Pharmageddon has been defined as, "the prospect of a world in which medicines and medicine produce more ill-health than health, and when medical progress does more harm than good".
We see the need to investigate and explore that risk and to identify the factors and features that describe it.
Pharmageddon embraces the arguments of Ivan Illich (1976) but extends his focus. He warned of the risks of medicalisation, the generally dehumanising and damaging effects of professional interventions: "the medical establishment has become a major threat to health". Beyond direct drug injury (clinical iatrogenesis), he was concerned about the ill-effects of medicine on culture and community, "the paralysis of healthy responses to suffering, impairment and death" that resulted from "the expropriation of health".
But since Illich wrote, the whole shape of medicine has changed – both the knowledge base and its applications - and the pharmaceutical industry has come to dominate the medical establishment and the thrust and ethos of drug research, regulation, prescribing, availability and use.
The values of the market increasingly count. Now the leading companies, ‘the Pharmas’, have the driving influence on lifestyle, well-being and health outcomes. Their interests and investments have a major impact on the nature and availability of drug treatments, and on the essence and conduct of medicine, worldwide.
The surge towards globalisation since the 1990s has placed the pharmaceutical industry where it is today. The Pharmas are now centred in the USA – which represents half the
global market – and mainly reflect American health values and ways of doing things. The Pharmas are also major instruments of US foreign policy, and their interests are well defended as such.
Pharmageddon stands for the lament that the state of world health represents a colossal waste of what medicine and medicines could accomplish, by structurally harnessing all the talent, energy and commitment that is there. Increasingly this is not happening, which is neither morally defensible, nor in the best interests of our future. It is damaging to the climate of health, the oxygen of community and the core of personal well-being.
Pharmageddon is marked by the contrast between over-medication and drug deprivation; it also implies a strong causal link between the two. Under-medication in poorer communities, and over-medication in richer ones, are connected as closely as obesity and malnutrition, like two sides of the same coin.
Intensive drug marketing and excessive drug consumption has produced an industry whose capacity to innovate and provide is compromised, and whose viability seems increasingly to depend on systematic exaggeration of drug benefits and suppression of evidence of risks and harm. In place of transparency, the industry has now largely taken into its own hands the role of providing information to the public and professionals, filling the air with messages about health priorities, expectations and needs. The net result is a drug supply system that starves national health and sustains global health deprivation.
Outside the major drug markets, populations suffer and die because drugs they need are completely unaffordable, because trade rules block access, and/or for lack of relevant innovation. Elsewhere, the obsession with drug treatment, health observance and disease awareness, is producing nothing like the desired effects. The USA exemplifies this trend: it is beset by diseases of affluence, most obviously by obesity, with diabetes and related complications. But in spite, and no doubt also because, of all the treatment options, fewer than one in twenty citizens manages to maintain a normal weight, eat a nutritious diet, take adequate exercise and not smoke.
For all this, the notion of Pharmageddon may still seem almost inconceivable – as did the risk and threat of Climate Change, just a few years ago. It is natural to deny risks when the misery in prospect results from so much good intent and great talent, and from the enjoyment of huge benefits, valued freedoms and countless goods. And because medicines are especially precious goods, the idea of Pharmageddon offends personal and vested interests alike.
Parallels seem to exist between health and environmental catastrophe. The issues compare to the relationship between a car journey and Climate Change: they are inextricably linked, but not remotely connected in scale or relevance in the average driver’s mind. Just as Climate Change seems inconceivable as a journey outcome, so most personal experience of medicines flatly contradicts the notion of Pharmageddon.
As clinical practitioners, or individual consumers with access to medicines, most people have seen, felt, witnessed and/or imagined their sometimes miraculous effects and results. But, to pursue the analogy, the risk of Pharmageddon is to do with the way in which all drug travel changes the climate of health, even when so many individual drug journeys seem vital or worthwhile.
Both because and in spite of all the benefits of good medicine, it seems crucial to consider whether, collectively, we are rapidly losing sight and sense of health. Increasingly it seems we are. At least we need to challenge the dominant fallacy that drugs more and more resemble magic bullets and offer ever better solutions for the main trials of life.
At the same time, we need to accept that Pharmageddon is not simply the product of malevolence, but the natural outcome of something like a ‘
conspiracy of goodwill’ – a universe driven by self interest, but dominated by a complex of corporate bodies all competing to survive. If Pharmageddon seems to beckon, it is in spite of what everyone wants, not because of it.
