Caduceus Newsletter: Summer 2013.01, June
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Table of Contents:
1. Cancer Doctors Protest
‘Astronomical Drug Costs’.
1. Cancer Doctors Protest ‘Astronomical Drug Costs’.
Cancer Doctors Protest 'Astronomical' Drug Costs
Lisa Collier Cool
With some new, potentially lifesaving cancer drugs costing up to $138,000 a year, about 120 leading cancer specialists have joined forces in an unusual protest aimed at getting pharmaceutical companies to cut prices.
Charging high prices for drugs cancer patients need to survive is like “profiteering” from a natural disaster by jacking up prices for food and other necessities, leading cancer doctors and researchers from around the world contend in a new paper published in Blood, the journal of the American Society of Hematology.
Of 12 new cancer drugs that received FDA approval last year, 11 of them cost in excess of $100,000 a year—prices that the specialists attack as “astronomical,” “unsustainable,” and maybe even immoral. What’s more, only three of these drugs were found to improve patient survival rates and of these, two only increased it by less than two months, according to the Washington Post.
“Advocating for lower drug prices is a necessity to save the lives of patients,” say the specialists who wrote the paper, who specialize in chronic myelogenous leukemia (CML), but emphasize that sky-high drug costs affect patients with many types of cancer.
Going Bankrupt to Stay Alive
“Medical illness and drug prices are the single most frequent cause of personal bankruptcy” in the US, according to the specialists, where patients’ copayments on drug prices average 20 percent of the total cost of the drug. That means that cancer patients often face having to shell out $20,000 to $30,000 a year, simply to stay alive.
The specialists also note that astronomical drug prices may be the single most common reason why patients stop taking lifesaving drugs. This is particularly true for those with CML, which requires daily treatment for long-term survival.
As a result the paper says, “grateful patients may have become the ‘financial victims’ of the treatment success, having to pay the high price annually to stay alive.” One study found that 10 percent of cancer patients fail to fill new prescriptions for oral cancer drugs.
For some patients, such as breast cancer survivor Patti Tyree, medical costs—not the disease—are stealing their future. The 57-year-old postal worker inherited $25,000, but after just one round of treatment for breast cancer, nearly half of the money is gone—and bills continue to pour in, she told USA Today.
One of the more expensive therapies for CML is Gleevec, a cancer drug that generated $4.7 billion in sales last year, making it the bestselling drug for its manufacturer, Novartis. Another Novartis leukemia drug, Tasigna, had sales of $1 billion, according to The New York Times.
Doctors Pressure Drug Companies to Slash Prices
Some of the specialists who joined the protest were inspired by the doctors from Memorial Sloan Kettering Cancer Center (MSKCC) who refused to use a new colon cancer drug called Zaltrap because it cost more than twice as much ($11,063 on average for one month of treatment) as another drug (Avastin) without improving outcomes.
“Soaring spending has presented the medical community with a new obligation. When choosing treatments for a patient, we have to consider the financial strains they may cause alongside the benefits they might deliver,” the MSKCC doctors wrote in an October, 2012 op-ed for The New York Times about their boycott.
Subsequently, the drug’s manufacturer slashed the price by 50 percent.
Cancer Drugs Rank Among the World’s Most Expensive
The idea that "one cannot put a price on a human life” has led to wildly overblown healthcare costs in the U.S., estimated at $2.7 trillion in 2011, according to the paper’s authors, who urge insurers and government to more aggressively negotiate with pharmaceutical companies.
Many reports show that cancer drugs consistently rank as the most expensive therapies, even though some only extend life by a few months or offer no benefit over older, less expensive drugs.
The paper discussed Gleevec, which was originally priced at about $30,000 a year when it was approved in 2001. Since then, the price has tripled. However, its manufacturer told The New York Times that relatively few patients actually pay the full cost—and that the price reflects the high cost of developing new medications, which reportedly exceeds $1 billion.
Yet even doctors involved with developing Gleevec, such as Dr. Brian Druker, are criticizing Novartis, which raked in $4.7 billion in sales for the drug in 2012.
“If you are making $3 billion a year on Gleevec, could you get by with $2 billion?” Dr. Druker, now director of Knight Cancer Institute at Oregon Health and Science University, said in an interview with The New York Times. “When do you cross the line from essential profits to profiteering?”
2. The American Association of Colleges of Osteopathic Medicine is pleased to announce that it’s Application Service for the 2013-2014 application is now LIVE.
