Tainan welcomes dengue fever ‘cleanup consultants’

As the total number of confirmed dengue fever cases yesterday reached 12,766 nationwide since the start of summer, the Centers for Disease Control (CDC) sent a group of “cleanup consultants” to Tainan to help with efforts to prevent the spread of the disease.

There were 397 cases of dengue reported nationwide on Monday, with 319 in Tainan and 65 in Kaohsiung, while other counties and cities had fewer cases — three in Taipei; two in Pingtung County, Taoyuan and Taichung; and one in Chiayi City, Chiayi County, Hualien County and Kinmen County.

The CDC said most of the cases reported outside of Tainan and Kaohsiung had traveled to southern Taiwan in the past few months.

As of yesterday, a total of 9,608 people, including 8,400 in Tainan and 1,042 in Kaohsiung, have already recovered from dengue, the centers said, adding that 48 patients remain in intensive care.

The cleanup consultants, volunteers that have experience in dengue fever prevention, arrived at Tainan North District Office yesterday to hold discussions with borough heads and community volunteers about further community cleanup actions.

Meanwhile, the Central Epidemic Command Center asked the Ministry of Health and Welfare’s Tainan Hospital to stop accepting patients that do not need urgent treatment, so that it can focus on the treatment of dengue patients.

The center also urged the public to examine their living environment and to clean anything that contains standing water at least once a week, because mosquito larvae in standing water hatch after about a week.

Patients that contract dengue fever should strictly follow their doctor’s instructions, take medicine, drink lots of water and rest at home as much as possible, the centers said, adding that they should make sure they do not get bitten by a mosquito within five days of being diagnosed to avoid spreading the virus.

Reference: http://www.taipeitimes.com/News/taiwan/archives/2015/09/21/2003628236

Young Taiwanese opting for life-changing experiences overseas

Hung Sheng-kai (洪聖凱, left) and his patient in Burkina Faso. Photo courtesy of Hung
By Elaine Hou, CNA staff reporter
Teaching people in Africa how to take medicine properly and advising them to get tested for HIV are not the typical tasks Taiwan’s young men perform when they serve their mandatory, typically one-year military service after graduating from college.

Many of the men are allowed to serve alternative military service by working in government offices as clerical staff.

But for an increasing number of Taiwanese young men, going to less developed countries to help the people there is a preferred alternative to fulfilling their conscription duty in Taiwan.

Two Taiwanese young adults who recently finished serving their alternative military service overseas said they learned a lot during their time in Burkina Faso and Belize, respectively, and that those experiences have changed their plans for life.

Instead of serving ordinary military service in Taiwan, Hung Sheng-kai (洪聖凱) and Robert Wang (王柏荃) were among the 86 draftees sent overseas last year to serve alternative service to help Taiwanese foreign aid programs.

Taiwan has many programs to help its diplomatic allies in Latin America, Africa and the South Pacific.

During an interview with CNA, Hung said he chose to serve in the African country of Burkina Faso because he was inspired by the story of Lien Chia-en (連加恩).

Lien, a graduate of National Yang Ming University’s medical school, is known for his work in Burkina Faso, including helping build wells and orphanages, while he was serving alternative military service there in 2002.

Lien was among the first group of Taiwanese men on the program initiated by the Ministry of Foreign Affairs in 2001 to promote youth international exchanges and provide opportunities to cultivate talent for international cooperation projects.

Under the program, draftees who pass the selection process and have sought-after skills are allowed to serve alternative service overseas to help with Taiwan’s technical and medical missions, or other aid programs in the Latin American, African and the South Pacific countries.

Since it was launched, the program has seen more than 1,000 Taiwanese young men go abroad to provide assistance to local people in the fields of agriculture, medical services, public health and others, according to the Foreign Ministry.

Before departing for the country they will be posted in, they receive six weeks of training that include foreign language and culture courses, said Taipei-based International Cooperation and Development Fund (TaiwanICDF), which is commissioned by the ministry to organize the pre-departure orientation.

With growing interest in the program, the number of spaces available each year has been gradually expanded, from 36 in 2001 when the program first started to 86 last year.

Learning of Lien’s story, the 26-year-old Hung said he made efforts to follow in his footsteps: enter a medical school and serve alternative service in Burkina Faso to help people there.

