Saxagliptin Approved (DPP4 inhibitor)

[Saxagliptin] which will be sold under the brand name Onglyza, is in a relatively new class, called DPP-4 inhibitors, that can be taken along with older diabetes drugs.

Until now, Merck’s Januvia has been the only drug in the class on the market in this country.

Saxagliptin Approval: Finally, Competition for Merck’s Januvia [WSJ Health Blog

Case Study: New Strain of HIV

researchers have now discovered an HIV infection in a Cameroonian woman which is clearly linked to a gorilla strain, Nature Medicine reports.

HIV originated from a similar virus in chimpanzees called Simian Immunodeficiency Virus (SIV).

French doctors treating the 62-year-old Cameroonian woman who was living in Paris said they initially spotted some discrepancies in routine viral load tests.

Further analysis of the HIV strain she was infected with showed it was more closely related to SIV from gorillas than HIV from humans.

She is the only person known to be infected with the new strain but the researchers expect to find other cases.

Before moving to Paris, she had lived in a semi-urban area of Cameroon and had no contact with gorillas or bush meat, suggesting she caught the virus from someone else who was carrying the gorilla strain.

Scientists find new strain of HIV [BBC News]

Pennsylvania’s Plummeting Malpractice Numbers

rule changes have dramatically lowered the number of malpractice suits filed in Pennsylvania. There were 1,602 filings last year, a 41% decline from the annual average between 2000 and 2002, before the changes were put in place.

One of the new rules requires a “certificate of merit” from a medical professional, establishing that “the medical procedures in a case fell below applicable standards of care”

Another rule requires cases to be filed in the county where the alleged malpractice took place — an effort to discourage so-called venue shopping, where cases would be filed in counties thought to be sympathetic to plaintiffs.

The number of malpractice cases fell sharply in 2003, when the rules were in place, and have stayed down.

Number of Malpractice Suits Falls 41% in Pennsylvania [WSJ]

Treating Swine Flu

Can the swine flu be treated with antiviral drugs?
Like some garden-variety flu, this swine flu is resistant to two drugs known as amantadine and rimantadine… CDC says Tamiflu and Relenza work against this strain of swine flu, the WSJ reports.

Does the flu vaccine protect against the swine flu?
The CDC reported earlier this week that the seasonal flu vaccine “might not” provide protection against the flu. The agency says it has created a “seed vaccine” specifically tailored to this swine flu. That could be used to manufacture a targeted vaccine if officials deem it necessary to do so.

Health Blog Q&A: Swine Flu in the U.S. and Mexico [WSJ]

Midwives and Prescriptions

The Pennsylvania Board of Nursing has published regulations implementing a 2007 law which gives nurse midwives the authority to prescribe, administer, and dispense drugs pursuant to collaborative agreement with a physician. The law and regulations also apply to medical devices, immunizing agents, and laboratory tests.  In order to obtain prescriptive authority, nurse midwives must hold a master’s degree or equivalent, have national certification, and complete at least 45 hours of advanced pharmacology coursework and 16 hours of continuing education in pharmacology every two years.

Pennsylvania Gives Nurse Midwives Authority to Prescribe [Physician Law]

TV’s Interference in Medical Education

Tom Blackwell:

Intubation is the insertion of a tube down the windpipe, usually so a patient can be hooked up to a mechanical ventilator when they are unable to breathe properly on their own.

The first step is to position the head properly so the tube can be quickly and easily installed.

Dr. Brindley said he and his colleague, Dr. Craig Needham, noticed that many students and residents – medical-school graduates training in specialities such as anesthesia, surgery and emergency care – positioned the head incorrectly.

To find out where the faulty knowledge was coming from, the physicians surveyed 80 students and residents. Many said they learned through “trial and error,” but a large proportion indicated they had picked up tips from white-coated TV characters.

ER was the program most commonly cited by the students, so Drs. Brindley and Needham analyzed a season of the show. Some aspect of the head positioning was wrong in all 22 intubations that could be fully viewed on screen, their paper says.

Young doctors learn bad habits from TV medical dramas [National Post]

21 Fraudulent Studies Retracted

Baystate Medical Center in Springfield, Mass., has asked several anesthesiology journals to retract the studies, which appeared between 1996 and 2008, the WSJ reports. The hospital says its former chief of acute pain, Scott S. Reuben, faked data used in the studies.

Take a look at Reuben’s work here.

A New Low in Drug Research: 21 Fabricated Studies [WSJ Health Blog]

Vaccines Vindicated

A special vaccine court ruled against parents with autistic children Thursday, saying that vaccines are not to blame for their children’s neurological disorder.

The judges in the cases said the evidence was overwhelmingly contrary to the parents’ claims — and backed years of science that found no risk.

“It was abundantly clear that petitioners’ theories of causation were speculative and unpersuasive,” the court concluded in one of a trio of cases ruled on Thursday.

The ruling, which was anxiously awaited by health authorities, was a blow to families who have filed more than 5,000 claims for compensation through the government’s Vaccine Injury Compensation Program.

Court Says Measles Vaccine Not to Blame for Autism [WSJ]

Cancer Patient Becomes Doc

“I wanted to work next to Dr. Mott and I wanted to train with him,” said Banka, a 28-year-old second-year oncology resident at Detroit’s Henry Ford Hospital. “We have a very special relationship.”

That relationship started in 1993 when a 12-year-old Banka was diagnosed with bone cancer in his right knee.

Mott and his former partner performed the surgery, removing the cancerous bone and replacing Banka’s knee with a prosthetic.

Mott continued to treat his patient throughout high school, college, and even periodically while Banka attended medical school at Michigan State University.

Shortly after Banka joined Henry Ford, Mott transferred to the hospital. They now work together occasionally.

“Going through this, I saw the ability the physicians had with, not only saving my life, but to give my life back,”

Doctor, former patient now colleagues in Detroit [Yahoo News]

Smoking Cessation Meta-Analysis

CMAJ.  2008; 179(2):135-44

We performed a meta-analysis to compare the treatment effects of 7 approved pharmacologic interventions for smoking cessation.

RESULTS: Six of the 7 pharmacotherapies studied were found to be more efficacious than placebo: varenicline (odds ratio [OR] 2.41, 95% credible interval [CrI] 1.91-3.12), nicotine nasal spray (OR 2.37, 95% CrI 1.12-5.13), bupropion (OR 2.07, 95% CrI 1.73-2.55), transdermal nicotine (OR 2.07, 95% CrI 1.69-2.62), nicotine tablet (OR 2.06, 95% CrI 1.12-5.13) and nicotine gum (OR 1.71, 95% CrI 1.35-2.21)… In our analysis of data from the varenicline trials that included bupropion control arms, we found that varenicline was superior to bupropion (OR 2.18, 95% CrI 1.09-4.08).

INTERPRETATION: Varenicline, bupropion and the 5 nicotine replacement therapies were all more efficacious than placebo at promoting smoking abstinence at 6 and 12 months.

Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials [Medscape]