Pharmaceutical drug

Doctors behind ADHD study question drug treatment.

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The co-authors of a 20-year-old study promoting the use of prescription drugs to combat the effects of attention deficit hyperactivity disorder (ADHD) are now claiming the report may have overstated medication’s benefits.

According to a report in the New York Times, at least two co-authors of the highly influential study – called the Multimodal Treatment Study of Children With ADHD – have come forward to express concern that the original report also downplayed the benefits of behavioral therapy.

“There was lost opportunity to give kids the advantage of both and develop more resources in schools to support the child — that value was dismissed,” said co-author Dr. Gene Arnold, a child psychiatrist and professor at Ohio State University.

“I hope it didn’t do irreparable damage,” added a second co-author, Dr. Lilly Hechtman of Montreal’s McGill University. “The people who pay the price in the end is the kids. That’s the biggest tragedy in all of this.”

The report originally claimed that not only was medication like Adderall and Ritalin more effective than therapy, but also that combining the two treatments offered little to no benefit to the patient. Even a 2001 report that showed a combination of medication and therapy effectively treating ADHD symptoms by 12 percent over medication only (68 – 56 percent) labeled the results“small by conventional standards.”

Boosted by marketing from pharmaceuticals, prescriptions for ADHD drugs have skyrocketed since the early 1990s, alongside a significant rise in the diagnosis of ADHD in general.

According to new data from the Centers for Disease Control and Prevention, 15 percent of high-school-age children have been diagnosed with the disorder, with roughly 3.5 million currently taking medication. These numbers stand in stark contrast to the 600,000 or so children diagnosed with ADHD in 1990.

“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Keith Conners, a psychologist and professor emeritus at Duke University, said to the Times earlier in December.“This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”

One of the reasons medication has been used so often to treat the disorder is that, at the cost of $200 a year, it’s significantly cheaper than therapy, which can run up to $1,000 a year or more and isn’t covered as comprehensively by insurance companies. While medication can be helpful, it also has its consequences – potential addiction, anxiety, depression, insomnia and, in some cases, suicidal tendencies and hallucinations.

Behavioral therapy, meanwhile, focuses on developing a child’s long-term academic and social skills. According to psychologist Ruth Hughes of the advocacy group Children and Adults With Attention-Deficit/Hyperactivity Disorder, medication may make a child ready to learn important skills, but it still requires someone to teach them.

Now, new studies are suggesting that the effects of medication begin to decrease once a child grows older, suggesting it’s extremely difficult to calculate how a child will react as they reach young adulthood. Some researchers pin the blame on the fact that many children stop taking the pills, while others say it demonstrates the inability of a medication-only approach to conclusively treat the disorder.

“My belief based on the science is that symptom reduction is a good thing, but adding skill-building is a better thing,” Stephen Hinshaw, a psychologist at the University of California, Berkeley, said to the Times. “If you don’t provide skills-based training, you’re doing the kid a disservice. I wish we had had a fairer test.”

Ulcer pills linked to B12 deficiency

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heartburn

Medication used to treat stomach ulcers may cause potentially harmful vitamin B12 deficiency, say experts.

A US study of 200,000 people in the Journal of the American Medical Association found the link.

People who took tablets known as proton pump inhibitors (PPIs) or histamine antagonists (H2RAs) were more likely to lack enough vitamin B12 for good health.

Left untreated, B12 deficiency can lead to dementia and neurological problems.

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Only a minority of patients on long term proton pump inhibitors showed evidence of vitamin B12 deficiency”

Prof Mark Pritchard of the British Society of Gastroenterology

The study authors say doctors should still prescribe these medicines, but that they should weigh possible harms against any benefits in patients who need the drugs for prolonged periods of time.

More investigations are needed to fully evaluate the risk which appears to be in people who take these medications for two or more years, they say.

Link not proof

The Kaiser Permanente researchers found that the link with B12 deficiency increased with dose and was stronger in women and younger age groups.

But the overall risk was still low.

