Malpractice Risk Reduction Medical Education

Lowering The Malpractice Risk To Your Practice In The New Competitive Healthcare Arena

With too many physicians today dissatisfied both personally and professionally with practice in the managed care environment, combined with a growing cry from patients for higher standard care, one solution is the reliable path to 21st Century healthcare practice - Integration of scientifically superior evidenced-based disease state management methods that satisfy both institutional requirements and values-centered doctors' need to be contributing the professional finest.

Modern Directions In Medical Application For Osteoporosis Syndromes

Osteoclast Suppression

Osteoporosis was not recognized as a treatable condition - as opposed to "just a part of getting old" - until comparatively recently in medical history. Public awareness of osteoporosis has been largely successful and patients are now asking for a strategy to counteract their lower bone density scores. Bisphosphonates are powerful suppressors of osteoclast cell life. This class includes etidronate (Didronel), pamidronate (Aredia), alendronate (Fosamax), risedronate (Actonel), zolendronate (Zometa), and ibandronate (experimental). Such an interruption of the bone forming process calls for circumspection in cases other than the most extreme.

Younger Women

In premenopausal younger women, bisphosphonates are NOT APPROVED for prevention of postmenopausal osteoporosis. They may be used in other situations, such as prolonged high dose steroid use, organ transplantation, fibrous dysplasia, and metastatic carcinoma. They should not be used in women who got a DEXA out of curiosity and discovered osteopenia. Studies in animals show fetal and maternal abnormalities in bones and calcium metabolism, so it is unethical to study this medication in pregnant women or women who might become pregnant while the bisphosphonate is still in the bones. The long-term effect of blocking bone formation rates are not known. There might be accumulation of micro-cracks, such as seen in animals given large doses. The bone could become more brittle, because increased mineralization can decrease the toughness of bones. In humans, it could be many years before any deleterious effects are seen - and perhaps they would never occur.

Genetic Susceptibility

In a study of over 1000 Iceland residents with osteoporosis, the firm DeCode Genetics found that those with certain bad versions of a gene called BMP-2 (bone morphogenic protein) were three times more likely to develop osteoporosis. DeCode (Nasdaq: DCGN), is collaborating with Swiss drug and diagnostic firm Roche Holding (Otc: RHHBY). A test for the variant forms of the gene is being developed by Roche Diagnostics and will be available in medical laboratories (early 2004), said Dr. Kari Stefansson, chief executive of DeCode.

Approximately 10% percent of the population is believed to have the bad versions of the BMP-2 gene.

Genomic Medicine

In the not-too-distant future, gene researchers envision that healthy persons will routinely get a battery of genetic tests that predict their risk of heart disease, diabetes, and other ailments while they are still young and healthy. People could then adjust their lifestyle and diet, try preventative drugs, or take other action to reduce their risk of ever becoming sick. The new osteoporosis gene finding offers an early example of how such genomic medicine might work.

New Clinical Strategy

Now that genetic testing has discovered a defect in the gene for BMP correlated to osteoporsis, the new clinical strategy is to upregulate BMP's and stimulate osteoclast formation in a combination osteoanabolic and osteoanticatabolic approach applied to a wider patient population with bone health concerns.

One Size Doesn't Fit All: Is your patient over-medicated and at excessive risk without a clinical pharmacogenomics strategy?

Glaxo chief Dr. Allen Roses speaks about new pharmaceutical drug development strategy
- "Our drugs do not work on most patients" -

Testing For Clinical Response

Dr. Roses is a senior executive with Britain's biggest pharamaceutical company. Roses is a firm believer that the study of single nucleotide polymorphisms, or SNPs (pronounced snips), will steer the future of drug development. SNPs are the slight but significant variations in genes that can decide how an individual will respond to a drug or be predisposed to a certain disease. "This is the biggest thing to happen in biotechnology in the past decade in lots of people's opinions," said Dale Pfost, CEO of Orchid Biocomputer, a gene research company specializing in SNPs. Roses stated "A SNP map is like a fingerprint or a profile. Using a SNP map you can measure people who have some sort of clinical response and compare them to people who don't get the clinical response and start targetting medicines."

Doseage And Reaction

"We have a drug that is an incredibly good anti-convulsant for epilepsy. We've got a problem with that drug; not a big problem but a small type of problem that keeps a very good drug from being a blockbuster. As a neurologist I can tell you that that drug is probably the best drug for certain forms of epilepsy that are commonly found in the population with fewer side effects than many of the other drugs. It is commonly used but why isn't it the blockbuster that everybody uses right off the bat? It is because about 2 per cent of patients get an itchy skin rash. If you're a doctor and you see a lot of people with epilepsy you certainly don't want 2 per cent of them calling on the phone questioning what kind of doctor you are because they've got this itchy skin rash. The drug gets used in a dose escalation by experts but it doesn't necessarily get used by the general doctors who don't want to get involved in dose escalation or don't want to hear that they are not a good doctor for giving someone a rash. What are we going to do? From a blood sample it can be determined that you are not going to get the skin rash and can take the drug. You avoid dose escalation, you avoid the nasty telephone calls in the middle of the night, and you become a happy user of a very good and otherwise safe drug. If we can bring individualised medicine, customised medicine, safely and efficaciously to the population the pharmaceutical industry is doing something good and I'm very very happy that Glaxo Wellcome is at the head of that movement."

