Los Farmacéuticos se suman al apoyo de la OMC a la Iniciativa por una Prescripción Prudente

Un grupo de farmacéuticos de Atención Primaria a través de la publicación en Internet “Hemos Leído” se ha sumado al apoyo de la OMC a la Iniciativa por una Prescripción Prudente, mediante la publicación de los 24 puntos o principios extraídos de esta iniciativa.
La Iniciativa por una Prescripción Prudente (IPP) puesta en marcha en Internet y Redes Sociales por cinco profesionales sanitarios, es un proyecto que aborda el concepto del uso racional de los medicamentos, en el que se destacan seis principios de una prescripción juiciosa, considerados como un requisito previo para el uso seguro y apropiado de los medicamentos. Estos principios se basan en pruebas experimentales y en lecciones de estudios recientes que demuestran problemas con medicaciones ampliamente prescritas y ofrecen una serie de consejos para una más cauta y prudente prescripción.
A continuación se enumeran las 24 conclusiones de la iniciativa:
Busca en primera instancia alternativas no farmacológicas

Considera las causas subyacentes, potencialmente tratables, de los problemas, en lugar de tratar los síntomas con medicamentos

Busca oportunidades para la prevención en lugar de centrarte en el tratamiento de síntomas o de una enfermedad avanzada

Siempre que sea posible usa el tiempo como un test diagnóstico y terapéutico

Maneja pocos medicamentos pero aprende a utilizarlos bien

Evita el cambio continuo a nuevos medicamentos sin tener motivos claros y concluyentes basados en la evidencia

Sé escéptico con el tratamiento individualizado

Siempre que sea posible, comienza el tratamiento con un sólo fármaco

Ante un nuevo problema de salud piensa en primer lugar si puede tratarse de una reacción adversa a un medicamento

Informa a los pacientes sobre las posibles reacciones adversas que pueden provocar sus medicamentos para que sean capaces de reconocerlas lo más pronto posible en caso de aparezcan

Considera si no se estás promoviendo y a la vez tratando, un síndrome de abstinencia

Infórmate de los nuevos medicamentos y las nuevas indicaciones empleando fuentes fiables e independientes

No tengas prisa por utilizar medicamentos de reciente comercialización

Asegúrate de que el medicamento mejora resultados clínicos orientados al paciente en vez de variables subrogadas orientadas a la enfermedad

Rehúye la ampliación o extrapolación de indicaciones

No dejarse seducir por la elegante farmacología molecular o fisiológica de algunos fármacos

Ten precaución con la promoción selectiva de estudios

No cedas de forma precipitada y poco crítica a las peticiones de los pacientes, especialmente con los medicamentos que conocen por la publicidad

Ante un fracaso terapéutico evita prescribir más fármacos sin antes comprobar laadherencia del paciente al tratamiento

Evita volver a prescribir medicamentos que ya han sido administrados previamente al paciente sin obtener respuesta, o que causaron una reacción adversa

Suspende el tratamiento con fármacos innecesarios o que no están siendo efectivos

Respeta las dudas expresadas por los pacientes sobre sus medicamentos

Piensa más allá de los beneficios a corto plazo de los fármacos y valora los beneficios y riesgos a más largo plazo

Busca oportunidades para mejorar los sistemas de prescripción y hacer cambios que hagan más segura la prescripción y uso de medicamentos.

