In the News

Contaminant identified in recalled heparin products.

Contaminant identified in recalled heparin products

The FDA has found that the contaminant in recalled heparin from China was an altered form of chondroitin sulfate, according to several news reports.

The agency is still investigating whether the chemically modified compound was mixed with heparin by mistake, or was used deliberately to cut costs, the March 20 Washington Post reported. The compound made up as much as 20% of the active ingredient in the recalled heparin. The FDA has received reports of at least 785 serious injuries and 19 deaths that appear connected with the product, but hasn't conclusively proven the contaminant is the cause.

The FDA has ordered all imported heparin and its active ingredients to be tested at the border, the March 14 Washington Post said. It also got approval last week to establish eight permanent positions at U.S. diplomatic posts in China, pending authorization from China's government, and five Chinese staff to help with inspections. Most of the world's heparin supply originates in China, as do many other pharmaceutical ingredients distributed worldwide, and there is growing concern that the FDA doesn't have the resources to adequately inspect products, devices and facilities from foreign countries.

Baxter Corp., which typically supplies half of the nation's heparin, began recalling lots of heparin products in November after reports of serious allergic reactions in patients. The company has now recalled all products and stopped production.

Phoenix Group issues hospitalist workforce recommendations

The Phoenix Group, a think tank made up of representatives from private practice hospitalist groups, has issued recommendations for ensuring an adequate supply of hospitalists in the U.S.

Projections by the Society of Hospital Medicine indicate that at least 40,000 hospitalists will be needed to meet demand over the next five years. In a recently published white paper, the Phoenix Group called that number “achievable only in the most theoretical sense” and suggested that the current workforce of 20,000 hospitalists may be close to peaking. Calling the difference between workforce supply and demand a “productivity gap,” the Phoenix Group made the following recommendations for addressing this potential problem, according to a recent press release:

  • Increase recruitment of family practitioners and osteopathic physicians;
  • Better utilize mid-level providers, such as physicians' assistants and nurse practitioners;
  • Address backlogs in issuance of new state medical licenses;
  • Work for changes in existing visa laws to allow additional international physicians to enter the U.S. health care work-force; and
  • Find ways to reassign or reroute nonclinical activities, allowing physicians to increase productivity by concentrating on patient care.

The Phoenix Group noted in its white paper that while shortages of hospitalists will have the greatest impact on private practice groups, other institutions will also feel the effects. It called for “bold and experienced leadership and management” to help resolve the issue.

Multidrug-resistant TB on the rise worldwide, says WHO

Multidrug-resistant tuberculosis is more widespread than ever with nearly half a million known new cases a year worldwide, accounting for about 5% of the 9 million new TB cases recorded annually, according to a report from World Health Organization.

The survey, based on data collected between 2002 and 2006 on 90,000 patients in 81 countries, found drug-resistant TB in 45 countries, said a Feb. 26 WHO news release. The rate was highest in Baku, capital of Azerbaijan, where almost one-quarter of new TB cases were multidrug-resistant. In the U.S., 1.2% of TB cases were multidrug-resistant and, of those, 1.9% were extensively drug-resistant, said the Feb. 26 Washington Post.

Data from Latvia and Ukraine revealed a link between HIV infection and multidrug-resistant TB, said the release. In those countries, the resistant strain was twice as common among patients with HIV as among patients without HIV.

The survey found widespread multidrug-resistant TB in China as well as parts of Moldova, the Russian Federation and Uzbekistan, said the release. The report was limited in scope, however, the WHO noted, because many countries lack the resources needed to collect data. In Africa, for example, which has the highest incidence of TB in the world, only six countries provided drug-resistance data.

The data highlight the need for more funding to stop the spread of TB globally, said the report's authors, in order to find new diagnostics and more effective drugs and vaccines.

AHA addresses hyperglycemia in acute coronary syndrome

Hyperglycemia predicts adverse outcomes in patients with acute coronary syndrome (ACS), but guidance on its evaluation and management in this population is limited, the American Heart Association (AHA) said in a recent scientific statement.

Although hyperglycemia is common in hospitalized patients with ACS and is associated with worse outcomes, it is often undertreated. Because of the clinical importance of this issue, the AHA's Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism set out to review the existing data on hyperglycemia in ACS, summarize the areas of uncertainty and provide recommendations for management. The group's scientific statement was published online by Circulation on Feb. 25.

