Chlamydia screening

It has been recommended that all sexually active women under the age of 25 be screened for Chlamydia. The reason being that most initial infections in women are asymptomatic but may progress to more serious diseases such as pelvic inflammatory disease, ectopic pregnancy, infertility, and chronic pelvic pain.

In the recent issue of the Annals, this strategy has proven to be cost-effective and only emphasizes the importance ...

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A reader writes:

It's impossible to perform a Google or Yahoo search using the word "colon", and not get flooded with hits advertising "proprietary" herbal blends guaranteed to cleanse the colon. Is this really necessary? As the ordinary person reads through any of these sites, he is led to believe that most all of us have 10 to 40 lb. of compacted debris in our colons. The "scare literature" continues ...

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Paying dearly

Dr. Centor links to a NY Times article asking whether the Vioxx findings are a class effect. He also ends condemning direct-to-consumer advertising:

I would hold Vioxx up as a clear example of the dangers of DCA. DCA tries to spur demand. It did. And now Merck will probably pay. And maybe some patients have paid dearly.

Contrast . . .

. . . between the Bush and Kerry approach to health care are summarized in several newspapers today.

It starts

The first lawsuits are coming against Merck in wake of the Vioxx recall:

Nevels says her 34-year-old daughter, Shelly South, took Vioxx for 21/2 years before dying of a heart attack in November 2002. She claims Merck knew of the risks of Vioxx long before its announcement Thursday.

Also named in the suit is Dr. Waclaw Alex Dymek, the Carrollton physician who prescribed the drug to South. Nevels claims ...

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A recent study has suggested that there has been increasing use of CT angiography in the diagnosis of pulmonary embolism:

A new study, published in the October 2004 American Journal of Roentgenology, shows that during a nine-month period in 1997 –1998, 81 patients underwent CT for suspected pulmonary embolism through the emergency department at University Hospitals of Cleveland. That number increased to 349 during the corresponding nine-month interval in 2002-2003, ...

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The empire strikes back

Following up the previous piece detailing the Pfizer insider that broke ranks and supported drug reimportation, Pfizer seems to be taking some action:

Pfizer Vice President of Marketing Peter Rost, who has publicly supported the legalization of prescription drug reimportation, on Thursday said that the company has launched an investigation into his political activities . . .

. . . Seven members of Congress on Wednesday wrote to ...

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I told you so

Cardiologist Eric Topol with an op-ed in the NY Times, saying good riddance to Vioxx.

The common perception that is being trotted out as an alternative to Vioxx is switching to Pfizer's Bextra or Celebrex, the other COX-2 inhibitors out there. However, these medications cannot be taken in those with a sulfa allergy or hypersensitivity. This excludes a large percentage of the population - studies estimate approximately 3.5% have a reaction to a sulfa drug. So, what are your alternatives if you can't take ...

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The day after

Now that everyone has gotten over the initial news of the Vioxx recall, some of the more interesting analysis emerges.

The San Francisco Chronicle details how understaffed the FDA is:

Miceli said the FDA is woefully understaffed. And its guidelines often lead it to look only at the evidence presented by drug manufacturers, he said -- not at the further data that could have been generated.
Forbes goes
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Colon cancer screening rates are still low:

Overall, 58 percent of men and 51 percent of women [aged 50 to 74 years -ed] in the study reported ever having undergone endoscopy, but only 35 percent reported being tested in the five years before 1997. Just 42 percent of men and 31 percent of women reported endoscopy for screening (rather than for disease diagnosis or follow-up).
It is recommended by most ...

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Vioxx FAQ

A nice summary of frequently asked questions to the Vioxx recall from WebMD, including more information on the trial:

What evidence supports the withdrawal?

Merck's decision to withdraw Vioxx from the market is based on new data from a trial called the APPROVe trial. In the APPROVe trial, Vioxx was compared with placebo (sugar pill). The purpose of the trial was to see if the 25 mg dose ...

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Pfizer responds

Pfizer stands by its drug in response to the Vioxx recall, calling Celebrex is an "appropriate treatment alternative," to Vioxx. Too soon to say whether this is a class effect, but certainly Celebrex and Bextra will be closely watched.

James Cramer with a view from TheStreet.com - Merck Will Be Tort Bar's Next Target:

Is Merck going to be a trust for those who took Vioxx? That's what you are betting if you sell this stock down $12. You are betting that the tort bar, which has almost finished destroying tobacco and asbestos, just found its newest target.

Frankly, I think that's a decent bet. I fear the ...

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Vioxx fallout

Now that Vioxx has been pulled from the market, what to do? My office has certainly been deluged with calls. From what I can gather, the study leading to the recall showed an increased risk of heart attack and other CV complications 18 months after patients took 25mg of Vioxx. Here are some options to ponder if you are on Vioxx:

1) Switch to Celebrex at ...

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Merck withdraws Vioxx

Following up this previously written piece, today Merck pulls Vioxx from the market. Huge news - and what does the future hold for other COX-2's, like Celebrex and Bextra?

Update:
Here is a link to the study leading to the withdrawal. Some key points:
1) There was an over 3-fold risk of acute MI and sudden cardiac death for those taking over 25mg of Vioxx.

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Debate on malpractice

There is an interesting debate going on at Medrants between Dr. Centor and a lawyer. The topic of defensive medicine came up:

Many physicians do order unnecessary tests. This phenomenon occurs most often in emergency rooms, but also occurs in office practice.

When does this occur? I do not have hard data (again db asks for help from the readers), but I believe that I see ...

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Insomnia

Medpundit comments on the recent study touting cognitive behavior over medications for insomnia. She writes:

Now, how do I get my patients to believe it? In my experience, people just want "something to help me sleep." I have a hand-out I give patients that describes the steps to improve sleep, which is basically an exercise in retraining bad habits. I go over it with them, but most ...

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Increasing revenue

Pharmacies are thinking about charging for consultations:

Pharmacists like White have long been called on by customers to do more than just fill prescriptions. But drugstores, from giants like Rite Aid to smaller regional chains, are looking to expand their counseling programs and boost revenue - a trend that could be bolstered by the prescription-drug benefit that will become available to Medicare enrollees in 2006.

Think the malpractice crisis isn't affecting the public? Think again:

The IssuesPA/Pew Poll has found that a remarkable 26 percent of Pennsylvanians polled "said rising malpractice insurance costs have forced their family to change doctors in the past year", and that state residents polled also favored a constitutional cap on pain and suffering damages by a margin of 68 percent to 24 percent.

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