PPIs and H2RAs are commonly prescribed for patients with symptoms of stomach ulcers such as heartburn and indigestion.

The tablets are also widely available to buy without a prescription, ‘over-the-counter’ at pharmacies.

They work by reducing the amount of acid made by your stomach.

Stomach acid is needed for us to absorb vitamin B12 from our food, such as meat, fish and dairy.

If identified, most cases of B12 deficiency can be easily treated by giving supplements or an injection of vitamin B12.

But symptoms, such as lethargy, can be vague and overlooked.

Prof Mark Pritchard of the British Society of Gastroenterology said people should not be concerned by the findings.

“Only patients who had taken these tablets for more than two years were at risk and only a minority of patients on long-term proton pump inhibitors showed evidence of vitamin B12 deficiency.”

He said people taking ulcer medications could ask their GP for a simple blood test to measure vitamin B12 levels if they are worried.

What Most Doctors Won’t Tell You About Colds and Flus.

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The next time you experience a cold or the flu, remember this: rather than take conventional drugs to suppress uncomfortable symptoms, it’s better for your health to allow the cold or flu to run its course while you get plenty of physical and emotional rest.

Conventional medicine and the pharmaceutical industry would have you believe that there is no “cure” for the common cold, that you should protect yourself against the flu with a vaccine that is laden with toxic chemicals, and that during the midst of a cold or flu, it is favorable to ease your discomfort with a variety of medications that can suppress your symptoms.

Unfortunately, all three of these positions indicate a lack of understanding of what colds and flus really are, and what they do for your body.

Colds and flus are caused by viruses. So to understand what colds and flus do at a cellular level, you have to understand what viruses do at a cellular level.

Do you remember learning about cellular division in grade seven science class? Each of your cells are called parent cells, and through processes of genetic duplication (mitosis) and cellular division (cytokinesis), each of your parent cells divides into two daughter cells. Each daughter cell is then considered a parent cell that will divide into two more daughter cells, and so on.

Viruses are different from your cells in that they cannot duplicate themselves through mitosis and cytokinesis. Viruses are nothing but microscopic particles of genetic material, each coated by a thin layer of protein.

Due to their design, viruses are not able to reproduce on their own. The only way that viruses can flourish in your body is by using the machinery and metabolism of your cells to produce multiple copies of themselves.

Once a virus has gained access into one of your cells, depending on the type of virus involved, one of two things can happen:
The virus uses your cell’s resources to replicate itself many times over and then breaks open (lyses) the cell so that the newly replicated viruses can leave in search of new cells to infect. Lysis effectively kills your cell.

The virus incorporates itself into the DNA of your cell, which allows the virus to be passed on to each daughter cell that stems from this cell. Later on, the virus in each daughter cell can begin replicating itself as described above. Once multiple copies of the virus have been produced, the cell is lysed.

Both possibilities lead to the same result: eventually, the infected cell can die due to lysis.

Here is the key to understanding why colds and flus, when allowed to run their course while you rest, can be good for you:

By and large, the viruses that cause the common cold and the flu infect mainly your weakest cells; cells that are already burdened with excessive waste products and toxins are most likely to allow viruses to infect them. These are cells that you want to get rid of anyway, to be replaced by new, healthy cells.

So in the big scheme of things, a cold or flu is a natural event that can allow your body to purge itself of old and damaged cells that, in the absence of viral infection, would normally take much longer to identify, destroy, and eliminate.

Have you ever been amazed by how much “stuff” you could blow out of your nose while you had a cold or the flu? Embedded within all of that mucous are countless dead cells that your body is saying good bye to, largely due to the lytic effect of viruses.

So you see, there never needs to be a cure for the common cold, since the common cold is nature’s way of keeping you healthy over the long term. And so long as you get plenty of rest and strive to stay hydrated and properly nourished during a cold or flu, there is no need to get vaccinated or to take medications that suppress congested sinuses, a fever, or coughing. All of these uncomfortable symptoms are actually ways in which your body works to eliminate waste products and/or help your body get through a cold or flu. It’s fine to use over-the-counter pain medication like acetaminophen if your discomfort becomes intolerable or if such meds can help you get a good night’s rest. But it’s best to avoid medications that aim to suppress helpful processes such as fever, coughing, and a runny nose.