F.D.A. Finds Short Supply of Attention Deficit Drugs

edicines to treat attention deficit hyperactivity disorder are in such short supply that hundreds of patients complain daily to the Food and Drug Administration that they are unable to find a pharmacy with enough pills to fill their prescriptions. The shortages are a result of a troubled partnership between drug manufacturers and the Drug Enforcement Administration, with companies trying to maximize their profits and drug enforcement agents trying to minimize abuse by people, many of them college students, who use the medications to get high or to stay up all night.
Caught in between are millions of children and adults who rely on the pills to help them stay focused and calm. Shortages, particularly of cheaper generics, have become so endemic that some patients say they worry almost constantly about availability.
While the Food and Drug Administration monitors the safety and supply of the drugs, which are sold both as generics and under brand names like Ritalin and Adderall, the Drug Enforcement Administration sets manufacturing quotas that are designed to control supplies and thwart abuse. Every year, the D.E.A. accepts applications from manufacturers to make the drugs, analyzes how much was sold the previous year and then allots portions of the expected demand to various companies.
How each manufacturer divides its quota among its own A.D.H.D. medicines — preparing some as high-priced brands and others as cheaper generics — is left up to the company.
Now, multiple manufacturers have announced that their medicines are in short supply. The F.D.A. has included these pills on its official shortages list, as has the American Society of Health-System Pharmacists, which tracks the problem for hospitals. And the American Academy of Child and Adolescent Psychiatry has told the more than 8,000 doctors in its membership that shortages seem to be “widespread across a number of states” and are “devastating” for children.
Officials at the Food and Drug Administration say the shortages are a result of overly strict quotas set by the Drug Enforcement Administration, which, for its part, questions whether there really are shortages or whether manufacturers are simply choosing to make more of the expensive pills than the generics, creating supply and demand imbalances.
The situation has made for a rare open disagreement between two federal agencies.
“We have reached out to the D.E.A. and told them that there are shortage issues,” said Valerie Jensen, associate director of the F.D.A.’s drug shortage program. “But the quota issues are outside of our area of responsibility.”
Still, Special Agent Gary Boggs of the Drug Enforcement Administration’s Office of Diversion Control, said in an interview, “We believe there is plenty of supply.”
Some high-priced pills are indeed readily available, and D.E.A. officials said that so long as that is the case, they believe that A.D.H.D. drug supplies are adequate. Agent Boggs attributed any supply disruptions to decisions made by manufacturers.
Novartis, for instance, makes both branded and generic versions of Ritalin; Shire Pharmaceuticals does the same for Adderall XR. In both cases, the companies have ensured that supplies of branded drugs are adequate while allowing generic versions to go wanting.
“We are working diligently to ensure our supply of these products meets demand, including discussions with D.E.A. regarding our quota levels for these controlled substances,” said Kathy Bloomgarden, a spokeswoman for Novartis.
But those who rely on the drugs can react very differently to apparently similar medicines, so an adequate supply of one drug does them no good when their preferred medicine is unavailable, patients and their doctors say. And prices can vary so much that some patients say they cannot afford to switch.
Lynn Whitton of Westport, Conn., who has an attention deficit hyperactivity disorder, expressed disbelief when told that the Drug Enforcement Administration said there were no shortages of A.D.H.D. medicines. “What?” she said. “I’m just flabbergasted!”
Ms. Whitton said she had recently gone to more than a dozen pharmacies in Westport and New York City before finding one that would partially fill Ritalin prescriptions for her and her 18-year-old son, who also has the disorder.
Erin Fox, manager of the drug information service at the University of Utah, said problems arise when there is a mismatch between what manufacturers choose to make and what patients are prescribed.

**Source: "THE NEW YORK TIMES"

New report highlights need for action on health in the aftermath of war

Countries recovering from war are at risk of being left to their own devices in tackling non communicable diseases, leaving an "open door" for exploitation by alcohol, tobacco and food companies, health experts warn.
Writing in the Bulletin of the World Health Organization, Bayard Roberts and Martin McKee, of the London School of Hygiene & Tropical Medicine, and Preeti Patel, of King's College London, argue that the post-conflict environment risks increases of mental health problems and other NCDs, such as high blood pressure, diabetes and cancer.
After exposure to violent and traumatic events, people may be prone to developing harmful health behaviours, such as excessive drinking and smoking, which exacerbate the problem of NCDs in the long-term. This is why the lack of a strong will from the authorities to restore the health system leaves an open door for commercial ventures to influence health policy to their advantage.
The authors write: "This toxic combination of stress, harmful health behaviours and aggressive marketing by multinational companies in transitional settings requires an effective policy response but often the state has limited capacity to do this."
Afghanistan has no national policy or strategy towards NCDs and, apart from the European Commission, none of its partners has given priority to introduce and support them. High blood pressure is largely untreated in Iraq, three times as many people die prematurely from NCDs in Libya than from infectious diseases and similar patterns can be found in other countries recovering from conflict.
"This policy vacuum provides an open door for multinational companies to influence policies in ways that undermine efforts to control tobacco and alcohol use or improve unhealthy diets in transitional countries," the experts say.
Little attention is paid in reconstruction and humanitarian efforts to helping countries emerging from conflict deal with their present or future burden of NCDs – with the topic virtually ignored during the United Nations high-level meeting on NCDs in September 2011. The authors argue that this gap must be filled, pointing out that the post-conflict period can provide an opportunity to completely rewrite strategies and undertake reforms to better address the health needs of a population and lay the foundations for a more efficient health system.
Dr Roberts, a lecturer in the European Centre on Health of Societies in Transition at LSHTM, says: "While great attention is rightly paid to infectious diseases, noncommunicable diseases should also be given attention –especially as the post-conflict environment can provide the perfect breeding ground for unhealthy activities like smoking, drinking and poor diet. We are making the argument that if the authorities do not step up to lead the way in developing policies which will benefit public health, then they leave the route clear for companies to step in and serve their own interests."

