No More Needles? Oral Flu Vaccine Tablet Shows Promise in Phase 2 Trial

Flu Vaccine Oral Tablet
Participants were successfully challenged intranasally with homologous A strain influenza virus 90-120 days after vaccination to see if they had developed any immunity,

An investigational H1 influenza oral tablet vaccine was found to provide similar protection against influenza as an injectable quadrivalent influenza vaccine (QIV) in a Phase 2 clinical trial. 

The trial participants were randomized to receive either a single dose of Vaxart oral tablet vaccine and a placebo intramuscular injection, a QIV injection plus a placebo tablet, or a double placebo. They were challenged intranasally with homologous A strain influenza virus 90–120 days after vaccination. Laboratory-confirmed homologous influenza A infections were compared among the groups.

Results showed that the tablet vaccine provided a 39% reduction in clinical disease relative to placebo, compared to a 27% reduction with injectable QIV. The tablet also demonstrated a safety profile similar to placebo.

“These results provide clinical proof-of-concept for Vaxart’s groundbreaking oral tablet vaccine technology,” said Wouter Latour, MD, MBA, CEO of Vaxart, in a press release. “A convenient and effective tablet vaccine could significantly increase current vaccination rates and generate important public health benefits for at-risk groups and the population as a whole.”

For more information visit Vaxart.com.

 

Click here to read the original article.

 

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The flu vaccine doesn’t cause the flu. Period.

by Jennifer Gunter MD

Child Receiving Flu Vaccination

Over 80 percent of children who died from flu last year were not vaccinated.

Flu vaccines are available, and so that means that the anti-vaccine brigade is out in force.

 

The Daily Mail published an anti-vaccine op-ed by a former reality TV contestant named Katie Hopkins. It was followed by a shorter counter argument by a doctor, but when you are given less than half the word count and are at the bottom of the page it is hard to mount an effective response. Hopefully the Daily Mail will give us an op-ed next week on how the earth is flat.

I noticed many responses to Ms. Hopkins on Twitter were from people who claimed that they previously caught the flu from the vaccine.

So one more time, for all the kids in the back: The flu vaccine does not cause influenza.

The flu vaccine is made with an inactivated virus that cannot cause illness or with a process using a recombinant technology that contains no virus at all.

The nasal spray, not recommended currently in the United States due to lower efficacy, also can’t cause the flu. It does have a live virus, but it is highly weakened and can’t cause infection.

Children should absolutely get the vaccine. In the 2016-2017 flu season over 100 children in the United States died from the flu. Over 80 percent of those who died were not vaccinated.

If you get sick right after the flu vaccine one of the following has happened:

  1. You have a cold, and you have mistaken it for the flu.
  2. You have the flu, but you were incubating it before the vaccine. The vaccine takes about two weeks to work.
  3. You have the flu and were unlucky enough to get a strain not covered by the vaccine.
  4. You have the flu, and it is a strain that is covered by the vaccine, but you did not get as sick as you would have without the vaccine.
  5. Nocebo effect. You expected something bad to happen and so your body produced symptoms.

If you aren’t sure, it is the flu let me tell you it isn’t the flu. With the flu, you really feel as if you are going to die. It’s that bad. I had it several years ago, and for two days I had to crawl to the bathroom. I was too weak to walk.

So let’s please put this myth to rest.

The flu vaccine doesn’t cause the flu.

 

Link to original article published in MedPage Today

 

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Mammography Patient Teaching-Aid Video

Mammography Training

Mammography

US Pharm..

Mammography Patient Teaching Aid Video

Mammography Detects Early Breast Cancer

The earlier cancer is found, the better the chance of a cure. Breast cancer is no exception because small breast cancers are less likely to spread to lymph nodes and vital organs such as the lungs and the brain. Mammography is an early screening test that can detect very small changes in breast tissue before a lump is felt. The low-dose x-ray of the mammogram shows abnormalities in breast tissue, such as masses or calcium deposits. Because an abnormality detected by a mammogram may not be cancerous, some follow-up testing is often required by a physician for a final diagnosis.

Capturing Clear Tissue Images

A mammogram is a simple test that uses a machine designed specifically to observe breast tissue. During the x-ray, the breast is positioned on the machine’s flat surface while it is compressed by another flat surface. Flattening the breast tissue allows the radiologist to see a clearer image of the tissue. The compression of the breast between the plates is done twice—once vertically and once horizontally.

