dras knowledge

Tuesday, November 14, 2006

Overseas Copyright of Expensive AIDS Drugs

http://society.guardian.co.uk/print/0,,329626738-112238,00.html
***Rich countries ‘blocking cheap drugs for developing world’***
§ US and EU have broken Doha pledges, says Oxfam
§ Stop Aids claims 75% of HIV patients not treated
Sarah Boseley, health editor
Tuesday November 14, 2006
Guardian
Poor people are needlessly dying because drug companies and the governments of rich countries are blocking the developing world from obtaining affordable medicines, a report says today.
Five years to the day after the Doha declaration - a groundbreaking deal to give poor countries access to cheap drugs - was signed at the World Trade Organisation, Oxfam says things are worse.
The charity accuses the US, which champions the interests of its giant pharmaceutical companies, of bullying developing countries into not using the measures in the Doha declaration and the EU of standing by and doing nothing. Doha technically allows poor countries to buy cheap copies of desperately needed drugs but the US is accused of trying to prevent countries such as Thailand and India, which have manufacturing capacity, making and selling cheap generic versions so as to preserve the monopolies of the drug giants.
“Rich countries have broken the spirit of the Doha declaration,” said Celine
Charveriat, head of Oxfam’s Make Trade Fair campaign. “The declaration said the right things but needed political action to work and that hasn’t happened. In fact, we’ve actually gone backwards. Many people are dying or suffering needlessly.”
The Indian generics firms make most of the cheap drug cocktails that are now being rolled out to people with HIV in Africa and are keeping more than a million people alive. They brought the price of a basic three-drug cocktail down from $10,000 (£5,250) a year to less than $150 (£79). But new Aids drugs will soon be needed because the virus will become resistant to the basic ones now in use - as has happened in the EU and the US.
Those newer Aids drugs, together with drugs for cancer and diabetes, are under patent. The Oxfam report points out that 4 million people were newly infected with HIV in 2005 and cancer and diabetes are expanding faster in developing countries than in the richer world.
The report says that, since the signing of the Doha declaration on November 14 2001, “rich countries have failed to honour their promises. Their record ranges from apathy and inaction to dogged determination to undermine the declaration’s spirit and intent. The US, at the behest of the pharmaceutical industry, is uniqely guilty of seeking ever higher levels of intellectual property protection in developing countries.”
The US has pursued its own free trade agreements with developing countries, tying them into much tighter observance of patent rights than anticipated at Doha. “The USA has also pressured countries for greater patent protection through threats of trade sanctions,” the report says.
The drugs firms are also fighting to have patents observed. Pfizer is challenging the Philippines government in a bid to extend its monopoly on Norvasc, a drug pressure drug. Novartis is engaged in litigation in India to enforce a patent for Glivec, a cancer drug, which could save many lives if it were available at generic prices.
The Stop Aids campaign, a coalition of 90 NGOs of which Oxfam is a member, is calling for the government to champion the issue at the G8 summit next year. Three-quarters of HIV drugs are still under monopoly and unaffordable in poor countries, it said. More than 75% of those who need HIV treatment urgently are still not getting it. Only 8% of children with HIV are on drugs, which cost four times more than those for adults.
“Sadly, promising words have not translated into life-saving treatments and five years is too long to wait when the stakes are so high,” said Steve Cockburn, campaign coordinator.

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My cynical comment:

I have a good idea. Let's mandate patent infringements so that BIG PHARMA companies in Thailand and India can manufacture and flood the world market with inexpensive knock-offs of high tech drugs that were expensively and painstakingly developed and brought to approval in the US, by US companies. And then not allow these cheap copycat drugs back in the US for purchase by American citizens who suffer from these horrible diseases.

Monday, November 13, 2006

Case study, alt med for respiratory distress in the acute inpatient setting

For your consideration.

A recent 7-day admission at an acute care hospital for a 8-year-old boy with difficulty breathing. On admission, his room air blood oxygen saturation is 85%, and no peak flow can be measured despite 2 days of oral prednisone and multiple back-to-back albuterol and Atrovent treatments.

