Men who buy erectile dysfunction drugs on the Internet risk ingesting hazardous contents and may miss out on treatment for associated conditions like cardiac disease and high blood pressure, according to a study in the International Journal of Clinical Practice.

To reach these conclusions, Graham Jackson and colleagues reviewed more than 50 studies of Internet drug purchasing behavior that had been published between 1995 and 2009.

ED drugs were the most commonly counterfeited product purchased over the Internet, presumably because of their high cost and the stigma associated with the underlying condition.  As many as 2.5 million men are using counterfeit Viagra in the European Union alone, according Jackson’s group.

As many as 2.3 million ED drugs are orderred online each month worldwide, and most of them are secured without a prescription. Approximately 44% of the Viagra purchased on line is counterfeit.

Counterfeit forms of other drugs are a problem as well, Jackson’s group found. In Argentina for example, 2 pregnant women died after receiving injections of a bogus iron preparation, and 51 children died of kidney failure in Bangladesh after swallowing a Tylenol-like syrup laced with antifreeze.

Jackson’s study also revealed examples of counterfeit contraceptives, antimalarials and antibiotics.

Global sales of counterfeit drugs will reach $75 billion this year, according to the Center for Medicine in the Public Interest. That’s up 92% in just 5 years. Nearly 90% of the bogus elixirs are sold on the Internet.

“In some cases producing counterfeit medicine can be 10 times as profitable per kilogram as heroin, yet in the UK someone can face greater legal sanctions if they produce a counterfeit T-shirt,” Jackson, a London cardiologist told BurrillReport.

 “What is clear is that we need much greater public awareness of the risks of buying counterfeit drugs, as lives are at risk.”

Many believe that healthy people should examine themselves regularly or submit to cancer screening because early detection saves lives.

That’s likely true for women, who should begin cervical cancer (Pap) screening by the age of 21, and for adults 50 years or older, who should get colonoscopy.

And it’s probably true for women at least 40 years old, for whom many suggest it’s wise to get mammograms annually to screen for breast cancer.

But that’s about it, at least according to today’s best evidence.

Which brings us to a well-meaning but ultimately dangerous PR campaign by the Light of Life Foundation to raise awareness about thyroid cancer.

“Confidence kills. Thyroid cancer doesn’t care how healthy you are,” read ads in People magazine, Sports Illustrated and elsewhere.  “Ask your doctor to check your neck.”

Thyroid cancer kills about 1,600 Americans per year. In other words, it’s responsible for about 0.3% of all cancer deaths in this country.

And there’s not a shred of evidence that routine neck exams cut the risk of death from thyroid cancer, according to Barnett Kramer, an associate director for disease prevention at NIH.

Most thyroid cancers grow slowly and are curable surgically no matter when they’re found, and the remaining ones are so aggressive that early detection doesn’t’ improve outcomes anyway, according to Kramer. 

A routine thyroid screening program would trigger thousands of unnecessary ultrasounds and needle biopsies not to mention thyroidectomies that risk damaging the vocal cords.

And there’s no guarantee that cursory palpations of the gland by busy PCPs would detect more than a small percentage of the tumors anyway.

Healthy people should consult with their physicians about cancer screening. And they should contact their physicians if new symptoms develop or if their health status changes in any way.

In the old days, patients could do little when physicians kept them waiting, blew-off their questions or seemed incompetent. A tale of woe over the phone to friends or family, or if things got really bad, a complaint to the state medical board was all they could muster.

The Internet has changed that. In the last 5 years, several dozen Web sites have cropped up where patients can post reviews of their physicians, and the chatter on such sites has been louder than the birds at Bodega Bay.

“The worst doctor I have ever encountered in my life,” ranted one consumer. “Impolite, unengaged and unfocused,” chirped another. “Long wait, rude staff, never sent me a follow-up on my tests.”

The most popular physician rating sites, according to the Washington Post, are RateMDs.com, DrScore, Yelp, and Vitals.com.

They support themselves via ad revenues from Google and they’ve become a force.

RateMDs.com for example, has ratings on more than 200,000 physicians and attracts a million unique visitors per month, not to mention the wrath of physicians.

“The people least capable of judging quality of care are patients,” argued Washington DC internist Nancy Falk. “They don’t know what we know.” 

“Doctors aren’t like dishwashers or trash compactors or minivans,” agreed orthopedic surgeon Peter Lavine. The sites, he told the Washiington Post, “attract patients who have an axe to grind.” 

Meanwhile, ethicist Arthur Caplan worries the sites don’t focus on care outcomes, which he insists is the most important consideration.

“One person’s brusque is another’s direct,” Caplan told the Post. “Many doctors who score well on ambiance are not good doctors… (I’ve seen) doctors who were well beyond the border of malpractice who kept going because patients loved them.”