Dear Advising Colleagues and Friends,
AACOMAS is pleased to announce that on Wednesday, May 1, 2013 we launched “live” the 2014 AACOMAS application cycle. We will begin to receive applications that may be submitted on June 3, 2013. At of today, we have already received over 2,100 applications that have been started by applicants around the nation.
You will find the 2014 AACOMAS application at: https://aacomas.aacom.org/ and 2014 AACOMAS Instructions at: http://www.aacom.org/Documents/AACOMASInstructions.pdf
Applicants applying in the 2014 cycle must submit their most current Spring coursework transcript with posted grades. We will not begin to process applications until Spring grades are posted.
AACOMAS 2014 Guest Account
We are pleased to provide you (and your students) with the following “Guest Account” established for your review with applicants to the AACOMAS 2014 application cycle. Please note, all advisors have access to this account so information entered into the application will change frequently.
Guest Account – 2014 AACOMAS Application
Email or Username: email@example.com
We hope this is a useful feature for your advising needs with students and applicants to the nation’s 29 Osteopathic Medical Colleges and 4 branch campuses this application cycle.
If you have any questions, please do not hesitate to contact me directly. We look forward to working with you and your applicants throughout the 2014 cycle.
PS: Additionally, please find below a wide array of 2014 AACOMAS resources for your use when advising students and applicants to the nation’s Osteopathic Medical Colleges. Please share this with your students so that they may become better informed on the many ways to have access to accurate and timely information on our programs and 2014 application cycle.
Information for Pre-Health Advisors
Information for Applicants and Potential Applicants
Advisor Information Center (AIC) Portal
2014 AACOMAS Application
2014 AACOMAS Instructions Manual
2014 College Information Book
Starting a Pre-SOMA Chapter at Undergraduate Campuses
Osteopathic Medical College Recruiting Events
A Brief Guide to Osteopathic Medicine, For Students, By Students
Glossary of Osteopathic Terminology
Data and Trends
What Is Osteopathic Medicine?
American Osteopathic Association
AOA's International Practice Rights Map
Gina M. Moses, M.Ed.
Associate Director of Application Services
American Association of Colleges of Osteopathic Medicine
5550 Friendship Blvd., Suite 310
Chevy Chase, MD 20815-7231
Tel: (301) 968-4184
Fax: (301) 968-4191
3. The United States Air Force offers a Health Professions Scholarship Program.
*** Air Force Scholarship Program ***
HEALTH PROFESSIONS SCHOLARSHIP PROGRAM
FOR MEDICAL STUDENTS
HOW WOULD YOU LIKE TO HAVE ALL FOUR YEARS OR YOUR FINAL THREE YEARS OF MEDICAL SCHOOL PAID FOR
And receive $2122.00 a month
PLUS A 20,000.00 Sign on Bonus?
WE HAVE A LIMITED NUMBER OF 3 & 4 YEAR HEALTH PROFESSIONS SCHOLARSHIPS AVAILABLE, BUT YOU WILL HAVE TO ACT FAST
Full Tuition and all required materials paid for including Books, Labs, Laptops etc…..
Two shots at the residency of your choice with the option of Civilian or Military Residency
Start your Professional Career Debt Free
CALL: TSgt Jacob Brandis
4. ===AAMC STAT===, News from the Association of American Medical Colleges, May 6, 2013 issue.
Autism manifests in early childhood and is characterized by qualitative abnormalities in social interactions, markedly aberrant communication skills, and restricted repetitive and stereotyped behaviors.
An examination of placentas obtained from 117 births from a cohort of families who have one or more previous biological children with ASD found that placentas from at-risk pregnancies had an eightfold increased odds of having two or more trophoblast inclusions (TIs) compared with control samples. The presence of ≥2 TIs yielded a sensitivity of 41% and a specificity of 92% for predicting ASD risk status. The presence of ≥4 TIs yielded a sensitivity of 19% and a specificity of 99.9%. At-risk placentas had as many as 15 placental folds, whereas none of the control group placentas (n = 100) had more than 2.[1, 2]
Behavioral and developmental features that suggest autism include the following:
· Developmental regression
· Absence of protodeclarative pointing
· Abnormal reactions to environmental stimuli
· Abnormal social interactions
· Absence of typical responses to pain and physical injury
· Language delays and deviations
· Susceptibility to infections and febrile illnesses
· Absence of symbolic play
· Repetitive and stereotyped behavior
Regular screening of infants and toddlers for symptoms and signs of autistic disorder is crucial because it allows for early referral of patients for further evaluation and treatment. Siblings of children with autism are at risk for developing traits of autism and even a full-blown diagnosis of autism. Therefore, siblings should also undergo screening not only for autism-related symptoms but also for language delays, learning difficulties, social problems, and anxiety or depressive symptoms.
