Study finds strong link between Zika virus and Guillain-Barre Syndrome

The Zika virus has been in the headlines quite often recently. It is a disease spread by daytime mosquitoes that leads to symptoms including rash, fever, joint pain and red eyes. Currently, it is concentrated in central and south America. However, the disease is spreading into North America and there have been 107 reported cases of the Zika virus in Americans who have travelled from the infected area.

Between October 2013 and April 2014, French Polynesia experienced the largest Zika virus outbreak ever described to date. A study was conducted once a correlation was noticed between areas with the Zika virus and increased cases of the neurological disorder, Guillain-Barre syndrome. Of those who developed Guillain-Barre, 98% of them had Zika virus antibodies, suggesting the virus could be causing the disease.

Guillain-Barre syndrome results in symptoms starting with weakness and tingling in the feet and legs that spread to the upper body. Paralysis can even occur. Overall, it is a condition in which the immune system attacks the nerves and it is triggered by an acute bacterial or viral infection. Treatment is extensive, and includes plasma exchange and immunoglobulin therapy to relieve symptoms. Physical therapy is needed, too.

This newly discovered risk associated with the Zika virus only stresses the importance of preventing its spread. Strategies should be shared on how to avoid daytime mosquitoes and protect yourself. Pharmacists can play a role in this by educating patients in community pharmacy settings on which products work the best to deter mosquitoes and what to look out for as far as early symptoms of the virus.

 

Read the full study here.

Cao-Lormeau VM, Blake A, Mons S, et.al. Guillain-Barre Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lancet. 2016;(published online):1-9

Pharmaceutical Policy Reform – Balancing Affordability with Incentives for Innovation

As student pharmacists, we come across adherence as a common drug therapy problem. Many patients are unable to take their medication as directed because of its high cost. Pharmaceutical prices are being debated at the institutional policy level, especially now with another presidential election coming up.

Policy makers are debating what is the best way to lower pharmaceutical drug costs. The current laissez-faire system is not working and drug prices are through the roof because there are no close substitutes. There has been talk of the government provided Medicare Part D plan being able to negotiate drug prices with drug companies to drive down the cost of medications. Considering this is where a huge portion of the drug companies’ market lies, this has potential for success. However, one could argue that putting a price limit would hurt drug companies’ drive for innovation. Lawmakers would actually prefer to stay out of the direct government negotiation about drug prices, and instead are talking about encouraging other forces in the drug market to drive prices down that way.

This is a complicated topic with no one clear answer. In order for companies to be motivated to keep producing high quality, high value products, there must be large compensation. However, if prices are the only mechanism through which research is rewarded, affordability will be compromised. Evidently, there is no single, easy answer to the constantly escalating drug prices in the United States.

 

Read the full article here.

Conti RM. Rosenthal MB. Pharmaceutical Policy Reform – Balancing Affordability with Incentives for Innovation. N Engl J Med. 2016;374:703-6

Clinical Genomics

Genomic testing is a huge topic lately. It is easy to see the benefits of pre-screening patients for predispositions to diseases or adverse effects of medications. However, this article investigated the drawbacks of clinical genomics and pointed out some of the very real concerns that exist in genomic testing as it exists today.

The main point of the article was to point out that genomic testing really doesn’t tell all. Sure, you can see if a certain gene is mutated or not, but there is no definite way to tell how that will affect the patient. Each patient has other, different genetic factors that certainly will affect their chances of developing a disease or reacting to a medication. Simply knowing if a mutation is present is not enough to counsel a patient in most cases. Most of the genes being tested for are not fully understood and other factors will go into the patient’s outcome.

This article is not to dismantle the progress we have reached when it comes to genetic testing. It does serve the purpose, however, to lower the expectations people have for clinical genomics. Right now, the idea of clinical genomics is highly acclaimed. In reality, it isn’t all that applicable yet and there is plenty of room for growth and improvement in the process.

 

Read the full article here.

Manrai AK. Ioannidis JPA. Kohane IS. Clinical Genomics: From Pathogenicity Claims to Quantitative Risk Estimates. JAMA. 2016;1519

Contraception and Disparities in the United States

This article outlined the history of access to contraceptives in the United States throughout the past century. Today, it is hard to imagine being denied personal rights like protecting yourself from an unwanted pregnancy, but this article demonstrates that this hasn’t always been the case.