That also applies to the Pharmas. All might be well if their products matched promise and met genuine health needs. In fact, the Pharmas are panicked by this huge shortfall and become more predatory, gluttonous, devious and oppressive, to try to compensate for it. Health outcomes drift further and further away from mainstream thinking; excessive promotion, data suppression and falsification, secrecy, bribery, fraud and deep conflicts of interest are increasingly revealed.
The consequences go far beyond the drug disasters that make the headline news. Pharmageddon implies that we have now arrived at a tipping point where leading companies devote their main energies to marketing lifestyle products, rather than on finding ways of meeting real medical needs. The brave new world in prospect is one in which commercial imperatives trump health priorities, when Pharmas and followers systematically change our understanding and experience of what it means to be human, flattening the distinctions between cultures, degrading the clinical arsenal, and developing vast numbers of drugs, most not needed and all purporting to be best. The net result is not only therapeutic disappointment, but also crushing pressures that no public health system could ever survive.
Many people have concerns about many different flaws in the present system of pharmaceutical medicine, but what do they all add up to? Our starting point is simply that the word, Pharmageddon, may mean something important and deserves to exist, if only as a description of forest rather than trees.
The etymology seems to fit. Pharmageddon conveys the idea of a battle between health and ill-health, right and wrong and for better or worse. It also challenges the tendency to take for granted that progress in pharmaceutical medicine leads naturally to better health. Armageddon was "the great symbolic battlefield of the Apocalypse, scene of the final struggle between good and evil". Apocalypse (
– APOKALYPSIS) literally means the lifting of the veil, "a term applied to the disclosure to certain privileged persons of something hidden from the mass of humankind…" (
Wikipedia, 2007).
The time has come to lift the veil: the broader significance of the risks must be explored and revealed. If Pharmageddon is part of any future reality, we all need to know.
***
SEE ALSO:
Notes and References and
CALL FOR ABSTRACTS
There is no standard definition for the word healthy, but in my private practice I sometimes find that if a food has even one healthy attribute it may be given a health halo.
We often forget that mental illness is a disease like any other disease and can be cured or contained with care and proper treatment
6-FEB-2012
Anjali Ojha
Ignorance, stigma and lack of doctors have long marred mental healthcare in India. But with stressful lifestyles and ever increasing cases of depression, this much neglected segment is now gaining importance in the country’s medical scenario.
According to an estimate by the World Health Organisation, depression will become the second largest illness in terms of morbidity in another decade. It already affects one out of every five women and one in every 12 men. “Social awakening towards mental diseases and their cure has finally started to come,” Anindita Paul, director of Sanjivini Society for Mental Health, said.
“In terms of the urban society, there is lot of awakening which is coming now. Still as a country a lot more needs to be done,” Ms Paul said. Globally, mental disorders account for 13 per cent of the burden of diseases.
In India, according to the National Institute of Mental Health, the prevalence of schizophrenia, a severe mental disorder, is prevalent among 1.1 per cent of the total population while the overall lifetime prevalence rate of mental disorders is 10 to 12 per cent.
While the Government has a separate programme for mental health, the segment is marred by a lack of adequate doctors and infrastructure. According to the latest figures provided by the Union Ministry of Health and Family Welfare, India has a mere 4,500 psychiatrists. National Human Rights Commission member PC Sharma said that a lack of proper care for mental patients is a major cause of concern. “In today’s world, everyone is living under constant stress. Still we have just 40 major mental health institutes,” Mr Sharma told IANS.
Mr Sharma said he had personally called the chief of the Medical Council of India and requested him to consider making psychiatry compulsory for all medical students. “The mental institutions are in a pathetic condition and the common perception is that these are ‘mad houses’,” he said.
Ms Paul agrees, but adds that the perspective is changing. “More rehabilitation centres are coming up, but the Government needs to take major steps,” she said.
The WHO preamble states, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”, suggesting there is no health without mental health.
Stress is seen as a major cause of worry as far as mental health is concerned, with studies showing a constant increase in stress, especially in the urban population.
The WHO, in its 130th session of its executive board, adopted a resolution on ‘Global Burden of Mental Disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level’. The draft resolution in the matter was moved by India on January 20.
Sanjivini runs counselling centres, a rehabilitation centre and group consultations for those suffering from mental problems ranging from stress, depression, social problems to severe mental illness.
