Re: Canadian doctors coming to the US

From: Robert (RobertJ_at_hotmail.com)
Date: 08/30/04 

Date: Sun, 29 Aug 2004 23:04:20 -0700

"fresh~horses" <fresh~horses@despammed.com> wrote in message
news:abf8de5b.0408292037.6abab6de@posting.google.com...
> sbharris@ix.netcom.com (Steve Harris sbharris@ROMAN9.netcom.com) wrote in
message news:<79cf0a8.0408291411.1c8a8bf9@posting.google.com>...
> > "Lictor" <ghostmlNOSPAM-REMOVE@online.fr> wrote in message
news:<41309b16$0$18253$79c14f64@nan-newsreader-05.noos.net>...
> >
> > > The problem is that I can make my own decision. I don't need to be
treated
> > > by a kid by some ads that think they can try to bully me into buying
their
> > > drugs.
> >
> > COMMENT:
> > Come on, as I note elsewhere in this thread, you tolerate advertising
> > in your politics, in your sexual relations, in your choice of car or
> > stereo or computer. But somehow you don't like it with drugs. And the
> > reason is very strange-- you think it drives effective prices up in
> > drugs more than it does with computers, cars, and women.
>
>
>
>
>
> Dr. Harris and Lictor:
>
> Allow me to jump in here gentlemen. I won't stay, only come to give
> you a gift that just came into my mailbox. Ahah! Thought I. This is
> for Steve Harris and Lictor. Anyway. Here....
>
> Healthy Skepticism and Barbara Mintzes on the Evra Patch and direct to
> consumer advertising. How DTCA conceals important (negative of course)
> information and glosses over the fact the product has more side effect
> is more costly, is less effective. (If you can't take it it's less
> effective.)

PubMed search

"Despite the efficacy of OCs, missed pills are quite common and contribute
to unintended pregnancy".

J Am Acad Nurse Pract. 2004 Jun;16(6):226-38. Related Articles, Links

Nondaily hormonal contraception: considerations in contraceptive choice and
patient counseling.

Freeman S.

Family Nurse Practitioner Program, Nell Hodgson Woodruff School of Nursing
at Emory University in Atlanta, Georgia, USA. Sfree01@emory.edu

PURPOSE: To review currently available choices for non-daily hormonal
contraception, considering efficacy, safety, patient counseling issues, and
appropriate patient selection. DATA SOURCES: Worldwide medical literature
and the individual products' prescribing information. CONCLUSIONS: Patients
and clinicians have many nondaily hormonal contraceptive options
available--from Depo-Provera quarterly injection, which has been available
in the United States for over 10 years, to several new entries (Mirena
5-year intrauterine system, Lunelle monthly injection, NuvaRing monthly
intravaginal ring, and Ortho Evra weekly transdermal patch). All these
options offer high efficacy and enhanced convenience for many patients over
daily oral contraceptives (OCs). Barriers to use of these agents may include
patients' lack of information as well as fear or misconceptions regarding
the hormones and methods. All of these can be addressed with adequate
patient counseling and open dialogue. The clinician and patient need to be
well-informed regarding these options so that they can work together and
identify the best contraceptive fit for the patient---with the ultimate goal
being to increase patient satisfaction and adherence and, thus, avoid
unintended pregnancy. IMPLICATIONS FOR PRACTICE: Despite the efficacy of
OCs, missed pills are quite common and contribute to unintended pregnancy.
Many women in all population categories would benefit from the convenience
and reliability of nondaily hormonal contraceptives. The highest efficacy
rates with typical use are associated with agents that require minimal user
participation (i.e., Depo-Provera, Mirena). Compared to daily regimens, all
nondaily options offer increased convenience and may contribute to improved
patient adherence. However, barriers to use may exist. Patient fears
regarding use of hormones can be minimized by discussing the long-term
safety of hormonal contraceptives. (The data are predominantly derived from
Depo-Provera and OCs because these agents have been available in the United
States and in the rest of the world for much longer than the newer nondaily
options.) Patient counseling and appropriate expectations regarding changes
in menstrual pattern have been demonstrated to further enhance patient
adherence to therapy. Finally, patient lifestyle preferences must be
considered. The finding that many women are comfortable with or even prefer
amenorrhea, which is associated with options such as Depo-Provera,
highlights how important it is for clinicians to avoid making assumptions
about a patient's contraceptive preferences. Rather, clinicians and patients
should exchange information through an open dialogue. For the majority of
patients, nondaily hormonal contraceptives should be considered and offered
as first-line options.