It’s important to note that just because colds and flus can be helpful to your body doesn’t mean that you need to experience them to be at your best. If you take good care of your health and immune system by getting plenty of rest and consistently making health-promoting dietary and lifestyle choices, your cells may stay strong enough to avoid getting infected by viruses that come knocking on their membranes. In this scenario, you won’t have enough weak and extraneous cells to require a cold or the flu to work its way through your body to identify and lyse them.

Curious about how to differentiate the common cold and the flu? Here is an excellent summary of the differences from cbc.ca:
A cold usually comes on gradually — over the course of a day or two. Generally, it leaves you feeling tired, sneezing, coughing and plagued by a running nose. You often don’t have a fever, but when you do, it’s only slightly higher than normal. Colds usually last three to four days, but can hang around for 10 days to two weeks.

Flu, on the other hand, comes on suddenly and hits hard. You will feel weak and tired and you could run a fever as high as 40 C. Your muscles and joints will probably ache, you will feel chilled and could have a severe headache and sore throat. Getting off the couch or out of bed will be a chore. The fever may last three to five days, but you could feel weak and tired for two to three weeks.

One final note on this topic: because the common cold and the flu are both caused by viruses, antibiotics are not necessary. People who take antibiotics while suffering with a cold or flu often feel slightly better because antibiotics have a mild anti-inflammatory effect. But this benefit is far outweighed by the negative impact that antibiotics have on friendly bacteria that live throughout your digestive tract. In this light, if you really need help with pain management during a cold or flu, it is usually better to take a small dose of acetaminophen than it is to take antibiotics.

Sources: drbenkim.com & realfarmacy.com

 

 

 

 

 

 

Cancer Risk From Diabetes Drugs Unproven, Say AACE/ACE.

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There is insufficient evidence linking glucose-lowering medications with an increased risk for cancer, and clinicians can continue to “confidently” prescribe all such Food and Drug Administration (FDA)–approved agents for the management of hyperglycemia, the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) say in a joint consensus statement released yesterday.

“For most people with diabetes, the benefits of treatment should take precedence over concerns for potential low-grade cancer risk until more definitive evidence becomes available,” according to the AACE/ACE task force for diabetes and cancer.

However, the group also recommends that physicians should “exercise caution when choosing medications implicated in the etiology of cancer for patients with the specific organ-related risk.”

Recent concern has emerged regarding links between diabetes drugs and cancer. In particular, debate has surrounded both a possible link between incretin drugs and pancreatic cancer and between basal insulin glargine (Lantus, Sanofi) and cancer.

But, the AACE/ACA task force explains, evidence suggests that both diabetes itself and obesity may increase the risk for certain cancers, and thus far there are no large-scale randomized studies to definitively link any medication with an increased cancer risk.

The 19-page document reviews the current evidence related to cancer and obesity, endogenous insulin, and diabetes itself, as well as to the various antihypertensive medications.

The authors note that the time lag between exposure to any carcinogen and cancer in humans can be as long as 20 to 50 years. “This is an essential point to consider when weighing the totality of evidence linking disease-state relationships with cancer or the role that pharmacotherapy may play in cancer development.”

Cancer screening and counseling on lifestyle changes should be a part of regular preventive care in people with obesity and/or diabetes, the group advises. Conversely, people who develop “typical” obesity-related cancers, especially at a younger age, should be screened for metabolic abnormalities.

When a physician prescribes antihyperglycemic medications, “a comprehensive risk/benefit analysis must be performed to include assessment of baseline personal and familial risk of malignancies in specific organ systems.”

And in general, “the current totality of evidence should not change clinical practice, though clinicians should be alert to the potential risk and should monitor patients more closely.”

