H1N1 Numbers Continue to Decrease Nationwide

The H1N1 data continues to improve across the nation. The numbers for last month are in and it appears that the country is right in the middle of a dramatic shift in the battle against the flu.

Only 14 states reported geographically widespread influenza activity as opposed to 25 states just one week earlier, according to U.S. health officials. The weekly report released Friday, done by the Centers for Disease Control and Prevention during flu season, said for the week of Nov. 29 to Dec. 5, seven states, the District of Columbia, as well as the U.S. Virgin Islands and Guam reported either local or sporadic influenza activity. The number of outpatient visits for influenza-like illness was nearly 3 percent, which is just above the national average of 2.3 percent, the report said. Six out of 10 U.S. regions reported influenza-like sickness at or above their respective baselines. Four reported below.

For more research data and information on H1N1, please click here.

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Study Finds Risk of Medication Discontinuation is Greatest for New Patients at the Start of Therapy

In a new study published online today by Clinical Therapeutics, researchers from Adheris, Inc., an inVentiv Health company, found that patients new to chronic disease medication face the greatest risk of medication discontinuation during the first 30 days of treatment—with rates of discontinuation ranging from 29.6% to 78.1%. Unlike most previous adherence studies, this robust study looked at the rate of discontinuation across multiple medication classes. A copy of this study can be downloaded by clicking here.

Medication discontinuation among 2.17 million patients prescribed agents for asthma, glaucoma, diabetes, cardiovascular disease, osteoporosis, breast cancer, and high cholesterol was measured over one year following the initial prescription. Patients considered new to therapy (naïve patients) included both newly diagnosed patients and patients restarting treatment after a lapse of 6 or more months.

Medication inexperience and patient age were strongly and more consistently associated with the risk of discontinuation than co-payment, income and sex in all the medication classes investigated. Overall rates of discontinuation for naïve patients were 12 times greater in the first month of treatment than during any subsequent month. Discontinuation was most rapid among naïve patients prescribed asthma inhalers, asthma pills, and glaucoma drops; intermediate for patients prescribed medications for breast cancer, diabetes (insulin), and osteoporosis; and least rapid for patients prescribed medications for cardiovascular illness, high cholesterol, and oral medications for diabetes. Three of the four medication classes most likely to be discontinued were all non-oral medications (inhaled steroids, glaucoma drops, and insulin injections).

Across all medication classes studied, patients who are aged 35 or younger faced a risk of discontinuation 19% to 196% higher than patients aged 65 or older. Of note, patients receiving medications for breast cancer who were less than 35 years faced almost three times the risk of discontinuation as did patients older than 65 years.

According to lead author Mark Vanelli, MD, MHS, Chief Medical Officer at Adheris and Harvard Medical School faculty member, “This study has clear and practical implications for improving routine clinical care and helping reduce healthcare costs. It pinpoints the need to provide patients who are new to medication or resuming medication after a lapse, with better education and follow-up during the first 30 days of treatment irrespective of the medication class prescribed.”

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New Survey: More Than Half of Americans Do Not Take Prescription Medicines as Instructed, Pointing to Growing Public Health Problem

A new survey finds that 54 percent of Americans say they do not consistently take prescriptions as instructed even though 87 percent believe prescription medicines are important to their health – pointing to a growing public health problem.

The survey examining prescription adherence was released today by Prescription Solutions, a pharmacy benefit management organization and a UnitedHealth Group, and the National Council on Patient Information and Education (NCPIE).

Poor adherence to medications – the extent to which people take their medications as prescribed by their doctor – can have adverse effects on people’s health. It diminishes the ability to treat chronic conditions like diabetes, heart disease, cancer, asthma and many other diseases; and it can result in suffering, an increase in hospitalizations and even death.

Non-adherence with prescription medications also is a key source of unnecessary cost in the U.S. health care system. According to a recent New England Healthcare Institute (NEHI) study, otherwise avoidable medical spending resulting directly from non-adherence accounts for up to $290 billion per year, or 13 percent of total health care expenditures.

The Prescription Solutions/NCPIE survey found that nearly 60 percent of respondents believe that when people take their prescription medications as instructed, it will lead to better health and it can help lower costs to the health system.

“The hidden health, financial and productivity costs of people not following their medication regimens as instructed are profound, making prescription non-adherence a national health problem,” said Jacqueline Kosecoff, chief executive officer of Prescription Solutions. “The survey clearly shows that people need and want more information, guidance and help understanding and using prescription medicines.”

Feeling Better and Side-Effect Concerns Are Top Reasons for Non-Adherence

Of those surveyed, 37 percent said they did not finish taking all the prescription medicine as instructed, and 31 percent said they skipped doses. Twenty-three percent said they did not refill their prescriptions as instructed.

When asked why they did not follow their doctors’ instructions, 59 percent said that they started to feel better and didn’t think it was necessary to keep taking the prescription medicine. Four in ten (37 percent) said they were concerned about side effects, while 25 percent said that they weren’t feeling any better so they didn’t think it was necessary to keep taking the prescription medicine. Nearly a quarter (24 percent) said they stopped taking the medicine because it was too expensive.