According to figures tabulated by the organisation, of all the patients who have come to them in the last nine years, some 19 per cent came to discuss issues pertaining to problems with people around them.
Another 17 per cent came to discuss their marital issues, 15 per cent for problems related to their personality, 18 per cent suffered from different mental ailments while one percent had suicidal tendencies.
Statistics also show women are more vulnerable to mental health-related problems as compared to men. Some 57 per cent of the patients in the last nine years have been women.
In 1982, India launched a special National Mental Health Programme to ensure the availability of minimum mental healthcare, encourage application of mental health knowledge in general healthcare and in social development and to promote community participation in mental health service.
“We are still somewhere in the middle of totally de-stigmatising mental illness. There is a need to understand that mental patients can be treated and can lead a normal life again,” Ms Paul said.
http://www.dailypioneer.com/columnists/item/51005-ignorance-stigma-mar-mental-healthcare.html
Dr Milind Deogaonkar
05 Feb 2012
At its just concluded executive board meeting, the World Health Organisation (WHO) adopted a resolution moved by India that focuses on the global burden of mental disorders, and the need for a comprehensive, coordinated response from health and social sectors at the country level. India had also successfully argued for mental disorders being included in the non-communicable disease list at the first Ministerial Conference on Healthy Lifestyles and Non-communicable Disease Control in Moscow last year.
India’s initiative has been lauded, as the gap between the need for treatment for mental disorders is wide all over the world. For example, between 76 and 85 per cent of people with severe mental disorders receive no treatment for their mental health problems, in low and middle-income countries; the corresponding range for high-income countries is also between 35 and 50 per cent.
It is internationally recognised that mental health is equally, if not more, important for the health of any country. We need to do much more in creating awareness, and governments too need to understand the implications of mental illness and its ramifications on quality of life of citizens, their families and society. While depression due to social factors is leading people to commit suicides on one side, there is also a bidirectional relationship between medical and mental illness. She points out that cardiovascular diseases, cancer, stroke and Parkinson’s disease also lead to prevalence of comorbid depression among those patients.
Yet it’s ironical then, that our mental healthcare scene is dismal, bordering on the negligent. A note prepared by the ministry says, seven per cent of India’s population suffers from mental disorders and over 90 per cent remain untreated. There is less than one psychiatrist available for every four lakh people.
The scene is worse in rural areas. This is not surprising considering India’s allocation for mental healthcare is less than 1 per cent of the health budget. Translated into ground reality, these figures mean that a huge percentage of the mentally ill are cared for by their families without even getting a proper diagnosis.
The social stigma associated with being mentally sick means that families can hardly hope for a support network outside the home. Even among the educated and better-off sections, it is common to see the severely mentally ill being hidden from the outside world, shunned by neighbours and relatives, while those suffering from less severe forms are accused of being work-shirkers and malingerers. Women sufferers bear a heavier burden. The mentally ill are also more prone to suffer violation of their human rights, remain unemployed and poor, and more susceptible to the other non-communicable diseases.
The strategies to fight mental illness call for a complex array that will deal with its multifaceted effects, and civil society must do its part as much as the government. Mental health and its ramifications affect every country and section of society. Unfortunately, official recognition of the incidence of the same in India has been more on paper than in practice. The National Mental Health Programme (NMHP) was launched in 1982, while the Mental Health Act (MHA), 1987, came into effect in the early 1990s. The implementation of the programme has, however, not been satisfactory, the most significant factor being the lack of priority given by the states to it.
Psychiatrists and judicial activists have called for an overhauling of the MHA to make it more patient-friendly and in tune with advances in the field of mental healthcare. The draft MHA 2010 needs to be publicised and discussed widely in the public domain.
One of their major demands is that the mental health programme should be incorporated in the National Rural Health Mission, and care and counselling should be available at primary health centres. There should be greater attention to rehabilitation in severe illnesses like schizophrenia, which is estimated to affect over 30 lakh patients in India.
(Dr Deogaonkar is a US-based neurosurgeon of Indian origin. The opinions expressed in this column are the author’s own)
http://expressbuzz.com/voices/Dismal-mental-health-scenario-in-India/359525.html
4-FEB-2012
K.P.M. Basheer
Draft rules to be submitted soon; centres will come under disabilities Act
KOCHI : The State government is planning new procedures to bring on board hundreds of mental health rehabilitation centres run by NGOs and philanthropic individuals, a situation unique to Kerala, and place them under the Social Welfare Department.
