Cheaper Medications Research Articles

Global healthcare needs integrative medicine tested on a scientific footing to shoulder the responsibility of holistic healing

The roadmap for building a brighter and more sustainable future for everybody is laid out in the United Nations Sustainable Development Goals. As pledged, we must accomplish the seventeen goals outlined therein by 2030, addressing the interconnected global challenges to positively impact every citizen. The third Sustainable Development Goal focuses on promoting and ensuring healthy living for people of all ages. At every stage of life, one’s health and well-being are essential to leading a fulfilling existence (1). This objective encompasses all vital areas of public health concern, like access to quality, cheap medications and vaccinations for everyone, reproductive, maternity, neonatal, child, and adolescent health, infectious and non-communicable diseases, universal health coverage, etc.

Effects of Non-Opioid Analgesics on the Cell Membrane of Skin and Gastrointestinal Cancers.

Skin and gastrointestinal cancer cells are the target of research by many scientists due to the increasing morbidity and mortality rates around the world. New indications for drugs used in various conditions are being discovered. Non-opioid analgesics are worth noting as very popular, widely available, relatively cheap medications. They also have the ability to modulate the membrane components of tumor cells. The aim of this review is to analyze the impact of diclofenac, ibuprofen, naproxen, acetylsalicylic acid and paracetamol on skin and gastrointestinal cancers cell membrane. These drugs may affect the membrane through topical application, at the in vitro and in vivo level after oral or parenteral administration. They can lead to up- or downregulated expression of receptors, transporters and other molecules associated with plasma membrane. Medications may also alter the lipid bilayer composition of membrane, resulting in changes in its integrity and fluidity. Described modulations can cause the visualization of cancer cells, enhanced response of the immune system and the initiation of cell death. The outcome of this is inhibition of progression or reduction of tumor mass and supports chemotherapy. In conclusion, non-opioid analgesics may be used in the future as adjunctive therapy for the treatment of these cancers.

“Palashaˮ A Curative Medicine in Diabetes Mellitus

Diabetes mellitus is a worldwide grave health problem challenging physicians globally. There are many factors that play role in the development of this disease, including environment, nutrition infection, genetic predisposition and side effect of modern drugs. Ayurveda refers to Diabetes mellitus as ―Madhumeha. Among the Ayurvedic texts Charka[1] , Vagbhata and Madhava have brought the word Madhumeha into use while, naming 20 subtypes of Prameha whereas Susruta has used the word Ksaudrameha. Madhu, and Ksaudra are literally synonyms of each other. But at a different place, Madhumeha‘ too has been used and Susruta has devoted one complete chapter to the treatment of Madhumeha. He has accepted Madhumeha to be the stage of complications of Prameha. If only the literal meaning of the words is to be seen Madhumeha‘ is the appropriate term for diabetes mellitus. The selected drug Palasha (Butea monosperma Linn. Kuntz) possesses Tikta, Kashaya rasaand has Pramehaghna properties and actions, therefore drug seems to be rational for treatment of Madhumeha. Palasha was proved to be useful and harmless remedy for Madhumeha. Today, it is a challenge for scientists to provide efficient, safe and cheap medications. In this scenario, Palasha can be an exclusive medicine which is widely available throughout country.

