Newsletter for PhaRmacists & MeDical Professionals Vol:5
Issue: 14
November 1-15
2008
Price Rs 20/-I
"Primary Health Care - now more than EVER" The World Health Report 2008, launched on October 15th, critically assesses the way that health care is organized, financed, and delivered in rich and poor countries around the world. The WHO report documents a number of failures and shortcomings that have left the health status of different populations, both within and between countries, dangerously out of balance. "The World Health Report sets out a way to tackle inequities and inefficiencies in health care, and its recommendations need to be heeded," said WHO Director-General Dr Margaret Chan at the launch of the report in Almaty, Kazakhstan. "A world that is greatly out of balance in matters of health is neither stable nor secure." The report commemorates the 30th anniversary of the Alma-Ata International Conference on Primary Health Care held in 1978. That event was the first to put health equity on the international political agenda. Striking inequities In a wide-ranging review, the new report found striking inequities in health outcomes, in access to care, and in what people have to pay for care. Differences in life expectancy between the richest and poorest countries now exceed 40 years. Of the estimated 136 million women who will give birth this year, around 58 million will receive no medical assistance whatsoever during childbirth and the postpartum period, endangering their lives and that of their infants. Globally, annual government expenditure on health varies from as little as US$ 20 per person to well over US$ 6000. For 5.6 billion people in low- and middle-income countries, more than half of all health care expenditure is through out-of-pocket payments.
With the costs of health care rising and systems for financial protection in disarray, personal expenditures on health now push more than 100 million people below the poverty line each year. Vast differences in health occur within countries and sometimes within individual cities. In Nairobi, for example, the under-five mortality rate is below 15 per 1000 in the high-income area. In a slum in the same city, the rate is 254 per 1000. "High maternal, infant, and under-five mortality often indicates lack of access to basic services such as clean water and sanitation, immunizations and proper nutrition," said Ann M. Veneman, UNICEF Executive Director. "Primary health care, including integrated services at the community level, can help improve health and save lives." Health systems lose focus Data set out in the report are indicative of a situation in which many health systems have lost their focus on fair access to care, their ability to invest resources wisely, and their capacity to meet the needs and expectations of people, especially in impoverished and marginalized groups. As the report notes, conditions of "inequitable access, impoverishing costs, and erosion of trust in health care constitute a threat to social stability." To steer health systems towards better performance, the report calls for a return to primary health care, a holistic approach to health care formally launched 30 years ago. When countries at the same level of economic development are compared, those where health care is organized around the tenets of primary health care produce a higher level of heath for the same investment. Such lessons take on critical importance at a time of global Contd...page 2
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Editor & Publisher
V. Bhava Narayana Associate Editors
EDITORIAL BOARD Prof.B.Suresh, President Pharmacy council of India
Dr. Aniruddha Malpani, M.D Dr. Mahesh Sharma,
Dr. Jawahar Bapna, Rtd Director, IIHMR
Prof. G.P.Mohanta
S.W. Deshpande, DG, AIDCOC
M.D (Ayurveda)
Dr. P.Hanumantha Rao, ASCI, Hyd
This Publication is Only for the use of Medical & Pharmacy Professionals Printed, Published and Owned by V. Bhavanarayana, and printed at Kala Jyothi Process Pvt. Ltd., 1-1-60/5, R.T.C. 'X' Roads, Musheerabad Hyderabad - 20. Published at 3-3-62/A New Gokhale Nagar, Ramanthapur, Hyderabad - 500 013, R.R. Dist. Editor : V. Bhavanarayana * RNI No.: APBIL/2004/12036 Postal LIC NO : HSE 806/2004-06. C Pharmed Trade News, 2004 * Person responsible under PRB act for selection of news Pharmed Trade News does not neccesarily subscribe to the views expressed in the publication. All views expressed to the magazine are those of the contributors Pharmed Trade News not responsible or accountble for any loss incurred, directly or indirectly as a result of the information provided.
