Enzyme could help fight against mid-life obesity and fitness loss

National Institutes of Health discovery of enzyme in mice could lead to new class of medications to fight mid-life obesity

A team of scientists led by researchers from the National Institutes of Health has identified an enzyme that could help in the continuous battle against mid-life obesity and fitness loss. The discovery in mice could upend current notions about why people gain weight as they age, and could one day lead to more effective weight-loss medications.

“Our society attributes the weight gain and lack of exercise at mid-life (approximately 30-60 years) primarily to poor lifestyle choices and lack of will power, but this study shows that there is a genetic program driven by an overactive enzyme that promotes weight gain and loss of exercise capacity at mid-life,” said lead study author Jay H. Chung, Ph.D., M.D., head of the Laboratory of Obesity and Aging Research at the National Heart, Lung, and Blood Institute (NHLBI), part of NIH.

Chung and his team used mice to test the potentially key role this enzyme plays in obesity and exercise capacity. They administered an inhibitor that blocked the enzyme in one group being fed high-fat foods, but withheld it in another. The result was a 40 percent decrease in weight gain in the group that received the inhibitor.

The study, the first to link the increased activity of this enzyme to aging and obesity, appears in the current issue of Cell Metabolism. Its findings could have ramifications for several chronic illnesses. With lower rates of obesity, the researchers say, rates of heart disease, diabetes, and other diseases that tend to increase with age, including cancer and Alzheimer’s disease, could fall as well.

Researchers have known for years that losing weight and maintaining the capacity to exercise tend to get harder beginning between ages 30 to 40 — the start of midlife. Scientists have developed new therapies for obesity, including fat-fighting pills. However, many of those therapies have failed because of a lack of understanding about the biological changes that cause middle-aged people to gain weight, particularly around their abdomen.

Click here to read the rest of this article originally published by National Institutes of Health

The joy is being sucked out of the practice of medicine. Here’s why.

Many providers — primary care physicians, physician assistants, and even many beleaguered specialists — are increasingly dissatisfied with their jobs.

What is happening to medical practice and what can we do to bring the joy back to being a health care provider?

She came to the urgent care center with a sprained ankle. The primary care provider gave her excellent care, expertly applying evidence-based evaluation guidelines to her situation, and, thereby, avoiding unnecessary x-rays. By all measures, the provider’s care was excellent, but the interaction still ended up reducing his salary. You see, that patient’s only medical interaction that year was for this ankle sprain, and the provider was therefore held accountable for all of her primary care needs. Since she had not received a mammogram that year, or received a diabetes screening, he incurred an end-of-the-year penalty for failing to meet these quality standards.

I am early into a one-year quest to connect with leading thinkers from inside and outside medical care, so I can better understand why many clinicians are miserable in their careers, and much more importantly, what can be done to help them thrive at work even though an increasing number of outside parties are looking over their shoulder, assessing the quality of the care they provide.

These increasingly burdensome rules and regulations are making it hard to enjoy medical practice these days. Several decades ago, physicians largely practiced as autonomous professionals, governed by standards developed by their professional peers. Physicians underwent intense and prolonged training to develop the knowledge and skills to know how best to help patients with their problems. And the world generally stood back and accepted, on faith, that most physicians would provide excellent care to most of their patients.

In recent years, however, outsiders have increasingly tried to assess just how well physicians are performing their jobs. Insurance companies and Medicare administrators are measuring the quality of care physicians provide, and even holding them financially accountable when that care is not up to standards. In part, these external accountability measures have been put into place because people paying for medical care — insurance companies, Medicare administrators, and even patients — realized that the quality of medical care wasn’t always as high as it ought to be. And since the profession wasn’t doing everything it could to promote high quality, they recognized that somebody from the outside needed to hold physicians accountable for their practice. As a result, medical practice has shifted from being autonomous to supervised; physicians have gone from being independent decision-makers to being bureaucrats forced to check boxes.