The group concluded that methodologic limitations and a lack of randomized trials are responsible for the dearth of definitive information on managing glucose control in ACS patients with hyperglycemia. Researchers must work to define hyperglycemia, determine methods of monitoring glucose values in patients hospitalized with ACS, and isolate the physiologic link between hyperglycemia and poor outcomes, the group wrote. However, the group said it is most important to investigate whether hyperglycemia causes or is a marker for adverse outcomes in patients with ACS.

The group noted that it is difficult to make evidence-based recommendations for glucose control in this population because of the gaps in current knowledge. Until additional research is done, the group offered a set of treatment recommendations as a general reference, including the following:

  • Glucose levels should be determined during initial laboratory evaluation in all patients with suspected or confirmed ACS.
  • Glucose levels should be kept between 90 and 140 mg/dL in ICU patients with ACS who are hyperglycemic at admission.
  • Glucose levels should be kept below 180 mg/dL in ACS patients who are not in the ICU.
  • Plans should be developed for outpatient glucose control in all patients with established diabetes, newly diagnosed diabetes, or insulin resistance.

Hypertension increasing among American women

Uncontrolled hypertension became more common among American women during the 1990s, while rates for men continued to decline but at a slower rate than in the past, a study recently reported.

Researchers used data from the National Health and Nutrition Examination Survey and a mobile examination clinic to evaluate rates of hypertension (defined as more than 140 mm Hg systolic) in each state. They found that between the early 1990s and the early 2000s the prevalence of uncontrolled hypertension in adult women increased from 17% to more than 22%. During the same period, male hypertension decreased from 19% prevalence to 17%. The study was published online in the journal Circulation on Feb. 11.

Southern states had the highest rates of hypertension, according to the researchers. In the District of Columbia, Mississippi, Alabama, Louisiana, Texas, Georgia and South Carolina, 18% to 21% of men had uncontrolled hypertension and 24% to 26% of women did. The states with the lowest rates were Vermont, Minnesota, Connecticut, New Hampshire, Iowa and Colorado.

The researchers also evaluated which states had seen the greatest change. For women, the ranks of the hypertensive grew the most in Idaho and Oregon and shrunk in Washington, D.C., and Mississippi. For men, the best states were Vermont and Indiana and the worst New Mexico and Louisiana. Researchers noted that it was impossible to tell whether these variations between states were due to better public health efforts in some areas or populations having hit a peak in the possible rates of hypertension.

It is alarming that U.S. states are experiencing worsening rates in a risk factor that is easily controllable by lifestyle, diet and medication, said a study author. States with the highest prevalence, in particular, need to focus on interventions to reverse the trends seen in the past decade, he concluded.

Despite costs, patients asking for and getting advertised drugs

Most Americans consider their doctor to be their primary source of information about prescription medications, but that does not stop a significant percentage of them from asking for the drugs they've seen advertised, according to a new survey.

The survey of 1,695 American adults was a joint project of USA Today, the Kaiser Family Foundation and the Harvard School of Public Health. Participants were asked about their perceptions of pharmaceutical companies and their use of prescription medications.

About a third of respondents said they had talked to a doctor about a prescription drug they saw advertised. Of those patients, 44% said the doctor gave them a prescription for the drug, and 54% said the doctor recommended another prescription drug. In total, 82% of those who asked about an advertised drug got a prescription for either that drug or another. The report also found that patients are having trouble paying for prescription drugs; 41% of respondents said that it is somewhat of a problem for their family to pay for their prescription drugs, and 16% said that it is a serious problem.

Issues of cost also appeared to affect general attitudes toward pharmaceutical manufacturers. The majority of survey respondents were positive about how pharmaceutical developments have affected public health, the attention paid by drug companies to safety and testing, and the value of advertising. However, 79% said that the cost of prescription drugs is unreasonable, and the same percentage attributed the high costs to corporate profits.

More than 70% of patients said that they rely on their doctor heavily to provide information about prescription drugs, compared with 51% for the pharmacist, 43% for drug packaging, 22% for government agencies, and 15% for family and friends.