financial crisis. "Viewed against current trends, primary patients of opportunities for comprehensive care. When health is skewered towards specialist care, a broad menu of protective and preventive interventions tends to be lost. WHO estimates that better use of existing preventive measures could reduce the global burden of disease by as much as 70%. Inequities in access to care and in health outcomes are usually greatest in cases where health is treated as a commodity and care is driven by profitability. The results are predictable: unnecessary tests and procedures, more frequent and longer hospital stays, higher overall costs, and exclusion of people who cannot pay. Fragmented health care In rural parts of the developing world, care tends to be fragmented into discrete initiatives focused on individual diseases or projects, with little attention to coherence and little investment in basic infrastructures, services, and staff. As the report observes, such situations reduce people to "programme targets." Above all, health care is failing to respond to rising social expectations for health care that is people-centred, fair, affordable and efficient. A primary health care approach, when properly implemented, protects against many of these problems. It promotes a holistic approach to health that makes prevention equally important as cure in a continuum of care that extends throughout the lifespan. As part of this holistic approach, it works to influence fundamental determinants of health that arise in multiple non-health sectors, offering an upstream attack on threats to health. Primary health care brings balance back to health care, and puts families and communities at the hub of the health system. With an emphasis on local ownership, it honours the resilience and ingenuity of the human spirit and makes space for solutions created by communities, owned by them, and sustained by them. Working towards fairness and efficiency The core strategy for tackling inequalities is to move towards universal coverage in a spirit of equity, social justice, and solidarity. Fairness and efficiency in service delivery are overarching goals. Primary health care also offers the best way of coping with the ills of life in the 21st century: the globalization of unhealthy lifestyles, rapid unplanned urbanization, and the ageing of populations. These trends contribute to a rise in chronic diseases, like heart disease, stroke, cancer, diabetes and asthma, that create new demands for long-term care and strong community support. A multisectoral approach is central to prevention, as the main risk factors for these diseases lie outside the health sector. The report says that health systems will not naturally gravitate towards greater fairness and efficiency. Deliberate policy decisions are needed. The evidence and arguments set out in the report should help in this task. "We are, in effect, encouraging countries to go back to the basics," said Dr Chan. "Thirty years of well-monitored experience tell us what works and where we need to head, in rich and poor countries alike."
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Delhi Society for Promotion of Rational Use of Drugs in collaboration with the World Health Organization is organizing an INTERNATIONAL TRAINING COURSE ON MEDICATION MANAGEMENT IN HOSPITALS: ROLE OF DRUG AND THERAPEUTICS COMMITTEES NEW DELHI, INDIA DECEMBER, 8-11, 2008 Why this training course? Inefficient and irrational use of medicines is prevalent at all levels of health care leading to wastage of scare resources. BMany of these sources of wastage could be reduced if some simple principles of drug management and use were followed. BHowever, it is difficult to implement these principles because staff from many different disciplines are involved in different aspects of drug management and use. In hospital settings, a Drug and Therapeutics Committee (DTC), also known as Pharmacy & Therapeutics Committee (PTC) provides a forum to bring together all the relevant people to work jointly to improve healthcare delivery. BAs such, a DTC may be regarded as a tool for promoting more efficient and rational use of medicines. Medication management through functional Drug and Therapeutics Committees is an integral requirement for hospitals seeking accreditation from National Accreditation Board for Hospitals & Healthcare Providers (NABH), a constituent board of Quality Council of India, set up to establish and operate accreditation programme for healthcare organizations. BThis training programme will provide an opportunity for such hospitals and institutes to get trained their human resource involved in medication management. Deadline for application Applications and fees are due no later than November 10, 2008. BDue to limited places available early applications are encouraged. Bfor details contact :
Dr. Usha Gupta Executive Vice President Delhi Society for Promotion of Rational Use of Drugs 2nd Floor, Delhi Government Dispensary Vasundhara Enclave Delhi - 110096 India Tel. 91 11 22612669 B B B B91 11 22612558 E.mail: Bdsprud2005@yahoo.com
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PhaR MeD News FDC RESULTS FDC Ltd, a Rs 500 crore Aurangabad-based pharma company, achieved better performance during the quarter ended September 2008 and its net profit increased by 44.4 per cent to Rs 26.25 crore from Rs 18.18 crore in the corresponding period of last year. Its net sales increased by 14.1 per cent to Rs 155.86 crore from Rs 136.54 crore. The earning per share for equity share of face value of Re 1 worked out to Rs 1.37 as against Rs 0.95 in the lat period. For the first half ended September, FDC’s net sales increased by 13 per cent to Rs 315.16 crore from Rs 278.88 crore in the similar period of last year. Its net profit increased by 49.4 per cent to Rs 60.95 crore from Rs 40.81 crore. For the full year ended March 2008, FDC achieved gross sales of Rs 525 crore and earned a net profit of Rs 65.76 crore with EPS of Rs 3.43.
