New treatment for hepatitis C - but affordable?

New treatment for hepatitis C - but affordable?- The burden of hepatitis C public health is enormous. 

This viral infection causes severe liver cirrhosis, terminal liver cancer and liver failure, often require a liver transplant. Over 3 million people in the United States and 150 million worldwide, are infected with hepatitis C, resulting in 700,000 deaths annually.

People who are infected with hepatitis C often have no symptoms. The virus persists in the liver damage liver tissue slowly over a long period of time. For this reason, it is essential that the progression of liver damage before stopping advanced liver disease or liver cancer occurs.

But there is good news: in recent years we have witnessed remarkable progress in the development of new drug treatments for hepatitis C. sofosbuvir (Sovaldi) and combined with ledipasvir sofosbuvir (Harvoni) are two well known examples these new drug treatments.

Another new drug combination, and sofosbuvir velpatasvir, which was recently described in a report published in the New England Journal of Medicine, is extremely effective against most forms of hepatitis C will become the standard treatment when this combination FDA approved. 

But although the new drugs can cure hepatitis C in many cases they are not accessible to all who need it. New drugs for hepatitis C cost between $ 80,000 and $ 150,000 per year.

People with excellent insurance coverage see low-pocket costs for these drugs. But because of the cost, many insurance companies have set up systems that require high switching costs quotas of people with less robust plans make these medicines out of reach of many people.

In the US, drug hepatitis C are just one example of "specialty drugs." These new drugs for many chronic diseases - such as cancer and arthritis - that were issued to levels that are unaffordable to many people in need.

Up to medicines for hepatitis C, and other drugs are sold at affordable levels, some people without sufficient funds being left behind and can not benefit from modern advances in drug therapy. 

As a society, we must find ways to make these drugs available to all who need it and at the same time compensate pharmaceutical companies for its fresh research and high development. It is a difficult balance, but in a society based on justice and equity, is that we must achieve. For those who have hepatitis C should go without treatment.
By: Gregory Curfman, MD

  

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The lesser number of PSA tests for prostate cancer means less?

The lesser number of PSA tests for prostate cancer means less? - It used to be that the prostate was cancer detection routine for men over 50.

The positive results to the test antigen (PSA) prostate specific trigger a biopsy and the results would almost inevitably lead to treatment cancer. 

But recently, the detection rate of the APS in the United States has declined - and the number of new cases of prostate cancer has decreased, too. That's according to a pair of studies published together last November in the Journal of the American Medical Association.

The studies could not prove these two trends are causally related; However, the authors think they are. In other words, the decline in the number of new cases likely reflects the decreased detection, instead of a decrease in the number of men who have prostate cancer. 

Like other cancer screenings, such as mammography for breast cancer, the PSA test has been the subject of increasing attention. Experts say too many low-risk tumors flags that can only become harmful to the life of a man. Cancer treatment can expose people to unnecessary risk of impotence, incontinence and other side effects.

Why the numbers are declining 

In 2008, the Working Group Preventive Services Task Force of the United States (USPSTF), an influential group of volunteer medical experts, it ruled against PSA screening in men over 75 Then, in 2012, a recommendation was issued against updating exam for all men, regardless of age, race or family history.

These recommendations are controversial. Although many experts acknowledge the PSA test boundaries, who fear that the abandonment of the total PSA test drive tumor diagnosis at an advanced stage may not be curable. 

One of the recently published revised national PSA detection data collected between 2000 and 2013. The results showed that the detection rate began falling in the 2010 study, but only in men under 75 years and above in the 50-54 and 60-64 age groups. The overall detection rate (for all men alike) fell from 36% to 31%.

The second study found a similar decline in PSA screening rates - 37.8% to 30.8% - as well as a decrease of 22% of new prostate cancer diagnoses. The authors of this study examined data maintained by the National Cancer Institute and found the number of diagnoses per 100,000 men aged 50 and older cases fell from 540.8 in 2008 to 416.2 cases in 2012. largest declines came after the USPSTF recommendations published a screening project updates in October 2011.

"These data are the first national, showing what appears to be an effect on prostate screening and diagnosis of the Working Group recommendations based on the population," said Ahmedin Jemal, DVM, Ph.D., Vice president of research services and health surveillance at the American Cancer Society, and a key author of the first study.