Review on medicinal importance of Vigna genus

Globally, there are more than 500,000 plant species (green scum, duckweed, lichens, liverworts, fungi, ferns, conifers, mosses and flowering plants etc.) that maintain earth’s environmental equilibrium, ecosystem stability and also possess vast endemic, aesthetic and cultural importance, provide medicine, food, fuel, shelter and clothing. Plants are used as therapeutic agents to improve health by a large part of population. Several clinical facts suggest that plant derived foods hold various potential health benefits and well known as neutraceuticals. These are the products that are used as food or as a part of food (foodstuffs), able to cure and prevent diseases in addition to their basic nutritional value. More than 200,000 chemical compounds are synthesized by plants and no doubt, also possess medicinal importance. Worldwide, about 70% plant based preparations are used as traditional medicines and also facilitate the base for 50 percent of prescription and/or over the counter drugs used in the Western-type practice of medicine. For underdeveloped and developing countries, it is a need to provide safe, efficient and cheap medications. In various part of India medicinal plants are widely distributed and always have increasing demand due to their medicinal properties. The present review is focused on the genus Vigna which is widely cultivated and used as neutraceuticals. They grow in varied climatic zones, in high temperatures, low rainfall and poor soils with low input in form of fertiliser and irrigation that make them valuable crop plants. As Vigna is an important genus that fulfils the food demand, useful in cosmetics and medicines, there is scope to enhance its productivity via resource conservation, optimum use of rainwater, bridging the yield gaps and innovations in technology transfer and up scaling. One of the important steps to find out a way to increase the production is the detection and analysis of naturally occurring DNA sequence variation by using DNA markers or molecular markers as these markers are indispensable tool that construct maps of genetic linkage and mark the agronomically important traits.

MON-097 THE EFFECT OF NICOTINIC ACID ON SERUM PHOSPHORUS AND LIPID PROFILE IN MAINTENANCE HEMODIALYSIS PATIENTS

Hyperphosphatemia and dyslipidemia are the important modifiable risk factors for cardiovascular disease in patients with end-stage renal diseases. Hyperphosphatemia is associated with increased cardiovascular mortality among dialysis patients. Non-calcium phosphate binders and lipid lowering agents are not frequently used in developing countries due to limited resources. Various additional treatments can add value for controlling these conditions and reduce the cost. The aim of this study was to assess the effect of nicotinic acid on hyperphosphatemia and dyslipidemia in maintenance hemodialysis patients. A multi-center, prospective study has been conducted on maintenance hemodialysis adult patients of both genders at Viet Duc hospital and 19-8 Hospital, Hanoi, Vietnam from May 2017 to October 2017. Nicotinic Acid (Niacin) with initial dose of 500 mg a day has been given to a cohort of patients with hyperphosphatemia and dyslipidemia. The dose has been adjusted every 4 weeks based on levels of phosphorus, total cholesterol and triglyceride levels with maximum of 1000 mg a day. The phosphorus target value recommended by KDIGO 2003 and lipid target values recommended by KDIGO 2013 have been adopted for reference. The values of phosphorus and lipid profile were evaluated every 4 weeks and compared to baseline using SPSS version 20.0. The proportion of patients who reached KDIGO target values after 16 weeks of treatment, the adverse events using a pre-developed questionnaire at week 4, week 8 and week 16 have been registered. The patients gave their written consent, and study has been approved by Scientific and Ethical Committee of Hanoi Medical University. Sixty of 135 screened patients have completed 16 weeks of studied treatment. There were 37 (61.7%) males and 23 (38.3%) females aged from 19 to 72 years, mean age was 49.39 ± 16.81 years. The mean phosphorus level was 2.27 ± 0.42 mmol/l at the baseline and significantly reduced to 1.91 ± 0.54 mmol/l, 1.84 ± 0.47 mmol/l, and 1.83 ± 0.45 mmol/l at week 4, week 8, and week 16 respectively (p<0.01). The proportion of patients reached phosphorus target increased from 1.7% at baseline to 51.7% at week 16. No significant change of total cholesterol, triglyceride, HDL-cholesterol and LDL-cholesterol levels has been registered at week 4 and week 8. At week 16, a numeric reduction of triglyceride and LDL-cholesterol levels has been registered (3.85 ± 2.09 mmol/l to 2.95 ± 1.88 mmol/l and 2.76 ± 0.83 mmol/l to 2.58 ± 0.72 mmol/l respectively), but this still did not reach significance. However, the level of HDL-cholesterol has been significantly increased at week 16 (0.87 ± 0.20 mmol/l to 1.02 ± 0.3 mmol/l, p=0.02). The most frequently registered complaints were headache (8/60), followed by GI upset (3/60), and diarrhea (2/60), mostly from those who received Niacin at 1000 mg a day. There was no non-anticipated adverse event reported. Our findings suggested the usefulness of Niacin as an additional treatment for hyperphosphatemia and dyslipidemia in maintenance hemodialysis patients with reasonable cost. This cheap medication can be considered for patients in developing countries. Niacin was well tolerated if the dose did not exceed 1000 mg a day. However, this dose could be less effective and longer treatment could be required to reach the therapeutic target levels