Click here to read all of this article originally posted on KevinMD.com

Dosage Forms: Introduction to Pharmaceuticals

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This article is a sufficient beginning to know everything about pharmaceuticals. If you are just starting to know about this amazing field, this is a good guide for you.

Drug is the substance used to cure, treat, restore the health state, or optimize a malfunction. Fundamentally, this substance is brought from plants or animals. Rarely, the drug is administered in its primary or crude form. In other words, the drug can be natural, synthetic, or semi-synthetic. The drug’s crude form passes by different processes to give rise to what is called dosage forms.

During manufacturing, the crude drug is called a pharmaceutical preparation. Dosage form is the crude drug in its final form after adding particular characteristics to it. The drug manufacture includes addition of additives; pharmaceutical ingredients.

The additives are mainly non-medicinal substances used for many purposes. They are added to enhance the drug form, quality, and efficacy.

They are used:

As solubilizing agents

For dissolving the drug in a solvent as in the formation of solutions

For dilution

To decrease or optimize concentration

As suspending agents

To suspend solid particles in a solution and form a suspension

As emulsifying agents

To dissolve water in oil or oil in water and produce an emulsion

As thickeners

To harden/thicken creams and ointments

As stabilizers

To maintain the stability of a pharmaceutical preparation

As preservatives

To protect the pharmaceutical preparations from contamination by microorganisms such as bacteria and fungi

As coloring agents

To give the drug a perfect appearance and attractiveness.

As flavoring agents

To hide a bad taste like the bitter taste. Moreover, flavoring agents are used to add a reasonably good taste to the drug and increase its palatability.

Click here to download a PDF with more information

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Worried about those pills you found in your teenager’s room? What are they?

What kind of pills are these?

Worried about those capsules you found in your teenager’s room? Not sure about some of those leftover pills still in the bathroom cabinet? There’s a good chance that our Pill Identification Wizard (Pill Finder) can help you match size, shape, colour… then lead you to find the detailed description in our drugs database.

NOTE: As a general rule, we should all periodically check our medicine cabinets for any expired, re-bottled, or unidentified pills. The safest bet is to keep all medications in their original bottles or packets, with pertinent labeling and instructions attached, to avoid confusion and mistakes.

Most pills can usually be identified by color, size, shape and a combination of letters and numbers.

Click here for a Pill Identification Wizard

Babies often get overdoses of prescribed narcotics

By Fran Lowry

NEW YORK (Reuters Health)  – Infants and children being treated with narcotics routinely receive overdose amounts, according to a study presented in Denver this past weekend at the annual meeting of the Pediatric Academic Societies (PAS).

Narcotics are usually given to young children in liquid formulations, which are difficult for parents to measure correctly. Also, pharmacists may not account for the child’s weight when prescribing, said Dr. William T. Basco, Jr, from the Medical University of South Carolina in Charleston.

“Narcotics involve a large proportion of drugs that are most commonly involved in adverse drug events and we also know that parents have problems properly measuring liquid preparations, so taking those two factors together, we wanted to find out more about the frequency of potential overdoses in young children,” Dr. Basco told Reuters Health.

He and his colleagues identified the top 19 narcotic-containing drugs prescribed for children aged 0-36 months from a review of 2000-2006 South Carolina outpatient Medicaid data. They calculated the expected daily dose of the narcotic based on Centers for Disease Control and Prevention growth chart data to impute the weight of each child as the 97th percentile based on age and gender, and then compared that dose with the actual amount of narcotic dispensed by the pharmacy.

During that time, there were 149,791 prescriptions for narcotic-containing preparations, for patients with a mean age of 18 months.

“Most of these prescriptions were appropriate, for post-operative or post-trauma pain. Some were for antitussants, and I think that is an important point to emphasize,” Dr. Basco said.

Fifteen percent of the prescriptions contained an overdose quantity of narcotic, the research team found. The average excess amount of narcotic dispensed was 53% more than expected.

