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Main Category: Pharma Industry / Biotech Industry
Also Included In: Primary Care / General Practice
Article Date: 06 Mar 2013 - 1:00 PST
The pharmaceutical industry has pulled back on marketing to physicians and consumers, yet some enduring patterns persist. According to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health, advertising peaked in 2004, with industry promotion to physicians declining nearly 25 percent by 2010, to $27.7 billion or 9 percent of sales. Similar declines were seen in direct-to-consumer advertising, which remains concentrated among a small number of products. The number of products promoted to providers peaked at over 3,000 in 2004, and declined by approximately 20 percent by 2010. Despite these changes, there was little change in the split of marketing between primary care physicians and specialists, and the proportion of all promotion taking place in physicians' offices also remains unchanged. Free samples and physician detailing accounted for over 70 percent of promotional expenditures in 2010, with the remainder comprised by consumer advertising as well as physician marketing through journal ads, e-promotion and sponsored conferences and meetings. The results are featured in the February 2013 issue of the open-access journal PLOS ONE.

"There have been important changes in the pharmaceutical marketplace during the past decade, including changes in the types of therapies being brought to market as well as an overall aging of the drugs with FDA approval," said G. Caleb Alexander, MD, MS, senior author of the study and an associate professor with the Bloomberg School's Department of Epidemiology and co-director of the Johns Hopkins Center for Drug Safety & Effectiveness. "Since pharmaceutical promotion can influence demand for drugs and affect physician prescribing, it is important to know how drugs are being marketed and promoted."

Alexander, along with colleagues from the University of Chicago, the University of Pittsburgh, Massachusetts Institute of Technology and the National Bureau of Economic Research, analyzed annual data from 2001 through 2010 to examine inflation-adjusted total promotion spending for the pharmaceutical industry as a whole and for top-selling and top-promoted therapies. Expenditures were also broken down by type of promotion and, for physician detailing, by specialty.

The authors were surprised to find that, despite anecdotal reports and calls from professional societies, there was no substantial change in the amount of overall proportion of promotion taking place in physicians' offices. Lead author Rachel Kornfield describes, "There has been growing concern about the conflicts of interest introduced by physicians' relationships with pharmaceutical companies, but the data show that physician detailing and the distribution of free samples is still the dominant form of drug promotion."

In addition, despite enthusiasm and publicity regarding new forms of marketing via the Internet and other electronic media, these channels accounted for a very small amount of overall marketing spending to providers - less than 2 percent over the decade examined. The authors found that the majority of marketing and promotion still takes place as it has in the past - through the distribution of free samples to patients and office calls to physicians.

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Main Category: Respiratory / Asthma
Also Included In: Pediatrics / Children's Health;  Infectious Diseases / Bacteria / Viruses
Article Date: 06 Mar 2013 - 1:00 PST

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Main Category: Primary Care / General Practice
Also Included In: Public Health;  Diabetes
Article Date: 06 Mar 2013 - 1:00 PST
Public reporting of how physicians and hospitals perform in quality of care measures leads to improved care for patients. A collaborative team of researchers led by Geoffrey C. Lamb, M.D., professor of internal medicine at the Medical College of Wisconsin, published their findings in the March 2013 edition of Health Affairs.

The researchers analyzed 14 publicly reported quality of care measures from 2004 to 2009 for the Wisconsin Collaborative for Healthcare Quality, a voluntary consortium of physician groups, and found that physician groups in the collaborative improved their performance during the study period on many measures.

Diabetes-related measures showed the most significant improvement, with three out of the six measures showing double-digit percentage gains. The other three measures showed improvement of two to nine percent. Blood pressure control improved by nine percent as well.

When asked about the public reporting and its effect on care, group practices indicated they were able to act on some, but not all, of the quality measures reported forcing them to prioritize their efforts.

"Our findings show that voluntary reporting of quality measures helps drive improvement for participants, which should lead to better healthcare for our patients," said Dr. Lamb. "Furthermore, these results suggest that large group practices are willing to engage in quality improvement efforts in response to that public reporting."

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Main Category: Liver Disease / Hepatitis
Also Included In: HIV / AIDS;  Genetics
Article Date: 06 Mar 2013 - 1:00 PST
Infectious disease experts at Johns Hopkins have found that among people infected with the hepatitis C virus (HCV), co-infection with HIV, speeds damage and scarring of liver tissue by almost a decade.