The ability to access contraceptives has stemmed from countless court cases over patients’ right to privacy and personal decision-making. For example, the article discussed the countless court cases brought up by religious groups about company provided health insurance that covers contraception. They felt like their right to religious freedom and privacy was violated because they had to seek out higher members of the company and deny the provided birth control.

This is a very timely article because of the debate over funding for Planned Parenthood. Right now, the organization is the single largest provider of contraceptive services for women living at or below the poverty level. Tax dollars from all US citizens currently go into funding for this program. The current debate consists of conservative citizens arguing their money going into something that directly contradicts their religious beliefs.

 

Read the full article here.

Prescott HM. “An Uncommonly Silly Law” — Contraception and Disparities in the United States. NEJM. 2016;374:706-8

 

Antiretroviral Pre-exposure Prophylaxis: Opportunities and Challenges for Primary Care Physicians

Almost all adults are sexually active and many do not adhere to safe sex strategies. There are populations that are particularly at risk for HIV for many reasons, including living in a low-income community and lack of proper sex education. Unfortunately, despite the increased numbers of treatments for HIV, the infection rate is still high. Even those at risk engage in risky sexual behaviors because of “therapeutic optimism”, the belief that HIV is no longer a serious illness.

Many ideas have been thrown around to address this issue, but an extreme solution that is becoming popular would be to administer an antiretroviral pre-exposure prophylaxis (PrEP) medication to those at risk. There are many pros and cons to this concept. An obvious benefit would be the prevention of further infections. Also, it would force those at risk to come in for regular check-ups, where they could be counseled on safe sex and regular HIV testing. However, many concerns have also been raised. For example, the medication recommended, tenofovir, is costly, and would be extremely expensive to distribute to the public. Supporters of the idea counteract this statement by pointing out the cost is much less than that of the medications that would be used to treat an HIV infected person. Another potential drawback would be patients might decide to relay on the medication and continue risky sexual behaviors. One could also argue that those at risk are not adherent using condoms or mechanisms for safe sex, so why would they be adherent with this medication?

Personally, I think there are better alternatives out there to prevent the spread of HIV than prescribing those at risk an expensive, medically risky medication. I think that money should go towards educating those at risk and providing HIV screening days to alleviate the number of sexually active adults who do not know they are infected. As a student pharmacist, it is easy to want to prescribe a medication to solve problems, but I think many disease states can be prevented by simple lifestyle changes.

Do you think the administration of a preventative drug like tenofovir would work to prevent the spread of HIV?

 

Read the original article here.

Mayer, KH. Krakower, DS. Boswell, SL. Antiretroviral Preexposure Prophylaxis: Opportunities and Challenges for Primary Care Physicians. Jama. 2016;0318

The Proposal for Smoke Free Public Housing

As pharmacy students in a city, we interact regularly with a wide variety of patient populations. It is not uncommon to speak with patients who live in government provided public housing and whose incomes fall below the poverty line. Unfortunately, most of these patients suffer from poor health outcomes. Home life and income are both social determinants of health; smoking rates are higher in these populations than the general population. In fact, though the US smoking rates have dropped in the general adult population to under 17%, yet it remains above 26% in populations with incomes below the poverty line. The effects of smoking reach even further because of secondhand smoke. Therefore, children and people nearby also suffer the consequences of their parents or neighbors smoking. In housing projects, 37% of children experience smoking related health problems simply by second hand smoke.

These are alarming statistics and the US Department of Housing and Urban Development (HUD) is taking action. By the end of 2016, HUD-provided housing will require non-indoor smoking to be listed in the lease agreement. This type of policy has the ability to impact more than 2 million individuals living in 954,000 government provided homes throughout the country. The Public Housing Authorities will be responsible for implementing this rule, and will not allow any form of lit cigars, cigarettes or pipes indoors. Residents will have to walk more than 25 feet away from the property in order to smoke. If a neighbor sees someone smoking, they are encouraged to report it. Though this seems like an intrusion on individual rights, the majority of current residents in public housing are in support of this new rule, as they are currently subjected to excessive second hand smoke through open windows and air vents from their neighbors.

In addition to the obvious health benefits of decreased smoking and second hand smoke, this plan also has several financial perks. A nation-wide effort would result in annual cost savings of $153 million, including $94 million in health care savings and $59 million in reduced poverty costs.

Implementation of a plan like this would help health professionals in the movement for smoking cessation all together. I believe making residents go outside in the cold to smoke rather than in the comfort of their own home will help push the patient to make the decision him/herself to quit. Pharmacists and other health professionals should jump on this opportunity and be ready to provide cessation resources to patients currently addicted to smoking who live in public housing.

