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Dr J Mercola The 50 most-advertised prescription medicines contributed significantly last year to the increase in the nation's spending on drugs. The report was prepared by the National Institute for Health Care Management, a nonprofit research foundation that was founded by the Blue Cross Blue Shield health insurance plans. Increases in the sales of the 50 drugs that were most heavily advertised to consumers accounted for almost half the $20.8 billion increase in drug spending last year, according to the study. The remainder of the spending increase came from 9, 850 prescription medicines that companies did not advertise or advertised very little. The study attributed the spending increase to a boost in the number of prescriptions for the 50 drugs, and not from a rise in their price. Only the United States and New Zealand permit advertising of prescription medicines to consumers. The advertising has grown more controversial as both the number of ads and spending on prescription drugs continue to rise. The Food and Drug Administration is now reviewing whether it should change rules it enacted in 1997 that made it easier for pharmaceutical companies to advertise their products on television. Among the other reasons for increased spending, the study said, are an aging population, newer drugs that are more expensive than older medicines and an increased use of drugs for chronic conditions like asthma or heart disease that involve taking medicines over long periods. According to the study, Vioxx, an arthritis drug sold by Merck & Company, was the most-heavily advertised prescription drug and also accounted for more of last year's increased drug spending than any other single drug. Merck spent $160.8 million to promote Vioxx to consumers - more than PepsiCo news quote ; spent to advertise Pepsi or Budweiser spent to advertise its beer, the study said. With the help of the advertising, Vioxx sales quadrupled to $1.5 billion last year from about $330 million in 1999. Celebrex, another arthritis drug, which is locked in a marketing battle with Vioxx, was the seventh most widely promoted drug to consumers and was the fourth-largest contributor to drug sales growth last year. Other heavily advertised drugs contributing to the rise in drug sales are the cholesterol-lowering drugs, Lipitor, Zocor and Pravachol; as well as Paxil and Prozac, for depression; Claritin, Allegra and Zyrtec for allergies; and Prilosec for ulcers. Over all, consumer drug advertising rose 35 percent last year, to $2.5 billion from $1.8 billion in 1999, according to the study. Two of the biggest drug companies, Merck and Pfizer, increased their advertising much more than the industry average. Merck's total spending on consumer advertising increased 118 percent, the study said, while Pfizer's spending almost doubled. GlaxoSmithKline, the British drug company, spent more on consumer advertising than any other.
The first cyclooxygenase-2 COX-2 ; inhibitors celecoxib [Celebrex] and rofecoxib [Vioxx] ; , which offer side effect advantages mainly related to gastrointestinal effects ; over previous NSAID products. As a result of these incremental advantages, these new agents are forecast to be among the top 10 products prescribed worldwide within only a few years Wood Mackenzie Consultants, 2000 ; . Oral Contraceptives The first estrogen-progestin combination oral contraceptive OC ; was approved by the Food and Drug Administration FDA ; in 1960. Formulations of OCs were changed in response to epidemiological studies linking the risk of serious cardiovascular side effects with the steroid content of OCs. Sequential OCs introduced in 1965 were subsequently withdrawn from the U.S. market, largely because of epidemiological findings related to endometrial cancer. As a result, OCs have evolved from high-strength and high-potency drugs to much lower strength, lower potency drugs. Low-estrogen OCs were first marketed in 1967; by 1976 they dominated the market, accounting for 85% of the OCs dispensed in 1984 Piper & Kennedy, 1987 ; . The multiphasic OCs represent another incremental advance. The amount of drug in each pill within a cycle has been carefully adjusted, further lowering the total dose administered over the use cycle. Advances in the delivery of contraceptives provide a long-acting effect and simplify dosing. Intramuscular implants of progestin-only contraceptives provide effective contraception for 5 years with an annual pregnancy rate of less than 1% Sivin, 1988 ; . This very effective, reversible new method of contraception represents an important alternative that overcomes the substantial compliance problems associated with traditional OCs. Newer synthetic progestins i.e. desogestrel, norgestimate, gestodene ; allow significant reductions in estrogen dosage in combined contraceptive agents and have relatively fewer androgenic effects Miller, 2000 ; . Combined with ethynyl estradiol, these progestins represent improved oral contraception, offering not only efficacy and safety, but also fewer side effects, including low rates of breakthrough bleeding, cycle irregularity, amenorrhea, nausea, weight gain, acne, and excess hair growth. The many choices among available combined OCs allow for individualized care. Breakthrough bleeding may improve with a product that has a higher progestin content. Nausea and weight gain may be minimized by a preparation with a lower dose of progestin. Patients with hirsutism or acne may benefit from a higher estrogen dose or a new generation progestational preparation and celexa.