On the flip side, there has also been emerging evidence that metformin and possibly the thiazolidinediones (TZDs) could be associated with a lower risk for cancer, the task force says. “Nonetheless, it is premature to prescribe metformin and TZDs solely for these as-yet-unproven indications.”

Source: medscape.com

Decriminalisation of psilocybin could help millions.

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Previous studies have shown that low doses of psilocybin produce no consciousness state altering effects. Administered in the correct amount, psilocybin could therefore be assumed to safely treat PTSD with minimal risk of adverse side effects. Magic mushrooms could help millions recover from the debilitating cycles of fight and flight and other conditioned biological responses caused by extreme trauma, if only they weren’t listed as a dangerous Schedule 1 drug with no medical benefits.
Meanwhile, doctors are authorised to dispense powerful, side-effect laden pharmaceutical drugs to army vets and others suffering from the symptoms of PTSD without any evidence that these treatments actually work, according to a major review by the committee of the Institute of Medicine on the topic.

The situation is so bad that an average of 18 American veterans commits suicide every day (http://www.naturalnews.com), linked to the sharp rise in prescription drugs, depression, and other psychological conditions. Safe, natural alternatives to pharmaceuticals such as homeopathic and herbal remedies have been found to alleviate symptoms (http://www.naturalnews.com). Meditation has also been shown to reduce high activity levels in the amygdala (the brain’s emotional centre) experienced in PTSD sufferers as anxiety, stress and phobias.

Sources used in this article:

http://www.ptsdalliance.org

http://intellihub.com

http://digitaljournal.com

http://www.thedoctorwillseeyounow.com

Better asthma drugs on way.

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Wai-Meng-Woo_AsthmaCompound_FreshScience

Asthma inhalers could soon become much more effective, thanks to a clever new way of making the particles they deliver invented by a Melbourne chemical engineer and his team.

Current puffer designs and typical size ranges of particles mean a large portion of the medication propelled into a patient’s throat remains there. Only a fraction reaches the lungs.

 

But Monash University lecturer Dr Meng Wai Woo and his team have now developed a method of making ultra-fine particles, which will make drug delivery much more consistent and efficient. The new method, known as anti-solvent vapour precipitation, uses ethanol to dehydrate droplets, and results in super-small particles of uniform size.

“Ultrafine uniform particles will ensure that fewer drug particles get stuck in the throat while more can reach the lower regions of the lungs,” said Dr Woo. “Because we can now make the small particles more uniform, it means the inhalers will work better.”

The team’s work results in particles smaller than a micron (thousandth of a millimetre) in diameter – much smaller than those produced by conventional dehydrating mechanisms, which are limited by the size of the atomised droplet.

The team’s discovery was unveiled at the 18th International Drying Symposium in Xiamen, China, last year. It is likely to excite a lot of interest among pharmaceutical companies. Infusion devices and metered dose inhalers account for around $US20 billion in worldwide sales each year, with the key development aim being to balance improved efficiency against the cost of manufacture.

“From a drug manufacturer’s perspective, this new approach can maintain the uniformity of the particle and yet potentially maintain commercially viable production rate,” said Dr Woo.

Investigations into using ethanol as a means of producing ultrafine particles began in 2011, as part of Dr Woo’s ongoing research into manufacturing processes in the dairy industry.

Attempting to produce lactose crystals, his team decided to reject the traditional hot air drying method and use nitrogen laced with ethanol vapour as an alternative dehydrating agent.

To their surprise, the result was not the crystals they expected, but hundreds of very tiny, very uniform lactose particles. Further testing showed that the amount of alcohol absorbed into the initial droplets was a key variable in influencing the outcome.

Dr Woo’s method means that the pharmaceutical industry can now potentially deliver critical medicines via the airway direct into the lungs with much greater accuracy.

Assisted by a grant from the Australian Research Council, the Monash team is now testing its method on another dairy product – whey – researching the ultrafine particle delivery of protein-based medicines. They are also building a demonstration unit to showcase the anti-solvent vapour precipitation process, which will be completed later this year.