How will the cost of biosimilars affect patients’ willingness to receive them?

e18338 Background: The cost of oncology care is increasing. The NIH projects that the oncology drug market will reach $111.9 billion by 2020. Studies show that oncology patients experience considerable financial burden, regardless of insurance status and in general believe that oncology medications are too expensive. However, there is some evidence outside of oncology that suggests patients may not trust generics or cheaper medications. Therefore, there is a need to assess oncology patients’ views of a biosimilars and their potential to reduce costs. Methods: We surveyed a convenience sample of 79 oncology patients in clinics and the infusion center. The survey consisted of five questions on cost and patient participation in decision making. Results: Of 79 patients approached, 75 (95%) completed the survey. Fifty (66%) believed that expensive medications do not work better than less costly ones for the same disease; yet only 30 of those 50 (60%) and 44% overall (33/75) would prefer that their doctor prescribe them the cheaper version of their anti-cancer medication. Of the 20 respondents who believed that expensive drugs do not work better but still wanted the more expensive drugs for themselves, 8 believed cancer was too serious of an illness to take any chances with a cheaper medication, 5 wanted the most expensive that insurance would cover and 2 wanted the best possible medication. 90.67% respondents (68/75) wanted to know if their physician was prescribing a cheaper version of their drug. Conclusions: Our results show that, overall, oncology patients agree that cheaper medications work as well as more expensive ones, but there are definite concerns among some patients that drug price may be a proxy for quality, particularly in cancer. Overcoming these negative perceptions among patients will be important if optimal cost savings are going to be realized with expanded biosimilar use.

Interactions between brain and spinal cord mediate value effects in nocebo hyperalgesia.

Value information about a drug, such as the price tag, can strongly affect its therapeutic effect. We discovered that value information influences adverse treatment outcomes in humans even in the absence of an active substance. Labeling an inert treatment as expensive medication led to stronger nocebo hyperalgesia than labeling it as cheap medication. This effect was mediated by neural interactions between cortex, brainstem, and spinal cord. In particular, activity in the prefrontal cortex mediated the effect of value on nocebo hyperalgesia. Value furthermore modulated coupling between prefrontal areas, brainstem, and spinal cord, which might represent a flexible mechanism through which higher-cognitive representations, such as value, can modulate early pain processing.

Drug Prices: Is There a Need for Transparency?