PMID: 15264608 [PubMed - in process]

Am J Obstet Gynecol. 2004 Apr;190(4 Suppl):S49-53. Related Articles, Links

The transdermal contraceptive system.

Burkman RT.

Department of Obstetrics/Gynecology, Baystate Medical Center, Springfield,
MA 01199, USA. rtb@bhs.org

The transdermal contraceptive system or contraceptive patch (Ortho EVRA,
Ortho-McNeil Pharmaceuticals, Raritan, NJ), approved by the Food and Drug
Administration in November 2001, is a novel combination hormonal
contraceptive that contains the hormones norelgestromin and ethinyl
estradiol. In clinical trials, the contraceptive patch was shown to have
comparable safety and efficacy with that of oral contraceptives (OCs), and
results indicated that the women who used the patch did so more correctly
and consistently than those who used OCs. The enhanced patient compliance
may be due to the once-a-week dosing and relative ease of use of this
system. The transdermal delivery approach minimizes the "peaks and troughs"
of hormone concentrations associated with daily oral administration and
avoids hepatic first-pass metabolism. Side effects are similar to those seen
with OCs with the exception of application site reactions that are obviously
unique to transdermal delivery.

Publication Types:
Review
Review, Tutorial

PMID: 15105798 [PubMed - indexed for MEDLINE]

Contraception. 2004 Mar;69(3):189-95. Related Articles, Links

The impact of improved compliance with a weekly contraceptive transdermal
system (Ortho Evra) on contraceptive efficacy.

Archer DF, Cullins V, Creasy GW, Fisher AC.

Contraceptive Research and Development Program, Clinical Research Center,
Eastern Virginia Medical School, Norfolk, VA, USA.

OBJECTIVE: The contraceptive efficacy of perfect dosing cycles and imperfect
dosing cycles has not been described previously. Method compliance
determines the proportion of perfect and imperfect dosing cycles, and
together can form the basis for evaluating differences in efficacy based on
differences in compliance. MATERIALS AND METHODS: The transdermal
contraceptive delivery system (Ortho Evra) has been studied in a North
American randomized trial vs. an oral contraceptive (OC) and in total has
been evaluated in 3319 women in contraceptive clinical trials. This article
explores the impact of perfect vs. imperfect compliance with the
contraceptive method on contraceptive efficacy. Previously published data
for a transdermal system (Patch, n = 812) and OC (Triphasil, n = 605) users
from the North American comparative study were reanalyzed to determine the
effect of imperfect use on the contraceptive efficacy of the different
methods. RESULTS: Contraceptive efficacy was significantly better (p =
0.007) in cycles with perfect dosing (Pearl Index = 0.83) compared to those
with imperfect dosing (Pearl Index = 6.32) for both methods. This difference
is homogeneous (p = 0.62) across the Patch and OC groups. Pooled data for
all Patch users confirm that perfect dosing cycles are associated with
significantly better efficacy than imperfect dosing cycles (p = 0.047). In
addition, compliance did not vary by age in the pooled Patch data, which are
in agreement with the previously published Patch data from the comparative
study. In the comparative study, the percentage of cycles with perfect
dosing was significantly higher with the Patch than with the OC (88.7% vs.
79.2%, p < 0.001), and was consistently high in all age groups (range,
89.6-91.8%). By contrast, among OC users, the percentage of cycles with
perfect dosing increased with increasing age (p < 0.001) from 67.7% in users
aged 18-20 years to more than 80% in those aged 30 years and older.
CONCLUSION: In conclusion, deviations from perfect use (whether corrected or
not) of a transdermal contraceptive system and of an OC increase
contraceptive failures by approximately 5-10-fold when compared to perfect
use. The weekly change schedule of the transdermal contraceptive delivery
system is associated with a significantly greater proportion of cycles in
which there is perfect dosing compared to an OC.