“Poor medicine adherence – dubbed by NCPIE over two decades ago as ‘America’s other drug problem,’ – appears to be as pervasive and costly in terms of health and economic consequences today as in years past,” said Ray Bullman, executive vice president of NCPIE. “These survey findings underscore the challenge of non-adherence and the need for frequent and ongoing communication between consumers and their health care providers about medicines so that consumers recognize the value of medicines properly used and can derive the maximum benefit – and the minimum risk – from their prescription medications.”

Data Suggest Refill Reminders, Regular Check-Ins, Easier-to-Read Instructions Would Aid Adherence

When asked what would help them take their medications as instructed, 39 percent cited refill reminders. Twenty-five percent of respondents said they would do better at taking their prescription medicines as instructed if someone were to follow up with them or encourage them along the way; this could include a loved one, caregiver or health care provider, for example. More than a third (34 percent) said that they would adhere better if they were provided easier-to-understand instructions about how to take their prescription medicines. Nearly half said lower cost for prescription medicines (49 percent) and fewer side effects (48 percent) would help them better take their medications as instructed.

Most Americans Are Reading Prescription Medicine Instructions; Men and Women Differ

Among additional findings of the survey, when it comes to reading the instructions that come with their medicines, 73 percent said they read both the label and the information on the medicine insert. Women are more apt to read both the label and the printed information on the insert (82 percent) compared with men (63 percent). Only 2 percent say they don’t read any of the materials.

In addition, when they’ve experienced a prescription medicine side effect, women are far more apt to talk to their doctor or pharmacist (72 percent) versus men (57 percent), further illustrating gender differences when it comes to problem solving through information seeking.

The Road to Better Adherence

“As our aging population grows, more people are taking multiple medications, and we have to employ a variety of pro-active and responsive strategies to help people improve their adherence,” said Joseph Addiego, M.D., senior vice president and chief medical officer for Prescription Solutions. “Prescription Solutions is doing its part to serve the needs of our customers and the entire health care system by offering an array of clinical programs that support people in adhering to their prescriptions so they can improve their health – ultimately leading to lower costs for everyone.”

Prescription Solutions and NCPIE both offer tips for consumers when it comes to taking prescription medications, including:

  • Ask your doctor or pharmacist about instructions for use and possible side effects whenever a new medication is prescribed.
  • Share information with your health practitioners about all the other medications, vitamins and herbal supplements you are taking to avoid negative drug/drug interactions and reduce the potential for side effects.
  • Keep a current list of all medications you are taking, both prescription and over-the-counter and share this with your doctor at each visit.
  • Read carefully the information that comes with your medication and save it for future reference.
  • Call your doctor, pharmacist or pharmacy benefits manager if you are experiencing side effects from your medication.
  • Consider cost-saving and convenient options like mail order and use generic alternatives where appropriate.

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Cancer Patients Not Given Adequate Information on Fertility Preservation

Life-saving cancer treatments such as chemotherapy and radiation can destroy the reproductive potential of both men and women; an added struggle for the 130,000 people in the US diagnosed with cancer each year. The good news is that advances in fertility technologies now give patients the ability to preserve their fertility prior to treatment, an option many oncologists fail to inform their patients.

Despite efforts by the American Society of Clinical Oncology (ASCO) to develop fertility preservation guidelines for oncologists, only 60% were aware of the guidelines while less than 25% said they followed them regularly, distributed educational materials or referred patients for fertility preservation discussions.

With the month of October dedicated to Breast Cancer Awareness – the leading cause of cancer among American women – Fertility Centers of Illinois (FCI) is committed to educating women about fertility preservation options now available. The new Fast-track Fertility Preservation Program at FCI enables women to fast freeze their eggs or embryos prior to cancer treatment, to be fertilized or used at a later date, and allowing them the possibility of having genetic children in the future. Patients in this program will be offered a discounted rate for treatment and medications.

Dr. Angeline Beltsos, medical director and reproductive endocrinologist with Fertility Centers of Illinois, explains that it is crucial for women be made aware of these options immediately, to allow enough time to pursue the treatment. “With any diagnosis, patients must be presented all of the information, which in this case, includes the important option of being able to have biological children in the future.” she adds.

To further assist patients, FCI has joined forces with Fertile Hope’s Sharing Hope Program for Women. Fertile Hope is national nonprofit organization dedicated to helping support cancer patients faced with infertility and The Sharing Hope Program increases access to egg and embryo freezing for newly diagnosed cancer patients, by working with companies and clinics to arrange discounted services and donated medication for eligible participants. For more information visit www.fertilehope.org

Furthermore, FCI has also joined forces with the 2009 Susan G. Komen Chicago Race for the Cure, taking place on Saturday, September 26th in Grant Park. Experts from FCI will be on hand supporting Komen’s mission to end breast cancer forever and also answer questions about advances in fertility preservation technologies.