HEALTHCARE STOCKS Share prices of almost all top pharmaceutical companies have recorded unprecedented fall during the week ended last Friday. Several of them touched to their 52-weeks lowest levels. The BSE Healthcare index of major 23 pharma companies drifted by 12.4 per cent during the week. The index touched its 52-week lowest level at 2772.73 points on October 24, 2008 with all the major companies suffered heavy losses. The undertone continues to be bearish and not likely to revive in the short time. Few shares from BSE HC index like Cipla, Glenmark, Matrix, Orchid Chem, Piramal Healthcare and Ranbaxy lost almost over 20 per cent during the week. The poor financial performances of top companies also impacted the trading sentiment. The net profit of Dr Reddy's declined by 52 per cent, Alembic (67 per cent), Wockhardt (43 per cent), Piramal Healthcare (13.4 percent), Cipla (21 per cent) and Biocon (54 per cent). Companies like Lupin and Cadila, however, improved bottom line by 53 per cent and 18 per cent respectively. The foreign exchange losses may put pressure on other pharma players in the quarter.
IPA The Indian Pharmaceutical Association (IPA), the largest national professional body of pharmacists in the country, is planning to conduct a conference on transdermal and topical delivery of dermaceutical and cosmeceutical products on December 9 and 10. The conference, the first of its kind on the dermaceutical sector in the country, will be conducted in association with the International Pharmaceutical Federation (FIP), the American Association of Pharmaceutical Scientists (AAPS) and the Academy of Pharmaceutical Science and Technology of Japan (APSTJ), according to S D Joag, general secretary, IPA. Sessions on regulatory and legal requirements, formulation of transdermal delivery systems, formulation of topical delivery systems and non-invasive technique for evaluating
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product efficacy will act as a platform for the companies in the derma and cosmeceuticals areas to interact with the global and Indian experts in the growing field, he added. TB- VAACCINE Researchers at Saint Louis University are one step closer to developing a vaccine that provides better protection against tuberculosis. The investigational vaccine for TB tested at the university appears likely to offer significantly better protection against the potentially fatal disease than the one in current use. "Not only was it as safe as the standard vaccine, it induced a better immune response, which suggests it will be more effective at protecting against tuberculosis," said Daniel Hoft, M.D., Ph.D., director of the division of immunobiology at Saint Louis University School of Medicine and lead author of the study. The investigational vaccine is made from a weakened TB germ from one of the strains of the current tuberculosis vaccine, which was created more than 75 years ago. The new "recombinant" vaccine uses an antigen, a secreted protein from a virulent strain of tuberculosis, to help focus the immune system on blocking aggressive and deadly TB organisms. In this phase I clinical trial, researchers vaccinated a total of 35 study participants. The standard TB vaccine - called Bacille Calmette-Gurin (BCG) - was given to 17 study participants, and 18 study participants received the investigational recombinant BCG vaccine. Researchers compared five immune functions induced by the vaccines and found that the investigational vaccine induced more powerful responses that are important for protection against tuberculosis. The investigational vaccine also was safe and well tolerated. The study has shown that the concept of using a recombinant vaccine holds promise in being able to better protect people from tuberculosis. This vaccine will not be tested further because it uses an antibiotic resistant gene that scientists want to keep out of the environment. However research in this area will continue as scientists test a similar recombinant BCG vaccine that expresses the same and additional key TB antigens that is expected to be even more potent than the one just studied and does not include the antibiotic resistant gene, Hoft said. "A new vaccine theoretically could not only protect against the overwhelming growth of TB organisms, but could kill residual organisms after a person has become infected. That's the hope," Hoft said. The study appears in the Journal of Infectious Diseases RANBAXY Ranbaxy Laboratories announced it will begin Phase III human clinical trials of a new combination malaria treatment after receiving approval from the country's Central Drugs Standard Control Organization,