Dr Woo is one of 12 early-career scientists unveiling their research to the public for the first time thanks to Fresh Science, a national program sponsored by the Australian Government through the Inspiring Australia initiative.

Source: http://sciencealert.com.au

 

Prevalence of Polypharmacy Exposure Among Hospitalized Children in the United States.

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ABSTRACT

Objective  To assess the prevalence and patterns of exposure to drugs and therapeutic agents among hospitalized pediatric patients.

Design  Retrospective cohort study.

Setting  A total of 411 general hospitals and 52 children’s hospitals throughout the United States.

Patients  A total of 587 427 patients younger than 18 years, excluding healthy newborns, hospitalized in 2006, representing one-fifth of all pediatric admissions in the United States.

Main Outcome Measures  Daily and cumulative exposure to drugs and therapeutic agents.

Results  The most common exposures varied by patient age and by hospital type, with acetaminophen, albuterol, various antibiotics, fentanyl, heparin, ibuprofen, morphine, ondansetron, propofol, and ranitidine being among the most prevalent exposures. A considerable fraction of patients were exposed to numerous medications: in children’s hospitals, on the first day of hospitalization, patients younger than 1 year at the 90th percentile of daily exposure to distinct medications received 11 drugs, and patients 1 year or older received 13 drugs; in general hospitals, 8 and 12 drugs, respectively. By hospital day 7, in children’s hospitals, patients younger than 1 year at the 90th percentile of cumulative exposure to distinct distinct medications had received 29 drugs, and patients 1 year or older had received 35; in general hospitals, 22 and 28 drugs, respectively. Patients with less common conditions were more likely to be exposed to more drugs (P = .001).

Conclusion  A large fraction of hospitalized pediatric patients are exposed to substantial polypharmacy, especially patients with rare conditions.

In the United States, for persons young and old, exposure to medications is essentially universal.1Over the past decade, the relatively neglected area of pediatric drug effectiveness and safety has received increasing attention. The 2002 Best Pharmaceuticals for Children Act (BPCA),2 building on the 1997 US Food and Drug Administration Modernization Act,3– 4 set forth the goal of reducing pharmaceutical errors in the dispensing of drugs to hospitalized children. In the hospital setting, the efficacy and safety of many pediatric medications have not been well established5; much of the use of medications is for off-label indications6; and medication errors occur.5,7– 10 Both the BPCA and the complementary Pediatric Research Equity Act of 200311 have underscored the need for pediatric studies regarding both on- and off-label drug treatments12– 14 and for improvements in pediatric drug labeling.15– 16

To advance this agenda, we need to refine our knowledge of the overall patterns of pediatric inpatient drug and therapeutic agent use, including what drugs and therapeutic agents are used most commonly, the number of different drugs and therapeutic agents that hospitalized children receive, and potential differences in drug and therapeutic agent exposures across different types of hospitals. This knowledge, especially if based on population-level data, would enhance efforts to prioritize and design research studies regarding the effectiveness and safety of pediatric inpatient medications.17– 19

To address these objectives, we combined hospital medication use data from 2 large databases, the first of which comprises data exclusively from children’s hospitals while the second data set comprises data from mostly general hospitals; together these data sets represent approximately 19.9% of all pediatric inpatient hospitalizations in the United States. In this report, we examine drug and therapeutic agent use patterns among hospitalized pediatric patients (excluding healthy newborns) evident in the combined data, focusing on exposure to polypharmacy, which has been shown to be associated with an increased risk of adverse drug reactions in adult patients in intensive care units and other settings.20– 21

Source: JAMA

 

Cannabinoid System Dysregulation in PTSD.

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Patients with posttraumatic stress disorder have more cannabinoid receptors and fewer endocannabinoids in plasma than people without the disorder.

