The information in these educational articles for consumers was obtained from members of the Michigan Pharmacists Association or from news releases sent to the association. Click on the title below to jump to that article.


CHPA/FDA Give Spanish-Speaking Parents 10 Tips on Giving Medicine to Kids
High Risk of Tetanus in Older Population
Most Drug Rehabs Missing Vital Ingredient
New Patient Education Booklet Available on Seborrheic Dermatitis
Two Decades of Progress in Heart Disease Medicines Improving Cardiovascular Health
146 New Medicines Now in Pipeline To Fight Heart Disease and Stroke
OTC Medications and Children - Take Great Care
Council on Family Health Offers Medicine Guide for Older Consumers
Promotions for Kids' Dietary Supplements Leave Sour Taste
Generic Drug Documentary Available On-line
Michigan Health and Safety Coalition Formed to Improve Health Care Quality and Patient Safety
Pharmacists Issue Public Alert: Beware Of Mail Order Medicine Theft
Amended Rule 9b Takes Effect April 13
Do You Know Your Pharmacy ABCs?
Spring Into Action - Clean Out Your Medicine Chest!
Spring Clean Your Medicine Chest
Be Prepared: Tips for a Well-Stocked Medicine Cabinet
APhA Foundation Says consumers Can Benefit from Patient Safety Activities
Directed by Pharmacy
Patients and Pharmacists Join Forces to Tackle Insurance Problems
Parents Warned About Overdoses
Cutting Cholesterol
USP Issues Parent Recommendations To Help Prevent Medication Errors in Children
New Database Will Help Needy Patients Get Free Medicines

CHPA/FDA Give Spanish-Speaking Parents 10 Tips on Giving Medicine to Kids

Washington, D.C., May 11, 2005 — The Consumer Healthcare Products Association (CHPA) and the U.S. Food and Drug Administration's (FDA’s) Center for Drug Evaluation and Research (CDER) have released the popular Kids Aren’t Just Small Adults pamphlet in Spanish. The informational pamphlet offers 10 tips on how to give over-the-counter (OTC) medicines safely to children.

“It’s so important for parents to understand that OTC medications are real medicines that must be taken with care,” said CHPA President Linda A. Suydam, D.P.A. “CHPA and FDA partnered to provide English- and Spanish-speaking parents helpful tips so that they may safely and responsibly give their children medicine.”

Recommendations in the pamphlet include reading and following the OTC Drug Facts label, which contains all the information necessary to safely give a medicine to a child; becoming familiar with active ingredients; and using the appropriate dosing or measuring tool.

“FDA is committed to educating the public about products the Agency regulates,” said FDA’s Ellen Shapiro, director of CDER's Division of Public Affairs. “Recommendations in this pamphlet are valuable year-round, and we are pleased to be able to offer them in both English and Spanish.”

Up to 100 copies of Kids Aren’t Just Small Adults or Los niños no son simplemente adultos pequeños may be ordered on CHPA’s web site at www.chpa-info.org/pubs.aspx.

EDITOR'S NOTE: A copy of this news release in Spanish can be obtained by clicking here.

CHPA is the 124-year-old trade association representing U.S. manufacturers and distributors of over-the-counter medicines and nutritional supplement products. For more information go to www.chpa-info.org.
(May 2005)

High Risk of Tetanus in Older Population

Over the years, we have successfully protected our children against tetanus by ensuring they receive multiple vaccinations from birth throughout their childhood. Yet, we often forget that older individuals are at as high, if not higher, risk for preventable diseases.

While the overall incidence of tetanus in the United States is low, the highest percentage of cases and tetanus-related mortalities are in older patients. Routine tetanus immunization has been standard practice in the United States since 1950; thus, older individuals may not have received vaccination and boosters and are at higher risk for infection than their younger counterparts. Although 91% of children aged 6 to 11 years are fully protected as a result of early vaccination, only 31% of adults aged 70 years and older have been immunized. 1-3 From 1980 to 2000, 70% of reported cases of tetanus occurred in individuals aged 40 years or older. Tetanus is also more likely to be fatal in those who were never vaccinated and those who are 60 years of age or older.

Tetanus is caused by an anaerobic bacterium, Clostridium tetani, which enters the body through a cut or wound. C tetani thrives in soil and the intestinal tracts of animals and humans; therefore, individuals who work in the garden or yard or raise animals or farm are at higher risk of contracting the disease. Though the most common case of tetanus is the rusty nail, infection can occur with just a cut or scrape, one even as minor as a needle stick.

The increased risk for tetanus among older persons mandates thorough assessment when they present with suggestive symptoms and appropriate treatment should a diagnosis of tetanus be confirmed. Commonly referred to as "lockjaw" tetanus is characterized by a stiff jaw and/or neck as well as a headache, difficulty swallowing, rigidity of abdominal muscles, and spasms. In concurrence with a recent injury, these symptoms may indicate tetanus.

Once a diagnosis is confirmed, the patient's vaccination history is a guide to treatment. If a patient's vaccination history is unknown or they have not received the recommended primary doses and subsequent boosters, it is necessary for them to receive both Tetanus toxoid (Td) and Tetanus Immune Globulin. Td primes the immune system and TIG provides direct antitoxin, giving the patient temporary immunity. The importance of heightened awareness of the potential for tetanus in older individuals is demonstrated by the following case which occurred in Kansas.

A 57-year-old man with diabetes presented to an emergency department (ED) with a puncture wound to his foot, caused by his stepping on a rusty nail. The wound was cleaned and Td was administered. Four days later, the man returned the to the ED complaining of severe foot pain, fever, vomiting, and neck pain and stiffness. Following onset of a stiff neck, the man was hospitalized with a diagnosis of tetanus and treated with TIG. He died less than 1 month later following cardiopulmonary problems and ultimately cardiac arrest. The family reported he had never received vaccination against tetanus.
(May 2005)

Most Drug Rehabs Missing Vital Ingredient

Cravings, guilt and depression make up the harness that keeps an addict in the downward spiral of drug addiction. In almost all cases these symptoms are generated after a long term of substance abuse. In the history of drug and alcohol rehabilitation it has always been known that the addict must first undergo a detoxification procedure, as the drug cravings are the first barrier to a successful recovery.

According to the Merriam-Webster® online dictionary, to detoxify means: to free (as a drug user or an alcoholic) from an intoxicating or an addictive substance in the body or from dependence on or addiction to such a substance.

Often this procedure means to ensure that the individual is no longer under the immediate effects of the substance or substances. This is rational thought, but it has been discovered through extensive research that simply "drying out" is not a thorough detoxification and that the drug residues that store primarily in body fat continue to impede the full rehabilitation process. These residues are called drug metabolites and get released back into the blood stream and can cause intense drug cravings. This is one of the primary causes of relapse. So how, if a person is no longer taking the drug, do you get rid of the metabolites?

One of the most effective means of ridding the body of drug metabolites has proven to be the use of aerobic exercise combined with a nutritional program that utilizes Vitamin B3 (niacin) and extended periods of sweating in a dry-heat sauna. This detoxification method was researched and developed by L. Ron Hubbard in 1978 and has helped increase the rate of recovery by eliminating the physical triggers that create drug cravings. It is this process called the New Life Detoxification Program that is utilized at the Narconon Arrowhead drug rehabilitation and education program. This program is thoroughly explained in a book called Clear Body Clear Mind.