After graduating from Tzu Chi University’s School of Medicine, he finally realized his dream when he departed for the African country last November and began his alternative service there.

Recalling his nine months there, Hung told CNA that the challenges he faced went beyond trying to help patients when there was only much less advanced medical equipment available.

While serving at a hospital in Koudougou, a city in central Burkina Faso, he encountered cases in which patients failed to take medicine correctly because the country’s rate of illiteracy was high and many people could not read the instructions.

After discovering the problem, he said, he started to ask his patients to come back to the outpatient clinic after obtaining the medicine from the pharmacy, and then he would “tell” them again how the medicine should be taken, to make sure they knew the dosage to take and how often they should take it.

Robert Wang (王柏荃, center) and his colleagues in Belize. Photo courtesy of Wang

Another unforgettable experience for him was when he found a local man suspected of being infected with the HIV virus. The man and his fiancee had gone to Hung for pre-marriage health checkup.

Hung told the man, in the presence of his fiancee, that he might be infected with HIV and that further testing was needed. The man, however, did not return for the tests, probably due to a sense of embarrassment, Hung said.

From that incident, Hung learned how to better deal with similar cases in the future in a way that avoided the risk of hurting patients’ feelings or making them embarrassed.

“I could have talked to the man individually that he might be infected with HIV virus, without the presence of his fiancee,” he said.

Despite the hardships and poorer environment he encountered in a less developed country, Hung was not deterred. His time in Burkina Faso, instead, sparked his desire to join Doctors Without Borders to provide international humanitarian assistance to refugees and other people in need.

Wang, who obtained a master’s degree in plant pathology and microbiology from National Taiwan University, was another Taiwanese man who learned valuable lessons from his alternative service.

The 25-year-old was posted in the Central American country of Belize to help with a program launched by TaiwanICDF to help combat the citrus greening disease, or Huanglongbing, which is caused by the tiny insect Asian citrus psyllid.

The disease poses a grave threat to Central America’s citrus industry, and could result in huge losses in the production of oranges, tangerines and other citrus fruits.

“I’ve learned a lot,” Wang said of his time in the English-speaking country of Belize from last November to August this year.

It provided him an opportunity to put what he learned at school into practice and apply his knowledge to help local farmers grow healthy citrus-bearing trees, he said.

Through working with local people on the program, he also learned to be patient with others, when being in a country of a different culture, Wang said.

But the most valuable experience was, perhaps, the confidence he gained from living overseas which gave him the courage to apply for a job with international firms that develop agricultural technology, such as Bayer.

“Before I went to Belize, I didn’t think about pursuing a career with big international firms and working overseas because my English ability is not that good,” he said.

“But now I think I can fit into a different culture in a foreign country.”


Reference: http://focustaiwan.tw/news/asoc/201509190008.aspx

Insurance covers asthma treatment with device


By Kiyohiko Yoneyama / Yomiuri Shimbun Staff WriterAsthma causes coughing and difficulty breathing. The predominant method of treating asthma is having patients use inhalers that expand the bronchial tubes, but this year in April, a method using a medical device to expand the bronchial tubes came to be covered by public insurance. It is hoped that this treatment, intended for patients with severe symptoms, can reduce the frequency of attacks.

Asthma can cause pain and wheezing noises when breathing, as well as severe coughing. Some people can also cough up sticky phlegm or feel pain in their chest. There are an estimated 6.9 million sufferers in Japan, and in some cases, if the condition worsens, it can prevent patients from breathing and cause death.

Bronchial tubes are hollow air passages throughout the lungs. As asthma patients experience inflammation inside the tubes, the walls of the tubes swell, constricting the hollow space available for air to pass through. Dust or other irritants can cause the passages to become even narrower and result in an asthma attack.

Until now, a common treatment is to use steroid inhalers that suppress inflammation and other inhalers that expand the bronchial tubes when symptoms occur. Some inhalers on the market offer both treatments.

With the medical device that became covered by public insurance in April, a tube is inserted from the mouth into the bronchial tubes and warms them so that they expand. First, a tube that is about 5 millimeters in diameter reaches the bronchial tubes, then an even thinner tube is inserted through the first tube. An electrode at the end of the thin tube is used to warm the bronchial tubes to 65 C for 10 seconds. This causes the swollen muscle tissue of the bronchial tubes to shrink and allow air to more easily pass through.