Publication Types:
Meta-Analysis
PMID: 14969665 [PubMed - indexed for MEDLINE]

ScientificWorldJournal. 2004 Jul 8;4:512-6. Related Articles, Links

Long-term evaluation of the use of the transdermal contraceptive patch in
adolescents.

Logsdon S, Richards J, Omar HA.

Department of Pediatrics, University of Kentucky, Lexington, USA.

The transdermal contraceptive patch, Ortho Evra, was approved in December
2001 and released on the market in June 2002. In this study, we reviewed
clinical data of young women who started the patch between June 2002 and
December 2003 in the adolescent medicine clinic at a university-based
outpatient center. A total of 62 patients started the patch in that period
and two of them were lost to follow-up. Mean age of patients was 17.9 years
and mean length of use was 10 cycles. Only 10 patients (16.7%) discontinued
use. Reasons for discontinuation were moderate to severe skin irritation (3
patients, 5%), complete detachment (3 patients, 5%), and economic reasons (4
patients, 6.7%). Compliance was excellent overall and the side-effects
profile was good. No pregnancies occurred during this period. These results
confirmed that the transdermal contraceptive patch is easy to use and an
effective method of birth control that may be better tolerated by young
women. It also seemed to improve contraceptive compliance in this
population.

PMID: 15258678 [PubMed - in process]

Rev Med Liege. 2003 Nov;58(11):709-12. Related Articles, Links

[Medication of the month. Evra: first contraceptive transdermal patch]

[Article in French]

Gaspard U.

Service de Gynecologie, CHU du Sart Tilman-Universite de Liege.

Evra is a transdermal patch releasing 20 micrograms of ethinylestradiol and
150 micrograms of norelgestromin/day during one week. The circulating levels
of steroids attained are of similar amplitude though steadier than after
intake of an oral combined low-dose estrogen-progestin pill. The transdermal
method is user-friendly and is abided by a high degree of acceptability, and
a low level of skin irritability. Its contraceptive effectiveness is similar
to that conferred by oral contraceptives except if the treated woman is over
90 kg, in which case Evra should not be prescribed. Cycle control is
excellent and similar to that of triphasic pills. Adverse effects and
tolerance are comparable to those described with low-dose oral
contraceptives with a slight estrogen dominance. Lipid and glucose
metabolism as well as coagulation are influenced in the same way.
Gastrointestinal disturbances (nausea, vomiting) do not prevent the efficacy
of the transdermal patch. Compliance with Evra is significantly higher than
with oral combined contraceptives--a major point for an effective
contraception. Accordingly, Evra constitutes an useful addition to the
current array of contraceptive methods.

Publication Types:
Review
Review, Tutorial

PMID: 14748201 [PubMed - indexed for MEDLINE]

>
> Medscape on the same drug. Wahoo this stuffs sounding better all the
> time. (Which pharmas sponsor Webscape?)
>
> http://www.medscape.com/pages/sites/infosite/ortho/article-evra.faq
>
> Then go to the evaluation done by the Canadian Coordinating Office for
> Health Technology Assessment found here:
>
>
http://www.ccohta.ca/CDR/cdr_pdf/cdr_submissions/Complete/cdr_complete_Evra_06-23-04.pdf
>
> Significantly, the latter notes that the Evra patch
> (norelgestromin/ethinyl estradiol) "is more expensive, of similar
> efficacy, and associated with more patient withdrawals in the clinical
> trials than oral contraceptive agents".