*More information: Noncommunicable diseases and post-conflict countries – Bulletin of the World Health Organization, January 2012
http://www.who.int … /1/11-098863
Provided by London School of Hygiene & Tropical Medicine

El Gobierno convoca el programa de ayudas del Plan Nacional de I+D+i

El Ministerio de Economía y Competitividad anuncia en el Boletín Oficial del Estado la convocatoria del programa de ayudas económicas a proyectos de investigación básica, en el marco del VI Programa Nacional de Investigación Científica, Desarrollo e Innovación tecnológica 2008-2011. La convocatoria, que incluye también el programa de personal investigador, se presenta con una estimación de financiación de 325 millones de euros en subvenciones y 105 millones en créditos (anticipos reembolsable).
Esta convocatoria, que se hace todos los años en diciembre para ser resuelta el año siguiente, selecciona, tras evaluación científica, los mejores proyectos de investigación presentados, a los que se concede la ayuda económica para tres años. Una carta enviada por el anterior Ministerio de Ciencia e Innovación a los directores de los centros anunciando que no haría la convocatoria por petición de los responsables del PP en la transferencia de poderes había llenado de inquietud e incertidumbre a miles de científicos que estaban pendientes de la misma. En 2011 se ha financiado con este programa a más de 3.400 investigadores. La convocatoria de hoy, por tanto, supone un respiro para el sistema español de i+D.
Tras la convocatoria, la nueva Secretaría de Estado de Investigación, Desarrollo e Innovación, con una Dirección General de Investigación y Gestión del Plan Nacional recogida en el organigrama del nuevo Ministerio de Economía y Competitividad, debe gestionar todo el largo proceso de recepción, evaluación científica y selección final de los proyectos que opten a esta financiación. La resolución del programa suele tardar unos 10 meses.

Outside temps, sun and gender may trigger glaucoma

When it comes to whether or not you will develop exfoliation syndrome (ES) — an eye condition that is a leading cause of secondary open-angle glaucoma and increased risk of cataract as well as cataract surgery complications — age, gender and where you live does matter.
“Although many studies from around the world have reported on the burden of the disease, some aspects of the basic descriptive epidemiologic features, which may help shed light on the cause, are inconsistent,” said Louis Pasquale, M.D., study co-author and director of Massachusetts Eye and Ear’s Glaucoma Center of Excellence. “In this study we found that women are more vulnerable to this disease then men, that ES is not a disease of Norwegian descent, and that where you live does matter when it comes to developing the disease.”
Researchers from the Mass. Eye and Ear, Harvard Medical School, Boston, Mass., Department of Medicine, Channing Laboratory, Brigham and Women’s Hospital, Boston, Mass., Department of Ophthalmology and Visual Sciences, and University of Michigan, Ann Arbor, Mich., set out to find out how demographic and geographic risk factors are associated with exfoliation syndrome (ES). Their study, the “Demographic and Geographic Features of Exfoliation Glaucoma in two United States-Based Prospective Cohorts” are published in the January 2012 issue of Ophthalmology.
Researchers used data from 78,955 women in the Nurses’ Health Study (NHS) and 41,191 men in the Health Professionals Follow-up Study (HPFS) residing throughout the continental United States who were prospectively followed for 20 years or more and who provided lifetime residence information to examine the descriptive epidemiologic features of ES or exfoliation glaucoma suspect (EGS).
This study confirmed established associations with age and family history and exfoliation glaucoma or exfoliation glaucoma suspect (EG/EGS), as well as provided new data on associations with gender, eye color and ancestry.
“Importantly, those with a lifetime residential history of living in the middle tier and south tier of the United States was associated with 47% and 75% reduced risks, respectively, compared with living in the northern tier, and across the life span, residence at age 15 was the most strongly associated with risk, followed by current residence,” the authors wrote.
The study showed an increased risk in females, but it was unclear as if gender-specific differences in the eye, such as axial length differences or environmental factors related to lifestyle, account for why women are more at risk for this disease.
Other findings include:
A positive family history of glaucoma was associated with a more than doubling of risk.
Neither Scandinavian decent nor Southern European ancestry was associated with risk when compared with the larger reference group of mainly other white persons in the study, which indicates that there may be strong environmental factors that may increase risk among populations in Scandinavian countries. Overall the study lacked adequate power to determine whether incidence rates differed by minority groups.