The treatment is limited to patients with severe symptoms who are 18 or older and for whom other treatments have been ineffective. The treatment is administered on three occasions separated by intervals of at least three weeks, one time each for the lower right lung, the lower left lung, and the upper parts of both lungs. On each occasion, the device is used to warm up 40 to 70 locations, taking about an hour.

A study team comprising members from the United States, Britain, Canada and others followed 162 patients for five years after receiving the treatment and found that the frequency of attacks declined by about half compared to before the treatment. The frequency of visiting the emergency outpatient unit at hospitals also declined by about 80 percent compared to before the treatment.

This treatment has just been introduced in Japan. It does not completely cure asthma, so patients must continue to take medicine even after receiving this treatment.

“In the future, I would like to verify whether patients could actually stop taking medicine after treatment,” said Yuji Toda, professor in the Department of Respiratory Medicine and Allergology at Kinki University’s Faculty of Medicine in Osaka Prefecture.

“One condition to use this medial device is that patients are only allowed to undergo this treatment once in their lives. The timing of the treatment should be determined in consultation with a doctor,” said Haruhito Sugiyama, chief director of the Department of Respiratory Medicine at the National Center for Global Health and Medicine in Tokyo. During the treatment, because a tube is inserted into the bronchial tubes, space through which air can flow becomes restricted. For this reason, patients with particularly low lung function may not be able to receive the treatment.

For hospitals to provide this treatment, doctors with vast knowledge and experience with asthma need to be trained by the device’s manufacturer.

In addition to the National Center for Global Health and Medicine and Kinki University Hospital, the treatment is available at such institutions as Dokkyo Medical University in Tochigi Prefecture, the National Hospital Organization Tokyo National Hospital in Tokyo and the National Hospital Organization Nagoya Medical Center in Aichi Prefecture.

While treatment of asthma is evolving, it remains essential to prevent attacks and the worsening of the condition. Carefully cleaning the house is important to avoid asthma triggers such as dust, dust mites, mold and animal hairs.

Reference: http://the-japan-news.com/news/article/0002409339

No more backyard business for alternative medicine

The health and wellness sector has experienced significant growth over the past decade as more people became conscious of their lifestyles.

A recent Accenture study said, “health conscious consumers are demanding more from the health and wellness industry—which will grow the consumer health market by more than $200 billion over the next five years.”

The projected market growth of almost 50 percent “will be driven primarily by preventive health and wellness categories,” the study further read.


In the Philippines, alternative medicine has been put aside to give way to western medicine. However, the former is making a comeback. A niche market has been created as a result.

A group of friends composed of Frances Vera Bernardino, Ryan Em Dalman and Carisse Diana “Candy” Drilon-Dalman discovered this niche and invested time, money and expertise to harness the full potential of creating a business out of the expanding consumer healthcare opportunity.

They are all medical doctors who took interest in alternative medicine. Promotion of alternative medicine led them to go on further studies, like in acupuncture.

“Alternative medicine is not taught in med school,” said Candy, who graduated from the Ateneo de Manila University with a medical degree and a master’s in business administration.

Candy and her friends studied the market and found out that most people want expanded alternative treatments in their lives.

“The treatments are available here, but it’s usually expensive. And sometimes it’s a backyard business. Meaning they operate without a license, so the risks of complications are quite high,” she said.

After completing their acupuncture studies in La Consolacion College and other online medical courses, the three friends and four other investors set up a clinic that specifically caters to the unmet needs of the health-oriented consumer searching for alternative medicine.

The concept of “Centro Holistico” is a clinic that offers alternative medical treatments, but at a lower price. Dr. Mikee Vergara, whom they consider their mentor, was tapped to guide them.

“Our approach to health is holistic. We don’t just address the current disease, but also the overall health and wellness of the patient. That’s why when we do consult, we also discuss the lifestyle factors (diet, work, stress, relationships, etcetera). If needed, we also address the emotional and sometimes spiritual aspects of the person. We wanted the name to give this message,” Candy said.