Tutorial on Mammography Types

There are three basic types of x-ray mammography: standard, digital, and three-dimensional (3D). The standard mammogram takes an x-ray, and the image is printed on a large sheet of film for review by a radiologist using a light box. A digital mammogram (called full-field digital mammography, or FFDM) takes a low-dose x-ray image that is stored digitally on a computer and reviewed on a digital screen. Because the x-ray images are easier to store and retrieve with digital mammograms, they are becoming more common. The newest type of mammogram is 3D mammography (or breast tomosynthesis). For this x-ray, the breast is compressed between the two flat plates only once, and the machine takes many low-dose x-rays as it moves around the breast. A computer then arranges the images  into a 3D picture. Three-dimensional mammography is not covered under all health insurance policies, but it may allow doctors to see the breast tissues more clearly.

Screening Recommendation Depends on Risk Factors

Approximately one in every eight women in the United States will develop breast cancer during her lifetime, and the risk of breast cancer increases dramatically with age. Regular screening mammograms in women over age 40 years have been proven to lower the number of deaths due to breast cancer.

Your doctor will recommend a breast cancer–screening schedule after taking into account your age and specific risk factors. The general recommendation for women with an average risk of breast cancer is for mammograms to begin at age 45 years, or as early as age 40 years if the patient chooses. For these women, follow-up mammograms should occur every 1 to 2 years. Women with a higher risk of breast cancer, such as those with a family history of breast cancer or with certain genetic markers for breast cancer, may need to start screening earlier and receive screening more often. Unfortunately, mammography is not a perfect testing procedure. X-rays of breast tissue may not show all cancers, or they may falsely show an abnormality that is not present. This imperfection is why repeated screening on an agreed-upon schedule is important.

Preparing for a Successful Mammogram

If you are going to a mammography facility for the first time, bring a list of the places and dates of mammograms, biopsies, or other breast treatments you have had before. On the day of the mammogram, refrain from using creams, deodorants, powders, and perfumes under the arms or near the breasts. In some women, the pressure used to flatten the breast causes some temporary discomfort, but most women do not consider mammograms painful. To minimize the discomfort of a mammogram, schedule your appointment when your breasts are not tender or swollen and try to avoid the week just before your period.

If you have any questions about mammograms for breast-cancer screenings or community resources that provide affordable low or no-cost screenings for women, speak with your trusted local pharmacist or another healthcare provider.

Link to Original Article in US Pharmacist Magazine

To comment on this article, contact [email protected]

 

Most people can’t successfully comparison shop for healthcare

by Ateev Mehrotra MD

Comparison Shopping for Healthcare

As a doctor,  I’m the perfect person to price shop for an operation. But the process went terribly.

 

After three months of using hot compresses to shrink the stye on my daughter’s eyelid, it wasn’t getting any smaller. My daughter is prone to this sort of growth, called a chalazion. This one would have to be removed surgically, like the one she had removed from the same eyelid two years earlier.

But there was one key difference this time around: Like tens of millions of people who get health insurance through their employer, my family was now in a high-deductible health plan. That meant we would have to pay for the entire cost of the surgery out of pocket. Suddenly, the cost of the surgery became very important to our family.

Encouraging patients to price shop for their health care is one reason employers are switching to high-deductible plans. The theory is that patients will compare prices across different doctors or hospitals and choose the lower-priced one, thereby saving themselves (and their employer) money. But in order to shop, you need to be able to see what something costs beforehand. Transparency in health care prices is a goal of President Trump’s health agenda, and is a priority for other politicians as well.

My family had every advantage that newly minted price shoppers could possibly have: We live in Massachusetts, one of the states that have passed price transparency laws to help patients shop for care; I am a physician; my research focuses on consumerism and price transparency, giving me plenty of insider information; and the surgery was minor and not urgent, giving us lots of time to shop around.

How did it go? Terribly. Here’s why:

On the website for our health plan, we muddled our way to its hard-to-find price transparency page. When we finally got there, we didn’t get the information we needed: removing a chalazion is not a common procedure, so it wasn’t listed.

An ophthalmologist would remove the growth. The billing department for the ophthalmologist who evaluated my daughter could tell us only what the doctor’s fee for the surgery would be ($1,007) and didn’t know the fees for the anesthesiologist or the operating room, both of which could be as much as, or more than, the doctor’s fee.

To get a better price estimate, we called our health plan. It asked us to submit a written cost request for the surgeon and the hospital we were considering. Twenty-four days later, we received an estimate of $452, which was both incomplete (it only showed the ophthalmologist’s fee) and incorrect (the health plan mistakenly assumed we were in a different insurance plan).

