According to results published last week by comScore, purplepill.com, the AstraZeneca-sponsored web site for its heartburn drug Nexium was the busiest of all company-sponsored web sites in Q2 2008, with more than 1 million unique visitors.

Here are the top five sites by number of unique visitors (in millions), and the percent change from Q2 2007:

Nexium (heartburn):  1,021, +55%
Actos (diabetes):  855, +2,399%
Ambien CR (insomnia):  756, -61%
Gardasil (HPV vaccine):  722, -21%
Lexapro (anxiety, depression):  549, +3%

“AstraZeneca has aggressively marketed Nexium this year, running approximately twice as much online display advertising in Q2 as either of its major competitors, Prevacid and Aciphex,” said comScore’s John Mangano. “This additional marketing muscle appears to have helped generate strong site visitation, a very important marketing step in the competitive pharmaceutical industry.”

comScore also credited marketing campaigns for the surge in volume on the web site for Actos, Takeda’s diabetes drug, although safety concerns about a competing drug, Avandia, probably played a role as well.

Sanofi-Aventis’ Ambien CR site lost significant volume in the past year, as the regular version of the drug faced generic competition for the first time.

Gardasil, Merck’s HPV vaccine was approved by the FDA in Q2 2006. Merck is not publicizing the vaccine as aggressively as it was a year ago, but the site still makes the top five.

When both houses of Congress approved bills last week requiring insurers to provide mental health benefits equivalent to those for physical illness, advocates who had worked 10 years to enact such legislation lauded it as a major step forward.

But the House and Senate versions differed, and the legislative session was coming to a close. It wasn’t clear Congress would act quickly enough to have something on the President’s desk before adjournment.

Subsequently the credit markets froze, the House turned Paulson’s 3 page scheme into a 240 treatise before voting it down, and the markets dropped like a stone.

The Senate had to clean up the mess, and thanks to a handful of clear headed, dedicated people  who seized the moment, the Senate’s version of the mental health bill became part of the bailout legislation (see page 310 out of 451) that it passed on Wednesday.

Now it’s on to the House. 

Terrific work right there by people who know how to get things done in Washington. There are some who will point to enactment of this mental health legislation as the crowning achievement of their careers. These people are, of course, “all in” on the bailout.  We wish them luck!

Ever since surgical resident workweeks started getting shaved (it’s now 80 hours), there has been debate about how the change impacts quality in teaching hospitals. Proponents of the shorter workweek believe less fatigued residents make less errors. Skeptics fear that frequent shift changes increase the risk of errors in information transfer.

To date, studies of the matter have failed to silence the debate one way or the other.

The same can be said of the latest study of laporoscopic cholecystectomy in the era of the 80 hour workweek. The problem isn’t its finding that quality improved after the workweek became shorter, but that it’s not possible to attribute the improvement to residents sleeping more.

Using a retrospective trial design, the investigators compared complication rates at their hospital before and after the change to an 80 hour workweek. After accounting for age, gender and presence of acute cholecystitis, they found that the incidence of bile duct injury and total complications was lower after the rule change.

But why?  It may be that rested residents make all the difference. But it also could be that attending physician supervisors got more involved for whatever reason, or that the manpower alteration caused risky patients (where complications are most likely) to get procedures other than laporoscopic cholecystectomy.

A frequently used toll-free help line for Medicare beneficiaries either gives out inaccurate information or no information at all, according to a report presented to the Senate Aging Committee.

The service in question is 1-800-Medicare. It is supposed to help beneficiaries find their way through the complex federal health insurance program.

Recently, Sen. Gordon Smith (D-Ore) had his staff place 500 test calls to the help line. Staff members found that the information they received was inadequate 90% of the time.  Callers to the toll free number are also plagued by wait times up to an hour and frequent dropped calls, according to the report.

1-800-Medicare will receive 30 million calls this year. It has been in operation for 10 years. Volume ramped up substantially in 2003 when Medicare’s Part D prescription drug plan went into effect.

CMS acting administrator Kerry Weems said Medicare will improve performance of the toll free service by upgrading training and improving the call center’s data bases. A senior officer at Vangent Inc., the contractor that operates the 1-800-Medicare call centers, pointed out that 85% of callers were actually satisfied with the program. He added that most real world callers had simpler issues than the ones posed by Smith’s staff.