The search for a location first led them to The Fort. But it was congested and the rent was high, Candy said. Eventually, they found a spot in Alabang.

Centro Holistico finally opened its doors in 2014.

They were all surprised by the turnout. A steady stream of patients visited the 88-square meter clinic in Commercenter. By the third month of operations, Centro Holistico was already in the black.

“People were coming in from Cavite, Laguna and Las Piñas. And some, as far as Cubao and Pasig,” said Candy.

Without the use of above the line advertising, Centro Holistico gained patronage via the social media, a kind note from friends, and mostly from word of mouth.

Candy believes that alternative medicine is not just a fad. Many people are seeking ways to cleanse their body using natural methods and are genuinely interested in acupuncture, she said.

Instead of turning to pharmaceutical medicines, more patients want to help their bodies recover and heal through natural processes, she said.

Aside from acupuncture, Centro Holistico offers services such as live blood analysis, colon cleanse, intravenous nutrients (an infusion of immune boosters like high-doses of vitamins C, B-complex, iron and glutathione), alternative cancer treatments, energy healing and ventosa.

“We try to veer away from pharmaceuticals. We want it to be as natural as possible. [We] try to control the illness with a combination of natural and western treatments,” Candy said.

At the clinic, there’s also a small health grocery. They sell superfoods—those that contain antioxidants and are often mixed with juices and smoothies.

“It’s not the cholesterol [that makes people sick], it’s the inflammation in the body. If you remove the inflammation, you will lower your chance of getting sick. The diet should be low in carbohydrates, high in fruits and veggies. If you can’t eat it, drink it. Green smoothies and freshly squeezed juices are perfectly acceptable,” she explained.

Centro Holistico also carries Fruit Magic’s juice line called “Pure Nectar.” Bottles of cold-pressed juice are available. “But we will soon launch our own juice line,” she said.

Centro Holistico is also now in the process of opening a second branch in The Fort next year.

Reference: http://business.inquirer.net/198606/no-more-backyard-business-for-alternative-medicine

Time to end ‘doctor diagnose, pharmacist dispense’ debate

doctor_medi_300KUALA LUMPUR: The Malaysia Consumers Movement (MCM) is calling for holistic consultation with all stakeholders before a decision is made on the “doctor diagnose, pharmacist dispense” proposal which is being hotly debated in the social media.

“The proposal will impact the people by putting individuals at risk for profits,” warns MCM President Darshan Singh Dhillon in adding to the debate.

Doctors would likely increase consultancy fees to make up for their losses, according to MCM, while pharmacists would have more options to maximise business growth. “The present state of uncertainties amid a volatile economy calls for the authorities to explore ideas so the rakyat (people) truly didahulukan (come first),” MCM said.

MCM recalled that the “doctor diagnose, pharmacist dispense” proposal was initially mooted by the government but received vehement objections from medical practitioners, consumer associations and the general public. “The plan which was once shelved has re-emerged in the mainstream media as well, as attempts are being made to reintroduce this proposal.”

“Speculation is rife that the proposal has been finalised, pending execution in April 2015.”

If true, why the intense level of secrecy and elimination of a public consultation period?

“It is worrying to note that objections raised previously would potentially be ignored.”

Is it right for the authorities to succumb to industry pressure at the rakyat’s expense, by ignoring the voices of protest?

At the moment doctors in Malaysia are entrusted to diagnose and prescribe medicines, while pharmacists only dispense drugs as instructed by the former.

“Seemingly, this adequate and time tested system is being subject to scrutiny whereby interested parties are recommending changes which MCM believes would put individuals at a disadvantage,” said Darshan.

The looming question is whether dispensing separation is part of a larger scheme which would be disclosed post April 2015?

The MCM believes that the “doctor diagnose, pharmacist dispense” proposal, if implemented, would have significant repercussions:

For starters, the cost of medical consultation will increase. Under the current system, doctors offset consultation cost by generating profits from the sale of medication. “Soon, medical practitioners would be lobbying to increase consultation fees if these functions are separated,” said Darshan. “Subsequently, consumers will be left at a lurch to pay twice, one for consultation and another for medicine.”

“The incidental price of travelling to a pharmacy would in itself be an additional cost element, not to forget the time required.”