In a second study of HCV infection, the Johns Hopkins research team participated in the discovery of two genetic mutations that make it more likely that patients' immune systems can rid the body of HCV. Both studies are described in articles published online in February ahead of print in the journal Annals of Internal Medicine.

"Our latest study results suggest that HIV might promote aging and disease progression in people with HCV," says infectious disease specialist and senior investigator, David L. Thomas, M.D., M.P.H. Thomas, who is the Stanhope Bayne-Jones Professor and director of infectious diseases at the Johns Hopkins University School of Medicine and a professor at the university's Bloomberg School of Public Health, says that among 1,176 study participants, those co-infected with HCV and HIV showed the same severity of liver fibrosis and cirrhosis as those who were infected only with HCV but were 9.2 years older. All study participants were current and former intravenous drug users from Baltimore whose health and disease progression were being monitored with bi-monthly check-ups and liver tissue samples taken from 2006 to 2011.

The United States Centers for Disease Control and Prevention estimates that a quarter of the 3.2 million Americans chronically infected with HCV are also infected with HIV.

"There has been a growing hypothesis that HIV may accelerate the aging process, resulting in an earlier onset of chronic disease, including cancer, cardiovascular and liver disease. Until now, there have not been strong data to support this theory," says study lead investigator and infectious disease epidemiologist Gregory Kirk, M.D., Ph.D., M.P.H.

"There has been concern that increased chronic diseases in people aging with HIV may simply reflect their greater exposure to alcohol, tobacco or illicit drugs," adds Kirk, an associate professor at the Johns Hopkins Bloomberg School of Public Health. "Importantly, this investigation showed an increased severity of liver disease among people with HIV compared to people without HIV but whose pattern of smoking, alcohol drinking and illicit drug use was very similar."

"Co-infected patients may have to be monitored more closely for worsening liver disease, and may require earlier and more aggressive treatment than people without HIV infection," adds study co-investigator and epidemiologist Shruti Mehta, Ph.D., M.P.H. Although the reason for the accelerated rate of liver disease with HIV is unclear, the study results suggest that HIV and aging may share common mechanisms of immune activation that speed up HCV disease progression, says Mehta, an associate professor at the Bloomberg School of Public Health. Mehta and Kirk are both co-principal investigators of the long-term monitoring of the Baltimore group, known as the ALIVE cohort, which is short for the AIDS Linked to the IntraVenous Experience study.

The second study is believed to be the largest genetic investigation ever conducted of people infected with HCV. In it, researchers at 13 medical centers in five countries, including Thomas' Johns Hopkins team, analyzed nearly 800,000 differences in the genetic code among 919 people whose immune systems showed antibody evidence of having successfully fought off HCV infection, and another 1,482 people who became infected with the disease.

Lead study investigator and genetic epidemiologist Priya Duggal, Ph.D., M.P.H., says 40 percent of people exposed to HCV, predominantly of white and Asian ancestry, "spontaneously fight off infection" without any need for drug therapy, suggesting a genetic basis to risk of infection.

The international team's analysis showed that 15 percent of study participants who failed to become infected with HCV had either or both of two genetic variants, one near the gene for interleukin-28B and the other near the genes for HLA class II. Duggal, an assistant professor at the Bloomberg School of Public Health, says this information may help explain "with a relatively high degree of genetic certainty" why racial differences exist among those who do become infected. However, she cautions that further research is needed to determine the full impact of these genetic variants on preventing and treating HCV in people of different ethnicities.

Thomas says the findings may help physicians predict the people who are most likely to self-recover from exposure to HCV, and those who will most likely require aggressive treatment right away.

HCV infection is the nation's leading cause of liver failure, liver cancer and liver transplantation. The disease, transmitted by contact with blood and other bodily fluids of an infected person, and through sexual activity, injection drug use or sharing of personal care items, kills more than 10,000 Americans annually. An estimated 185 million people worldwide are infected with HCV.

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Main Category: Alcohol / Addiction / Illegal Drugs
Also Included In: Public Health
Article Date: 06 Mar 2013 - 1:00 PST
A new study by the Centre for Addiction and Mental Health (CAMH) shows that alcohol is now the third leading cause of the global burden of disease and injury, despite the fact most adults worldwide abstain from drinking.