The consolidation of emotionally aversive memories that underlies the development of posttraumatic stress disorder (PTSD) occurs via a synergistic interaction between stress-induced cortisol and norepinephrine inputs into the amygdala, which are modulated by endocannabinoid signaling. These researchers examined availability of cannabinoid 1 (CB1) receptors during resting positron emission tomography in 25 untreated PTSD patients, 12 non-PTSD trauma controls, and 23 healthy controls. Cortisol and other possible biomarkers were also measured.

Compared with healthy and trauma controls, PTSD patients had significantly more CB1receptors (20% and 14% higher, respectively) both overall and in CB-rich and fear-relevant hippocampal, amygdala, and corticostriatal areas. PTSD was associated with lower plasma levels of the endocannabinoid anandamide (53% and 58% lower). Both effects were more pronounced in women. Cortisol levels were lower in PTSD patients and trauma controls than in healthy controls. Use of all three biomarkers enabled accurate classification of 85% of PTSD cases.

Comment: This study is the first to document abnormalities in cannabinoid signaling in PTSD, with lower endocannabinoid levels likely driving the greater CB1 receptor availability. The findings are consistent with reports of frequent self-medication with cannabis in PTSD patients. The authors warn against cannabis self-medication; note that chronic use of CB agonists down-regulates CB receptors, thus producing a depressive phenotype over time and aggravating substance dependence; and suggest that medications blocking anandamide degradation or uptake are much more likely to restore CB1 system integrity. Cannabis self-medication in anxious patients might provide short-term relief, but is likely to result in problems similar to those seen with overuse of benzodiazepines to treat anxiety.

 

Source:  Journal Watch Psychiatry

 

Inadvertent prescription of gelatin-containing oral medication: its acceptability to patients.

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When prescribing, doctors usually only consider the ‘active’ component of any drug’s formulation ignoring the majority of the agents which make up the bulk of the tablet or capsule, collectively known as excipients. Many urological drugs contain the excipient gelatin which is, universally, of animal origin; this may conflict with the dietetic ideals of patients. A questionnaire-based study, undertaken between January and June 2010 in a mixed ethnicity inner-city population presenting with urological symptoms, asked which patients preferred not to ingest animal-based products, who would ask about the content of their prescribed treatment and who would refuse to take that medication if alternatives were available. Ultimately, the authors sought to find out how many patients had been inadvertently prescribed gelatin-containing oral medications and to suggest ways in which prescriptions might be more congruous with an individual patient’s dietetic wishes. This study demonstrated that 43.2% of the study population would prefer not to take animal product-containing medication even if no alternative were available. 51% of men with lower urinary tract symptoms were also found to have inadvertently been prescribed gelatin-containing products against their preferred dietary restriction. Education of healthcare professionals about excipients and getting them to ask about a patient’s dietetic preferences may help avoid inadvertent prescription of the excipient gelatin in oral medications. Substitution of gelatin with vegetable-based alternatives and clearer labelling on drug packaging are alternative strategies to help minimise the risks of inadvertently contravening a patient’s dietetic beliefs when prescribing oral medication.

Discussion

Our current study shows that, in our inner-city catchment area, 40% of patients would prefer to take oral medication which contains no animal products; this is considerably in excess of the 20% of our population which might practice dietetic restriction on a religious basis. Patients practicing dietetic restriction do not ask what the formulation contains before commencing drug treatment, which puts them at risk of transgressing their belief. This may simply be due to ignorance about what an oral medication contains, not reading, or being able to read, the patient information leaflet which contains a list of excipients, or belief that the doctor or pharmacist involved in the prescription would tell them if the medication contained ingredients that might contravene their beliefs. We already know that doctors are fairly ignorant about the issue of excipients in medication,4 while data from 2008–20097 shows that pharmacists are dispensing only 50% of the generic oral medications prescribed. This indicates that pharmacists are tailoring prescriptions for an individual patient’s needs, and this could, possibly, include reasons of dietetic preference. Those patients preferring to avoid the ingestion of animal products do, however, appear willing to take gelatin-containing medication if no effective alternative oral drug was available, as is permitted by dietarily restrictive religions.8

This observational study may include bias as a consequence of questionnaire design and the limited use of interpreters to enable the most appropriate response from the multi-cultural population studied. Equally, the dietetic preferences of our ambient population may not be totally referable to other communities, and this means our conclusions may need to be used with caution when considering the applicability of these data.