*Director, Drug Information Group and Prior Authorization Services, Clinical Associate Professor, Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois In recent years, the rapid and significant upward trend in prescription drug prices has become a focus of national debate involving multiple actors including pharmaceutical manufacturers, insurers, health care providers, patients, and legislators. This is particularly true for “specialty” medications that are used to treat complex, chronic conditions (cancer, hepatitis C, HIV) and often require special handling and administration. In August 2015, the Kaiser Health Tracking Poll confirmed that the American public is broadly supportive of a number of actions aimed at keeping drug costs under control.1 These include allowing the federal government to negotiate with pharmaceutical manufacturers with regard to drug pricing for patients on Medicare (83%), limiting the amount companies can charge for high-cost medications for potentially chronic conditions such as hepatitis and cancer (76%), allowing patients to import cheaper medications from Canada (72%), and requiring manufacturers to disclose information to the public on how drug prices are set (86%). This last proposed action is the basis behind “prescription drug cost transparency” legislation recently introduced in various states including California, Massachusetts, New York, North Carolina, Oregon, Pennsylvania, and Texas.2-4 Some of these proposed state bills would require manufacturers of drug products with a wholesale acquisition cost of greater than or equal to $10,000 annually, or per course of treatment, to disclose specific information related to drug costs.5,6 Others would require cost information for any medication regardless of price.2 This information could include costs related to conducting clinical trials, marketing and advertising, manufacturing, regulation, research, and development and costs related to acquiring a medication, including patents and licensing. Additionally, some states would require pharmaceutical manufacturers to disclose the cumulative annual history of average wholesale price and wholesale acquisition cost increases for the drug, the total profit attributable to the drug, and the costs associated with providing financial assistance programs to patients. By far the boldest proposal is within a Massachusetts state bill that would allow the state’s Health Policy Commission to set caps on some medications.7 Unsurprisingly, pharmaceutical manufacturers and their leading trade group, the Pharmaceutical Research and Manufacturers of America (PhRMA), view these bills in a negative light. Industry argues that compiling and reporting all of the required information is onerous and complicated; that the price charged for an individual medication is not really a reflection of development costs or other costs that would be required to be reported; that some of the information that states would like to collect is proprietary, confidential, or sensitive in nature; and that these bills inappropriately and negatively focus on one aspect of increasing health care costs.2,5,7 Some industry representatives view these new bills as being political in nature since other players in the health care arena including insurers, hospitals, and health systems have a history of increasing costs to patients exorbitantly without explanation or justification. In summary, the cost of prescription drugs, especially specialty medications, has been increasing dramatically in recent years. This has led to widespread interest in how the price of these medications is determined by pharmaceutical manufacturers and the introduction of prescription drug cost transparency legislation in various states. This new legislation would require pharmaceutical manufacturers to report cost information for high-cost medications to the state in an effort to understand and justify pharmaceutical pricing and may even set price caps on some medications. Critics of this legislation state that passage and implementation would result in onerous and complicated requirements for drug manufacturers and that this type of legislation is merely political in nature given that drugs are not the only drivers of increased health care costs in the United States.

Organophosphorus poisoning: A social calamity

Poisoning with organophosphorus (OP) compounds is a global public health problem. According to World Health Organization (WHO), 3 million cases of pesticide (mainly OP compounds) poisoning occur every year, resulting in an excess of 250,000 deaths. Of these, about 1 million are accidental, and 2 million are suicidal poisonings. The incidence has steadily increased in the recent past and has reached a level in the developing countries, where it can be called a social calamity. Diagnosis is mainly on clinical grounds. The wellknown antidotes of OP poisonings are atropine and oximes. However, investigations over the recent years have introduced new adjunct therapy and cheap medications such as sodium bicarbonate and magnesium sulfate as well as antioxidants that should be considered for the management of OP poisoning. While efficacy of atropine is clinically proven, clinical experience with pralidoxime has been controversial. A lot of new modalities of management like K-oximes, hemoperfusion, and Fresh frozen plasma are under evaluation. Prevention still appears to be the best modality of management. Appropriate legislations and pesticides control are recommended for the developing countries to prevent occupational, accidental, and intentional poisonings.

Vitamin D status in critically ill patients: back to basics!

The problem of vitamin D deficiency during intensive care requires a number of clarifications. Initially, it is essential to focus on the fundamentals of vitamin D status assessment. Total 25-hydroxyvitamin D (25OH-D) is currently considered as the best indicator of vitamin D status. Due to practical reasons (less knowledge needed, higher throughput), immunoassays are generally preferred to measure serum 25OH-D levels. In the critical care context, however, they may be biased due to matrix effects [1]. During the acute phase of critical care, these assays should then be abandoned in favor of liquid chromatography-tandem mass spectrometry. Moreover, standardization of vitamin D assays is crucial: such a process is ongoing worldwide but, to date, is still incomplete. It is important to note that both points are rarely considered in the published studies related to vitamin D in critically ill patients: the data may thus be interpreted with caution. The bioavailable and free fraction of 25OH-D are attractive complementary markers of vitamin D status; however, progress is needed before establishing their evidence [2]. We need an accurate assay rather than formulas to measure free and bioavailable concentrations. We also need to determine normal or optimal ranges and to investigate their clinical impact. In the future, it seems important to consider these analytical prerequisites when studying vitamin D in critically ill patients. Meanwhile, these patients should benefit from the potential beneficial effects of vitamin D. Cholecalciferol is, in fact, a cheap medication with a wide therapeutic window. We believe that the critically ill should be supplemented with vitamin D as they are clearly at risk of deficiency. Meanwhile, for specific protocols, intensivists should at least follow the Endocrine Society guidelines [3,4].