This research, part of the 2010 Global Burden of Disease study, was published in this month's issue of the journal Addiction. It also found that Canadians drink more than 50 per cent above the global average.

"Alcohol consumption has been found to cause more than 200 different diseases and injuries," said Kevin Shield, the lead author of the study. "These include not only well-known outcomes of drinking such as liver cirrhosis or traffic accidents, but also several types of cancer, such as female breast cancer."

The study reports the amount and patterns of alcohol consumption by country for 2005, and calculates estimates for these figures for 2010. It reveals vast differences by geographical region in the numbers of people who consume alcohol, the amount they drink, and general patterns of drinking. Some other findings:

• Drinkers in Europe and parts of Sub-Saharan Africa are the world's heaviest consumers of alcohol, on average.
• People in Eastern Europe and Southern Sub-Saharan Africa consumed alcohol in the unhealthiest manner, as they frequently consumed large quantities, drank to intoxication, engaged in prolonged binges, and consumed alcohol mainly outside of meals.
• People in North Africa, the Middle East and South Asia consumed the least amount of alcohol.
• North Americans in general, and Canadians in particular drink more than 50 per cent above the global average, and show a more detrimental drinking pattern than most EU countries, with more bingeing.

The global burden of disease and injury attributable to alcohol is large and growing. In 2010, it was responsible for 5.5 per cent of this overall burden, third after high blood pressure and tobacco smoking, among 67 risk factors overall.

This study summarizes the results from population surveys, sales or production data, and data on alcohol consumption not covered in official records, from all countries, territories and regions.

Researchers also found that almost 30 per cent of alcohol consumed in 2005 was "unrecorded" alcohol - referring to alcohol not intended for consumption, home-brewed alcohol, and illegally produced alcohol. In some regions, unrecorded alcohol constituted more than half of all alcohol consumed.

"The amount of unrecorded alcohol consumed is a particular problem, as its consumption is not impacted by public health alcohol policies, such as taxation, which can moderate consumption," said Dr. Jürgen Rehm, a study author and director of CAMH's Social and Epidemiological Research Department.

"Improving alcohol control policies presents one of the greatest opportunities to prevent much of the health burden caused by alcohol consumption," said Dr. Shield "To improve these policies, information on how much alcohol people are consuming, and how people are consuming alcohol is necessary, and that is exactly the information this article presents."

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Main Category: Autism
Article Date: 06 Mar 2013 - 1:00 PST
New findings published in Pediatrics (Epub ahead of print) by the Kennedy Krieger Institute's Center for Autism and Related Disorders reveal that 70 percent of children with autism spectrum disorders (ASD) who have a history of severe language delay, achieved phrase or fluent speech by age eight. This suggests that more children presenting with ASD and severe language delay at age four can be expected to make notable language gains than was previously thought. Abnormalities in communication and language are a defining feature of ASD, yet prior research into the factors predicting the age and quality of speech attainment has been limited.

The study used the largest sample to date to examine the relationship between key deficits associated with ASD and attainment of phrase and/or fluent speech following a severe language delay, characterized by a child not putting words together into meaningful phrases by age four. As a common milestone of speech development, phrase speech is defined as using non-echoed three-word utterances that sometimes involve a verb and are spontaneous meaningful word combinations; whereas fluent speech is defined as the ability to use complex utterances to talk about topics outside of the immediate physical context.

"We found that nonverbal intelligence was the strongest predictor of phrase speech, while social interest and engagement were as robust, if not greater, when predicting the age that children attained phrase speech and fluent speech," said Ericka L. Wodka, Ph.D., a neuropsychologist in Kennedy Krieger's Center for Autism and Related Disorders and lead study author. "Children with typical nonverbal intelligence attained language almost six months ahead of those with scores below the average."

These findings reinforce that core abilities, such as nonverbal intelligence and social engagement, have a greater influence on the development of communication than other behaviors associated with ASD, such as repetitive and abnormal sensory behaviors. "Our findings continue to support the importance of considering both nonverbal intellectual level and social communication in treatment planning, highlighting the differing impact of these factors as related to treatment goals," said Dr. Wodka.