This study does, however, highlight the importance of asking about cultural and lifestyle factors in the prescription and dispensing of oral medications when more than 50% of men with lower urinary tract symptoms were already receiving medications which transgressed their dietetic preference. This is, almost certainly, a much bigger issue for the 860 million non-urological preparations, prescribed in the UK each year, whose excipient content is not easily identified.2 These data highlight the necessity to prescribe, and dispense, with diligence across the totality of the pharmacopea9 as is recommended for best practice.10

Although this study shows there is significant potential for transgressing an individual’s dietetic preferences, many excipients, such as gelatin, have non-animal-based alternatives. Agar Agar (E406) and Carrageenan (E407) are derived from various seaweed species and are used as gelling agents, in the food industry, and in some oral medications already.11 Universal incorporation in oral medications would negate the potential for dietetic transgression.

It is tempting to suggest that several things might decrease inadvertent prescription of animal-product-containing medications. These could be educating healthcare professionals about the issue of dietetic preference, making it easier to identify a medication’s constituents or by altering the manufacturing process so that only non-animal excipients are used in drug formulation.

In particular, we would recommend that every doctor needs to be aware that it is not just the active drug being dispensed but a whole group of other agents which may have relevance to an individual patient’s compliance with treatment when oral treatments are prescribed. We would also suggest that it should be easier to find out what the composition of a drug’s formulation is; hierarchical constituent listing, as used on food packaging,12 is one option, although labelling to denote products of vegetarian composition might be easier. Adoption of the Vegetarian Society’s ‘Seedling’ symbol,13 a voluntarily applied symbol used on accredited merchandise,14 might be an easily identified logo to denote a medication containing no animal ingredients.

In conclusion, we feel that our service evaluation has identified a number of issues for further research and which, clearly, have ethical implications for doctors across the totality of drug prescribing. Systems to help patients, doctors and pharmacists identify those oral medications containing animal-based products require evolution. This would facilitate choice for patients about the oral medication they take, whatever their dietetic beliefs, and would conform to best practice in medical care.

Source: BMJ.

 

 

Increased risk of inflammatory bowel disease in women with endometriosis: a nationwide Danish cohort study

Abstract

Background An association between endometriosis and certain autoimmune diseases has been suggested. However, the impact of endometriosis on risk of inflammatory bowel disease (IBD) remains unknown.

Objective To assess the risk of Crohn’s disease (CD) and ulcerative colitis (UC) in an unselected nationwide Danish cohort of women with endometriosis.

Design By use of national registers, 37 661 women hospitalised with endometriosis during 1977–2007 were identified. The relative risk of developing IBD after an endometriosis diagnosis was calculated as observed versus expected numbers and presented as standardised incidence ratios (SIRs) with 95% CIs.

Results Women with endometriosis had a increased risk of IBD overall (SIR=1.5; 95% CI 1.4 to 1.7) and of UC (SIR=1.5; 95% CI 1.3 to 1.7) and CD (SIR=1.6; 95% CI 1.3 to 2.0) separately, even 20 years after a diagnosis of endometriosis (UC: SIR=1.5; 95% CI 1.1 to 2.1; CD: SIR=1.8; 95% CI 1.1 to 3.2). Restricting analyses to women with surgically verified endometriosis suggested even stronger associations (UC: SIR=1.8; 95% CI 1.4 to 2.3; CD: SIR=1.7; 95% CI 1.2 to 2.5).

Conclusion The risk of IBD in women with endometriosis was increased even in the long term, hence suggesting a genuine association between the diseases, which may either reflect common immunological features or an impact of endometriosis treatment with oral contraceptives on risk of IBD.

Source: BMJ.