SAT0310 Use of Low Dose Aspirin is Associated with Reduced Medial Tibial Cartilage Loss in Symptomatic Osteoarthritis: Data from a Cohort Study

BackgroundInflammation and vascular disease have recently been shown to play a role in the pathogenesis of osteoarthritis (OA). Low dose aspirin is commonly used in the prevention of cardiovascular disease....

Ensureing access to psychotropic medication in Sub-Saharan Africa

In this review article, the issues related to provision of psychotropic drugs in services in sub-Saharan Africa are explored. Problems encountered in procurement of drugs, their safe prescription and practical supply systems are discussed, with possible solutions suggested. The evidence-base for the preferential use of first-generation drugs is presented, with the practical implications for cost-effective service delivery shown. Options for sourcing of quality drugs are outlined with practical examples. An argument is made for a wider range of medical personnel to be allowed to prescribe than is often currently the case. This is so as to allow for the scale up of community based psychiatric services which will otherwise fail to meet the needs of the majority of persons with mental illnesses, particularly in rural communities. Drug Revolving Funds are proposed as a means of managing supplies by local projects in a context of a lack of an alternative supply. Some suggestions are made for practical solutions to the problem of those cannot afford even cheaper medications.

For Country's Only Psychiatrist, Multitasking a Must

For Country's Only Psychiatrist, Multitasking a Must

Differences in Prescription Drug Use in HMO and Self-insured Health Plans

Using pharmacy benefits manager claims data, this study analyzed how cost-management techniques including cost sharing affected enrollees in health maintenance organizations (HMOs) versus employer-sponsored fee-for-service plans. Because HMOs bear the risk of pharmaceutical costs and influence the prescribing practices of the physicians in their network, we expected different patterns of prescription use, such as proportionately more generic medications in HMOs. Also, because HMO physicians are likely to prescribe relatively more drugs for high-severity conditions, HMO enrollee demand should be less price sensitive. The impact of cost sharing was found to be significantly less for HMOs. A 5-dollar increase in copayments decreased expenditures by 16 percent in fee-for-service plans but only by 1 percent in HMOs. Furthermore, when cost sharing was set at zero, HMO plans were found to have significantly fewer and cheaper medications, resulting in lower per-enrollee medication expenditures.

Quitting-related beliefs, intentions, and motivations of older smokers in four countries: findings from the international tobacco control policy evaluation survey

Older smokers represent an important subgroup that has been shown to benefit considerably from quitting smoking. However, to date little is known about relevant beliefs, intentions, and motivations. This study examined factors associated with older smokers' (aged 60 years and above) intention to quit smoking using data gathered via the International Tobacco Control Policy Evaluation Survey (ITCPES), a random digit dialed telephone survey of over 9000 adult smokers from United Kingdom, United States, Canada, and Australia. Having smoked for a long time and having survived, it was hypothesized that older smokers would perceive themselves as being less vulnerable to the harm of smoking (self-exempting beliefs); be less concerned about the health effects of smoking; be less confident about being able to quit successfully (self-efficacy); not perceive any health benefit of quitting, and hence be less willing to want to quit. Controlling for possible confounders, the hypotheses were all confirmed. Further analysis into reported considerations for quitting revealed that price of cigarettes, health professional advice, cheap quitting medication, and information on health risks were important predictors of quitting intention, with cigarette price and cheap medication also associated with recent quit attempts. Together, these findings have important implications for developing strategies for encouraging older smokers to give up smoking.