Data for this retrospective study were from the Simon Simplex Collection (SSC), a unique multi-site database project that gathers biological and phenotypic data on children with ASD aged four- to eighteen-years-old without a previous genetic history of ASD. The database establishes a permanent repository of genetic samples from 2,700 families, each of which has one child affected with an ASD and unaffected parents and siblings.

From the SSC, a total of 535 children, ages eight years or older, were studied. Using the Autism Diagnostic Interview-Revised (ADI-R), a standard parent-interview that distinguishes children with ASD from non-ASD populations, and the Autism Diagnosis Observation Schedule (ADOS), a clinician-administered observation that assesses social, communicative and stereotyped behaviors, researchers selected children because they either had no phrase speech at their time of enrollment in the SSC or their phrase speech onset occurred after age four. Based on ADI-R results and their language presentation, children in this study were administered one of four evaluation modules - no words or single words (Module 1), phrase speech (Module 2) or fluent speech (Module 3 or 4). Of the 535 participants in the study, 119 children mastered phrase speech and 253 children were speaking fluently by their eighth birthday, while 163 children never attained phrase or fluent speech

"We hope the results of this study empower parents of children with autism and severe language delays to know that, with the appropriate therapy, a child will likely make significant gains in this area over time; however, progress should be expected to be slower for those children with lower intellectual abilities," said Dr. Wodka. "Additionally, we hope these findings provide clinicians with better defined therapeutic targets for their patients with autism."

Future longitudinal studies, including both simplex and multiplex families, are required to fully capture the prevalence and predictors of language development in children with ASD. Additionally, further research into the impact of social cognition strategies (e.g., perspective taking) on the development of language, as well as the relationship among specific social deficits and fluent speech development, may hold important implications to the design of intervention.

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Main Category: Neurology / Neuroscience
Also Included In: Depression;  Sports Medicine / Fitness
Article Date: 06 Mar 2013 - 0:00 PST
A marathon runner approaches the finishing line, but suddenly the sweaty athlete collapses to the ground. Everyone probably assumes that this is because he has expended all energy in his muscles. What few people know is that it might also be a braking mechanism in the brain which swings into effect and makes us too tired to continue. What may be occurring is what is referred to as 'central fatigue'.

"Our discovery is helping to shed light on the paradox which has long been the subject of discussion by researchers. We have always known that the neurotransmitter serotonin is released when you exercise, and indeed, it helps us to keep going. However, the answer to what role the substance plays in relation to the fact that we also feel so exhausted we have to stop has been eluding us for years. We can now see it is actually a surplus of serotonin that triggers a braking mechanism in the brain. In other words, serotonin functions as an accelerator but also as a brake when the strain becomes excessive," says Associate Professor Jean-François Perrier from the Department of Neuroscience and Pharmacology, who has spearheaded the new research.

Help in the battle against doping

Jean-François Perrier hopes that mapping the mechanism that prompts central fatigue will be useful in several ways. Central fatigue is a phenomenon which has been known for about 80 years; it is a sort of tiredness which, instead of affecting the muscles, hits the brain and nervous system. By conducting scientific experiments, it is possible to observe and measure that the brain sends insufficient signals to the muscles to keep going, which in turn means that we are unable to keep performing. This makes the mechanism behind central fatigue an interesting area in the battle against doping, and it is for this reason that Anti Doping Danmark has also helped fund the group's research.

"In combating the use of doping, it is crucial to identify which methods athletes can use to prevent central fatigue and thereby continue to perform beyond what is naturally possible. And the best way of doing so is to understand the underlying mechanism," says Jean-François Perrier.

Developing better drugs

The brain communicates with our muscles using so-called motoneurons. In several diseases, motoneurons are hyperactive. This is true, for example, of people suffering from spasticity and cerebral palsy, who are unable to control their movements. Jean-François Perrier therefore hopes that, in the long term, this new knowledge can also be used to help develop drugs against these symptoms and to find out more about the effects of antidepressants.

"This new discovery brings us a step closer to finding ways of controlling serotonin. In other words, whether it will have an activating effect or trigger central fatigue. It is all about selectively activating the receptors which serotonin attaches to," explains Jean-François Perrier.

"For selective serotonin re-uptake inhibitor (SSRI) drugs which are used as antidepressants, we can possibly help explain why those who take the drugs often feel more tired and also become slightly clumsier than other people. What we now know can help us develop better drugs," concludes Jean-François Perrier.

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