Secondly, pharmacists may step out of line by diagnosing illnesses and the cost of inaccurate prognosis may lead to greater health complexities. The risk is real as the authority of dispensing medication would reside solely in the hands of pharmacists.

Is this a disaster in the making as big pharmacies start to monopolise and proliferate to the detriment of consumers?

Thirdly, it imposes inconvenience for consumers as the current practice provides a one stop mechanism for patients. If the new proposal is adopted, consumers will require increased resources, from time to money and logistics, merely for heading over to a pharmacy which may be a distance away.

How would it be convenient for the underprivileged or senior citizens?

The new system has little good to offer, especially to consumers.

Fourthly, patients may opt for cheaper medication or given the haste, ignore the purchase of medication to reduce cost or in the name of convenience at the expense of one’s health. In some cases, patients may even self-prescribe medication. Collectively, this puts the life of a patient at risk.

Is it viable to take on such risk?

The proposal also allows some individuals to manipulate the system by making it easy to obtain prohibited drugs such as sleeping pills. The pharmacists may not necessarily be held liable as the new system does not necessitate the need for a prescription by doctors prior to the purchase of controlled medication.

Would the new system become a tool for some to harm their own lives?

“Let us not be overzealous in our quest for attaining a high income nation status to the extent of neglecting consumer welfare,” said Darshan.

In this case, he stressed, it was the MCM Agenda to ensure that consumer welfare got top priority. “The act of discussing or allowing dialogue on this proposal makes it appear that the authorities are compromising on their responsibility in upholding the nation’s well-being.”

Needless to say, said Darshan, the new system has little good to offer, especially to consumers.


Reference: http://www.freemalaysiatoday.com/category/nation/2015/02/18/time-to-end-doctor-diagnose-pharmacist-dispense-debate/

Pharmac funds first rare disorder medicine

People with the potentially life-threatening blood condition hereditary angioedema (HAE) will be the first to benefit from Pharmac’s decision to fund medicines for rare disorders.

Pharmac has announced the first medicine it will fund under its new competitive process will be Icatibant (Firazyr), which treats HAE.

The genetic condition causes episodes of swelling that can be life-threatening, and there were up to 90 patients with the condition in New Zealand.

Pharmac hopes to make more funding decisions in the coming months.
Petr Malinak 123RF
Pharmac hopes to make more funding decisions in the coming months.

* Pharmac plea for funds rejected by Government
* TPP could add $1bn to Pharmac costs

In 2014 Pharmac identified up to $25 million available over five years, and sought proposals from companies supplying medicines for rare disorders.

Chief executive Steffan Crausaz said Pharmac had received proposals for 28 medicines, many previously not seen in New Zealand before.

“We’re intending this to be the first of several medicines that will be affordable within the $25 million we have identified as available for rare disorders medicines.

“This is a great outcome for people with hereditary angioedema, and we’re confident of more agreements being reached for other rare disorders in the near future,” Crausaz said.

Health Minister Jonathan Coleman welcomed Pharmac’s decision, and said it would mean HAE patients could get treatment closer to home as the medicine could be self administered.

“Currently people with the condition have to go to hospital if they have a swelling attack.

“With an injection they can take themselves, sufferers of this disorder will be able to live a more normal life.”

Coleman said around 25 patients were likely to meet the access criteria for Icatibant.

He added it was encouraging that so many suppliers had engaged with Pharmac to develop new funding options in providing medicines for small groups of patients.

“I look forward to more negotiations being concluded by Pharmac over the next few months so that New Zealanders can gain benefits from these medicines.


Reference: http://www.stuff.co.nz/national/politics/72100101/pharmac-funds-first-rare-disorder-medicine














For more information: http://www.medsafe.govt.nz/profs/class/agen54.htm

This pill could change how we take medicine forever

“Edible” and “battery” are two words that traditionally don’t make a lot of sense together. Neither do “smart” and “pill”. This is set to change in the coming years.

We all know the human body is extraordinarily complicated. When it comes to taking medicine, your doctor can give you a strong educated guess at what dosage you need, but what if it clashes with another condition? What if you simply forget to take it on time?

Smart pills could revolutionise medicine. It could sense problems on its own, choosing and releasing only the medicine your body needs to fight it.