Eric was a heroin addict from Michigan that underwent this rehabilitation program and in his words, "The program changed my life forever. The mental and physical cravings that are associated with recovery from heroin addiction are GONE. I am no longer trapped in the dwindling spiral of addiction."

Addressing the biophysical aspects of addiction in an effective manner is one thing that puts Narconon Arrowhead at the top, achieving a success rate of approximately 70% for stable, long-term recovery.

"There are many other good programs out there," comments Luke Catton, a supervisor for Narconon Arrowhead, "but if you don't reduce or eliminate the physical cravings for drugs it is often too difficult to overcome."

To learn more information or to get help for a loved one, contact Narconon Arrowhead today at 1-800-468-6933 or log on to www.stopaddiction.com.

New Patient Education Booklet Available on Seborrheic Dermatitis

Fort Worth, TX (April 19, 2005)— Coria Laboratories Ltd. today announced the availability of the new educational booklet for patients with seborrhic dermatitis. The booklet describes in words and pictures what this common skin distorder is and how it can be treated and managed.

An estimated 14 million Americans are affected by this skin disorder, which can occur in both males and females at any age and on various parts of the body including the face, scalp, chest, armpits and groin. In infants, seborrheic dermatitis of the scalp is often called "cradle cap."

Coria Laboratories has introduced a comprehensive range of Ovace (sodium sulfcetamide 10%) formulations for treating seborrheic dermatitis, including Ovace (sodium sulfcetamide 10%) Wash, a gentle medicated cleanser for the face and other areas of the body, Ovace (sodium sulfcetamide 10%) Foam for the scalp, Ovace (sodium sulfcetamide 10%) Cream for dry skin and Ovace (sodium sulfcetamide 10%) Gel for oily skin.

Copies of the booklet, called "Managing Seborrheic Dermatitis," are available free of charge to health professionals by calling toll-free 866/819-9007, or by writing Coria Laboratories, Ltd., 3909 Hulen Street, Fort Worth, TX 76107.

Characterized by a red, scaly, itchy or burning rash, seborrheic dermatitis is generally confined to areas on the body where sebaceous glands are prominent. Although the exact cause of the condition remains unknown, a number of potential factors in the development of the disorder have been identified, including Pityrosporum yeast, as well as genetic, hormonal and environmental factors and poor hygiene.

Ovace products' active ingredient, sodium sulfacetamide, provides a broad spectrum of treatment activity, while its added ingredients facilitate gentle, fragrance-free, non-steroidal and non-irritating formulations that allow rapid therapeutic outcomes.

Ovace products are contraindicated in persons with known or suspected hypersensitivity to sulfonamides or to any ingredients of the products. Reports of irritation and hypersensitivity to sodium sulfacetamide are uncommon. Instances of Stevens-Johnson syndrome and systemic lupus erythematosus have been reported with sulfonamides.

Coria Laboratories, Ltd., formerly knows as Healthpoint Dermatology, is a rapidly growing pharmaceutical company that specialized in research, development and merketing of branded prescription drugs and over-the-counter dermatology products. More information on Coria Laboratories and its Ovace family of products is available by calling 866/819-9007.

Two Decades of Progress in Heart Disease Medicines Improving Cardiovascular Health

Washington, D.C. (February 3, 2005) — America’s pharmaceutical companies strongly support today’s heart month message to women that heart disease is treatable and largely preventable. National Wear Red Day for Women is heightening awareness that cardiovascular diseases kill nearly 500,000 women each year.

America’s pharmaceutical companies have 123 medicines in the development pipeline to treat heart disease and stroke. These include 21 for congestive heart failure, nine for high cholesterol — which can lead to coronary artery disease and heart attacks — and seven for heart attacks. The number of treatments in development for heart disease and stroke has steadily increased, from 87 in 1988 to the current group of 123.

“Every day, new progress is being made in finding more and better treatments for heart disease and stroke,” said PhRMA president and CEO Billy Tauzin. “Our goal is to one day soon stamp out heart disease as a leading cause of death in American women.”

Today, heart disease is treatable and often preventable thanks, in part, to scientific breakthroughs over the past 20 years that have made it possible to develop an arsenal of pharmaceuticals that have helped revolutionize the treatment of heart disease and stroke. These include statins, first introduced in 1987, which reduce the production of cholesterol within the body, and two ways to control blood pressure that were first introduced in 1981 — calcium channel blockers that prevent the movement of calcium into heart muscle cells and results in the dilation of the arteries, and angiotensin-converting enzyme (ACE) inhibitors that work by preventing blood vessel-constricting hormones from forming. In 2002, an important new class of medicines was introduced that reduce absorption of dietary cholesterol (cholesterol absorption inhibitors).

Some 70 million Americans have heart disease, which is the leading cause of death in the United States. Fifty-four percent (37.6 million) of those with heart disease are women. High cholesterol is a major risk factor for heart disease and affects 37 million Americans. Strokes are experienced by 700,000 Americans every year.

Numerous PhRMA-member companies run programs or provide information online on heart disease and stroke and how to prevent them. Pfizer Inc. is a national sponsor of the American Heart Association’s Go Red for Women Campaign, and Johnson & Johnson is sponsoring an event for the Heart Truth national campaign.

The Pharmaceutical Research and Manufacturers of America (PhRMA) represents the country’s leading pharmaceutical research and biotechnology companies, which are devoted to inventing medicines that allow patients to live longer, healthier, and more productive lives. PhRMA members invested an estimated $33.2 billion in 2003 in discovering and developing new medicines. PhRMA companies are leading the way in the search for new cures.

PhRMA Internet Address: http://www.phrma.org

For more information on how innovative medicines are saving lives visit: http://www.innovation.org/

146 New Medicines Now in Pipeline To Fight Heart Disease and Stroke

Washington, D.C. (February 28, 2005) — As many as 146 medications may soon be available to help patients fight heart disease and strokes. These treatments are being developed by America’s biopharmaceutical companies and are now in the pipeline according to a survey released today by the Pharmaceutical Research and Manufacturers of America (PhRMA).

“Heart disease and strokes are still a leading cause of early death,” said Billy Tauzin, PhRMA president and CEO, “but we are working to change that. We are proud of the contribution that America’s biopharmaceutical companies have already made to the fight against heart disease and strokes. These 146 medicines now in development or in the final approval process may help save more lives and help more people turn from being patients and back into healthy and productive mothers, fathers and grandparents.”

Since 1900, heart disease has topped the list of killer diseases every year but one. (The exception was 1918, when an influenza epidemic killed more than 450,000 Americans.) Strokes are the third leading cause of death in the United States after cancer. Every 34 seconds, an American dies from cardiovascular disease and more than 70 million Americans suffer from one or more types of cardiovascular disease, costing our society nearly $400 billion a year.