Iris (eye) color did not seem to be a risk factor.
“This large prospective cohort study demonstrates that there is a positive association between latitude and ES risk that is robust and not related to demographic features or other systemic covariates,” Dr. Pasquale explained. “Another manuscript we published recently suggests that lower ambient temperature interacts with increased solar exposure to increase the risk of ES. This new work demonstrates a relation between increasing latitude and a condition with a strong predisposition to glaucoma. More work is needed to determine how environmental factors conspire to contribute to ES.”
According to the National Eye Institute, ES is the major known cause of open-angle glaucoma, and is one of the leading causes of blindness. With the rapid aging of the U.S. population, the number of individuals affected by the disease will increase to more than three million by 2020.

**Published in "SCIENCE BLOG"

El presidente del CSIC advierte en EL PAIS sobre una posible fuga masiva de cerebros en España

¿Fuga masiva de cerebros?
"Estas medidas de recorte presupuestario tienen un efecto gravísimo en los recursos humanos, incluida la formación de los científicos, porque si los investigadores no tienen oportunidades aquí acaban por irse al extranjero y se puede producir una auténtica avalancha de fuga de cerebros", advierte Rafael Rodrigo, presidente del CSIC hoy en el diario español EL PAIS.
De la misma opinión es Jesús Ávila, profesor de investigación del CSIC en el Centro de Biología Molecular Severo Ochoa: "Esto puede suponer un problema para la carrera científica de los jóvenes, si no hay contratos... pero también por el impacto negativo en el sistema científico en general, que es donde se forman los jóvenes investigadores". En su opinión, una nueva oleada de recortes supondría un panorama muy negro: "Entraríamos en recesión de la investigación científica en España". En el Ciemat trabajan unas 1.400 personas; más de la mitad son titulados superiores. Si el sistema de I+D español no da cabida a la nueva generación de investigadores, hay que contar con que la gente busque acomodo para su carrera en otros países. "Y se van los mejores, que son los que fácilmente logran contratos fuera, y nos quedamos con los mediocres", apunta Cayetano López, director del Ciemat. Entre las medidas anunciadas el viernes pasado por el Gobierno está la congelación de la tasa de reposición de plantillas (con algunas excepciones que no atañen a la I+D), de manera que no se cubrirán las plazas vacantes de investigadores que se produzcan el año que viene. En cuanto a buscar trabajo en el sector privado, el gasto en I+D en las empresas está reduciéndose desde hace dos o tres años

**Publicado en "EL PAIS"

Poor sleep linked to increased health and behavior problems in young diabetics

A new study suggests that young diabetics may be struggling to get a good night’s sleep, resulting in worse control of their blood sugar, poorer school performance and misbehavior.
“Despite adhering to recommendations for good diabetic health, many youth with Type 1 diabetes have difficulty maintaining control of their blood sugars,” said Michelle Perfect, PhD, the principal investigator in the study. “We found that it could be due to abnormalities in sleep, such as daytime sleepiness, lighter sleep and sleep apnea. All of these make it more difficult to have good blood sugar control.”
The study, appearing in the January issue of the journal Sleep, tracked the sleep health of 50 Type 1 diabetics, ages 10 to 16. Perfect and her colleagues compared that data with a similar control group. They found that the young diabetics spent more time in a lighter stage of sleep than youth without diabetes, which was related to compromised school performance and higher blood sugar levels.
“Sleep problems were associated with lower grades, poorer performance on state standardized tests, poor quality of life and abnormalities in daytime behavior,” Perfect said. “On the upside, sleep is a potentially modifiable health behavior, so these kids could be helped by a qualified professional to get a better night’s sleep.”
Perfect and colleagues also found that nearly one-third of the youths in their study had sleep apnea, regardless of weight. Sleep apnea is associated with Type 2 diabetes, often referred to as adult-onset diabetes. These young participants with sleep apnea showed significantly higher blood sugar levels – the same pattern linked to adults.
“Sleep apnea and its impact may not be confined to older people with diabetes, we don’t know,” she said. “It’s something that needs to be looked at again.”

**Published in "SCIENCE BLOG"