Worried about taking it on time? It could send a signal to your doctor as soon as it detects your stomach acids, ensuring your records are accurate. It could even withhold its contents, releasing only the amount your body needs.

According to Singularity Hub, common treatments for osteoporosis and arthritis would no longer need to be injected; a smart device could simply wait until it’s passed through the stomach before releasing its contents.

While the ideas are all solid, one core problem has yet to be cracked: making them safe to swallow.

Researchers are now working hard to find safe ways the body can digest complicated electronics, allowing them to disintegrate or pass through without the body wanting to fight back.

Writing for Trends in Biotechnology, Christopher Bettinger, a professor in materials science and engineering at Carnegie Mellon University, made a strong case for pushing forward with this research.

“The breakfast you ate this morning is only in your GI tract for about 20 hours,” said Professor Bettinger. “All you need is a battery that can do its job for 20 hours and then, if anything happens, it can just degrade away”.

“The primary risk is the intrinsic toxicity of these materials – for example, if the battery gets mechanically lodged in the gastrointestinal tract – but that’s a known risk. In fact, there is very little unknown risk in these kinds of devices”.

One of the main reasons medications today are so expensive is that only a small portion of the pill actually makes it where it needs to be in the body. Professor Bettinger says that a smart pill, ensuring the medicine goes exactly where needed, could ultimately be more cost effective in the long run, as it would require less of the medication itself.

“There are many rapid advances in materials, inventions, and discoveries that can be brought to bear on medical problems,” says Professor Bettinger.

“If we can engineer devices that get the most mileage out of existing drugs, then that is a very attractive value proposition. I believe these devices can be tested in patients within the next 5-10 years”.

Would you like to see this technology made a reality? Would you be willing to swallow a smart pill?


Reference: http://www.startsatsixty.com.au/health/this-pill-could-change-how-we-take-medicine-forever

World drug map shows how Australia compares to others on recreational substance abuse

YOU’D expect different drugs to be more or less popular in different countries around the globe.

And for reasons of availability, culture and market forces they tend to be — as this fascinating interactive map shows.

Opiates are big for Russians, Pommy clubbers are in the grip of ecstasy and cannabis is hot in Iceland (although ice, or crystal methamphetamine, is not).

But there’s one shameful standout: Australia. Our country leads the way in consuming four out of five categories. That’s more even than the Americans.

Take a look at how the world gets high, then read on:

The last United Nations World Drug Report confirmed that Australia leads the world in ecstasy and cannabis use, was third for methamphetamines and fourth for cocaine.

The 2014 report also showed that annual use among Australians and New Zealand for all drugs except for opiates like heroin “remain much higher than the global average”.

Cannabis is the most widely used illicit substance across the globe, with the highest prevalence of use among Australians and New Zealanders. More than 10 per cent of the working-age population regularly use cannabis, with 1.9 million people aged 15-65 using it in the 12 months.

Colombia, Peru and Bolivia provide most of the world’s cocaine and are the major sources of the cocaine in Australia.

Most heroin that arrives in Australia is sourced from Southwest Asia. Afghanistan is the primary global producer but smaller quantities are grown in Myanmar, Laos, Thailand and Pakistan.

The data suggests ecstasy is the only drug that is declining in use in Australia — although that may be because of seizures, not because of fading popularity.


In the past five years, there has been significant growth in the detected importation, manufacture and supply of methamphetamine — in particular “ice”. The purity has also increased, making its use even more dangerous. Fifty per cent of the drug is made in Australia and the other half is made overseas: mainly China, Iran, Mexico, US and Canada.

Follow the links above and below to catch up on journalist Paul Toohey’s recent chilling journey through the heart of the “Ice Nation” — and see how it is hitting one city’s children by clicking here.

Professor Michael Farrell, director of the National Drug and Alcohol Research Centre, said long-term drug trends go in cycles: rising, falling or finding a plateau of stability.


“We think we’ve got an ageing heroin using population and that we haven’t currently got many new people coming into it which is a plus. That’s also happening in Europe.

“Interestingly, the United States has diverged and they’ve actually got a new heroin problem. They say it’s coming from Mexico and Colombia.”

Nicole Lee, associate professor at the National Centre for Education and Training on Addiction at Flinders University, said drugs market was quick to adapt to threats and opportunities.

