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Can Pharmacogenomic Tests Help To Improve Public Health?

Adverse drug events are a serious public health problem. Consider the following facts:

  • an estimated 82% of American adults take at least one medication and 29% take five or more;
  • 700,000 emergency department visits and 120,000 hospitalizations are due to adverse drug events annually;
  • $3.5 billion is spent on extra medical costs of adverse drug events annually;
  • at least 40% of costs associated with adverse drug events occurring outside hospitals can be prevented.

How can genomics help? Pharmacogenomics is the study of genetic variation as a factor in drug response, affecting both safety and effectiveness. The intended applications of pharmacogenomics research include identifying responders and non-responders to medications, avoiding adverse events, optimizing drug dose and avoiding unnecessary healthcare costs.  The Food and Drug Administration has added pharmacogenomic information to the labeling for more than 70 drugs. Labels may include information on genetic determinants of clinical response or risk for adverse events.

In spite of current enthusiasm about pharmacogenomics in the research community, Read more »

*This blog post was originally published at Genomics and Health Impact Blog*

Institute Of Medicine Suggests 8 New Preventive Services To Improve Women’s Health

Eight preventive health services for women should be added to the services that health plans will cover at no cost to patients under the Patient Protection and Affordable Care Act of 2010, according to a report by the Institute of Medicine.

The recommendations encompass diseases and conditions that are more common or more serious in women than in men. They are based on existing guidelines and an assessment of the evidence on the effectiveness of different preventive services. They include:

1) screening for gestational diabetes in pregnant women between 24 and 28 weeks and at the first prenatal visit for women at high risk for diabetes,
2) adding high-risk human papillomavirus DNA testing in addition to conventional cytology testing in women with normal cytology results starting at age 30, and no more frequently than every 3 years,
3) offering annual counseling on sexually transmitted infections for all sexually active women,
4) Read more »

*This blog post was originally published at ACP Internist*

Thrombolytics: To Give Or Not To Give

For years now, we’ve all heard the drum-beat.  Bill-boards in cities have proclaimed it.  Various medical associations have touted it’s importance.  Stroke symptoms have to be treated immediately!  Give clot-busting drugs, also known as ‘thrombolytics!’

Until, of course, those in favor of giving the drugs (namely neurologists)  realized that a)  Not everyone with a stroke, aka ‘brain attack’ has insurance and b) people have a very inconsiderate habit of having said strokes at the most inconvenient of hours.  For instance, after 5PM, on the weekend, on holidays.  The nerve!

So across the country, physicians in emergency departments like mine are finding themselves expected by the court of public opinion to give a potentially dangerous drug (albeit a sometimes useful drug) without any neurologist being available to evaluate the patient.  Our emergency department thought we had a tele-medicine link; even that has failed, as nearby physicians in our regional referral center don’t feel keen to take responsibility for our patients.  Our own neurologists, of course, have Read more »

*This blog post was originally published at edwinleap.com*

The CDC Reports That Salmonella Is Still A Major Problem

Salmonella food infections continue despite success reducing disease caused by other pathogens, the Centers for Disease Control and Prevention reports.

Easter 2010 by by raleighwoman via Flickr and a Creative Commons licenseSalmonella should be targeted because while infection rates have not declined significantly in more than a decade, they are one of the most common, the CDC reports in its latest Vital Signs.

Contaminated food causes approximately 1,000 reported disease outbreaks and an estimated 48 million illnesses, 128,000 hospitalizations, and 3,000 deaths annually in the U.S. Salmonella causes 1 million foodborne infections annually, incurring an estimated $365 million in direct medical costs. Salmonella infections in 2010 increased 10% from 2006-2008.

The same prevention measures that reduced Escherichia coli infections to less than 1 case per 100,000 need to be applied more broadly to reduce Salmonella and other infections, the CDC reports. These measures include: Read more »

*This blog post was originally published at ACP Internist*

Many Parents Still Lack Confidence In Vaccines

Some parents remain unpersuaded that all childhood vaccines are safe or even necessary, a new survey published in Health Affairs shows.

Photo by James Gathany via the CDCWhile most parents vaccinate their children, they lack confidence in them, researchers pointed out. Parental education should include thorough explanations why infants should be fully immunized before age two.

Vaccination levels for most recommended vaccines were above 90% of national immunization goals in 2009, reported the CDC’s National Immunization Survey. But, researchers wrote, high immunization rates aren’t the same as high confidence in the vaccines.

Using data from the 2010 HealthStyles survey of 6,253 households (response rate 67%), researchers identified Read more »

*This blog post was originally published at ACP Internist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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