Do you think a plan like this is feasible? Do you think this is violating a patient’s right to make personal lifestyle decisions?

 

Read the original article here.

Geller AC, Rees VW, Brooks DR. The Proposal for Smoke-Free Public Housing: Benefits, Challenges, and Opportunities for 2 Million Residents. JAMA. 2016;1380

The Need for More Education on Prescribing Opioids

When hearing the term “opioids” several ideas come to mind: addiction, abuse, under-treatment, overtreatment, severe pain, and suspicion are just a few. Opioids are undoubtedly an extremely successful route of treatment for severe pain and play a huge role in daily pain management cases. However, there is always a discussion of the risks associated with prescribing this medication.

There is often an air of distrust between physician and patient when a patient insists on opioid therapy. Unfortunately, pain cannot be measured, and there needs to be trust when prescribing this drug class. The prescriber will not know if the patient really needs the opioid for pain management or if they have developed a dependence on it. The physician is put in a position where they could under-treat the patient by refusing therapy because of the risk of abuse, or they could over-treat the patient by believing their plea for a medication they were addicted to.

There are several guidelines already in place regarding opioid prescribing, but still, much of it is up to the physician’s discretion. Right now, there is a big push for more prescriber education on the topic. For example, in 2012, the FDA encouraged a single shared Risk Evaluation and Mitigation Strategy (REMS) which required manufacturers of extended release or long acting opioids to fund accredited education on safe opioid prescribing. Currently, this program has not reached its goal number of prescribers. However, I believe with the advancement of this program, physicians will be able to make more educated and thorough decisions when it comes to prescribing opioids.

Managing pain is extremely complex, yet education on the topic is lacking. The ultimate goal would be to maintain a patient-centered approach and treat the patient in a manner in which they are comfortable and compliant with. Perhaps with more education on the topic, the physician and pharmacist can work together to make a confident decision in how to proceed with drug therapy, and hopefully avoid the mistakes that have been occurring concerning opioid therapy.

I personally see this as an opportunity for pharmacists to get more involved in the prescribing process, as they have a stronger background education on the topic. Do you think this could play a role in pharmacists eventually gaining prescribing rights?

 

Read the full article here.

Alford, Daniel P.  Opioid Prescribing for Chronic Pain — Achieving the Right Balance through Education. N Engl J Med. 2016;374:301-3

 

Advocating Against the Health Risks in Youth Tackle Football

As Super Bowl weekend winds down, many are left with football on the mind. When played correctly and fairly, the sport is in its glory and one of America’s favorite past-times. However, this is not always the case and injuries are common, especially in younger age groups learning to play the game. In fact, in the past Fall 2015 football season, at least 11 US high school athletes died due to football injuries. Brain traumas are not uncommon and studies show repetitive injuries to the head have serious short- and long-term consequences, including behavioral problems, headaches, cognitive attention disorders, sleep disturbances and mood disorders.

This is not a new discussion. It first began in the 1950s when the AAP decided to take a stronger stance against tackling in youth football. This was met with mixed emotions from the football community. Some agreed whole-heartedly and turned to medicine and technology to alleviate some of these injuries. For example, they encouraged new helmet designs and required players to have medical supervision while playing the game. Others disagreed, and argued that modifying the game would take away from the boys learning teamwork and mental toughness. Nevertheless, even with constant supervision, regular physical exams and improved helmets, players still were dying from a bad hit or the accumulation of minor head traumas. The main focus of this article is on brain injuries, but it points out the countless additional orthopedic risks posed to youth football players as well.

Policies are being made in response to these findings, both in football and other contact sports. For example, this past November, the US Soccer Federation passed a policy prohibiting headers for players under 10 years old. Right now, the biggest thing that can be done is encouraging conversations about the dangers of tackling with youth athletes. It is important to weigh the risks and benefits of the sports parents choose for their kids. Health care professionals can only do so much once an injury has occurred; prevention is key right now. Advocating for the safety of youth athletes is developing into an important role future health care providers will have to assume.

My question for the readers is: how do you think pharmacists can play a role in advocating for this cause? What about a pharmacist’s position allows them to get involved?

Original article can be read here.

Reference: Bachynski, Kathleen E. Tolerable Risks? Physicians and Youth Tackle Football. N Engl J Med. 2016;374:405-7