These 146 medications now in development keep up the momentum of medicine discovery that has helped cut deaths from heart disease and stroke in half in the past 30 years. The new medicines now in development include 17 for stroke, which afflicts about 700,000 Americans each year; 16 for congestive heart failure, which kills more than 50,000 Americans a year; 10 for high blood pressure, a leading risk factor for both heart disease and stroke; 8 for heart attacks, which strike more than half a million Americans a year; and 13 for arrhythmias, which cause more than 37,000 deaths a year.

Due in large part to new medications and treatments developed by America’s pharmaceutical and biopharmaceutical companies, heart disease and stroke death rates continue to fall. Without the new medications developed over the last 30 years, according to the National Heart, Lung and Blood Institute (NHLBI), 815,000 more Americans would die annually from heart disease and 250,000 more would die from strokes. However, also according to NHLBI officials, much of the progress made in cutting heart disease and stroke death rates springs from the development of effective medications to control blood pressure and cholesterol. Additionally, heart treatments have vastly improved in the last 25 years. For example, bed-rest, once the standard treatment for heart attacks, has been replaced by medicines that can stop a heart attack in mid-stream and other effective treatments.

The Pharmaceutical Research and Manufacturers of America (PhRMA) represents the country’s leading pharmaceutical research and biotechnology companies, which are devoted to inventing medicines that allow patients to live longer, healthier, and more productive lives. PhRMA members invested an estimated $38.8 billion in 2004 in discovering and developing new medicines. PhRMA companies are leading the way in the search for new cures.

Click here for a list of selective medicines in development for heart disease and stroke.

PhRMA Internet Address: http://www.phrma.org

For more information on how innovative medicines are saving lives visit: http://www.innovation.org/

Back to School is a Time to Think About Giving Children OTC Medicines Correctly
The National Council on Patient Information and Education (NCPIE)

Washington D.C.; August 10, 2002 - As many Americans turn their attention to back-to-school preparations, a coalition of health-related organizations urges parents whose children will encounter the inevitable coughs ad colds during the next school year to "be medwise" when giving over-the-counter (OTC) medications.

As part of its ongoing Be MedWise public education campaign about the appropriate use of OTC medicines, the National Council on Patient Information and Education (NCPIE) today issued this practical advice: Just as there are the "three Rs" involved in schooling, remember the "three Rs" of using medicines correctly: risk, respect, and responsibility.

Underscoring the need for this new advice, a survey of 1,011 adult Americans conducted for NCPIE by Harris Interactive and released in early 2002 finds that many Americans are unclear about the relationship between a child's weight and age in determining dosages of OTC medicines. In addition, the poll finds that parents are having trouble understanding about different concentrations. This matter is especially significant because infant formulations are often more concentrated than medicines formulated for older children.

To help parents and caregivers select and use children's OTC medicines correctly, NCPIE has developed these ten tips to "be medwise."

1. When in doubt, ask first. Your child's health is too important for guesswork. So any time you have a question about which OTC medicine is best for your child or how and when to give the medicine, ask your doctor or pharmacist first.

2. Make sure the pediatrician knows about all the OTC medicines your child takes before he or she writes a new prescription. Similarly, if your child takes prescription medicines check with your pediatrician or pharmacist before giving your child an OTC product.

3. Know your child's weight so you can give the proper doses of medicine as recommended on the product label. Most pediatricians and pharmacists agree that the child's weight is the best way to determine the correct dose. For this reason, health professionals often recommend that parents keep an accurate scale in the house so that they can check a child's weight before giving OTC medicines.

4. Follow the directions on the label carefully. Because OTC drugs are serious medicines that can cause harm if taken incorrectly, always read the entire label information before giving a child any OTC medicine. In this way, you will be certain that you have selected the right product, understand the dosing instructions, and are aware of any warnings or precautions that could apply.

5. Use the specific dropper, dosage cup, or other device that comes packaged with the child's medicine. Because kitchen spoons and other household utensils vary in size and are not accurate enough to measure doses of medicines, using them can result in giving your child either too large or too small a dose of the medication. The same thing can happen when using a dosing device from another OTC medicine.

6. If using multiple OTC medicines, you have to watch for both duplicate ingredients and usage. First check the active ingredient(s) used in each OTC medicine and make sure that you are not giving your child more than one product with the same active ingredient without first checking with a healthcare professional. Because many cough and cold preparations contain the same active ingredients as pain relievers, it is possible to give a child two different products with the same active ingredient without realizing it. Second, check for usage duplication. For example, two cold medicines may contain different active ingredients, but both of those ingredients act as fever reducers. That's usage duplication and it should also be avoided. To play it safe, read the medication's "Drug Facts" label and compare. Don't be afraid to ask your pediatrician or pharmacist for advice on product selection.

7. Give babies and children only those medicines that are especially formaulated for their weight and age. Cutting adult strength tablets in half or trying to estimate a child's dose of an adult-strength liquid can result in accidental overdose. Similarly, giving older children liquid medicines that are specially formulated for babies can also lead to dosing errors.

8. Keep in mind that most OTC medicines are for temporary relief of minor symptoms. If the condition persists or gets worse contact your pediatrician.

9. Don't give medications in the dark. This is often a problem because children get sick at night and the parents can make a mistake reading the dosing device if they can't see well.

10. Teach children that OTC medicines are not candy and they should not touch, sniff, or taste them on their own. Only let children take OTC medicines from a responsible adult. Keep all medicines and household products out of childrens' reach.

Launched in January 2002, the Be Medwise campaign employs a wide variety of media channels - the mass media, print and broadcast advertising, the Internet and consumer education materials - to help Americans select and use OTC medicines wisely. Coinciding with the recent move to a standardized "Drug Facts": label on the majority of nonprescription drugs, the campaign features a new website - www.bemedwise.org -- where consumers, health professionals, educators and the media can get detailed information about the new OTC label and how to compare products, learn about dosages and understand information about specific warnings.

Established in 1982, the National Council on Patient Information and Education is a diverse non-profit coalition that works to stimulate and improve the communication and information about the appropriate use of prescription and OTC medicines, through events such as Talk About Prescriptions Month, every October. NCPIE's members include consumer organizations, patient advocacy groups, voluntary health agencies, schools of medicine, pharmacy and nursing, health-related trade associations, prescription and over-the-counter pharmaceutical manufacturers and local, state and federal government agencies. More information about NCPIE is available through its website www.talkaboutrx.org.

Council on Family Health Offers Medicine Guide for Older Consumers
CFH and NCOA Partner to Educate Seniors on Medicine Use

Washington, D.C., July 5, 2000 - The use of multiple medicines, a greater prevalence of chronic health conditions and normal body changes caused by aging can increase the likelihood of potential problems with medicines for many seniors, according to experts in the field of aging. With this important health issue in mind, the Council on Family Health (CFH) has updated its educational guide for seniors on safe and responsible medicine use, Medicines and You: A Guide for Older Americans.