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Malvinder Mohan Singh, CEO and managing director of Ranbaxy, said the upcoming clinical trials are a "landmark achievement" for Ranbaxy's research and development team. He added that the new drug will be "safer and more effective" than artemisinin-based combination therapies and will "have a clear cost advantage." Sudershan Arora, Ranbaxy's president of clinical and drug development, said the company is "looking forward" to completing the clinical trials and moving on to marketing approvals. Singh added that researchers must remain committed to launching the new drug for "needy" people living in malaria-endemic countries . FDA WARNING The two aspirins are: Bayer Women's Low Dose Aspirin + Calcium (Bayer Women's) and Bayer Aspirin with Heart Advantage (Bayer Heart Advantage). Bayer Women's has aspirin and calcium carbonate in a single tablet and Bayer Heart Advantage has aspirin and phytosterols in a single tablet. They both carry labels that describe them as being a drug and a dietary supplement, but when these are together in one tablet the product is subject to FDA regulation said the FDA. Mike Chappell, the FDA's acting associate commissioner for regulatory affairs said in a statement that: "The FDA considers these products new drugs and thus they must undergo the FDA's drug approval process." Chappell said the federal agency was prepared to enforce action against manufacturers who broke the law or who tried to get around the drug approval process. The two aspirins are labelled not only as pain relievers, but also carry claims that they reduce the risk of heart disease, said the FDA statement. Bayer's Women's also claims to "fight" osteoporosis. Neither of these uses is approved by the FDA. Moreover, the drugs are misbranded said the agency since such uses take the products out of the OTC category because these conditions should be diagnosed by a healthcare professional who then advises which medication to take and then supervises the patient on the drug. PATIENTS COMPLIANCE STUDY InfoMedics, Inc., the patient feedback company, announced the results of a survey examining the behaviors of patients on prescription medications. The findings show that a significant portion of medication users tend to ignore or stray from their doctor's orders, and that there are opportunities for improved patient-physician communication. Thirty-four percent of respondents said they do not always fill a new prescription from their doctors; another 5 percent said they never fill those prescriptions. With regard to communicating that decision to their physician, 46 percent said there is a chance they would not tell their doctor if they stopped taking a medication or decided not to fill a prescription. The survey also revealed that: -- 67 percent forget to take their medication at times
medication if they started feeling worse -- 34 percent sometimes, often or always stop taking medication if they feel better -- 46 percent are careless at times when taking medications -- 32 percent are always motivated to take a newly prescribed medication -- 46 percent said there is a chance that they would not tell their doctor if they stopped taking a medication or decided not to fill a prescription "We know that about one-third of the prescriptions doctors write are never filled, but what concerns us is the number of people who stop taking medications without their physician's input," said Stanley Wulf, MD, chief medical officer at InfoMedics. "Taking measures into your own hands and not communicating that to your doctor can be quite dangerous." The survey also found that fewer patients are turning to their doctors for information about their medications. When asked for multiple responses about where they go for medication information, 51 percent of respondents said they look to the Internet for this information; 49 percent said they ask their pharmacists and 37 said they ask their doctors. "Medication non-adherence is a huge problem for the medical community and it needs to be addressed as part of the overall public health agenda," said Gene Guselli, CEO of InfoMedics. "There is a serious rift between patients and their physicians, and once that communication gap is closed, we will be one step closer to getting better treatment outcomes and helping medical providers understand the efficacy of the drugs they prescribe. It is our company's goal to encourage more physician-patient communication so patients have the guidance they need and can receive better treatment outcomes."
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-- Only 9 percent said they would keep taking a
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ASK ME NOW Questions you should ask your pharmacist to learn more about your prescribed medications: 1. what is the name of the medication and what is it supposed to do? 2. When and how do I take the medication? 3. How long should I take the medication? 4. Does this medication contain anything that can cause an allergic reaction? 5. Should I avoid alcohol, any other medicines, food and/or activities? 6. Should I expect any side effects? 7. What if I forget to take my medications? 8. Is it safe to become pregnant or to breast-feed while taking this medication? 9. Is there a generic version of the medication that my physician has prescribed that may be more affordable? 10. How should I store my medications?