Day 1: Difficulty breathing, with cough especially when he ambulates. Nebulized albuterol at least every 2 hours provides no relief. Respiratory rate around 30. Oxygen via nasal cannula averages 3 liters per minute to keep saturation above 90% Chest x-ray shows reactive airway disease with a possible perihilar mass.

Day 2: Condition not improved. Oxygen needs occasionally reach 8 liters per minute. CAT scan is done and doesn't identify a perihilar mass, but does see a hypodensity around the liver. Liver function tests are ordered.

Day 3: Slight improvement in symptoms with less difficulty breathing. Still requires up to 5 liters per minute oxygen. Decreased cough, but increased nasal congestion is noted. Liver tests are all essentially normal. Pulmonary consult is performed and a series of antibody tests are ordered.

Day 4: Symptomatic especially with exertion, still requires 2-5 liter per minute oxygen by mask due to nasal congestion. Parents (who are constantly at the bedside) request that they administer "homeopathic drops", which is granted. IgE antibody result is 602, significant for severe allergies. Allergy/immunology studies ordered.

Day 5: Still requires around 3 liters per minute oxygen. Lung sounds are noted as not nearly as "noisy." Parents request that the family's chiropractor come in to do an "adjustment" and also perform acupuncture. Hospital and physician agree that nothing prevents the chiropractor from coming in as a visitor (as he has no practice privileges at the hospital.) Meanwhile, 5-day course of Zithromax is completed and the medical specialists contemplate an etiology and careplan based on the "one airway" theory. Allergy and upper airway medications are added to the treatment regimen.

Day 6: Oxygen is weaned throughout the day with intermittent episodes of room air. EKG shows axis deviation and an echocardiogram is ordered, which rules-out significant cardiac abnormalities. Discharge planning is initiated for the next morning.

Day 7 Discharged to home without supplemental oxygen and on a combination of allergy and asthma medications. Parents request that a "natural" brand of Iron supplement be used instead of the one available at pharmacies.

Complimentary Medicine Summary: This boy did not show much improvement in symptoms despite all the treatment and medications given for more than two days in the hospital. But he shows some, almost immediate improvement soon after homeopathic drops are administered. And he no longer needs supplemental oxygen one day after his chiropractic adjustment and acupuncture treatment.

Case conclusion/comments: The patient likely experienced an upper airway viral infection or other antigen that exacerbated his known asthma and as yet unidentified allergies. Through natural course, standard medical treatment, and the addition of allergy medication and treatment, the patients symptoms subside on the sixth day of admission. The homeopathic and alternative treatments concurrently administered are likely inconsequential to clinical outcomes. Standards of medical practice dictate that even though the CAT scan, echocardiogram, and liver functions tests are normal, they are essential in this case, especially in the presence of an unclear etiology causing a persistent hypoxemia. Finally, caution should be used in prescribing so-called "natural" iron supplements due to no manufacturing oversite or guarantee of potency or purity.

Friday, November 10, 2006

Laser Light Treatment Gizmos are Just Gizmos

Premier Physical Therapy runs a daily ad in the Chicago Tribune. I've been asked if it's legitimate so I'm hoping someone can answer the question. Thanks in advance for any input.

http://www.ptnerve.com/



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A couple years ago I was deep into finding out about the different light and laser gadgets and gizmos... er, that is: medical treatment devices. I know they've been brought up on this list before. Maybe hit internet search for Anodyne.

Despite FDA approval, use of MIRE devices including Anodyne for anything isn't supported in scientific literature. A lot of what I came up with about the Anodyne is supported/repeated here:

https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=176
http://www.regence.com/trgmedpol/dme/dme63.html

The sticky thing about these things is that most insurance, including Medicare won't want to cover treatment associated with using them, but it's very easy to be vague (or even misleading) on a claim form when describing the treatment.

Since they are FDA approved, used by P.T.'s in clinical settings, and covered by insurance, sounds like legitimate mainstream medicine to me.

N-

P.S. The cool thing is that you can find yourself a tad richer when you turn in the fraudsters who are billing Medicare for this. http://www.cms.hhs.gov/FraudAbuseforConsumers/01_Overview.asp#TopOfPage