Medicines and You provides practical information for older Americans about the use of prescription and nonprescription medicines. The educational guide gives facts about drug interactions, tips for talking to health professionals and ideas on ways seniors can cut medicine costs. The 15-page guide also features "My Medicine Record," a chart on which seniors can list the medicines they take and other relevant health information.
CFH and The National Council on the Aging (NCOA) have also partnered to launch a program on safe medicine use for seniors. The program includes a kit for seniors entitled "Don't Mix and Match Your Medicines" to be used in workshops on safe and responsible medicine use. The kit will be distributed via NCOA's nationwide consumers Information Network. The kit features educational materials for seniors, as well as tools to conduct senior center workshops such as a poster and bags in which seniors can carry their medicines to be reviewed by a health professional. CFH's Medicines and You guide is included in the kit.
A free copy of Medicines and You: A Guide for Older Americans is available by sending a self-addressed, 6x9 stamped envelope to: Council on Family Health, "Medicines and You," 1155 Connecticut Avenue, N.W., Suite 400, Washington, D.C. 20036. "My Medicine Record" and a tip sheet on safe medicine use for older Americans are available on the CFH web site at www.cfhinfo.org.
(07/05/00)

Used to be that you couldn't expect a kid to stomach much more than a daily dose of cod liver oil or a multivitamin supplement. But lately, with the trend toward marketing herbs and other non-traditional dietary supplements for children's use, it's the Federal Trade Commission that's raising objections. The products are being advertised for maintaining kids' health as well as for treating their ailments.

"We're very concerned about how some of these products are being portrayed in advertisements," says Jodie Bernstein, director of the FTC's Bureau of consumers Protection. "There are many worrisome unfounded claims. A lot of these products have not been proven to provide any benefit and in some cases, may even present safety risks."

The FTC has noted an increase in dietary supplement advertising that promotes products as preventives or cures for a variety of childhood ailments, ranging from colds and ear infections to serious conditions like asthma and chronic bronchitis. In the past two years, the Commission has taken action against several marketers of kids' supplements for making unsubstantiated advertising claims. The marketers touted their products as safe, effective treatments for colds in children and attention deficit/hyperactivity disorder (AD/HD), which affects as many as 2.5 million school-aged kids in the United States.

"Our concern with these claims is that parents fall for the products and ignore proven, perhaps essential, treatments for their child's disorder," Bernstein says.

Though the marketers charged in these cases agreed to stop making the fraudulent claims, there's no guarantee that similarly egregious claims about certain supplements for kids will not surface in the marketplace. Says Bernstein, "The bottom line for parents is to exercise caution in giving supplements to kids."

Supplements for Kids
Traditionally, the term dietary supplement referred to vitamins and minerals. But in the wake of a rapidly expanding market, it has come to mean herbs and other botanical products, enzymes, animal extracts and more.

The need for vitamins and minerals is well-established. These nutrients are necessary for life and are widely available in food. Sometimes, though, nutrients must be consumed as supplements to treat or prevent nutritional deficiencies. Other supplements, such as some herbs, may offer health benefits, too, but the science on that issue is still developing.

For most healthy children who eat a variety of foods, experts generally agree that dietary supplements beyond a daily multivitamin and mineral supplement are not necessary, let alone safe or effective. "I don't recommend dietary supplements for children under 12," says Varro Tyler, professor emeritus at Purdue University and a leading authority on herbal medicines. Many of the products being marketed for kids have not been adequately tested in children to determine their safety and value.

"We have no systematic scientific data," says Dennis Bier, a pediatrician and researcher at the Children's Nutrition Research Center in Houston. "Yes, some of these products may have been used for millions of years, but no one has ever systematically collected data on their use in children. We don't know if these products are safe."

Experts also advise against giving children dietary supplements because unlike medicines in this country, their manufacture is not currently held to any set of federal standards to ensure purity and quality.

"It's a crapshoot," says Susan Baker, a professor of pediatrics at the Medical University of South Carolina. "You have no idea what these products contain."

Professor Tyler believes that the risk of consuming substances not made according to any national standards is one that adults can weigh for themselves. "But," he says, "they shouldn't push that risk off on children."

Taking Aim at Disease Prevention Claims
Parents whose children suffer from chronic disorders may find it especially hard to resist dietary supplements promoted as effective treatments for their children's disease. Ads for these products promote them as safe, natural alternatives to prescription drugs, which some may view as having harsh side effects. But as the FTC has found, these claims often are unfounded.

"False claims exploit parents' fears about giving their children prescription drugs, " the FTC's Jodie Bernstein says. "But these alternative therapies may actually do the children more harm than good."

Often, the deceptive ads describe the supplement products as "natural," a term that consumers generally take to mean as "safe," especially when compared with prescription medicines. But according to Michelle Rusk, an attorney in the FTC's Division of Advertising Practices, natural is not necessarily safe. "Botanical products, like drugs, can have potent pharmacological effects," she says.

In the FTC's experience, many deceptive ads have focused on AD/HD, a disorder whose diagnosis and treatment arouse controversy among parents and health care providers alike.

Kids with AD/HD usually display inappropriate activity for their age, are easily distracted and act impulsively. They often cannot sit still or pay attention in class, and their behavior often can lead to academic and social problems. The recommended treatment combines medicine, usually a stimulant such as Ritalin, with behavior management and parent training. Studies have found this regimen to be safe and effective.

"AD/HD is a difficult, frustrating problem," pediatrician Bier says. "It interferes with a child's growth...and with family lives. Parents want to find something that will work. They're looking for a magic bullet."

The traditional treatment is viewed as time-consuming and inconvenient, and many parents, concerned about long-term effects, balk at giving their children stimulants.

In three of the cases brought by the FTC, the marketers were promoting dietary supplements as safe and effective treatments for AD/HD. Ads for one product, Efalex, appeared in such national magazines as Parenting, Parade and People and on the Internet.

Ads for another product, called God's Recipe, claimed the product was a safe alternative to the prescription drug Ritalin. God's Recipe was widely advertised on the Internet.

Yet another product, Pycnogenol, a supplement derived from tree bark imported from France, was promoted as an effective treatment for AD/HD, as well as arthritis, diabetes, multiple sclerosis, heart disease and cancer. The promoters of Pycnogenol advertised through multilevel marketing.

Additional Concerns
The FTC also has objected to ads making unfounded safety claims. The Commission sought and received an injunction against the makers of so-called body-building supplements used by teenagers and athletes. The manufacturers, MET-Rx USA Inc. and AST Nutritional Concepts, were unable to substantiate their claims that the products could increase strength and muscle mass "safely and with minimal or no negative side effects." The products contain androgen and other steroid hormones known to have harmful effects, including unwanted changes to male and female sexual features.

"Children may take steroid hormone supplements to emulate popular athletes," the FTC's Rusk says. "But there's a potential for harm, especially considering that, as children, they're still growing and developing."

Some products that contain gamma butyrolactone (GBL) --  like Renewtrient, Revivarant, Blue Nitro and Gamma G -- are touted as performance enhancers. Taken orally, GBL is converted in the body to gamma hydroxybutyrate (GHB), an illegal drug that can cause unconsciousness, coma and even death.

Giving children dietary supplements raises still another concern: that products recommended for adults will be given to children. "Parents shouldn't assume that supplements work the same way in children as they do in adults," Rusk says. "What's safe for an adult may be risky for children."