A draft set of rules, tentatively titled The Kerala Registration of Psycho-Social Rehabilitation Centres, has been formulated by the Social Welfare Department by invoking Section 73 of the Persons With Disabilities (Equal Opportunities of Protection of Rights and Full Participation) Act 1995 (the PWD Act).
The rules intend to take the mental health care homes and rehabilitation centres out of the purview of the Mental Health Act 1987 and bring them under the PWD Act.
“The rules, after consultations with the stakeholders, will be submitted to the government in a couple of weeks,” K.K. Mony, additional secretary in the Social Welfare Department, told The Hindu .
The Mental Health Act (which also created the State Mental Health Authority) mainly deals with mental health care hospitals and psychiatric nursing homes.
There is no separate law to govern rehabilitation centres. The result: hundreds of such centres function ‘illegally.' The Mental Health Authority cannot issue licence to majority of rehabilitation centres because of legal lacuna.
In other States
The Mental Health Act does not recognise the fundamental differences between a mental health hospital and a mental health rehabilitation centre. States such as Tamil Nadu and Gujarat found a way out by bringing the mental health rehabilitation centres under the PWD Act whose definition of disabilities includes mental illness. The Kerala rules have borrowed some provisions from Tamil Nadu's.
The rules, in the first place, recognise the social reality of the existence, and need for, mental health care homes and rehabilitation centres.
The rise in the number of persons with mental illness and families' tendency to go ‘nuclear' have added to the relevance of such centres.
The public sector treatment facilities are clearly unequipped to handle the load.
The Kerala rules would include registration norms of the centres, criteria for inmates' admission, accommodation, sanitation, and medical help among others.
Local community
The rules would also look into the functioning, funding, licensing, supervising, and monitoring of the centres. They would encourage the participation of the local community in the well-being of the inmates, Mr. Mony said.
Facilitated by the People's Council for Social Justice, the first round of consultation with functionaries of care homes, social workers, and psychiatrists was held at Kochi on Tuesday.
Consultations
Two more consultations, one at Kannur and another at Thiruvananthapuram, would be held before finalising the draft, Mr. Mony said.
One major outcome of the rules would be that the Social Welfare Department, not the Health Department, would have the responsibility of licensing, supervising, and channelling government aid to the care homes and rehabilitation centres.
Centres to be taken out of the ambit of Mental Health Act
Many private-run centres function ‘illegally'
http://www.thehindu.com/todays-paper/tp-national/tp-kerala/article2859543.ece
We often overlook our oral health as an important component of our overall health. It's estimated that nearly 75% of Americans suffer from some form of gum disease which has been linked to serious
health complications. The truth of the matter is that oral health can and will impact your whole body, so it's important to tell/ask your dentist certain things for better health in general.
Dr. Pankaj Singh, founder and CEO of Arch Dental, offers the following top five things you need to tell/ask your dentist at the next visit.
Related:
Is Skipping Dental X-Rays a 'Wise' Decision?
Ask
you dentist what can your dentist do now to prevent future problems
Ask
your dentist how your diet is affecting your teeth
Tell
you dentist if you have any underlying illnesses or ailments and ask how your other illnesses are affecting your teeth.-- Dr. Singh notes that if someone comes in after having a
surgical procedure, they may need an antibiotic first (to prevent bacteria). Also if you have any type of breathing ailment, your dentist will need to know this as certain issues and precautions may come in to play.
Tell
your dentist if you have ben snoring or have trouble sleeping.
Tell
your dentist if you have bad breath--Dr. Singh says that dentists wear masks so they may not be able to smell it. Bad breath can be a sign that your mouth has bacteria build up and that's something dentists need to know about in order to treat it.
More from GalTime:
Teeth Whitening: The Basics
Fear of the Dentist: Is it All in Your Head?
Need Dental Work? Grab Your Passport!
5 Tips for a Healthy Heart
Tara Weng is the national editor of parenting and health for GalTime. She is also a media consultant with a focus on medical and consumer topics. Her professional experience includes a stint as a medical/features producer at the NBC affiliate in Boston, MA and a media relations position at a top teaching hospital in Boston. Tara has also done public relations consulting work and has written for several online and print media outlets. She is a wife and a mother to two children (who are fantastic) and an enthusiastic New England sports fan.
