription drug for smoking cessation, was linked to an increased risk of a heart attack, stroke or other serious cardiovascular event for smokers without a history of heart disease compared with smokers who did not use the drug, according to a Canadian medical journal report released on  Monday.

    The finding added to previous warnings about the pill’s connection to psychiatric problems and cardiovascular risks for people with a history of heart disease.

    It posed a new challenge to a product that has been prescribed to 13 million people and had $755 million in sales last year.

    Officials of Pfizer, the manufacturer of Chantix, and the Food and Drug Administration responded that they had been planning to conduct a joint analysis of clinical trials on whether Chantix posed heart risks, due next year.

    “This would have raised a red flag for us if the flag hadn’t already been flying,” Dr. Celia Winchell, a team leader with the agency’s Center for Drug Evaluation and Research, said in an interview.

    Pfizer, in a statement, said the analysis in the Canadian Medical Association Journal was based on too few heart or cardiovascular events to draw conclusions about the risks. The company said Chantix brought “immediate and substantial” health benefits to smokers who quit.

    The senior author of the new report, Dr. Curt D. Furberg, a Wake Forest medical professor, said there were better ways to quit and called for removal of the drug from the market.

    “It piles up,” he said. “I don’t see how the F.D.A. can leave Chantix on the market.”

    The lead author, Dr. Sonal Singh, assistant professor of medicine at Johns Hopkins University, said the agency and Pfizer had failed to pursue signs of cardiovascular risk since Chantix was approved in 2006.

    “The F.D.A. should have already put it on their warning label,” Dr. Singh said. “The risk is substantial, the risk is present in smokers without heart disease, and Pfizer knew about this for five years.”

    Last month, the agency issued a safety notice about cardiovascular risk from Chantix use by people with a history of cardiovascular disease, based on a study of 700 people.

    The new report is broader, analyzing 14 randomized clinical trials involving 8,200 patients, excluding those with cardiovascular disease so that it gives a better picture of which heart problems the drug could cause in otherwise healthy people trying to quit smoking.

    The new study, known as a meta-analysis, compiled data from 14 random, blinded, placebo-controlled clinical trials that tracked cardiovascular outcomes. It found 52 out of 4,908 people taking Chantix had serious cardiovascular events, a rate of 1.06 percent, compared with 27 out of 3,308 people taking a placebo, a rate of 0.82 percent. While the absolute difference is only 0.24 percent, the weighted, relative difference is 72 percent.

    “We have known for many years that Chantix is one of the most harmful prescription drugs on the U.S. market, based on the number of serious adverse effects reported to the F.D.A.,” Dr. Furberg said in a statement. “It causes loss of consciousness, visual disturbances, suicides, violence, depression and worsening of diabetes. To this list we now can add serious cardiovascular events.”

    Dr. Furberg, who once directed clinical trials for the government and writes widely about drug safety, has been paid as an expert witness in cases against Pfizer. Dr. Singh and two other researchers said they had no conflicts of interest.

    When combining studies of smokers with and without pre-existing disease, the study found that doctors could expect to get one extra cardiac event associated with Chantix for every 28 smokers they treated with the drug. The researchers also estimated one additional person would quit for every 10 treated with Chantix.

    The benefit of Chantix was emphasized in a separate commentary in the journal by Dr. J. Taylor Hays of the Mayo Clinic in Rochester, Minn. He described the meta-analysis as “timely and important” but said it lacked overall size and standardization. Dr. Hays, who has been paid by Pfizer to study Chantix, said the benefits of quitting smoking outweighed the risks of the drug.

    Chantix is selling well overseas. In Japan, for instance, some pharmacies ran out for a while recently, even as the drug failed to meet expectations in the United States because of health warnings and bad publicity.

    I think this is of interest, but I think that Chantix is the most effective smoking cessation medicine to date.  It may be safe to use for short periods of time as is the approved indication.  I would pay attention and treat patients’ other risk factors while they are on Chantix.  It certainly can cause depression and patients should be caused about this.

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    Google Health to End

    Monday, July 4, 2011 // Uncategorized

    The New York Times reports that Google is ending it’s entry into personal health records due to lack of interest.  Personal health records have been touted as a way of having patients store their own medical records online which would make them more portable.  The downsides were that one might receive advertising based on the content of those records and that they did not meet federal privacy regulations.


     


    June 24, 2011

    Google to End Health Records Service After It Fails to Attract Users


    By STEVE LOHR


    Google is giving up on its vision of helping people live healthier lives with online personal health records.


    When Google Health was introduced in 2008, Marissa Mayer, a Google executive, said it would be a “large ongoing initiative” that the company hoped would attract millions of regular users.


    But Google Health never really caught on. In a posting on the company’s blog on Friday, Aaron Brown, senior product manager for Google Health, wrote that the goal was to “translate our successful consumer-centered approach from other domains to health care and have a real impact on the day-to-day health experiences of millions of our users.”


    Yet, after three years, Mr. Brown said, “Google Health is not having the broad impact we had hoped it would.”


    In the drive to apply information technology to health care, personalized health records are the element that relies most heavily on individual motivation and efforts. They are controlled by the consumer, and require individuals to put in, update and edit their health data. By contrast, the federal government has begun a five-year campaign to accelerate the adoption of electronic patient records by hospitals and doctors, with the incentive payments to physicians topping $40,000.


    Personal health records, analysts say, are a new concept to most people, and early users have found them difficult to use. “Personal health records have been a technology in search of a market,” said Lynne A. Dunbrack, an analyst at IDC Health Insights, a research firm.


    In a survey earlier this year, IDC Health Insights found that 7 percent of consumers had tried online personal health records, and fewer than half of those continued to use them.


    Google is by no means the only company to abandon the field of consumer health records. Revolution Health, for example, retired its personal health record service last year, citing few users.


    Suppliers of online personal health records include WebMD, Microsoft, RelayHealth and Dossia. But analysts note that what success these offerings have had has often been in partnership with insurers and health providers, while Dossia is an employer-sponsored personal health record.


    Adam Bosworth, a former manager of Google Health, who left in 2007 before the service was introduced, said the service could not overcome the obstacle of requiring people to laboriously put in their own data.


    “In the end,” Mr. Bosworth said, “it was an experiment that did not have a compelling consumer proposition.”


    The consumer technologies that catch on, he said, inform or entertain users, or enable social communication. Mr. Bosworth said he learned that in his own health information technology company, Keas. The business started in 2009, but switched its approach last November to focus on social games to encourage participation in wellness programs.


    Technology companies have often underestimated the complexity of the health field, assuming that fresh ideas and new digital tools will bring quick results, said Dr. David J. Brailer, the national coordinator for health information technology in the Bush administration.


    When that does not happen, they pull back, Dr. Brailer said. The Google experience, he said, fit that pattern, and the company had been pulling resources from Google Health for some time.


    “For a long while, everybody knew that Google Health was dead, except Google,” said Dr. Brailer, who is the chief executive of Health Evolution Partners, an investment fund.


    Google is also shutting down its PowerMeter service, which let consumers track their energy use.



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