The researchers also found that the younger the children, the more frequent the overdoses. More than half (61%) of infants aged 0 to 2 months who received a narcotic got an overdose, compared with 35% of infants 3 to 5 months old, 17% of infants 6 to 11 months old, and 8% of children 12 months or older (p<0.0001).

Younger children also got larger overdoses. Compared to expected doses, actual doses were 90% higher in the 0 to 2 month age group, 53% higher in the 3 to 5 month group, 36% higher in the 6 to 11 month set, and 34% higher for babies 2 months and older (p<0.05).

In addition, the youngest infants were dispensed more than twice the expected quantity 20% of the time. In comparison, infants 3 to 5 months got more than twice the expected quantity 3.8% of the time, infants 6 to 11 months, 1.5% of the time, and for children 12 months or older, it was just 0.2% of the time (p < 0.05).

“Clinicians need to remember that the younger the child, even small deviations from the appropriate dose will make a big difference,” said Dr. Basco. “Giving 20% more drug when you are 5, 6, or 10 years old doesn’t matter as much, but when you are a 2-month-old, then it matters a lot.”

The sedative effects of the narcotics can cause young children to stop eating and drinking and become dehydrated. “Very few would die from overdose but that is possible, but the greater issue is dehydration and this is harmful,” Dr. Basco said.

He added that, ideally, all pediatric prescriptions should be based on the child’s weight.

“For inpatients, our hospital pharmacy will not send any drugs to the floor unless the child’s weight is on the order, but ambulatory prescriptions that you get at Walgreens or CVS do not consider the child’s weight,” Dr. Basco added.

Click here to read the rest of this article.

Steps you can take to be more informed about your medicines

Safe Medical Treatments: Everyone Has A Role

by Dorothy L. Smith, Pharm.D.

Don’t be afraid to ask questions! 

1. Remember, we are all consumers. The only way a person can make informed decisions and use medicines safely is to know what information is important to obtain from health professionals, how to incorporate the medication into your daily lifestyle, how to manage side effects, when to seek medical help and how to keep track of important information for the doctor and pharmacist.

2. Ask your doctor why YOU need the medicine being prescribed and how it is going to help you. Discuss any concerns you have about taking the medicine so that you have all the information you need to decide whether you want to take it. If you do not want to take the medicine, discuss this with your doctor so that a treatment more acceptable to you can be prescribed.

3. Ask your doctor or pharmacist if there is an FDA-approved Patient Package Insert (PPI) for the medicine you are taking. More and more pharmaceutical companies are developing these informational sheets. They are written in language consumers can understand and are reviewed by FDA for fair balance and clinical accuracy. Many companies are also posting the PPI on their website for consumers to read.

4. Since the average person forgets 50% of what the doctor told them by the time they arrive at the pharmacy, ask the pharmacist to go over all the instructions again.

5. If you would feel more comfortable speaking with the pharmacist in a private area, ask for it. More and more pharmacies have private counseling areas to ensure confidentiality and better learning.

6. Ask the pharmacist to show you the actual medicine so that you know which medicine is used to treat which symptom(s).

· Many people stop taking a medicine because they think they are allergic to it. Actually they may have had a minor side effect. Some allergic reactions can be very serious and require immediate medical treatment. If you have any questions about whether a symptom is an allergy or a side effect, always ask your doctor and pharmacist.

· Be sure you know how to administer the medicine correctly. Some medicines, such as inhalers to treat asthma, require complicated steps. Your doctor and pharmacist can show you the steps to follow when using an inhaler so that the medicine will reach your lungs and not get sprayed on the back of the throat where it will not work. You may want to ask the pharmacist to let you practice using the inhaler in the pharmacy.

7. A prescription label that states “Take 1 tablet three times a day” does not give you enough information. Ask your doctor or pharmacist to help you determine the best times to take the medication so you can easily work the dosage schedule into your daily activities, meal times and work. You will find it easier to remember to take your medicine if it fits in with your normal lifestyle.