Do not scratch the PSA test for now 

In an accompanying editorial, Dr. David F. Penson, President of urologic surgery at Vanderbilt University Medical Center, warned that the "pendulum" of popular opinion could turn too far from screening. But instead of stopping the complete projection, Penson asked the most intelligent, the most specific detection approaches aimed primarily at women considered at high risk of developing prostate cancer. 

"These new results are an expected consequence of the conclusion of the Working Group that the PSA test is probably more harm than good," said Dr. Marc Garnick, Gorman Brothers professor of medicine at Harvard Medical School and of Beth Israel Deaconess Medical Center and editor of the Harvard Knowledge.org prostate.

However, Dr. Garnick also called for better screening, recognizing that the number of men with more advanced prostate cancer now likely to increase. "We also need studies focused on those that offer potentially high risk of more aggressive forms of detection of prostate cancer," he said. "The investigation must determine whether early treatment saves lives or lowers death rates from prostate cancer. Until we have this data, the true effect of lower detection rate remain unknown, and discussions about the PSA test will, without clear answers in sight ". 
By: Charlie Schmidt  

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The "right" target in the management of pain

The "right" target in the management of pain - It is logical that the main goal of pain management should be to reduce the pain. 

However, a recent editorial in the New England Journal of Medicine made a strong case for looking beyond the pain intensity assessed what is the pain management "success".

The "balance" the management of chronic pain 

Here's the problem: For people with chronic pain, pain affects nearly every aspect of their lives. At the same time, treatment to relieve chronic pain also have the potential to influence many aspects of a person's life. 

Our best medications for pain relief have many unpleasant side effects. Even non-pharmacological interventions (such as physical therapy) and complementary therapies (such as acupuncture) usually not only have a unique effect.

This means that if we give priority to reducing the pain any other result, we end up doing as much damage as we do it well. In particular, the authors suggest that the editorial focus solely on reducing the intensity of pain, and the creation of a moral mandate to relieve pain, have contributed to the crisis of opiates in that country. In recent decades we have seen a steady increase in prescriptions for opioids, misuse and abuse of opiates and related overdose deaths. 

Patient surveys also show that people with chronic pain care more about the experience less pain. They care more enjoy life, have a strong sense of emotional well-being, increased physical activity, improve sleep and reduce fatigue, and to participate in social and recreational activities. These objectives must be weighed against the disadvantages of pain.

For example, opioids such as oxycodone (OxyContin) may reduce the intensity of pain and make it easier to fall asleep. But they make people tired, cause constipation and memory problems, and bear the risk of abuse and overdose. 

How the pros and cons cell is very personal and varies from patient to patient. For some people, the risk of abuse is small side effects are minor, and the drug reduced a lot of pain. For others, these drugs reduce the pain just a bit, so that fatigue and cognitive side effects are so bad that it is difficult to carry out routine activities such as driving or going to work.

The future of pain 

The authors also suggest that editorial treatment to control pain is not only that but also individualized multimodal (ie, a combination of different therapies) can produce the most benefits with the least damage. A solid base of scientific research supports this position.

For example, a person with chronic back pain, a recent history of alcohol abuse and depression and insomnia may do better with a combination of non-opioid analgesics for pain, cognitive behavioral therapy and antidepressant, while the other person, also with chronic low back pain can get the best results with a combination of low-dose opioids daily and weekly acupuncture.

Dr. Robert Jamison hospital at Harvard-affiliated Brigham and Women of shown that behavioral treatment to improve adhesion of opioids in patients suffering from chronic pain actually reduced rates of drug abuse among patients most likely to abusing these drugs. 

The "success" of pain is very individual. So you can not assume that what you read or hear online with other people (eg, "Drug X is large, you should try" or "drug Y is terrible, why would prescribe this") represent how a drug will work for you.

The field of pain management needs a lot more research to determine which patients are most likely to benefit from a given treatment. Perhaps, for example, patients Younger migraine sufferers can gain more drug A, while elderly patients with tension-type headaches can do better with drug B.

This kind of categorization, known as the "phenotype", provide a basis for management Custom pain, ideally, it would improve the clinical management of people with pain and minimize damage related to treatment.

Above all, I believe the combination therapies that not only reduce pain, but contribute to long quality life goals with a renewed focus on individualized treatment approach represents significant progress in the field of management pain and are important steps towards the full effectiveness of our duties to suffering patients. 
By: Robert R. Edwards, Ph.D.   