Some dietary supplements are not deemed safe even for adults. According to the Food and Drug Administration, the following supplements are potentially dangerous: chaparral, comfrey, lobelia, germander, willow bark, ephedra (ma huang), L-tryptophan, germanium, magnolia-stephania preparations, dieter's teas, and excess amounts of some vitamins and minerals.

Because these substances are sold in products for kids, parents should always read the ingredient list on the labels of dietary supplements and avoid giving their children any that contain these potentially dangerous substances. But what about other dietary supplements? How can parents determine whether they are safe to give to their children?

Ask an expert -- for example, a pediatrician or other health care practitioner who is knowledgeable about herbal medicine and the disorder or condition for which the product might be used.

"Parents need to be careful," says New York City dietitian Wahida Karmally. "There are so many kinds of supplement products on the shelf, and none of them may be necessary or safe for their child."

Pointers for Parents
Before you give your child a dietary supplement, be aware that:

• Many dietary supplements, especially herbal products, have not been tested in kids to determine their safety or effectiveness.

• Dietary supplements in this country are not held to any set of federal standards for quality or purity.

• Your best advisor is your child's pediatrician or another health care provider. Be sure to check with them before starting your child on a supplement. And keep them informed of your child's continuing use of the product.

• Supplements advertised as "natural" are not necessarily safe. In fact, herbs, like other so-called natural products, can have powerful drug-like effects. Some of these effects can be especially risky for people who take other medicines or have certain medical conditions.

• Fraudulent promoters often fall back on the same claims to trick consumerss into buying their products. Tip-offs that they're trying to fool you are:

  • Claims that the product is a "scientific breakthrough," "miraculous cure," "exclusive product," "secret ingredient," or "ancient remedy." Says Jodie Bernstein, director of the FTC's Bureau of consumers Protection: "Ask yourself, 'If a product is so amazing, why would I be reading about it for the first time in an ad?'"
  • Claims that the product is a quick and effective cure for a wide range of ailments.
  • Claims that use medical terms that sound impressive. This ploy is an attempt to cover up a lack of good science.
  • Claims that the government, medical profession and health care industry are in a conspiracy to suppress the advertised product.
  • Undocumented case histories of people who've had supposedly amazing results.
  • Claims that the product is available from only one source, and payment is required in advance.
  • Claims of a "money-back guarantee."

(May 2000)

A 30-minute documentary examining generic pharmaceuticals is now available on-line from the National Association of Pharmaceutical Manufacturers. "Generic Drugs: An Affordable Alternative" was first seen in a national broadcast on Fox Television's Health Network on April 27 as part of "The Cutting Edge Medical Report" series. The video file can be linked, at no cost, to any website with a 26K or 58K modem. The file is viewed directly on the host site, returning viewers to the original web page whenever the file is exited.

The program explores the myths and misconceptions surrounding generic drugs and attempts to separate fact from fiction through interviews with every segment of the pharmaceutical marketplace. Included are interviews with consumerss, pharmacists, a physician, pharmaceutical regulators from the Food and Drug Administration and U.S. Pharmacopoeia, a U.S. Senator, a generic drug manufacturer and industry officials. It is anchored by Dr. Stephen Schondelmeyer, Director of the Prime Institute, University of Minnesota, who is widely regarded as a leading authority on generic drugs.

"Generic Drugs: An Affordable Alternative" can be viewed on the WebMD site at www.webmd.com. VHS tapes of the program are also available from NAPM. For information about how to establish a link with the video file, or to order a tape, contact NAPM at (631) 580-4252.
(6/28/00)

A group of physicians, pharmacists, nurses, and hospital organizations, health care purchasers, labor and health plans have formed the Michigan Health and Safety Coalition, the first group of its kind in the state that brings together diverse groups committed to improving the safety of patient care.

The coalition is comprised of representatives from Blue Cross Blue Shield of Michigan, International Union-UAW, Michigan Association of Health Plans, Michigan Health & Hospital Association, Michigan Nurses Association, Michigan State Medical Society, Michigan Osteopathic Association and Michigan Pharmacists Association, the Michigan Peer Review Organization, as well as representatives from several employer groups - General Motors Corp., Michigan Education Special Services Association and the Michigan Public School Employees Retirement System.

The issue of patient safety drew nationwide attention earlier this year with the release of a report called "To Err is Human; Building a Safer Health System" by the Institute of Medicine's Committee on Quality in Health Care in America.

The Institute of Medicine report estimated that 44,000 to 98,000 Americans die each year as a result of medical errors, based on two studies that looked at outcomes fora combined 60,000 hospitalized patients in three states. The report went on to say that errors are costly, generating total national costs between $37 billion and $29 billion.

The report said medical errors occur because of system failures and preventing errors means designing safer systems of care. The authors defined a medical error as the failure of a planned medical action to be completed as intended or the use of a wrong medical plan to achieve an aim. They also said any adverse outcome must be the result of a medical intervention and not the result of the underlying condition of the patient in order for it to be related to medical error.

The three Michigan residents who were members of the Institute of Medicine committee commented on the formation of the Michigan coalition.

"The Institute of Medicine's report speaks less to individuals and more to environments that invite mistakes. I'm pleased that the Michigan coalition plans to develop a common understanding in our state of medical error and patient safety issues and identify opportunities for intervention," said Dr. William C. Richardson, president and chief executive officer of the Kellogg Foundation. "The report says we need to do this systemically, universally, across the board."

"We believe this is a critical issue for patient care in Michigan and all the organizations that are participating have a stake in improving care," said Rhonda Beale, M.D., Blue Cross Blue Shield of Michigan executive medical director of Medical and Care Management Programs. "The coalition members hope to make Michigan a leader in this effort."

"Health care organizations must respond quickly, if they want to hold the public's trust," said Gail Warden, president and chief executive officer of Henry Ford Health System.

The group anticipates it will interact with government agencies, academics, legislators and others during the course of its activities.

A large portion of the group's initial work will be to identify and compile existing information on practices relating to patient safety in order to identify areas for improvement. The group will then make recommendations for action.
(6/7/00)

Pharmacists Issue Public Alert: Beware of Mail Order Medicine Theft

Sacremento, Calif. -- Citing U.S. Postal Service reports of an alarming increase in mail theft, California pharmacists issued a public alert to Californians about the rising danger of mail order medicine theft.

"With the growing number of people using mail order services to obtain their medicines, the California Pharmacists Association (CPhA) wants to ensure Californians don't become victims of medicine theft," said Carlo Michelotti, R.Ph., MPH, chief executive officer of CPhA. "We are concerned that the public, which is generally trusting of the U.S. mail system, is unaware that there are thieves who will steal medicine from those who need it to survive."

The U.S. Postal Service and Federal prosecutors say mail theft is on the rise. In fact, the postal service has indicated that mail theft is currently the leading white-collar crime in the United States, despite punishments of up to five years in prison and $250,000 in fines.

"We are especially concerned about the effect of mail order medicine theft on seniors and individuals with chronic health conditions who require continual and life-saving medications," said Michelotti.

