Mashable reports that TargetRX has landed $9.6 million in funding for its website. According to the website, TargetRX “offers member physicians an online forum to share their attitudes and beliefs with pharmaceutical companies through surveys and other market research activities.”

It is a site that is attempting to step into Sermo’s playground. Sermo has built a brand around itself. TargetRX is going to have extreme difficulty in establishing itself as the place to go to discuss issues.

The majority of topics on health forums are dedicated to physicians asking each other for medical advice or opinions about a case or how to deal with hospital politics. So the idea that an online forum made of physicians used to track behavioral prescribing is strange to me. From my clinical rounds, prescribing medication or pharmacist recommendations are mostly dependent on evidence-based practices and then afterwards, the hospital’s formulary.

So after convincing my dear friend to register for Health 2.0 physician-only sites awhile back so that I can take a look, I realize that venture capitalist firms are in need of a medical professional on their team. There is a fine balance in combining technology with health but a larger piece of the puzzle is understanding the fragile relationship or should I say non-existent relationship between healthcare professionals and the pharmaceutical industry.

As for my dear friend who is a medical resident at Cedars-Sinai Hospital he hasn’t logged on since.

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As I’ve commented many times before, Airborne is just an unsafe product and furthermore, their claims are highly inaccurate. Airborne was sued with a class action suit in California courts for having deceptive advertising and among which it claimed to have a clinical trial on the efficacy of its product. The clinical trial turned out to be fraudulent. The courts claim that theirs was “a fraud scheme alleged to have cost consumers hundreds of millions of dollars.”

They settled out of court Wednesday for $23.3 million dollars. Attorneys on the state side are still going forward with charges, stating that the settlement does not include statues that Airborne must stop their fraudulent advertising. Airborne faces similar litigations in New Jersey federal court.

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File for a refund here (you don’t need to have a receipt)

According to a new survey released by comScore today, sixty percent of women turn to the Internet and Web sites for health information.

Eighty-two percent of respondents reported turning to medical professionals for health information, while 51% said they consult their friends, family or significant others.

The survey also found that 85% of women who use the Internet have researched women’s health issues online, while nearly two out of three women who use the Internet have researched birth control options online.

Results are based on a survey of 921 women ages 18 to 44.

marble-blast-ultra-20051221062258837.jpgTo the numerous list of health innovations the Wii can do, we add in improving surgery performance by 50%.

The BBC reports that researchers at the Banner Good Samaritan Medical Center studied eight surgeon trainees who trained for an hour on a Wii before performing 50% better on a virtual surgery simulator. Their scores excelled in the areas of tool control and overall performance as compared to those who did not.

The game in question is called Marble Mania, which involves moving a marble through a 3D maze.

To be fair, the researchers should pit these “Wii-surgeons” against those who meditate, visualize, pray, or perform hand exercise before surgery.

In any case, the researchers claim that the fine movement of a ball through a maze are complementary to skills which would help a surgeon in surgery.  They also suggested that perhaps spending $250 for a surgery prep device is a great alternative for poorer countries to train their surgeons as compared to buying an expensive surgery virtual simulator.

Read more on: Health Games, Medutainment, Tech

It looks like Merck find themselves in court once again.  On January 17, Merck and Schering-Plough are listed as defendants in a class action suit which charges them with fraud and misrepresentation for withholding a study that could be damaging to their drug – Vytorin.

Vytorin (Simvastatin and Ezetimibe), a cholesterol lowering agent, is a joint venture between the two companies, with Merck contributing the drug simvastatin and Schering-Plough contributing Ezetimibe. 

The clinical trial in question is called the ENHANCE study.  The trial began in June of 2002 and looked at 720 patient who has a genetic disorder which gave them high blood cholesterols.  This population is different from the majority of people who are high blood cholesterol who may have a genetic disposition to have high cholesterol, but are more of a result of age and diet. 

It was recently discovered that the ENHANCE trial showed that Vytorin did not decrease blood cholesterol more effectively than simvastatin alone and additionally, Vytorin may cause MORE atherosclerotic plaque build-up in the blood vessel than through using simvastatin alone.  The rub about this information is that the first part is shown to be statistically significant and the latter point has not shown to be statistically significant (p=0.28).