SHORTAGE OF HEALTH WORKERS Many developing countries are facing a shortage of medical workers — leaving health care gaps in nations with high HIV/AIDS, malaria and tuberculosis burdens . Although Africa has 25% of the world’s disease burden, it has only 3% of the world’s health care workers, adding that the continent also is most affected by medical brain drain worldwide. In addition, the continent’s high HIV/ AIDS prevalence has led to an even greater shortage of medical workers who have died from the disease. HIV/ AIDS patients in Africa often use clinics staffed by a single nurse and a few untrained assistants, with a physician visiting once every few weeks.. “A nurse taking care of 400 patients is paid $3 a day in Malawi,” a situation that leads many medical workers in the country to migrate abroad or work for private companies, Moses Massaquoi,
PHARMACIST AT YOUR SERVICE
a physician with Medecins Sans Frontieres in Malawi, said.. some international disease experts earlier this year called the recruiting of African health care workers by Western
nations
an
international
crime.
In India, which has the world’s third highest HIV/AIDS caseload, people often sleep outside of health clinics while waiting for medications and tests, HIV/AIDS advocate Loon Gangte said. Gangte added that the challenge of obtaining care leads some patients to abandon treatment. India has a significant shortage of
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medical workers, with one nurse for every 1,000 patients, compared with 11 nurses for every 1,000 patients in Europe. “Demand is greater than the supply,” Sunita Maheshwari, a pediatric cardiologist in Bangalore, said.
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RNI NO : APBIL 2004/12036
CODEINE Health Canada is advising the public, especially nursing mothers, about the very rare but serious health risk to breastfed babies posed by codeine use in mothers. Once ingested, codeine is converted by the body into morphine. Some people convert codeine into morphine more rapidly and completely than others. The babies of nursing mothers who rapidly metabolize codeine may be at increased risk for morphine overdose due to higher-than-expected morphine levels in breast milk. Codeine is found in prescription and non-prescription products used to relieve pain or to treat coughs. Despite the common use of codeine products to manage postpartum pain, reports of adverse events in infants are rare. However, awareness of this new information is important because in severe cases, infant death can occur. Health Canada recommends nursing mothers take the following precautions to minimize the risk of morphine exposure in breastfed babies: -- Consult a physician before taking any codeine-containing products. -- Read the ingredient list of all over-the-counter medications, especially cough or pain medications, to see if they contain codeine. -- If treatment with codeine is necessary, use the lowest effective dose for the shortest period of time. -- People who metabolize codeine very rapidly may experience overdose symptoms themselves such as extreme sleepiness, confusion, or shallow breathing. While the amount of overdose is generally not considered life-threatening in adults, if you are nursing a child and experience these symptoms, it is important to monitor your child carefully and talk to your doctor.
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POSTAL LIC NO : HSE-806/2006-08
-- Contact a doctor if your breastfed baby is sleepier than usual or has trouble breastfeeding. Seek immediate medical attention if your breastfed baby has difficulty breathing or is limp after you take a health product with codeine.
Tamil Nadu State AIDS Control Society Is launching a campaign that will focus on providing a comprehensive package of HIV/AIDS services to private maternity hospitals in the state in an effort to match services provided at government-run maternity hospitals.. Such services include counseling, treatment, the prevention of motherto-child transmission and managing HIV/TB coinfection. A "key requirement" of the program is "to make counseling an integral feature of HIV testing," according to Supriya Sahu, project director of TANSACS. Private maternity hospitals account for about 38% of the more than 1.1 million deliveries recorded annually in Tamil Nadu, while state-run maternity hospitals account for about 60% of deliveries.. Under the campaign, TANSACS will provide participating hospitals with training, assistance in developing HIV/AIDS treatment capacity, rapid test kits and informational resources. Participating hospitals will be required to implement the package of services and report to TANSACS. In addition, hospitals will be encouraged to participate in the program under an incentive-based component that provides accreditation. As part of an effort to map private maternity hospitals in the state that conduct at least 50 deliveries monthly, TANSACS has measured 1,400 hospitals against specific parameters, such as quality of basic services, pre-test HIV counseling, services offered when a pregnant woman tests positive and interventions to prevent MTCT .
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