Read more:
http://galtime.com/user/38415#ixzz1lQK5zTnh
http://www.nih.gov/news/health/feb2012/od-06.htm
Agency-wide resource provides important information for the public and health care providers
The National Institutes of Health has created a new website,
NIH Clinical Research Trials and You to help people learn more about clinical trials, why they matter, and how to participate
http://www.nih.gov/health/clinicaltrials/
documents implicating Taco Bell as the restaurant likely involved in the 10-state outbreak, first reported by the Centers for Disease Control and Prevention (CDC) on January 19. The CDC's summary outbreak report referred to the restaurant only as "Restaurant Chain A" and linked it to a cluster of Salmonella enteritidis infection that had sickened at least 68 individuals. The document provided by the Michigan health department summarizes statistics from a case-control study comparing outbreak victims with a control group. In interviews, 29 out of 48 victims (62 percent) reported eating at Taco Bell during the outbreak window, versus 17 out of 103 respondents (17 percent) from a general population control group taken from the ten states involved in the outbreak. The investigation compared those numbers against other fast food chains, none of which received the large disparity shown in the Taco Bell comparisons. Statistically, the study estimated an odds ratio of 9.24 to 1 that Taco Bell distributed the food contaminated with Salmonella enteritidis. CDC investigators believe the illnesses resulted from an ingredient distributed by Taco Bell that was contaminated before reaching restaurants, although the investigation could not pinpoint a single suspect ingredient. Of the victims who ate at Taco Bell, 94 percent reported eating ground beef, while 90 percent ate lettuce and 77 percent ate cheese. University of Minnesota environmental health professor Craig Hedberg, Ph.D., said that the document's data show a "reasonably strong" association between Taco Bell and the illnesses. "Elevated odds ratios and confidence intervals such as these do not prove causation, but would certainly support the hypothesis that the contaminated food item was distributed by Taco Bell to its customers," Hedberg said. Michigan reported one illness associated with the outbreak, though an epidemiologist at the Michigan Department of Community Health said the victim had not eaten at a Taco Bell during the outbreak window. Food Safety News could not confirm whether the victim had been traveling when he or she contracted Salmonella enteritidis.
The mystery behind the identity of "Restaurant Chain A" prompted some public health experts and consumers to question the transparency policies of the agencies involved in the investigation. In a response to inquiries about the Food and Drug Administration's transparency policy in such outbreaks, the FDA issued this response:
"FDA strives to provide reliable information and be as transparent and proactive as possible, particularly when there is an issue that threatens the public health," the statement read. "In situations where there are current illnesses associated with a specific food manufactured by a specific firm, or contaminated foods are distributed without known illnesses, FDA will continue to issue health advisories and press releases, as needed, to provide consumers with specific information so they may take steps to decrease their risk of illness and avoid further exposures."
"We will also continue to work with CDC and State health officials to provide support during their investigations," it added. "We are currently re-examining our practices and policies to ensure they will provide as much transparency as possible while adhering to laws and regulations." On February 1, Food Safety News received documents from the Oklahoma State Department of Health naming Taco Bell as "Restaurant Chain A," providing the first confirmation of the restaurant's identity. With 16 confirmed illnesses, Oklahoma had the second greatest number of outbreak-related cases behind Texas, which had 43. Following the release of the CDC's summary report on January 19, Food Safety News sent public records requests to the CDC, the FDA and the 10 state health departments involved in the outbreak, asking health officials for the name of the fast food chain and the locations of the three restaurants where more than one victim ate. The 10 states involved in the outbreak were: Texas (43 illnesses), Oklahoma (16), Kansas (2), Iowa (1), Michigan (1), Missouri (1), Nebraska (1), New Mexico (1), Ohio (1), and Tennessee (1). The state health departments in Nebraska and Texas have cited confidentiality for their denials of the records request. Iowa and Ohio said they did not have information on the identity of the restaurant, while the remaining state health departments have not yet responded to records requests and phone calls. The CDC has also yet to respond. For more than a week, Food Safety News has placed multiple phone calls to Taco Bell's public relations division asking for additional information on how the restaurant chain responded to the outbreak. After repeated promises to respond, Taco Bell has still not returned any calls. On Monday morning, a Taco Bell representative said the company is busy responding to many inquiries, but would put a priority on responding to Food Safety News.
Filed under:
Pet Health,
Animal Sites We Love
PDXdj, Flickr
Vetstreet
February is Dental Health Month, which means it's time to lavish some attention on your pet's teeth. It's important to take proper care of canine and feline teeth, because if left untreated, plaque and tartar buildup can progress to painful periodontal disease. The bacteria from periodontal disease can spread to other organs and cause illnesses. More than 85 percent of cats and dogs over four years old are affected by periodontal disease - you don't want your four-legged companion to become part of that alarming statistic.