8. Try not to adjust your medicine doses or take “drug holidays” without discussing this first with your doctor or pharmacist. Some medicines can have very serious side effects if they are stopped suddenly.

· Many prescription medicines can interact with each other as well as with over-the-counter products and herbal remedies. Your doctor and pharmacist should review your medicines at each visit and make sure that you are not taking two prescription medicines that can interact. It is important that you tell them if you are self-treating with any over-the-counter product or herbal remedies. Even better, ask them before you start self-treating!

· If you receive written instructions that just list side effects that could occur, ask for more information. You need to know how to recognize the early symptoms of common side effects and how to manage side effects that may be annoying but are minor. You also need to know when you should contact your doctor because of a side effect. If you do not understand a medical term, do not be embarrassed to ask what that term means. Keep asking until you understand it!

· If you have a side effect, you need to tell your doctor and pharmacist. You also need to tell them if you did anything to try to treat it–such as skipping a dose, stopping the medicine or taking an over-the-counter or herbal remedy. This information is important for them to include in both your medical record and pharmacy record.

· Some people find it helpful to keep a “medicine diary” they can take with them to their next doctor and pharmacy visit. This diary can help you remember important information to tell your doctor so the doctor can decide if you really had a side effect or if the symptom may have been caused by something else. Your diary can also help remind you of important questions you want to ask.

· Some medicines must be stored away from heat, light or moisture in order to keep their strength. Transdermal patches should not be thrown away where children can find them and put them on like Band-Aids. If you are traveling in a car during hot weather, don’t store your medicines in the glove compartment of the car. The heat can destroy the medicine and it may not work.

· Select your pharmacist with the same care that you select your doctor. You want a pharmacist who will take the time to counsel you at every visit and answer your questions. You should also expect to receive written information that you can take home. However, the written instructions should NEVER take the place of personal counseling. You need your questions answered so you can manage your medicines safely!

· Find out how many days in advance you should order your refills. Ask your pharmacist to develop a program to help remind you to get your refills.

· If you are having trouble remembering to take your medicine, it is important to let your doctor know this. Otherwise, your doctor may think that the medicine is not working and may prescribe another medicine that is less effective or has more side effects. All that really may be needed is to work out a more convenient dosage schedule for you.

· Be sure at each pharmacy visit to tell the pharmacist if you have had any problems with any of your other medicines. Your pharmacist can often provide helpful advice.

Important Things to Know about Medicare Part D

Medicare Part D Patient Facts

  1. It is voluntary, except for people who have both Medicaid and Medicare.
  2. Private insurance companies, not Medicare, offer the prescription plans.  However, Medicare has approved of every company that has a plan.
  3. There are two ways of getting prescription drug coverage:  through a stand alone plan or from a Medicare Advantage Plan with prescription benefits (MA-PD). The MA-PD combines coverage for Medicare Parts A and B with drug coverage.
  4. Plans will have a monthly premium and costs for the drugs you get through that plan. These costs vary depending on what state you live in and what plan you choose.
  5. Your yearly income and the amount of assets you have (not including the home you live in or your car) determine how much of the Part D costs Medicare will pay.
  6. If your income is under 150% of the Federal Poverty Level and you have limited assets, Medicare will give you “extra help” in paying for Part D. This can mean paying for part or all of your premium costs and paying a larger share of the medication costs than it does for people who have higher incomes.
  7. If your income is over 150%, once your drug costs (the part you pay and the part Medicare pays) go over $2,400 you are in the doughnut hole or coverage gap.  Now, you will need to pay all of your drug costs until you spend $3,051 more on
  8. medication. Then Medicare will pay almost all of your drug costs for the rest of the year.
  9. Most states have many, many plans to choose from, making it difficult to make a decision. All plans have to offer what Medicare calls a basic package, but some companies will offer more than one plan.  The average premium in 2007 will be about $24, but premiums can be higher or lower, depending on the plan and where you live.  See
    www.medicare.gov in the Compare Prescription Drug Plans link.
  10. In order to reduce your medication costs should:
    • Decide whether you can take generic medications for any of the brand name medications you are currently taking;
    • Decide whether you can use a mail order pharmacy or another pharmacy if the pharmacy you usually use is not one that the plan uses
  11. In order to decide which plan is best for you should:
    • Make a list of all the prescription medications you are taking as well as the dosage and how much medication you use in a month;
    • Make sure the medications you take are covered by the plan;
    • Look at your what the plans tell you your annual costs will be, based on your medication list and their monthly premiums;
    • Decide whether it makes sense for you to find a plan that has coverage in the doughnut hole.
  12. Enrollment for 2007 begins on November 15, 2006 and ends onDecember 31, 2006.  After that date you will not be able to enroll in a plan until November 15, 2007. If you do wait to enroll and you haven’t been part of another prescription plan that the government considers to be as good as Part D you will have a late fee added to your premiums. This fee is one percent of the premium.