See Clinical Presentation for more detail.
Examination for patients with suspected autistic disorder may include the following findings:
· Abnormal motor movements (eg, clumsiness, awkward walk, hand flapping, tics)
· Dermatologic anomalies (eg, aberrant palmar creases)
· Orofacial, extremity, and head/trunk stereotypies (eg, purposeless, repetitive, patterned motions, postures, and sounds)
· Self-injurious behaviors (eg, picking at the skin, self-biting, head punching/slapping)
· Physical abuse inflicted by others (eg, parents, teachers)
· Sexual abuse: External examination of genitalia is appropriate; if bruises and other evidence of trauma are present, pelvic and rectal examinations may be indicated
Only clinicians who have considerable experience with children with autism should administer tools that have been developed to diagnose autism and other pervasive developmental disorders.
Children who display some features of autism are broadly categorized in the class of autism spectrum disorders. The formal nomenclature for these disorders remains in flux. Identification of the key dimensions characteristic of autism spectrum disorders may be a more accurate means of distinguishing subtypes of these conditions.
The DSM-IV-TR has 3 key criteria for the diagnosis of autistic disorder, as follows :
· Impairments in social interaction
· Impairments in communication
· A restricted, repetitive range of interests, behaviors, and activities
There are no blood studies recommended for the routine assessment of pediatric autism spectrum disorder. Although several metabolic abnormalities have been identified in investigations of people with autism (eg, elevated 5-HT, reduced serum biotinidase, abnormal neurotransmitter functions, impaired phenolic amines metabolism), a metabolic workup should be considered on an individual basis. No biologic markers for autism currently exist.
The American Academy of Neurology and the Child Neurology Society recommend genetic testing (eg, with high-resolution chromosome studies and DNA analysis) for fragile X in autistic children who meet any of the following criteria :
· The child has mental retardation
· Mental retardation cannot be excluded
· There is a family history of fragile X or undiagnosed mental retardation
· Dysmorphic features are present
Studies that may be helpful in the evaluation of autistic disorder include the following:
· EEG: To exclude seizure disorder, acquired aphasia with convulsive disorder (Landau-Kleffner syndrome), biotin-responsive infantile encephalopathy, related conditions
· Psychophysiologic assessment: To show lack of response habituation to repeatedly presented stimuli (in respiratory period, electrodermal activity, vasoconstrictive peripheral pulse amplitude response); auditory overselectivity may be seen
· Polysomnography: To identify sleep disorders and to demonstrate seizure discharges
There is currently no clinical evidence to support the role of routine clinical neuroimaging in the diagnostic evaluation of autism, even in the presence of megalencephaly. Although characteristic abnormalities have been identified, no single finding is diagnostic.
The following imaging techniques have yielded inconsistent results in evaluating autism:
· MRI with or without diffusion tensor imaging
· CT scanning
· PET scanning
· SPECT scanning
See Workup for more detail.
The established therapies for autistic disorder are nonpharmacologic and may include individual intensive interventions. Individuals with autism spectrum disorder and unspecified pervasive developmental disorder typically benefit from behaviorally oriented therapeutic programs developed specifically for this population. Autistic children should be placed in these specialized programs as soon as the diagnosis is suspected.
· Intensive individual special education
· Speech, behavioral, occupational, and physical therapies (eg, assisted communication, auditory integration training, sensory integration therapy, exercise/physical therapy)
· Social skills training in some children with autism spectrum disorder, including those with comorbid anxiety disorders; children with autism spectrum disorder and comorbid ADHD may benefit less from social skills training
No pharmacologic agent is effective in the treatment of the core behavioral manifestations of autistic disorder, but drugs may be effective in treating associated behavioral problems and comorbid disorders (eg, self-injurious behaviors, movement disorders). The possible benefits from pharmacotherapy must be balanced against the likely adverse effects on a case-by-case basis (eg, venlafaxine may increase high-intensity aggression in some adolescents with autism )
Medications used in managing related behavioral problems and comorbid conditions in children with autism include the following:
· Second-generation antipsychotics (eg, risperidone, aripiprazole, ziprasidone)
· SSRI antidepressants (eg, fluoxetine, citalopram, escitalopram)
· Stimulants (eg, methylphenidate)
Individual intensive interventions, including behavioral, educational, and psychological components, are the most effective treatments of autistic disorder. Beginning the treatment early in infancy increases the likelihood of a favorable outcome. Thus, regular screening of infants and toddlers for symptoms and signs of autistic disorder is crucial because it allows for early identification of these patients.