Here are five steps to help your pet's teeth and gums remain healthy:
1. Beware of Bad Breath
If a musky scent is coming from Fluffy's mouth, don't ignore it. This could be a warning sign that she has periodontal disease or another oral disease such as stomatitis, a common feline condition that causes painful inflammation of the gums and mouth tissues.
SEE ALSO:
Warning Signs Your Pet Has Gum & Teeth Issues
Other dental-health warning signs include bleeding gums, yellow or brown teeth, pawing at the mouth, and loose or missing teeth.
Continue reading
5 Best Ways to Keep Your Pet's Teeth Healthy
A Correction Has Been Published
Perspective
The Shortage of Essential Chemotherapy Drugs in the United States
Mandy L. Gatesman, Pharm.D., and Thomas J. Smith, M.D.
N Engl J Med 2011; 365:1653-1655
November 3, 2011
Comments open through November 9, 2011
- Article
- References
- Citing Articles (1)
- Comments (14)
For the first time in the United States, some essential chemotherapy drugs are in short supply. Most are generic drugs that have been used for years in childhood leukemia and curable cancers — vincristine, methotrexate, leucovorin, cytarabine, doxorubicin, bleomycin, and paclitaxel. 1 The shortages have caused serious concerns about safety, cost, and availability of lifesaving treatments. In a survey from the Institute for Safe Medication Practices, 25% of clinicians indicated that an error had occurred at their site because of drug shortages. Many of these errors were attributed to inexperience with alternative products — for instance, incorrect administration of levoleucovorin (Fusilev) when used as a substitute for leucovorin or use of a 1000-mg vial of cytarabine instead of the usual 500-mg one, resulting in an overdose. Most cancer centers quadruple-check drugs for accuracy, and we're unaware of any documented death of a patient with cancer such as the nine deaths in Alabama attributable to the use of locally compounded liquid nutrition because the sterile product was not available. However, it is only a matter of time.
These shortages have increased the already escalating costs of cancer care. Brand-name substitutes for generic drugs can add substantial cost. For instance, Abraxane, a protein-bound version of paclitaxel, costs 19 times as much as equally effective generic paclitaxel (see table
Average Wholesale Prices (AWPs) of Selected Oncology Drugs in Short Supply and Their Potential Alternatives.). Since 2010, health care labor costs in the United States have increased by about $216 million because of the increased time and work required to manage drug shortages. 2 A gray market for essential drugs — an unofficial alternative market of drugs obtained by vendors outside the usual distribution networks — has grown rapidly, with unregulated vendors charging markups of up to 3000% for cancer drugs.
The main cause of drug shortages is economic. If manufacturers don't make enough profit, they won't make generic drugs. There have been some manufacturing problems, but manufacturers are not required to report any reasons or timetable for discontinuing a product. Contamination and shortages of raw materials probably account for less than 10% of the shortages. In addition, if a brand-name drug with a higher profit margin is available, a manufacturer may stop producing its generic. For instance, leucovorin has been available from several manufacturers since 1952. In 2008, levoleucovorin, the active l-isomer of leucovorin, was approved by the Food and Drug Administration. It was reportedly no more effective than leucovorin and 58 times as expensive, but its use grew rapidly. Eight months later, a widespread shortage of leucovorin was reported.
The second economic cause of shortages is that oncologists have less incentive to administer generics than brand-name drugs. Unlike other drugs, chemotherapeutics are bought and sold in the doctor's office — a practice that originated 40 years ago, when only oncologists would handle such toxic substances and the drugs were relatively cheap. A business model evolved in which oncologists bought low and sold high to support their practice and maximize financial margins. Oncologists buy drugs from wholesalers, mark them up, and sell them to patients (or insurers) in the office. Since medical oncology is a cognitive specialty lacking associated procedures, without drug sales, oncologists' salaries would be lower than geriatricians'. In recent decades, oncology-drug prices have skyrocketed, and today more than half the revenue of an oncology office may come from chemotherapy sales, which boost oncologists' salaries and support expanding hospital cancer centers.