The ENHANCE trial was first expected to be release in November of 2006 but the companies delay the release until March of 2007 and then again until March of 2008 and at which point the company tried to change the original endpoint of the study and when the FDA took up the investigation.

The companies had foretold that if this research gets out, it would undermine the sale of Vytorin.  I personally, don’t think the plaintiffs in this case will be victorious unless they fall into this small population of patients whose high blood cholesterol is caused by their genetics.  But through the poor handling of this situation and the public reading poor interpretations of the ENHANCE trial, their reputation and the reputation of Vytorin will be significantly smeared. 

I do not recommend that anybody stop taking their prescribed therapy until speaking with their primary care physician. 

Stocks of both companies fell today after the news.

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On Jan. 2, the U.S. Food and Drug Administration (FDA) expanded the indication for a liquid fibrin sealant to help control bleeding during general surgery. Fibrin is a protein that helps blood clot.

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The sealant, called Evicel, is sprayed or dripped on small, oozing blood vessels. Once applied, it forms a covering that helps stop bleeding. Evicel was previously approved for use during liver and vascular surgery. This approval expands Evicel’s indication to include general surgery applications.

“This approval provides a new option to help control bleeding during general surgery, when other approaches and techniques are ineffective or impractical,” said Jesse L. Goodman, M.D., M.P.H., director of FDA’s Center for Biologics Evaluation and Research.

Evicel contains fibrinogen and thrombin, two proteins involved in the production of fibrin. Fibrinogen and thrombin are found in human plasma, the liquid portion of blood. The plasma used to manufacture the product is collected from donors who have been screened and tested for blood-transmitted infections. The fibrinogen and thrombin also undergo a two-step process to further reduce the risk for the transmission of potentially contaminating bloodborne viruses. While the potential risk for infectious disease transmission is remote, it cannot be eliminated.

A study of 135 patients undergoing abdominal surgery showed Evicel to be safe and effective in controlling bleeding. Adverse events reported during the clinical trial included anemia, abdominal abscess, blockage of the small intestine, and loss of urinary bladder tone, when the urinary bladder does not empty effectively, which can cause discomfort and infection.

FDA approved Evicel’s predecessor (Crosseal) in 2003 for use during liver surgery. It became Evicel in May 2007 when FDA expanded the indication to include use during vascular surgery.

Evicel is manufactured by OMRIX biopharmaceuticals LTD (located in Kiryat Ono, Israel) and marketed by .

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In a study published January 16th, in the British Medial Journal (BMJ) [equivalent to our New England Journal of Medicine (ENJM)] found that postmenopausal women receiving extra-dietary supplements may be at increased risk of myocardial infarction, stroke and sudden death.

The study was down out of the University of Auckland, New Zealand. They looked at data from a research done on 1,471 postmenopausal women over the age of 55 (average age 74) randomized into a placebo and calcium supplement arm to look at calcium supplement’s effect on bone fracture. The study followed the medical history of these women over five years.

The results showed that:

  • Reports of myocardial infarction (heart attack) were significantly higher in the calcium group than in the placebo group (45 events in 31 women versus 19 events in 14 women).
  • The occurrence of any three vascular events, myocardial infarction, stroke, or sudden death was also significantly more common in the calcium group (101 events in 69 women versus 54 events in 42 women).
  • Because the results were so important, the researchers went back and checked hospital records and death certificates to look for any unreported events.
  • After adjusting the figures for the newly found and previously unreported events, they discovered that myocardial infarction (heart attack) was still more common in the calcium group (36 events in 31 women versus 22 events in 21 women on placebo).
  • The figures for heart attack, stroke or sudden death also went up in the calcium group (76 events in 60 women versus 54 events in 50 women on placebo) but were shown to have borderline significance.

The researchers concluded that:

“Calcium supplementation in healthy postmenopausal women is associated with upward trends in cardiovascular event rates.”

However they cautioned against rash treatment decisions by saying that:

“This potentially detrimental effect should be balanced against the likely benefits of calcium on bone.” This was particularly important in the case of elderly women they said.