Individuals with autism spectrum disorder and unspecified pervasive developmental disorder typically benefit from behaviorally oriented therapeutic programs developed specifically for this population. Autistic children should be placed in these specialized programs as soon as the diagnosis is entertained.
Parents, teachers, pediatricians, and other health care providers are advised to seek the assistance of people who are familiar with early intervention programs for children with autistic disorder. The Autism Society can help parents to obtain appropriate referrals for optimal interventions.
Parents understandably become exhausted by the relentless performance of challenging behaviors by their child with autism. A specially trained educator or behavioral psychologist can help to teach them effective ways to modify these challenging behaviors. Parents also frequently benefit from temporary respite from the child.
The possible benefits from pharmacotherapy must be balanced against the likely adverse effects on a case-by-case basis. In particular, venlafaxine may increase high-intensity aggression in some adolescents with autism.
Limited, largely anecdotal evidence suggests that dietary measures may be helpful in some children with autism. Avoidance of certain foods, notably those containing gluten or casein, and supplementation with specific vitamins and minerals have reportedly proved helpful in select cases.
The National Autism Center has initiated the National Standards Project, which has the goal of establishing a set of evidence-based standards for educational and behavioral interventions for children with autism spectrum disorders. The project has identified established, emerging, and unestablished treatments.
Special education is central to the treatment of autistic disorder. Although parents may choose to use various experimental treatments, including medication, they should concurrently use intensive individual special education by an educator familiar with instructing children who have autistic disorder or a related condition. Intensive behavioral interventions, instituted as early as possible, are indicated for every child in whom autistic disorder is suspected.
The Education for All Handicapped Children Act of 1975 requires free and appropriate public education for all children, regardless of the extent and severity of their handicaps. Amendments to the Education of the Handicapped Act of 1986 extended the requirement for free and appropriate education to children aged 3-5 years.
Pediatricians and parents cannot assume, however, that their community’s school will provide satisfactory education for a child with autistic disorder or a related condition. The Individuals with Disabilities Education Act authorized states to determine how to provide educational services to children younger than 3 years. Pediatricians and parents need to determine the best way to proceed with local agencies.
Legal assistance may be necessary to influence a board of education to fund appropriate education for a child with autistic disorder or a related condition. TheAutism
In addition, social skills training helps some children with autism spectrum disorder, including those with comorbid anxiety disorders. Children with autism spectrum disorder and comorbid attention deficit hyperactivity disorder may not benefit from social skills training.
In a 2-year randomized, controlled trial, children who received the Early Start Denver Model (ESDM), a comprehensive developmental behavioral intervention for improving outcomes of toddlers diagnosed with autism spectrum disorder, showed significant improvements in IQ, adaptive behavior, and autism diagnosis compared with children who received intervention commonly available in the community.A follow-up electroencephalographic study showed normalized patterns of brain activity in the ESDM group.
In contrast, a 12-week study of parent-delivered ESDM intervention found no effect on child outcomes compared with usual community treatment. However, starting intervention at an earlier age and providing a greater number of intervention hours both related to the degree of improvement in children's behavior.
Individuals with autistic disorder or a related condition need 3 well-balanced meals daily. Dietary consultation may be useful to evaluate the benefits of special diets, including those lacking gluten and casein. Vitamin B-6 and magnesium are among the vitamins and minerals hypothesized to help some patients.
In a randomized, double-blind, placebo-controlled trial, 3 months of treatment with a vitamin/mineral supplement produced statistically significant improvement in the nutritional and metabolic status of children with autism. In addition, the supplement group had significantly greater improvements than did the placebo group in its Parental Global Impressions-Revised (PGI-R) Average Change scores.