Other ophthalmologists we called said they would give us a price quote for the surgery only if we brought our daughter in to be evaluated. Each evaluation visit would cost more than $200.

One month into our price-shopping effort, all we knew was that the ophthalmologist’s fee would be in the $452 to $1,007 range, and the total surgery would cost much more. All the while, the red, swollen eyelid on our increasingly miserable middle-schooler was waiting to be treated. So, we decided to go ahead and have the original ophthalmologist do the surgery, even though we had no idea what it would really cost.

In the end, it cost us $1,443, including $556 for the ophthalmologist and $887 for the anesthesiologist and hospital. Despite the challenges, we recognize that we were fortunate — our daughter’s surgery went well and we could afford this unbudgeted expense. Others aren’t so fortunate.

Sadly, my family’s price-shopping experience is the norm in the U.S. My colleagues and I have found that most people can’t successfully shop for care, and that offering people a price transparency website doesn’t help them switch to lower-cost providers and doesn’t decrease health care spending.

Why isn’t price transparency currently working? It’s not that Americans don’t agree with the idea of shopping for health care. Most believe it makes sense and could save money for families and the health care system. Many recognize that there’s a great deal of price variation and believe that health care prices have little relation to quality, a suspicion our research backs up.

What can be done? First, we need to bundle payments to hospitals and surgery centers: a single payment that covers everything related to a procedure or doctor visit. Patients shouldn’t have to navigate the craziness of different bills for the hospital, surgeon, operating room, pathologist, anesthesiologist, and the like.

Click here to read the rest of this article originally published in STAT

 

 

 

JD Power Identifies Decline in Pharmacy Customer Satisfaction Driven by Escalating Prescription Drug Costs

by Michael Johnsen

 

The U.S. pharmacy industry, perennially one of the highest-scoring industries measured by J.D. Power, experienced notable declines in overall customer satisfaction this year, the research firm reported Tuesday.

According to the J.D. Power 2017 U.S. Pharmacy Study, decreases in satisfaction with both brick-and-mortar and mail order pharmacies were driven primarily by declines in satisfaction with cost.

“Pharmacies have historically earned very high marks for customer satisfaction, so any significant year-over-year decline is cause for closer investigation,” stated Rick Johnson, director of the Healthcare Practice at J.D. Power. “Consumer concerns about rising drug prices have likely affected perceptions of the cost for their retail prescriptions. The decrease in satisfaction with cost is the primary drag on overall customer satisfaction, creating a serious challenge for retailers.”

“Pharmacies have historically earned very high marks for customer satisfaction, so any significant year-over-year decline is cause for closer investigation.”

Decreases in satisfaction with brick-and-mortar pharmacies were driven by year-over-year declines in satisfaction with cost, which fell 27 index points to 789 (on a 1,000-point scale), and the in-store experience, a 14-point drop to 851.  Decreases in satisfaction with mail order pharmacies were driven by declines in satisfaction with cost (minus 49 to 787) and the prescription ordering process (minus 15 to 877).

This year’s study measured drug adherence levels across the different pharmacy channels for the first time, and found that 79% of customers who filled prescriptions through a brick-and-mortar pharmacy reported they always were adherent to their medications. This compares with 84% among mail order customers and 74% among specialty pharmacy customers. Customers who discussed a prescription with a pharmacist in a brick-and-mortar pharmacy at the time of pick-up had the highest overall levels of adherence.

Among all channels studied, supermarkets had the highest levels of overall customer satisfaction (859), followed by mail order (853); hospital or clinic (851); chain drug stores (849); specialty pharmacy (842); and mass merchandisers (839).

AmerisourceBergen’s Good Neighbor Pharmacy ranked highest overall among brick-and-mortar chain drug stores with a score of 889.  McKesson’s Health Mart (886) ranked second and Cardinal Health’s The Medicine Shoppe Pharmacy ranked third (879).

Sam’s Club ranked highestoverall among brick-and-mortar mass merchandisers with a score of 874. Fred’s (873) ranked second and Costco (875) ranked third. While CVS Pharmacy at Target placed fifth this year, it had the largest increase in satisfaction of any pharmacy from 2016 (+20).

Brookshire Grocery ranked highest overall among brick-and-mortar supermarkets with a score of 894. H-E-B (893) ranked second and BI-LO (891) ranked third.

Walgreens Specialty Pharmacy ranked highest among specialty pharmacies with a score of 853. BriovaRx (851) ranked second and CVS Specialty/CVS Caremark (840) ranked third.

 

Link to original article posted in Drug Store News