For those who are unable to get medications directly from their community pharmacists, CPhA recommends following tips to avoid being victimized by mail order medicine theft:

• Try to have your medicine delivered to a location where you or an adult you trust can sign for it

• Arrange for delivery of medicines to a post office box or mail box that cannot easily be accessed by a stranger

• Always think of security when determining where and to whom your medications are delivered

Theft is only one of the risks of getting prescription medicines through mail order drug suppliers, said Michelotti. Mail order patients are deprived of crucial direct patient-pharmacist interaction; pharmacist counseling about medication misuse and possible interactions; and patient care services such as disease management and prevention offered by pharmacists, including flu shots, cholesterol screenings and blood pressure checks.
(Press Release issued from the California Pharmacists Association, June 1, 2000)

After two years of debate, R338.479b of the Michigan Administrative Code has been amended. Rule 9b previously limited the number of prescription drug orders on the same form to two medications. This limitation was intended to prevent errors related to illegible prescriptions. Due to controversial issues related to the increased administrative burdens, enforcement concerns and timely care of the patient, this rule has been amended to increase the number of medication orders allowed per form. By authority conferred on the Director of the Department of consumers and Industry Services by Section 16145 of Act No. 368 of the Public Acts of 1978, as amended, and Executive Reorganization Order No. 1996-2, being 333.16145 and 445.2001 of the Michigan Compiled Laws, R338.479b of the Michigan Administrative Code is amended as follows and is effective as of April 13, 2000:

R338.479b Prescriptions.

Rule 9b. (1) A prescriber who issues a written prescription for a noncontrolled legend drug shall date and sign the prescription and shall ensure that the prescription contains all of the following information:

1. The full name of the patient for whom the drug is being prescribed.
2. The prescriber’s printed name and address.
3. The drug name and strength.
4. The quantity prescribed.
5. The directions for use.
6. The number of refills authorized.

1. A prescriber shall ensure that a written prescription is legible and that the information specified in subrule (1)(c) to (f) of this rule is clearly separated.
2. A prescriber shall not prescribe more than the following on a single prescription form as applicable:

1. For a prescription prescribed in handwritten form, up to 4 prescription drug orders.
2. For a prescription prescribed on a computer-generated form or a preprinted list or produced on a personal computer or typewriter, up to 6 prescription drug orders.

1. A prescriber shall not add handwritten drugs to a preprinted form and shall clearly designate which drugs are to be dispensed.
2. A prescriber shall not prescribe a controlled and noncontrolled substance on the same prescription form.
3. A prescription is valid for 1 year from the date the prescription was written.
4. A prescriber shall clearly indicate the total number of drugs prescribed for each prescription.
5. This rule does not apply to inpatient medical institutions.

Do You Know Your Pharmacy ABCs?

Ask
Be Sure
Call

This guide was made to help you learn about the medicines you take so that you get the best results from them.

Ask – The best way to learn about your medicines is to ask about them – and the best person to ask is your pharmacist. The pharmacist is a medication expert and is there to answer your questions. Ask these questions:

1. How am I supposed to take this medicine?
2. What is this medicine supposed to do?
3. What are the common side effects?
4. Can I take this with my other medicines?
5. How will food or alcohol affect my medicines?
6. Are there any activities I need to avoid while taking this medicine?
7. How should I store this medicine?

Be Sure – When you get your medicine from the pharmacy, take a minute to look at it. Look for the following.

1. Make certain you have the correct medicine container.
   
   • The label has the right name (Be careful if you are a "junior" or a "senior"!)
   • The label has your correct address (and not the one of someone else with your same name who lives across town).
   • It is the right medicine being filled or refilled.
     
2. Look for differences from your last refill (shape, color, size).
3. Make sure the container has the correct lid. (If you asked for an easy-open lid or a child-proof cap, make sure it has the lid you requested.)

Call – The pharmacy’s telephone number is on the label of your medicine.

1. Call your pharmacist or physician if you have questions regarding your medicine.
2. Always check before taking any new medicines (whether they are prescription or non-prescription)
3. Call if you are not sure what to do if you missed taking a dose of your medicine.

• If you are traveling, remember that the glove compartment or trunk of your car can get very hot and is not a good place to store medicines.

• To make sure no one takes the wrong medicine, keep all medicines in their original containers.

Spring Clean Your Medicine Chest

1. Clean out your medicine chest at least once a year. Check expiration dates on medicines before each use.
Throw away all medicines that are out of date. If a doctor tells you that a prescription medicine should no longer be taken, it should be thrown away. Any medicine that has a noticeable change in color or smell should be thrown away.

If the label or package instructions are missing or cannot be read clearly, the product should be thrown away.

1. What are the brand and generic names of the medications?

2. What does it look like?

3. Why am I taking it?

4. How much should I take, and how often?

5. When is the best time to take it?

6. How long will I need to take it?

7. What side effects should I expect, and what should I do if they happen?

8. What should I do if I miss a dose?

9. Does this interact with my other medications or any foods?

10. Does this replace anything else I was taking?

11. Where and how do I store it?

Patients and Pharmacists Join Forces to Tackle Insurance Problems

By Ann P. Kluck, Licensed Pharmacist

Duties of the pharmacist have changed dramatically since the early 1970s. Since that time, prescription drug insurance programs and computers have made a great impact on the duties of a pharmacist and pharmacy technicians. Unfortunately, patients are often unfamiliar with the language and abbreviations used in the documents they receive about their prescription insurance plan. Understanding the details of your plan is the key to being a satisfied consumers. This feature will attempt to explain some of the areas of confusion to consumerss.

There is more to prescription insurance than just presenting your card and having your prescription covered. There are always limitations and exceptions, especially if a plan is a "managed care" plan or part of a Health Maintenance Organization (HMO).

The first piece of correspondence from the insurance company often is an identification card and information packet. Read all the information carefully. If you don’t understand something, contact the benefits coordinator or the plan sponsor before using the card. Even if you do understand the information in the packet, a call to the benefits coordinator could be helpful, since some situations are not described in the initial correspondence. Keep their number handy, as they are the key to working out insurance challenges. The card contains valuable information. It should be presented each time it is used to cover a purchase at the pharmacy. The card is especially important when there is a rejected claim. Check to see if the card you received serves as both the medical care identification card and the prescription ID card (sometimes both cards don’t arrive at the same time). The ID card frequently uses the social security number of the primary member as a contract number. The ID card should contain the name of the insurer, their logo and a phone number to contact the insurer. It may or may not contain the copayment amount.

If your insurance company hasn’t provided you with a listing of participating pharmacies, ask the benefits coordinator for a printed list. Many insurance companies have arranged exclusive arrangements with certain pharmacies to provide their customers with prescriptions. Ask your benefits coordinator if you can be reimbursed if you go to a non-participating pharmacy. When you bring a prescription to the pharmacy, check ahead to see if the pharmacy participates in your plan. Some insurance plans require or encourage (through higher copays or limited quantities at community pharmacies) a mail-order service be used to provide maintenance drugs to their members.