Although 70% of children with autism spectrum disorder receive medications, only limited evidence exists that the beneficial effects outweigh the adverse effects.No pharmacologic agent is effective in the treatment of the core behavioral manifestations of autistic disorder, but drugs may be effective in treating associated behavioral problems and comorbid disorders.
The second-generation antipsychotic agents risperidone and aripiprazole provide beneficial effects on challenging and repetitive behaviors in children with autism spectrum disorder, although these patients may experience significant adverse effects. Risperidone and aripiprazole have been approved by the US Food and Drug Administration (FDA) for irritability associated with autistic disorder. The second-generation antipsychotic agent ziprasidone may help to control aggression, irritability, and agitation.
Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed for children with autism and related conditions. Beneficial effects on children and adolescents with autism and other pervasive developmental disorders have been reported with fluoxetine, escitalopram, and citalopram[126, 127] .
On the other hand, a multicenter, randomized, controlled trial by King and colleagues in 149 children with autism spectrum disorders found no difference between citalopram and placebo among children rated as much improved or very much improved. Participants in the treatment arm received liquid citalopram daily for 12 weeks at a mean maximum daily dose of 16.5 mg (maximum 20 mg). Nearly all the citalopram recipients reported adverse effects (eg, impulsiveness, hyperactivity, diarrhea).
Children with autistic disorder are at risk of developing a serotonin syndrome when treated with serotonergic agents. Therefore, children who are treated with serotonergic agents should be evaluated at baseline before beginning treatment and then regularly evaluated for symptoms of a serotonin syndrome using the serotonin syndrome checklist.
Children with autistic disorder appear sensitive to medication and may experience serious adverse effects that outweigh any beneficial effects. For example, children may develop catatonia when treated with haloperidol and other traditional neuroleptics. Additionally, Kem et al noted priapism in an adolescent with autism who was treated with trazodone.
Practice guidelines from the American Academy of Pediatrics stress the importance of having some quantifiable means of assessing the efficacy of medication used for the treatment of children with autism. Validated, treatment-sensitive rating scales that have been used in clinical practice to measure the effects of treatment on maladaptive behavior include the Clinical Global Impression Scale, the Aberrant Behavior Checklist, and the Nisonger Child Behavior Rating Form.
Various interventions, including chiropractic manipulations, are reported to help with autistic disorder. The results of individual case reports, however, cannot be generalized to the overall autistic population; scientific research is needed to investigate whether treatments truly are generally helpful.
Several anecdotal reports suggested that secretin, a gastrointestinal hormone that may function as a neurotransmitter, was an effective intervention for the symptoms of autism. This led to several scientific studies of secretin for children with autism spectrum disorders.[131, 132, 133] However, 2 reviews of these trials failed to demonstrate that secretin had a beneficial effect on these children.[134, 135]
Beneficial effects from hyperbaric oxygen therapy have been reported in 6 patients with autism. The risks of this procedure must be weighed against the benefits for individual patients. Controlled clinical trials and other studies are needed to confirm the potential value of this intervention.
Children with autism and related conditions typically benefit from intensive, thorough evaluation performed by experienced professionals. Intensive diagnostic evaluation and treatment are accomplished quickly and effectively by well-trained clinicians at well-staffed centers. Valuable resources are listed below.
The American Association of Colleges of Podiatric Medicine would like to cordially invite your students to FootFest2013 at the Western Podiatry Conference in Anaheim, CA. Taking place on Friday, June 21st from 9:30 am until 4:00 pm at the Disneyland Hotel and Convention Center located at 1150 West Magic Way, FootFest2013 is an exciting day inside the world of podiatric medicine. Students will participate in a panel of current members of the podiatric medical community, spend the day attending lectures on cutting edge surgical techniques, and receive a free lunch as well as special giveaways and goodie bags. The entire program is completely free of charge and a limited number of spots are available. Attached, please find the flyer for this program. We encourage you to please share the information about this event with your students as registration for this event is filling up fast. To register or for questions regarding this exciting event, please contact Daniel Taubman via email at firstname.lastname@example.org or via phone at 301-948-0958 or. We look forward to seeing you in Anaheim!
allergic to the metric system, corn starch, or unbridled joy, you'd probably
be more comfortable watching Matlock than at the starting blocks of this
Stan Eisen, Director
Preprofessional Health Programs
Christian Brothers University
650 East Parkway South
Memphis, TN 38104
Caduceus Newsletter Archives: http://www.cbu.edu/~seisen/Caduceus.html