“Availability is definitely one of those things we can identify that is a good predictor of how many people will be using it at any one time,” she said.

“I think the drug trade and drug use operate within similar parameters to other market forces so there’s a little bit of supply and demand”

In recent years, the focus of greatest community concern has been ice, the street version of the powerful stimulant methamphetamine.

The drug, which can be sniffed as a powder, smoked in crystal shards or dissolved in water and injected, is considered highly addictive.

“Sixty to 80 per cent of methamphetamine is made in Australia but nearly all the precursor chemicals come from Southeast Asia,” Lee said.

“That’s why we have one of the highest rates of methamphetamine use in the world.”

Reference: http://m.heraldsun.com.au/news/national/world-drug-map-shows-how-australia-compares-to-others-on-recreational-substance-abuse/story-fntzoymk-1227515964278


Explainer: why are off-label medicines prescribed?

The off-label use of medicines is not illegal and it doesn’t mean regulators have specifically “disapproved” its use. But there are a number of issues to consider before using a medicine off-label.

Before prescription medicines can be used in Australia, the drug company must apply for approval from the government-run Therapeutic Goods Administration (TGA). The same goes for the Food and Drug Administration in the United States, the European Medicines Agency in the European Union, and similar agencies elsewhere in the world.

The drug company has to specify the health conditions the medicine will be used for (also called “indications”), the doses, the routes of administration (tablet, injection, lotion, for instance) and the types of patients who will use the medicine (adults or children).

The drug company has to provide the TGA with evidence to support the use of the medicine in this way, including clinical trial data. The TGA then evaluates this evidence. If it supports the request, the medicine will be approved for use as requested in the application.

If a prescription medicine is used for a different reason, at a different dose or route of administration, or in different patient groups from those approved by the TGA, then this is referred to as “off-label” use.

You might have heard that there are concerns about people using antipsychotic medicines off-label, for instance, to help with sleeping problems or anxiety.

Why are medicines prescribed off-label?

Doctors should prescribe medicines off-label only when there are no suitable TGA-approved medicines to treat a patient. There also needs to be evidence to show the medicine is safe and effective for the off-label patient groups or conditions.

Evidence to support use of a medicine for a new indication or in different patient groups often becomes available years after a medicine is first approved. To change the TGA approval to reflect such evidence, the drug company needs to make an application for approval for these new uses.

The TGA approval process is expensive and it may not be in the commercial interests of the drug company to pay the fees to extend the listing, especially for older medicines.

Medicines are also frequently used off-label in groups of patients who weren’t included in clinical trials for the medicine. This includes children, pregnant women and people receiving palliative care, who are usually excluded from clinical trials. Off-label use of medicines is also common in psychiatry and cancer.

What are the risks?

One of the risks with using medicines off-label is that the quality of evidence to support such use may be lower than for approved indications.

The effectiveness of a medicine used for an off-label indication might not have been tested in clinical trials, so the extent to which patients will benefit from using the medicine might be unknown. Studies have shownthat when medicines are used off-label, they are less effective than medicines used for approved indications.

If the medicine is used for an off-label patient population, the risks and side effects in these patients might be unclear. Off-label medicine use is more likely to be associated with side effects.

The cost of using medicines off-label may also be prohibitive. Most prescription medicines in Australia are subsidised on the Pharmaceutical Benefits Scheme (PBS). Patients pay a co-payment for PBS medicines, with the government subsidising the remainder of the cost. Medicines prescribed off-label aren’t subsidised on the PBS, so the patient has to pay the full cost. Depending on the medicine, this can be expensive.

What are the benefits?

Although there are risks associated with off-label use of medicines, in some situations off-label use may be the best or only treatment option for patients, particularly children, pregnant women and palliative care patients.

Off-label prescribing also allows medicines to be used for new indications or in different patient groups as soon as new evidence becomes available, rather than having to wait for the TGA approval process to occur, which can take some time.

Off-label use of medicines can play an important role in health care, particularly when this is the only treatment option for patients. But it’s important to remember that we still need evidence to show the medicine works for the off-label condition and that the benefits of using the medicine outweigh the risks.


Reference: http://theconversation.com/explainer-why-are-off-label-medicines-prescribed-44783