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The high cost of low cholesterol

The high cost of low cholesterol - You've probably heard of new drugs to reduce cholesterol Repatha Praluent and approved by the FDA in recent weeks. Maybe you've even started taking one yourself.

These drugs are miraculous in its ability to reduce LDL (cholesterol low-density lipoprotein), the type that leads to heart disease. But this power comes at a price - literally. Both drugs have an annual cost of about $ 14 600 per year.

The domino effect of drug prices through the roof 

Of course, people who take these medications can not pay the full cost themselves - which will fall to your insurance company. Exactly what a person would have to pay out of pocket depends on your health insurance plan in particular, but many people could end up paying a significant portion of the bill. So if your doctor prescribes these drugs for you, it is important to check with your insurance company about coverage before you start taking it.

But the prices of these drugs can still affect you, even if you take one of them personally. If enough people enrolled in their health plan of the individual, they are prescribed one of these drugs, the total cost of your insurance could be high enough to cause an increase in the premium for all.The high price of new drugs for cholesterol is not unique. New drugs for hepatitis C, arthritis and cancer (called "specialty drugs") are also quite expensive, and together we put a strain on the budgets of health care - and to offset the savings by use of generic medicines cost.

Why new medicines for cholesterol - and other specialty drugs - so expensive? In the US, pharmaceutical companies can set prices based on what the market will bear. Unlike Canada and Europe, the US government can not establish price controls on drugs, so that our drug prices are generally higher than the prices of these same drugs in these regions.

In fact, a new report from the Institute for Clinical and Economic Review (CIRE), which analyzes the cost-effectiveness of the new drug relationship, concluded that the cost of new medicines for cholesterol is too high . ICER recommends annual price tag of $ 2,177.

What to do with new medicines for cholesterol price 

Although we still have no evidence that the new cholesterol-lowering drugs actually reduce the rate of heart disease, for people with a rare genetic form of high cholesterol (called familial hypercholesterolemia, or FH) they are a godsend. But for people who have the most common form of high cholesterol, there are other options, much less than should be tried first.

Change in diet and regular exercise can help reduce cholesterol levels low, and (generic), an inexpensive statin therapy remains the drug of choice for treatment. A drug called ezetimibe (Zetia) can be added to a statin if statin alone is not fully effective.
 
Democratic candidates Hillary Clinton and Bernie Sanders have both proposed legislation to control drug costs, but it is unlikely that these laws were adopted in the short term. Until then, consumers must be aware of the price of drugs that doctors prescribe for them. Often there are less expensive alternatives that should be considered first.
By: Gregory Curfman, MD

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Incredible and true: the placebo effect

Incredible and true: the placebo effect - The placebo effect is a mysterious thing. I have always been fascinated by the idea that something so inert and harmless as a sugar pill can ease the pain of a person or speed recovery with only the hope that it would.

Studies using placebo - an inactive treatment such as a sugar pill - in an attempt to understand the true impact of the active substance.

Comparing what happens to a group of patients taking the active drug with the results of those taking a placebo may help researchers understand how good is the active drug.

The word "placebo" comes from Latin and means "I will please." And "please" did. In study after study, many people taking a placebo improved program in your symptoms or condition.

The placebo effect is real

Recent research on the placebo effect only confirms how powerful it can be. - And the benefits of treatment with placebo are not just "in your head" measurable physiological changes can be observed in those who received placebo, similar to those seen in people who take drugs effective. in particular, blood pressure, heart rate, and blood test results were shown to improve subsets of research subjects who responded to placebo.

Of course, not everyone has a therapeutic response to a placebo. If that were the case, we would not need medication at all. Instead, we just could exercise the power of suggestion. Understanding why some people improve with placebo treatment and others are not the "holy grail" of research placebo.Nocebo: Placebo evil twinThe power of suggestion is a double edged sword. If you plan a treatment to help you, they are more likely to do so. And if you expect to prejudicial treatment, it is more likely to feel the negative effects. This is called "nocebo effect" (Latin for "I will harm").  

For example, if you tell someone that a headache is a common side effect of a particular drug, that person is more likely to report headaches, even if they are actually taking a placebo. The power of expectation is great and probably plays an important role in the benefits and side effects of commonly prescribed drugs.

It is the power of the placebo effect increases?