“Options are essential when a shocking diagnosis like breast cancer has been delivered to you, and FCI gives patients another option. We are excited to have them support our cause here in Chicago and look forward to FCI at our race this year,” states Michael Ziener, executive director of Susan G. Komen Chicago.

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Stanford Professor Sequences His Entire Genome at Low Cost, with Small Team

The first few times that scientists mapped out all the DNA in a human being in 2001, each effort cost hundreds of millions of dollars and involved more than 250 people. Even last year, when the lowest reported cost was $250,000, genome sequencing still required almost 200 people. In a paper to be published online Aug. 9 by Nature Biotechnology, a Stanford University professor reports sequencing his entire genome for less than $50,000 and with a team of just two other people.

In other words, a task that used to cost as much as a Boeing 747 airplane and required a team of people that would fill half the plane, now costs as much as a mid-priced luxury sedan and the personnel would fill only half of that car.

“This is the first demonstration that you don’t need a genome center to sequence a human genome,” said Stephen Quake, PhD, professor of bioengineering. “It’s really democratizing the fruits of the genome revolution and saying that anybody can play in this game.”

There are at least two reasons why lowering the cost and effort required to sequence all the genetic information of individuals is important. The more examples scientists have of the whole human genetic code, the more they can discern about how specific genes and mutations result in the traits that make us all different, the diseases that plague us and our response to medicines. As that understanding increases and costs drop, doctors could then sequence their patients’ genomes and provide “personalized medicine” in which prevention and treatment of disease would be informed by the patient’s exact genetic profile.

“This can now be done in one lab, with one machine, at a modest cost,” said Quake, the Lee Otterson Professor in the School of Engineering and a member of Stanford’s Cancer Center. “It’s going to unleash an enormous amount of creativity and really broaden the field.”

Quake’s genome, one of less than a dozen sequenced so far because of the cost and resources needed, is now available to researchers worldwide. Quake’s colleagues at Stanford’s School of Medicine have been looking through it and sometimes examining Quake himself, mining the data for interesting connections between what they can observe about him, his DNA and his family history.

“Some of the doctors are starting to poke and prod me to see how they can couple my genome with medicine,” he said.

Simpler sequencing

To sequence his genome, Quake’s team used a commercially available, refrigerator-sized instrument called the Helicos Biosciences SMS Heliscope. Quake, who pioneered the underlying technology in 2003, is a co-founder of the Cambridge, Mass.-based company and chairs its scientific advisory board.

The technology—the SMS in the instrument’s name—is called single molecule sequencing. While many techniques require generating thousands of copies of a subject’s DNA, the single molecule technique does not, reducing the cost and effort involved. Instead, the technique requires chopping the 3 billion or so fundamental units of DNA (called bases) into strands about 30 bases long. The four bases in DNA are adenine (abbreviated A), cytosine (C), guanine (G), and thymine (T).

Each base of DNA matches with a specific other base: For example, T only matches with A. The machine captures each of the millions of strands on a specially treated glass plate, holds them there and washes successive waves of fluorescently labeled “letters” over the plate. As each complementary letter sticks next to a strand, the machine can read out the sequence of each strand. A video of the process can be seen on the Web: http://www.helicosbio.com/Technology/TrueSingleMoleculeSequencing/tabid/64/Default.aspx.

Assembling the strands back into a cohesive genome is then done by powerful computers, which compare it to the reference genomes that have been compiled before. The process is akin to assembling an enormous jigsaw puzzle by referring frequently to the picture on the box. The team said the sequencing process took about one month to complete.

Still, several tricky problems had to be solved before the machine could reliably sequence a whole human genome. Quake worked with Norma Neff, a research manager in Quake’s lab, and physics doctoral student Dmitry Pushkarev to write a sophisticated algorithm that would enable them to determine how accurate the process is.

Overall, the genome is 95 percent complete, a rate comparable with other sequenced genomes, the team found. In the paper, the authors are careful to note that all genome-sequencing technologies, including the one they’ve demonstrated, have produced incomplete approximations of the actual genome. Still, it is enough to help produce genuine insights about a person’s traits and health.

A professor’s personal revelations

Quake’s genome has already yielded a few interesting connections between his genetics and his health. One is that he carries a rare mutation associated with a heart disorder; the revelation, he said, sheds light on what members of his family have always wondered with regard to the health of prior generations. The good news, he said, is that he’s also apparently genetically predisposed to respond well to common cholesterol-lowering statin medicines.

Quake said the information has also forced him to take heed of that history. “If you know your uncle had something, you kind of discount that you can get it, but to see you’ve inherited the mutation for that is another matter altogether,” he said.

One amusing “revelation” is that Quake’s code contains a form of a gene that has sometimes been associated with increased disagreeability, he said. The details of the code can be found on the Web at http://www.snpedia.com/index.php/Rs6832769.

“Of course, you don’t need my genome to tell you that,” Quake acknowledged. “My wife could have told you that and certainly the dean could have as well.”

Funding for the research came from the National Science Foundation and from the National Institutes of Health.

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