So the Canadian government won't pay for the expensive newer drugs so what
else is new. Listen to the Canadian Cancer Society and see how happy they
are about lack of the new chemotherapy out patient regiments not covered by
the government.

>
> Keep the latter in mind the next time you hand a patient one of the
> pharma's glossy ads for the product.
>
> Zee
>
>
>
>
>
>
>
> I think
> > you're wrong. Rather, I think what you're saying is you're willing to
> > let third parties choose your drugs to a greater extent than other
> > consumer goods, and you hope you're getting away with doing it that
> > way. I think you're not.
> >
> > >The problem is that, if I lived in the USA, I would *pay* for these
> > > ads with buying that drug. And if I compared how much you pay for your
drug
> > > and how much I do pay for the very same drug, I would say these ads
are
> > > worth around 90% of the price of the drug.
> >
> > COMMENT
> > Bull***! As you admit, you just made that figure up. There are no
> > drugs in France which cost (counting government subsidy) 10% of what
> > the same drug costs in the US. If you argue not, please provide three
> > examples. Otherwise just admit that you're blowing smoke.
> >
> > Yes, it's true that in the US we pay more for given tradename drugs
> > than anybody else in the world. But the factors are something like 2
> > or 3, not 10. Some of the extra is advertising. Some of it is lack of
> > ability of the US consumer to collectively bargain with drug companies
> > in many cases.
> >
> > Interestingly, you French probably pay more per person for
> > pharmaceuticals than we do here in the US, because you take so many of
> > them that it completely makes up for the lower prices. You do love
> > your pills. And it's quite remarkable that you love them so much with
> > so little advertising. Could it be that all your unbiased sources on
> > the benefits of liver pills are not quite so unbiased as you think?
> >
> > >Advertisements should plainly [not] exist. I mean, they provide no
> > > information to help me with taking a decision. Why should I pay for
them
> > > then?
> >
> > COMMENT
> > You don't have to. Simply don't buy any advertised product. But you'll
> > still pay for hidden advertising in that case.
> >
> >
> > >When you advertise, you are actually *forcing* me to buy a service
> > > (the "information" on the ads) I have no desire for, because don't be
fooled
> > > and think that you're not the one paying for these ads in the end.
> >
> > COMMENT
> > I'm not forcing you do to anything, since you never are forced to buy
> > any product. There's always an alternative.
> >
> > > Being an adult doesn't mean being an American. It means being able to
make
> > > your own decisions, based on your own convictions. Not the ones of the
> > > society you live in, or the official line of thinking, or what the
party
> > > told me to think. You should try that sometimes... But of course, Big
> > > Brother is always right, and it's the rest of the world that is
un-American
> > > and doesn't like your "freedom of thinking"...
> >
> > COMMENT:
> > It's pretty funny to see you here espousing the French standard
> > government policy (you can advertise cars but not drugs) and saying
> > that *I* am a victim of propaganda? Say what? I'm not here arguing
> > for my government's policy (I'm no record that we in the US should be
> > free to buy drugs from whereever we like overseas). So I do think for
> > myself. I have yet to see any evidence that you do.
> >
> >
> > > > And now, next tell me. I've heard that in the US, it is money
> > > > interests that rule the government. And that this is not so in
other
> > > > countries, such as (for example) that utopia of Canada.
> > >
> > > No, that's the case everywhere. The only difference is that the whole
world,
> > > except people like you, *knows* that. So, we can try to act against
it,
> > > instead of believing blindly what Big Brother tells us.
> >
> > COMMENT:
> > The whole world saw the many French oil companies in bed with Saddam
> > Hussein like a bad cartoon. And we inferred that all that smoke coming
> > out of the French goverment on how we should give the nice man a
> > third, and a fourth, and manybe a fifth chance to come clean, was not
> > exactly driven by perfectly pure French egalitarian principles. Call
> > me cynical.
> >
> > SBH

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