A new fascinating study examined the impact of the placebo effect in 84 trials for treatment of nerve pain that occurred over the last 23 years. The researchers found that the placebo effect has become much stronger, but this observation was seen in US studies.  

What for? One theory is that the flow of direct to consumer advertising of drugs in the United States (which is banned in most other countries) raises expectations of a drug to help patients. Stronger and expectations of a drug can lead to a greater placebo effect efficiency.

Another theory links the increased effectiveness of placebos to test their own research: the largest, most expensive and most elaborate judgment, plus expectations of study participants. Analyses of this type tend to be more common in the US than elsewhere.

Whatever the reason, there is a downside to this trend. A powerful placebo effect makes it more difficult for the researchers show that a new drug works. The stronger the placebo effect, it becomes more difficult to show a significant difference between the placebo and active drug - even if the active drug is quite good. Consequently, some effective drugs can "fail" in clinical trials. And that could lead researchers to spend their education outside of the US

What future?

Research on the pros cons of the placebo effect has changed the number of people think about this phenomenon. We used to think that the placebo effect is limited to those influenced disease-free "real"; Now we know better. But there is much that remains a mystery. We do not know how to predict who will respond to a placebo or how to reliably operate their power.  

And it is important to note that while "feeling better" is important, they do not always come with genuine health benefits. For example, some study subjects who took a placebo for asthma reported improvement of their symptoms but their lung function measures are not really better.

Yet the day will come when a better understanding of the placebo effect and, in appropriate circumstances, which are used effectively in clinical practice. Like many people either do not respond to standard medications or have unpleasant side effects, that day can not come soon enough.
By: Robert Shmerling, M.D.

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The problem with prescription painkillers

The problem with prescription painkillers - Pain. It is an almost inevitable part of human experience. Whether as a result of an injury or accident, surgery, or a health problem, such as a headache or infection, arthritis or fibromyalgia, pain can interfere with your ability to sleep , work and enjoy life.

There are many ways to treat pain. Opioids are a. Examples include hydrocodone (Vicodin used), oxycodone (Percocet used), methadone, codeine and morphine. These prescription drugs reduce pain recognition brain by binding to certain receptors in the body. In many situations, opioids are a reasonable choice for pain control - for example, severe pain caused by cancer.

Part of the problem is that a person can develop a tolerance to these drugs. Finally, increasing doses may be required to achieve the same level of pain relief. Overdose may prevent a person from breathing and cause death. In addition, the body can become physically dependent on these drugs, so that withdrawal symptoms if the drug is stopped.  

These factors are a recipe for dependence, which is the loss of control over the use of a drug, even if it harms the person. Furthermore, opioids may also cause a "high" pleasant and are often used for recreational purposes and not for its intended medical purpose, which further increases the risk of addiction. Opioid dependence is the greatest risk factor for addiction to heroin.

What is the opiate epidemic? 
The epidemic of opioid is the crisis currently facing our countries in terms of widespread abuse of opioid analgesics. Much of the problem comes from the increased availability of these drugs. Four times as many prescription painkillers are offered each year, compared to 1990 At the same time, we are seeing an increase in deaths from overdose of opiates.  

Thank you for the efforts to fight against this problem, the number of prescriptions for opioids and opioid-related deaths 44 people appears to have stabilized since 2012. However, on average, in the US a day die from overdose 'prescription opioid pain relievers. Double the number of deaths from heroin overdose.

What is being done about the epidemic of opiate?
Health authorities are working to educate health professionals on the safe prescribing and educate the public about the risks of opioid analgesics, especially when used for chronic noncancer pain. For example, state monitoring programs to track the number of prescriptions for these drugs are filled, to try to prevent drug abuse. They also make efforts to increase the availability of drug treatment, including detoxification (or "Detox") programs.

Specially licensed physician Treatment programs can provide methadone maintenance for people who have difficulty leaving opioids. These programs provide controlled dose of methadone given under careful monitoring, which reduces withdrawal symptoms, drug cravings, and the risk of overdose.

Trained doctors can prescribe other treatments such as buprenorphine / naloxone (Suboxone), which reduces withdrawal symptoms by partially mimicking the effects of opioid receptors in the body less than a "high" risk and fewer overdose.