Before 2003, Medicare reimbursed 95% of the average wholesale price — an unregulated price set by manufacturers — whereas oncologists paid 66 to 88% of that price and thus received $1.6 billion annually in overpayments. 3 To blunt unsustainable cost increases, the Medicare Modernization Act mandated that the Centers for Medicare and Medicaid Services (CMS) set reimbursement at the average sales price plus a 6% markup to cover practice costs. This policy has reduced not only drug payments but also demand for generics. In some cases, the reimbursement is less than the cost of administration. For instance, the price of a vial of carboplatin has fallen from $125 to $3.50, making the 6% payment trivial. So some oncologists switched to higher-margin brand-name drugs. 4 Why use paclitaxel (and receive 6% of $312) when you can use Abraxane (for 6% of $5,824)?
Now practices are struggling to treat their patients because of the unavailability of drugs. Short-term solutions include gray-market purchases, which more than half of surveyed hospitals say they've made, but that option introduces safety and quality-control issues. Pharmacists are intensively managing inventories and alerting prescribers to developing shortages and potential alternatives. Some centers now have a red–yellow–green system for quickly recognizing developing shortages and determining which patients get priority (usually those with curable cancers) when supply is limited.
Long-term, non–market-based solutions have been elusive. Proposed legislation would require manufacturers to give 3 to 6 months' notice before discontinuing a drug in order to allow others to pick up production. However, it is likely that gray-market vendors would buy the remaining inventory of such drugs and charge huge markups. Creating a national stockpile is impractical: Do we stockpile the drugs and then waste whatever is not used or stockpile the ingredients and make new batches as needed? A national health care plan with a single formulary and a central pharmacy stockpile is possible for Medicare or Veterans Affairs but unrealistic given oncologists' dependence on drug income and difficulties with timely, safe distribution.
Market solutions take one of two approaches: let the market work and accept short-term uncertainties or regulate the market more tightly. For instance, the CMS could reimburse at the average sales price plus 30%, but that wouldn't help if the drug price has fallen from $125 to $3.50 per vial. The government could set a floor for average sales prices to encourage the production of generic drugs, but that would increase the total cost of cancer drugs unless brand-name prices were reduced. Europe has fewer shortages for that reason: prices are set higher for generics so that companies will make them, but prices of brand-name drugs are often much lower than U.S. prices.
More far-reaching reforms of oncology practices and reimbursement are necessary if there is no national intervention or federal market regulation. One solution is adopting clinical pathways for which practices are paid disease-management fees that are not based on chemotherapy sales. For instance, one large oncology group has developed care pathways specifying preferred drug combinations and sequences — for example, allowing only a few first-line, mostly generic regimens for patients with non–small-cell lung cancer, as compared with the 16 possible drugs and many more combinations included in National Comprehensive Cancer Network pathways. This approach has been shown to result in equal or better survival, less use of chemotherapy near the end of life, and 35% lower costs than usual care. 5 Another solution is to pay physicians salaries, as Kaiser Permanente, Veterans Affairs, and most academic centers do, but that would reduce oncologists' earnings at a time when a 40% workforce shortage is predicted, so the effect must be monitored.
To ensure a predictable supply of generic cancer drugs, manufacturers need reasonable markets and profits, and oncologists need incentives to use generics. Standardized clinical pathways with drug choices based only on effectiveness will enable the prediction of drug needs, practices for effective management of inventory, and planning by manufacturers for adequate production. Such pathways, disease-management fees, and physician salaries would dramatically change oncologic practice, but since drug costs will increase by 4 to 6% this year alone, they are necessary. The current system not only is unsustainable but also puts oncologists in potential ethical conflict with patients, since it hides revenue information that might influence drug choices and thus affects costs and patients' copayments.
The only good news is that the drug shortages may catalyze a shift from a mostly market-based system to one that rewards the provision of high-quality cancer care at an affordable cost.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
This article (10.1056/NEJMp1109772) was published on October 31, 2011, and updated on November 2, 2011, at NEJM.org.
Source Information
From the Virginia Commonwealth University Health System, Richmond (M.L.G.); and the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore (T.J.S.).
creamy, fruity, and crunchy concoction with just 208 calories, 3 grams of fat (mostly healthy fat from the almonds), and 15 grams of protein—it's a perfectly satisfying gluten-free breakfast or dessert!
squeezable applesauce pouches are designed for kids, but they make a great natural fruit snack on the go. Throw one of five flavors—apple, apple strawberry, apple banana, apple cinnamon, or apple peach—in
your gym bag for a quick and easy snack before or after your workout. Each gluten-free pouch contains 99.9 percent fruit and has just 60 calories. If you're looking for something a little more hearty, pair one pouch with a handful of walnuts.
curried butternut squash soup recipe takes 35 minutes to make and is full of veggies. A filling 1.5-cup serving has 195 calories and 3 grams of fat, along with 6 grams of protein, 12 grams of fiber, and 171 milligrams of calcium. It's a gluten-free power snack that you can whip up over the weekend, store in containers, and enjoy all week!
belly-filling fiber than other dried fruits, so this makes a great afternoon snack to keep you satisfied until dinner.