This brings up the subject of copayment or copay. A copay is the part of the fee for a service that the employee contributes. Both the insurance company and the customer contribute a part of the cost for a service or prescription. Copays are variable depending on plans. Some are a flat fee for each prescription, while others are based on a percent of the cost of the medication. Some plans have a dual- or triple-tiered copay in which the copay is determined by the type of drug dispensed. The pharmacy has little to do with determining the copay for your prescription. The amount of the copay on your prescription is determined by the insurance company when the pharmacy processes the claim at the time the service is provided. The insurance company provides the pharmacy with the appropriate amount to charge the patient. Your benefits coordinator should be able to provide you with precise information as to how your copay will be calculated. If your copay for a prescription turns out to be different than what you expect, ask the pharmacy personnel if they can clarify it. They may need to make a call to the insurance company. Keep in mind that some plans may require that a yearly prescription deductible be met before your coverage starts.

Now the MAC list comes into play. MAC is a term pharmacy uses, which is short for maximum allowable cost. Each insurance company has a list of drugs they consider to be multi-source medicines. This means that the drug entity is available through many different sources (each source at a different price), including a brand name source. To make things simpler, the insurance company decides upon a certain reimbursement to the pharmacy for each drug entity. When the pharmacy bills for any of these multi-source drugs the insurance will only reimburse them at the pre-determined rate (MAC rate). The MAC rate for a drug reflects the cost of the generic medication. When the fee the pharmacy charges the insurance company exceeds the MAC rate, the additional charge is assessed to the patient. This is often the reason for additional or ancillary charges above and beyond the copayment when the patient (or sometimes the physician) specifies a particular brand name of product must be dispensed. Ask your benefits coordinator if your coverage is subject to "maximum allowable cost" restrictions. If MAC is in effect, ask for a list of those drugs that are subject to maximum allowable cost. Keep in mind these lists change quickly. Many insurance companies add drugs to the MAC list as soon as the generic is released. This happened with ZantacŪ (ranitidine). As soon as the generic was released, some insurance companies charged an additional charge to the patients who opted for the brand name.

On-line billing – this is the way the pharmacy bills the insurance company. A claim goes from the pharmacy’s computer, through the phone lines to a "host" computer that connects to the insurance company’s computer. If you are covered by a policy through your employer, your employer has to communicate with the insurance company and the insurance company must communicate to the host computer before a claim can be successfully paid to the pharmacy.

You can see that there are many places where the system can break down. The best things a consumers can do when they encounter a problem such as "coverage terminated" are: 1.) Make sure the pharmacy has the correct information by showing them your card. You may want to ask if the pharmacy can contact the insurance company, but be aware that it may take awhile to contact the insurance company. 2.) If you need the medication right away, you can either pay the cash amount for the prescription and submit it directly to the insurance company or pay cash for small amount and contact your benefits coordinator to work out the problem. Then, hopefully, by the time it gets resolved, the pharmacy can take care of the billing. Ask your benefits coordinator if you can pay cash at the pharmacy and submit the receipt to the insurance company for reimbursement. It is always good to know this before you need to take advantage of it.

Many managed care benefit packages mandate use of a "formulary" when prescribing medicines. A formulary is a list of preferred drugs that has been determined by health care professionals based on cost and effectiveness. Each insurance company has a different formulary. Ask your benefit coordinator if your prescription coverage encourages use of a formulary. If it does, be sure you have a copy of the list or book with you every time you or a family member goes to the doctor. Your doctor may or may not have a copy of this list. If your physician writes a prescription for something that is not on the formulary (non-preferred), you may have to pay extra for it or have a long wait at the pharmacy while the pharmacist contacts the physician to change the medication to something that is preferred by the insurance company. Ask your benefits coordinator for a new formulary every year. These lists change due to changes in costs and availability of new drugs. If you change from one insurance plan to another that has a strict formulary, you may need to get some of your prescriptions changed or pay a penalty.

Have you ever been to the pharmacy to pick up a refill, only to find that the insurance won’t cover the prescription because it is too soon to bill it? This happens quite often. When the pharmacy sends a claim to the insurance, a day supply is calculated. This day supply is referred to when the next claim for the prescription is made. If the insurance company thinks you should still have plenty of medication left, they will deny the pharmacy payment for their claim and give a "refill too soon" reason. This can sometimes happen on new prescriptions too. Each insurance company has a different way of determining what "plenty of medication" is. Most of the time they want the patient to wait until 75 percent of the medication is gone. Let the staff at your pharmacy know if your prescription has changed from the last time, as they may need let the insurance company know this. You should always get a new prescription when the doctor tells you to take your medication differently than it states on your prescription. If you ever need an early refill, let the pharmacy know ahead of time that it may be too soon. Let them know why you need the early refill (directions change, vacation supply, etc.). The pharmacy may be able to get the insurance company to pay when they otherwise wouldn’t. Ask your benefits coordinator if your new coverage pays for vacation supplies (how much and how many), lost or stolen medication, or spilled medication.

Going into the pharmacy with some information about your new insurance will help to make your trip a little easier. Unfortunately, the staff at your pharmacy usually does not have access to any of the details on your coverage until they submit your claim and get a rejection. Even after they receive the rejection, they don’t have all the information they need to advise you on the best way to handle your situation. The staff at your pharmacy spends a good deal of time on the phone with insurance companies, trying to help people work out problems with their insurance coverage. This takes them away from consultation with customers and filling prescriptions. Knowing your coverage is a way that you can help your pharmacy to be more efficient, which will make both the patient and the pharmacist happy.

Parents Warned About Overdoses

As a result of several TylenolŪ (acetaminophen) overdoses, the makers of TylenolŪ have decided to put a warning on their product. The warning mentions the risk of serious health problems that could result if children are given too much of the medication. This warning will also accompany the product’s magazine advertising.

Parents can easily become confused by the different formulas for children’s fever and pain relief. The liquid formulas are available in infant drops (which contain 80mg/0.8ml) and children’s liquid (which contains 80mg/2.5ml).

The infant drops are more concentrated than the children’s liquid. Parents using the cup for the children’s liquid to give infant drops can give too much medicine to the child. The dosing device that comes with a product should be used only for that product.

Parents should not guess at how much medicine to give their child. They should always read the label on the bottle from which they are giving the medicine. A pharmacist or doctor can be consulted if there is a question.

Do not use dosing devices that do not have clear markings. As little as a double dose of acetaminophen, over time, can cause liver problems.

Cutting Cholesterol

By Gary Jurkeviewcz, R.Ph., Licensed Pharmacist

In 1990 the NHANES III report estimated that over 52 million Americans are candidates for cholesterol lowering with diet and/or drug therapy. More than 70 percent of these patients require3d less than a 30 percent reduction in serum cholesterol to achieve the desired therapeutic goals.

It has been recommended that all adults over the age of 20 years have their cholesterol evaluated at least once every five years. The testing should be done when the patient is fasting because triglycerides may be elevated in a non-fasting person. Cholesterol is only modestly affected by fasting. Patients with mild-to-moderately high cholesterol benefit from cholesterol reduction therapy as well as those with very high levels.

Because cholesterol is derived from exogenous and endogenous sources, the therapy for cholesterol reduction involves modifying its intake, altering its adsorption and decreasing its production. This can be done with diet and/or drug therapy. Modifying the person’s diet should be the first step in cholesterol reduction. Many sources advocate the reduction in dietary intake of cholesterol, saturated fat, and total fat while increasing the amount of complex carbohydrates and exercise. Although this seems to be a very logical approach and has produced good results in many cases, there are also some patients that need something more.