Expanding access to naloxone (Narcan) - a drug "rescue" that blocks the effects of opioids on the body - can help prevent some overdose deaths. Naloxone Rescue Kits come in nasal spray and forms of self-injection, and are available without prescription in some states. However, as the application of naloxone has increased, therefore the cost of such kits.

How do people who use prescription painkillers can reduce the risk of abuse and overdose? 

People taking opioid analgesics should follow these steps:

 *  Store medicines safely and never share with anyone.
 *  Take the medication exactly as directed.
 *  Ask your doctor if a lower dose may be an option.
 *  Ask your doctor about other ways to manage pain - many non-pharmacological options can help.
 *  If the drug is not working properly, talk to your doctor.
 *  Do not take overlapping requirements of several suppliers.
 *  Do not take these drugs with other substances, such as alcohol or prescription sedatives for anxiety.
 *  Naloxone have a first aid kit available and train friends and family members how to use.
 *  If you think you may be developing an addiction, seek help as soon as possible.
By: Wynne Armand, MD

 

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Why many generic drugs become so expensive

The high cost of prescription drugs is great news. You hear on TV, in the doctor's office, and even in the election campaign. When you think of expensive drugs, you can think of new therapies for lung cancer or hepatitis C. But in fact, prices are also soaring for generic versions of some commonly prescribed drugs.

An article published last year in the New England Journal of Medicine reported that between 2012 and 2013, captopril - a generic drug used to treat hypertension and heart failure - increase in the price of 1 cent to 40 cents pill. During this same period, the cost of doxycycline, an older antibiotic, rose 6 cents to $ 3.36 per pill. 

Connecture, a company of information technology for health insurance, reports that while the price of most generic drugs remained constant between 2008 and 2015, nearly 400 increases over 1000% saw prices generic. At a time when 18% of the costs of prescription drugs are paid out of pocket and 8% of Americans do not take their medication reports to save money, these dramatic increases in generic prices placed a heavy burden on public health.

Why is your product going in the price? 
Most of us think of cheaper generic version of a brand name for a prescription alternative - and that is often the case. Pharmaceutical companies that manufacture generic drugs can sell at lower prices because they do not have to pay for research and development that brought the drug to market first.  

However, this advantage may take a backseat in situations like these, where competition is reduced or delayed, allowing generic manufacturers to increase their prices:

  * The marketing of certain generic drugs is so small it attracts several producers such as pyrimethamine (Daraprim), an ancient drug used to treat a parasitic infection called toxoplasmosis. GlaxoSmithKline has long been the only producer of pyrimethamine, but at a modest price. This August, however, Turing Pharmaceutical acquired the rights to the drug and operated its monopoly, the price increase of 5,000% (from $ 13.50 to $ 750 per pill).

  * In some cases, the number of producers of generic drug decreases due to a continuous wave of market consolidation within the pharmaceutical industry.

  * Unforeseen safety issues may limit the supply of a generic drug. Hikma Pharmaceuticals, for example, was forced to stop production of doxycycline in 2011 because of quality problems at its plant in New Jersey. The shortage led to an increase of 6,000% in the price of drugs.

  * It can be difficult and expensive for a manufacturer for a generic drug to market first. The average time to the Food and Drug Administration (FDA) for the treatment of an application for generic drugs was 42 months in 2014, compared to an average of eight months to apply for a new standard drugs.

  * A generic manufacturer must prove that his version of a drug product is equivalent to a "reference" existing on the market. When only one company produces a tightly controlled drug and distribution, it can be extremely difficult for other companies to provide reference samples for products.

What you can do 
While Congress, the FDA and other government agencies to explore possible solutions to prevent soaring prices of generic drugs, there are several steps you can take to limit the number of victims in your wallet.

First, when the doctor recommends a drug for you, ask about its cost. In some situations, another drug (cheaper) which has a similar mechanism of action could be safe and effective.

When this is not possible or desirable, you might be able to save money by purchasing generic drugs independent of their health insurance. Websites like GoodRx offer online tools to compare the real drug prices in your area. Discount drug programs or discounts can also help. Note that while these programs may provide some relief, which are often available only for a short period of time (most are not valid after one year), and which can undermine policies to reduce insurance costs - and therefore premiums - down.

Finally, use your voice to help keep this issue a political priority. If you experience a substantial increase in the price of generic drugs, tell your elected officials. 
By: Ameet Sarpatwari, JD, PhD

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