What counts as an asset?

Under the Medicare Part D regulations, assets to be considered in determining eligibility for “extra help” are:

  • Real estate other than the beneficiary’s primary residence, such as rental property, vacation or undeveloped property
  • Business equity
  • Assets at financial institutions, such as savings, checking accounts, CDs
  • Retirement accounts such as IRAs, Keogh, 401(k) accounts
  • Stocks and mutual funds
  • Bonds, securities and U.S. savings accounts
  • Other financial assets

Primary residence, first and second cars and burial plots and/or life insurance worth less than $1,500 do not count as assets.

An asset test is required ONLY for beneficiaries seeking “extra help.” If your total household income is over 150% of the Federal Poverty Level you are not eligible for “extra help” so it doesn’t matter how many assets you have.

If your total household income is between 135% and 149% of the Federal Poverty Level, in order to get “extra help” from the government your assets must be less than 10,000 for an individual and $20,000 for a couple. You may have life insurance worth less than $1,500.

If your total household income is under 135% of the Federal Poverty Level, in order to get extra help from the government your assets must be less than $6,000 for an individual and $9,000 for a couple.

Medicare Part D Resources

www.medicare.gov
The official Medicare web site; the drug plan comparison tool is very useful for looking at the costs of different plans in your community.

www.ssa.gov
The website of the Social Security Administration where Medicare beneficiaries may apply for Medicare’s “extra help” for assistance with Part D costs.

www.medicarerights.org
Medicare Rights Center (MRC) is the largest independent source of health care information and assistance in the United States for people with Medicare. Founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care. MRC provides telephone hotline services to individuals who need answers to Medicare questions or help securing coverage and getting the health care they need. MRC also works to teach people with Medicare and those who counsel them–health care providers, social service workers, family members, and others–about Medicare benefits and rights.

www.mymedicarematters.org
The Access to Benefits Coalition and the National Council on Aging are working together to help enroll individuals in Medicare Part D and to make information available to consumers. This website gives information in easy-to-understand language so that people with Medicare can work on their own to assess their options, find and compare plans, and enroll online if they choose to enroll.

www.eldercare.gov
The Eldercare Locator is a public service of the U.S. Administration on Aging. The Eldercare Locator connects older Americans and their caregivers with sources of information on senior services. You can also call 1-800-677-1116.

www.shiptalk.org
The State Health Insurance Assistance Program, or SHIP, is a national program that offers one-on-one counseling and assistance to people with Medicare and their families. Through federal grants directed to states, SHIPs provide free counseling and assistance via telephone and face-to-face interactive sessions, public education presentations and programs, and media activities.

http://www.thedesk.info/PartD
This website uses information prepared by the Disability Policy Collaboration, a partnership between The Arc and United Cerebral Palsy, and is tailored for individuals with disabilites.