How to make it: Fill the crevice of one large celery stalk with one tablespoon of almond butter and sprinkle with 1/8 cup of small, chopped dried plums like
Sunsweet's Plum Amazins. The whole snack is about 160 calories and is filled with healthy fats, fiber, and vitamins.
vegan—almost anything—there's likely a gluten-free bar to meet your needs. Just be sure it says "gluten-free" clearly on the label (different flavors of the same brand vary) and that it has fewer than 250 calories. Ideally, your healthy snacks should have about 150-200 calories each.
Simply 7 Hummus Chips in Sea Salt are a great gluten-free snack on the go. There are only 130 calories in a 30-chip serving, along with 5 grams of fat and 2 grams of protein. If you like your chips with a little dip (who doesn't?), try two tablespoons of Tostitos all-natural pineapple and peach salsa, which adds just 20 calories per serving.
eating spicy foods can help boost your metabolism.
avocados, jalapenos, onion, salt, and garlic, for just 100 calories.
To save even more calories, ditch your chips and try cutting up peeled jicama into matchsticks. One cup of jicama slices has just 46 calories, 6 grams of fiber, and 40 percent of your daily vitamin C needs.
salty, savory, and sweet snack with about 200 calories.
baked sweet potato? Fantastically filling, healthy, and indulgent-tasting, this gluten-free snack just requires a little time in the microwave, a teaspoon of butter, and a small drizzle of honey. With about 150 calories, 4 grams of fiber, and 2 grams of protein, it's a sweet treat that will keep you feeling satisfied for hours!
One of the biggest FMCG Group in KSA with a portfolio of food and agriculture. They were established as a leading manufacturer and distributor of food and agricultural products.
Job Purpose:
To ensure well being of flocks by designing & implementing vaccination regimes and supporting the hatcheries, broilers & breeder in maintaining health of flocks.
Duties & Responsibilities:
Technical Duties:
• Design and implement vaccination regimes for hatcheries, broilers and breeder flocks.
• Design and implement medication, cleaning and disinfection and monitoring regimes for broiler and breeder flocks.
• Design new vaccination teams for hatcheries, broiler and breeder Farms.
• Arrange for suitable training required for all vaccination teams through Animal Health & Training Department.
• Negotiate with medicines and vaccines suppliers for timely and cost effective availability as per budgeted forecasts.
• Forecast the vaccines, medicines and all chemical requirements of all broiler and breeder farms.
• Monitor randomly the physical application of all type of vaccinations at broiler and breeder farms.
• Monitor closely the health status of all broiler and breeder flocks through epidemiological monitoring regimes.
• Decide on the basis of diagnostic tools about any essential change in any of the preventive and therapeutic regimes at all broiler and breeder farms.
• Develop and implement bio security protocols at all broiler and breeder farms in liaison with Quality Assurance Department.
• Update the technical knowledge on continuous basis, of all of Animal Health Division Team in particular, and all production teams in general about latest developments in the various areas of Animal Health issues.
Administrative Duties:
• Human resource management of all Animal Health Teams for continual improvement, motivation and achieving desired goals and objectives. (50-60 personnel)
• Check all daily and weekly reports of hatcheries, broiler and breeder farms performance, evaluate the health status of flocks, hatcheries vaccination evaluation, and take decision accordingly.
• Assist in selecting, developing & evaluating staff at all levels to maximize their productivity and competence with on the job training where required.
• Assist, co-operating, liaising closely with the Agriculture Production Director and keeping him abreast, on at least twice weekly basis, of the progress and performance of each farm and flock.
• Annual evaluation of direct sub ordinates.
Related Procedures:
Department SOP’s.
Job Details
| Date Posted: | 2012-02-07 |
| Job Location: | Riyadh, Saudi Arabia |
| Job Role: | Healthcare/Medical |
| Company Industry: | FMCG |
Preferred Candidate
| Career Level: | Management |
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