That being the case, these people are put on drug therapy. The three categories of drug choices are: niacin/nicotinic acid, the bile acid sequestrants and the HMG-CoA reductase inhibitors. Selection of these various drugs depends on which lipoproteins are elevated in the blood.

Niacin inhibits lipolysis which results in a decrease of cholesterol, and triglycerides, and an increase in the "good" cholesterol (HDL). Unfortunately, compliance is not always at its best because of the major side effect of vasodilation which causes flushing, itching, and uticaria -- almost like a mild sunburn. Liver toxicity is perhaps the most life-threatening side effect fo niacin. Early detection of elevated liver enzymes and discontinuation of the drug causes a reversal of the toxicity. The sustained release forms of the drug have a much higher rate of liver toxicity than the immediate release forms. Individuals should check first with their physician before taking this drug so their liver enzymes can be monitored.

Bile sequestrants bind bile salts in the gut interrupting their circulation and increasing their excretion in the feces. Because these drugs are not absorbed in the blood stream, they have limited side effects, mainly those affecting the gastrointestinal tract: nausea, bloating, fullness, flatulence, constipation and diarrhea. Their binding capabilities also have a tendency to bind with their medications taken at the same time. It is therefore advisable to take other medications two hours before or after taking the bile acid sequestrants.

The last class of drugs is the HMG-CoA Reductase Inhibitors. These drugs inhibit an enzyme, you stop or slow down the production of cholesterol. If you stop the enzyme, you stop or slow down the production of cholesterol. This class of drugs is very well tolerated with significantly fewer side effects than either niacin or the bile acid sequestrants. However, they may increase the levels of the liver enzymes, but with less chance of liver toxicity. Again, your doctor may monitor these liver enzyme levels while you are on this class of drugs.

Garlic, omega-3 oils, and oat bran have also been cited in the literature as being useful in lowering blood cholesterol levels to some degree.

Another method utilizing the diet approach is the Dr. Atkins diet. This diet has been around for years and is used for weight loss, but it also has been used to lower blood cholesterol levels. What is controversial about this diet is that it advocates eating high protein foods (meats, butter, fish, cream, cheese) which may be high in fat, which is the complete opposite of what may people in the medical profession advise. Dr. Atkins explains in his book, Dr. Atkins’ New Diet Revolution, why his diet can work, and why the low-fat/high carbohydrate diets currently used are not the answer to lowering blood cholesterol. He goes further to state that there is no well documented medical studies to prove that his diet will increase the risk of coronary artery disease. He does stress that a high-fat/high-carbohydrate diet could increase lipid levels, whereas, a high-fat/low-carbohydrate diet rarely will. He blames the high consumption of fats. He has some interesting theories, and brings up some valid points which the medical community should seriously evaluate with an open mind.

I tell you about his book so you can read it, and discuss Dr. Atkins’ thinking with your physician. (As a personal side note, when I stuck with his diet and didn’t cheat, my cholesterol fell from 295 to 231 in about 60 days -- no medications, no exercise, and very few carbohydrates. When I was on the low-fat/high-carbohydrate foods, I couldn’t get it down. I’m still in the process of evaluating this with my own physician. I also know of some diabetics who went on this diet and they have decreased the use of their diabetic medications.)

Dr. Atkins gives an interesting presentation. Something worth knowing about, especially if you’ve been having difficulty getting your cholesterol/lipid levels down. His books are available in most book stores.

USP Issues Parent RecommendationsTo Help Prevent Medication Errors in Children

Rockville, Maryland -- January 21 -- The United States Pharmacopeia (USP) today announced recommendations for preventing medication errors when children are in the hospital and at home.
USP’s Center for the Advancement of Patient Safety (CAPS) created the recommendations after analyzing medication error data from its databases. Pediatric medication errors can often occur, for example, when a decimal point is misplaced in a medication dose or an incorrect weight conversion from pounds to kilograms is made. Health care practitioners must consider a child’s age, weight, medication dosing frequencies, and a number of other factors to help ensure the safety of young patients.

“Medications for children are usually dosed by weight in kilograms, which means that adult dosages are often diluted based on weight conversions from pounds to kilograms,” said Diane Cousins, R.Ph., vice president of CAPS at USP. “Because weight calculations are recognized as a frequent problem in pediatric medication dosing, parents can help prevent errors by knowing their child’s weight in kilograms and re-confirming with their child’s doctor that their child is receiving the proper dosage.”

“Parents should also inform the health care provider of any and all allergies their child has and make sure the provider lists them on their child’s medical chart,” added Cousins. “In the home, it is essential that parents use their senses to identify their child’s medication by size, shape, color, smell, and sight. If their child is old enough, parents can also teach them to use their senses as well.”

Tips for Parents: Preventing Medication Errors

While medication errors can happen to any patient at any age, the consequences can be far more devastating when children are involved. With this in mind, USP offers parents the following tips to help prevent medication errors from happening to their children:

On admittance to the hospital, provide the health care practitioner (HCP) with an up-to-date list of all medicines (prescription and over-the-counter) and dietary supplements that your child is taking. This will help minimize medication errors and prevent drug interactions during your child’s hospital stay. Make sure your child’s HCP is aware of any allergies your child may have. For life-threatening allergies, be sure that your child wears a MedicAlert bracelet at all times. Medications administered to children are based on the child’s weight in kilograms. For purposes of preparing appropriate dosages of medicines, your child’s weight in pounds must be divided by 2.2 in order to convert his or her weight into kilograms. Be aware of this calculation and/or your child’s weight in kilograms, and reconfirm the correct dosage with your child’s HCP if you have concerns. Be sure that you are provided with verbal and written information about your child’s medications, the common side effects, and the adverse events that should be reported to your child’s HCP. Pay close attention to how your child is feeling while in the hospital. Notify the HCP immediately if you notice any negative side effects from the administered medications, such as sudden difficulty in swallowing or breathing. If your child is given a liquid medication to take after release from the hospital, be sure you are provided with an appropriate measuring device and instructions to ensure proper medication doses. In case of an emergency, be sure that your child’s school has a list of any medical conditions or allergies your child may have. “Recommendations such as those issued by the USP should help to alert both parents and health care providers of ways to prevent such serious medication errors,” said Dr. Phil Walson, who is professor of pediatrics at University of Cincinnati Children's Hospital Medical Center and a member of the American Academy of Pediatrics. “Parents and their children have the right to expect that health care providers will do everything possible to avoid such errors.”

In December 2002, USP released an analysis of medication errors captured in 2001 by MEDMARX, the anonymous, national reporting database operated by USP. This third annual report, Summary of Information Submitted to MEDMARX in the Year 2001: A Human Factors Approach to Medication Errors, is the most comprehensive compilation of medication error data submitted by hospitals and health systems nationwide.

Of the 105,603 errors documented by MEDMARX, 3,361 errors, or 3.2 percent of total errors, involved pediatric populations (birth to 16 years). Although the majority of errors were corrected before causing harm to the patient, 190 errors, or 5.7 percent of to