Open Secret

Dr. Allen Roses has admitted that most prescription medicines do not work on most people who take them. As worldwide vice-president of genetics at GlaxoSmithKline (GSK), he has said that fewer than half of the patients prescribed some of the most expensive drugs actually derived any benefit from them. It is an open secret within the drugs industry that most of its products are ineffective in most patients but this is the first time that such a senior executive has gone public. His comments come days after it emerged that the NHS drugs bill has soared by nearly 50 per cent in three years, rising by 2.3bn a year to an annual cost to the taxpayer of 7.2bn. GSK announced that it had 20 or more new drugs under development that could each earn the company up to $1bn (600m) a year.

Genes That Interfere

Dr. Roses, an academic geneticist from Duke University in North Carolina, spoke at a recent scientific meeting in London where he cited figures on how well different classes of drugs work in real patients. Drugs for Alzheimer's disease work in fewer than one in three patients, whereas those for cancer are only effective in a quarter of patients. Drugs for migraines, for osteoporosis, and arthritis work in about half the patients, Dr. Roses said. Most drugs work in fewer than one in two patients mainly because the recipients carry genes that interfere in some way with the medicine, he said. "The vast majority of drugs - more than 90 per cent - only work in 30 or 50 per cent of the people," Dr. Roses said. "I wouldn't say that most drugs don't work. I would say that most drugs work in 30 to 50 per cent of people. Drugs out there on the market work, but they don't work in everybody."

Pharmacogenetics Removing Uncertainty

"He is a pioneer of a new culture within the drugs business based on using genes to test for who can benefit from a particular drug." Dr. Roses has a formidable reputation in the field of "pharmacogenomics" - the application of human genetics to drug development - and his comments can be seen as an attempt to make the industry realise that its future rests on being able to target drugs to a smaller number of patients with specific genes. The idea is to identify "responders" - people who benefit from the drug - with a simple and cheap genetic test that can be used to eliminate those non-responders who might benefit from another drug. This goes against a marketing culture within the industry that has relied on selling as many drugs as possible to the widest number of patients - a culture that has made GSK one of the most profitable pharmaceuticals companies, but which has also meant that most of its drugs are at best useless, and even possibly dangerous, for many patients. Dr. Roses said doctors treating patients routinely applied the trial-and-error approach which says that if one drug does not work there is always another one. "I think everybody has it in their experience that multiple drugs have been used for their headache or multiple drugs have been used for their backache or whatever. "It's in their experience, but they don't quite understand why. The reason why is because they have different susceptibilities to the effect of that drug and that's genetic," he said. "Neither those who pay for medical care nor patients want drugs to be prescribed that do not benefit the recipient. Pharmacogenetics has the promise of removing much of the uncertainty."

Response rates

Therapeutic area: drug efficacy rate in per cent

Alzheimer's: 30

Analgesics (Cox-2): 80

Asthma: 60

Cardiac Arrythmias: 60

Depression (SSRI): 62

Diabetes: 57

Hepatits C (HCV): 47

Incontinence: 40

Migraine (acute): 52

Migraine (prophylaxis):50

Oncology: 25

Rheumatoid arthritis: 50

Schizophrenia: 60

Beyond The Usual Top Experts:

Professional Research Reports That Serve To Educate Professors Of Medicine - Strategies To Lower Malpractice Risk In The Delicate Senior Patient Population

New protocols for practice education based on a meta-analysis of the most promising applied research and clinical practice in the field.

Neuropathy - New Directions In Treatment Based On Clinical Practice In Germany And The US

Bone Health &
Disease Treatment Strategies

Pre-Alzheimer's - Slowing Down The Progression At The Base of The Process

Failed Back Syndromes - Innovative Theory and Management Strategies That Obviate Surgery In Many Cases

Prostate Cancer - The Most Advanced Nerve Sparing Procedures

Young Scientists In School

Now more than ever, our society needs passionately dedicated scientists who understand the health science issues that affect our loved ones and neighbors. Young people can be excited about science when they meet an inspiring example that they can relate to. We believe that nothing is more important for the fast-approaching future than the cultivation of wonderfully contributing young people who have found a path to fulfillment and satisfaction in discovery and service. Increasingly high-technology nations need informed citizens, making scientific literacy a human right and scientific illiteracy a disability. To have a speaker for your school, contact us at medicalscience@auroralifesciences.com

Board of Advisors

Aurora Life Sciences Health Media is advised by medical leaders deeply dedicated to higher standard healthcare in action. If you would like a list of our advisors, please contact us.

Book an educational session with our medical analyst.

First time clients can get the initial educational consultation which is one and a half hours on the telephone. You must email first to make the appointment and for us to get information from you about your current questions and other issues. We will set up a time that works for both of us. At the appointed time you will call us. We will address any important issues you are currently curious about and guarantee your satisfaction.