You can read the whole article at BMJ.

So what does all this information mean? There are experts out there who have came out publicly saying that this data is a fluke and should be disregarded. I don’t think this view point is wise to judge the data so harshly, one way or the other. Clearly this data is unnerving, especially when it goes against the commonly recognized practices in medicine, but this data is significant and should be treated with care. In my opinion, something like this should call for is more researchers to look into the problem. A retrospective analysis could quickly be done on previous data done on this patient population.

The women in the study specifically took Citracal (Mission Pharm., San Antonio, TX) perhaps it is this specific formulation that is causing the adverse results, we just don’t know.

If you’re a patient currently on calcium supplement therapy, I would recommend printing out the article and making an appointment with your doctor to discuss your particular situation before making any therapy changes.

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Benefits Check-Up
Free, useful service that lists federal and state assistance programs for older Americans. It was the answer to address the problem of older adults being eligible for benefits and yet not utilizing them. Millions of older Americans may benefit from public programs that offer such things as health coverage,  supplemental income and utility bill assistance.

PhRMA
Provides updated lists of patient assistance program directory

Needy Meds
Similar format to RXAssist in that the site provides a catalog of available programs listed according to drug name and manufacturer

Shoot-up to stay drug-free – the promise by Drs. Tom and Therese Kosten, the husband and wife team, researchers at the Baylor College of Medicine, who’ve developed a cocaine vaccine.

According to the Houston Chronicle, the Kostens have been working on the cocaine vaccine for the last decade. The idea behind the concept is to inject a modified cocaine molecule into the body to stimulate the immune system. After the immune system recognizes the cocaine molecule, subsequent exposure to the cocaine molecule will stimulate the immune system to destroy the molecule before it is able to mount its activity on the brain. The reason that the cocaine molecule evades the immune system is because it is too small to be recognized. The Kostens have created a molecule large enough to stimulate the immune system.

It’s a brilliant idea and it is working.  From Phase 2 clinical trials, the Kostens found that addicts who receive their vaccine on average use 50% less than they did previously. They are currently waiting approval by the FDA to start Phase 3 clinical trials where they will enroll 300 addicts in their cocaine withdrawal program that will include vaccine therapy and psychological counseling.

There are many ethical issues being put on the table in regards to the vaccine’s use. Although it may be a great tool to stop cocaine addiction, the concern is whether or not it is ethical to give the vaccine to children in an attempt to steer-head their use of the drugs before it even occurs?

[the structure on the left :: Hyoscyamine; right :: Cocaine]

My concern is the medical safety of this vaccine. Cocaine is a small molecule that has chemical properties as well as structures similar to those molecules that naturally occur in the body. In the above figure, one can visually see that cocaine is a very similar in structure to the drug hyoscyamine. Hyoscyamine is used to calm intestinal spasms. What will happen when we create an immune system that looks after similar molecules? Yes, it does destroy the cocaine molecule when it sees it, but does it also destroy drugs with similar structure or naturally occurring molecules in the body with a similar structure?

That being said, it is wise to note that there are over 22 million cocaine users in the United States, costing the US population nearly half a trillion dollars annually. In the end, I’d to take a quote from Dr. Peter Cohen, a Georgetown law professor and chairman of the District of Columbia Medical Society’s physician health committee: “Overall, the benefits to society of such vaccines would outweigh the risks. There are certainly important issues there, but I don’t think any are insurmountable.”

Crayon Physics Deluxe is a game developed by Kloonigames. It is a sequel to the freeware game, Crayon Physics. The creator describes the game as a “2D physics puzzle game” in which objects that you draw are transformed to objects that can physically interact with one another on your Tablet PC. The challenge of the game is to solve puzzles using your artistic vision and creativity. Crayon Physics Deluxe is still in development and will launch soon.

This is an interesting concept that can be applied to foster a child’s development and creativity. While technology such as LeapFrog develops a child’s math and spelling skills, games such as Crayon Physics Deluxe will foster their problem-solving skills and introduce kids to relationships between objects.

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[Last modified: 12/08/07]