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Gailagher, R.P., Elwood, J.M., Hill, G.B. 1986 ; . Risk Factors for Cutaneous Melanoma: The Western Canada Study. Recent Results Cancer Res, 102: 38-55. Gies, H.P., Rot, C.R., and Elliott, G. 1986 ; . Artificiai suntanning: Spectral irradiance and hazard evaluation on ultraviolet sources. Health Physics, 50 6 ; : 691-703. Heaith and Welfare Canada, Radiation Ernitting Devices Act 1984 ; . Canada Gazette P r II, at Vol.114, No. 13. Health and Welfare Canada 198 1 ; . Sunlarnps and tanning facilities: A burning issue, No. 14. Health Canada 198 11, A Word of Caution on Suntanning Booths, Information letter. Hersey, P., MacDonald, M., Henderson, C., et al. 1988 ; . Suppression of Natural Kiiler Cell in Humans by Radiation from Solarium Lamps Depleted of W B Invest Dermatol, 90: 305-3 10. Holly, E.A., Aston, D.A., Credd, RD et ai. 1995 ; . Cutaneous melanoma in women. 1 Exposure . to sunlight, ability to tan, and other risk factors related to ultraviolet light. American Journal of Epidemiology, 141 10 ; : 923-33. International Agency for Research on Cancer 1992 ; . Bienniai Report. International Non-Ionizing Radiation Cornmittee of the International Radiation Protection Association 1991 ; . Health Issues of Ultraviolet "A" Sunbeds Used for Cosrnetic Purposes. Heaith Physics, Vol 61, No. 2 August ; , pp. 285-288. Jeurgen, H.B. & Reudriger, M. 1987 ; .Human Exposure to Ultraviolet Radiation: Data. In hurnan & exposure to ultraviolet radiation: Risks and regulations Passchier, W.F. Bosnjakovic, B.F.M., eds. ; , pp. 201-21 1, Elesvier Science Publishers. Klignan, L.H., & Gebre, M. 1991 ; . Biochemicai Changes in Hairless Mouse Skin Collagen M e r Chronic Exposwe to Ultraviolet-A Radiation. Photochemistry and Photobiology, 54 2 ; : 233-237. Kligman, L.H., Kaidbey, K.H., Hitchins, V.M. et al. 1987 ; . in Human exposure to ultraviolet radiation: Risks and regdations Passchier, W.F. & Bosnjakovic, B.F.M., eds. ; , pp. 77-81, Elesvier Science Publishers. Smith, M.E. 1991 ; . Tanning Salon Exposure Suppression of DNA Larcom, L.L., Morris, T.E., Repair Capacity and Mitogen-Induced DNA Synthesis. Photochemistry and Photobiology, 53 4 ; : 5 11-516 and cipro.
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The method used is based on the selection of study sites in diverse geographic areas, dealing with different population types. These are mainly intravenous drug users, sex workers, and individuals consulting on sexually transmitted diseases or women using antenatal clinics. In spite of the limited number of sites surveyed 62 sites against 232 in 2000 ; , this study highlighted a high concentration of the infection in the States of Maharashtra, Tamil Nadu, Karnataka, Andhra Pradesh and Manipur cf. Annex 4 ; . What is particularly troubling is that Maharashtra, Tamil Nadu and Manipur themselves account for 77% of the cases documented in 1996, according to the National AIDS Control Organization NACO ; . This body was created in 1992 to collect data on the evolution of HIV and specify the contents of all national policies on the fight against AIDS. Besides, it may be observed that the prevalence rate among the populations at risk is rather high. The epidemic essentially affects populations whose risk of contracting and transmitting HIV AIDS is high because of sexual behaviours and those related to the use of narcotics that are deemed risky. Among these populations, one therefore finds a large number of intravenous drug users, sex workers or homosexuals. Until 1990, the infection rate of these populations at risk remained low. But after that, for example, buy vioxx. 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ICH Topic E2A. Clinical safety data management: definitions and standards for expedited reporting. London: The European Agency for the Evaluation of Medicinal Products, 1994.
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T.T. is clearly at risk for deep vein thrombosis post her total knee replacement. The current standard of therapy is that some type of prophylaxis be given. The low molecular weight heparin, enoxaparin Lovenox ; , is considered the treatment of choice for the prevention of thrombotic events. Because of her history of narcotic use, obesity, and respiratory disease, epidural pain control is chosen to control pain while minimizing the adverse effects of narcotics. Also, the adjunctive use of the injectable non-steroidal anti-inflammatory agent NSAID ; ketorolac Toradol ; , is attractive as it has been shown to decrease narcotic requirements thereby avoiding the potential adverse effects of respiratory depression and postoperative ileus. Ketorolac inhibits platelet aggregation and may impair homeostasis as well. The newer class of NSAIDs, the Cox-2 inhibitors celecoxib Celeberx ; or rofecoxib Vioxx ; or valdecoxib Bextra ; have minimal anti-platelet effects, have been proven to cause less GI bleeding than other NSAIDS Bombardier 2000 ; , and may be safer to use in patients on other anticoagulants.
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