The FDA has warned General Mills that claims about heart benefits appearing on Cheerios boxes violate federal laws.

In particular, the company’s assertion that the iconic breakfast cereal has been “clinically proven to help lower cholesterol” effectively renders the product a drug, according to federal law.

Stephen Sundlof, the director of the FDA’s food-safety center, added that General Mills needs to file a new-drug application for Cheerios if it intends to leave the box labeling as it is.

Tom Forsythe, a gobsmacked GM spokesperson responded that Cheerios’ claim it can “lower your cholesterol 4% in 6 weeks” has been posted for 2 years, and that the labeling references a study in which Cheerios was factored into a low saturated fat, low cholesterol diet.

“The clinical study supporting Cheerios’ cholesterol-lowering benefit is very strong,” Forsythe told the Wall Street Journal.

An unimpressed Sundlof shot back that “we try to make a bright line between what can be said about a drug and what can be said about a food.”

A less specific claim that consuming whole-grain foods can reduce the risk of heart disease risk would be permissible in certain circumstances, he added.

In a letter to General Mills, the FDA said the food-maker must “promptly” correct the violations or else it would be forced to take action, which might include seizing products.

Apparently, the FDA’s intervention was prompted by a tip from the National Consumers League.

The FDA’s love letter follows by one month a case in which the Federal Trade Commission settled a dispute with Kellogg Co. regarding claims that Frosted Mini-Wheats improved children’s attentiveness by 20%.

The Senate Finance Committee is considering whether to levy a new federal tax on soda and other calorie-leaden drinks to help pay for the proposed remake of the nation’s healthcare system.

Early estimates for the cost of the overhaul are in the $1.2 trillion range. To date, team Obama has come up with about half that total.

A soda tax of, say, 3 cents per 12-oz. serving would contribute a bunion-sized $24 billion over the next 4 years according to the Congressional Budget office. Thankfully, it’s just one of hundreds of ideas being considered.

The proposed soda tax would exclude most diet beverages, but sugary beverages not normally considered to be unhealthy, such as Gatorade and Capri Sun would be dunned.

Soda tax advocates cite research pointing to a link between obesity and the consumption of sugary drinks.

They believe the tax would cut consumption and associated health issues, and thus contribute indirectly to reductions in medical costs.

A dozen states already tax sugar-laced drinks, according to Michael Jacobson, the executive director of the Center for Science in the Public Interest.

“Soda is clearly one of the most harmful products in the food supply, and it’s something government should discourage the consumption of,” Jacobson told the Wall Street Journal.

Jacobson also plans to propose increased federal taxes on alcohol, and wants to legislate the elimination of artificial trans fat from the US diet, not to mention the reduction of sodium content in packaged and restaurant food.

But Susan Neely, president of the American Beverage Association worried a soda tax would have a disproportionate impact on low-income Americans.

“Taxes are not going to teach our children how to have a healthy lifestyle,” she insisted to the Journal.

In a move guaranteed to give physicians the heebie-jeebies, insurance giant WellPoint has inked a deal with restaurant provocateur Zagat to publish reviews of doctors.

The result will be a scorecard covering areas like communication and trust that will be viewable only by WellPoint’s 35 million enrollees.

Nina Zagat told the New York Times that unlike their hotel, spa, nightlife and food reviewers, patients are discouraged from being pithy or witty which hopefully means we’ll be spared reading about how a physician’s “onion-breath” and the “dreary waiting room” made the experience “hit-or-miss.”

Apparently more than 75% of patients given the opportunity are posting comments, and 88% recommend their physician.

That may be, but physicians in Connecticut, California and North Carolina, where the idea is being piloted, have panned the project.

“It is curious that they would go to a company that had no experience in health care to try to find out how good a doctor is,” William Handelman, the president of the Connecticut State Medical Society told the Times. 

To which Arthur Caplan added, “there is no correlation between a doctor being an inept danger to the patient and his popularity.”

The director of the Center for Bioethics at the University of Pennsylvania concluded that reviewing physicians is “a recipe for disaster.”

Nina Z. responded that the ratings aren’t intended to be a primary driver in selecting physicians. It’s more like a companion guide to help people pick from a menu of specialists recommended by their primary care doctors.

“One patient might…care more about communications skills,” she told the Times. For another, “having a modern, attractive office may lead to a different choice.”

The FDA has announced plans to study whether TV ads for prescription drugs display side-effect information in a fair and balanced manner.

The plan is to concoct a series of sham TV advertisements for a fictitious blood pressure drug and play them for 2,000 adults. The ads will differ in the images displayed during the time the announcer recites side-effect information.

The ads will display scenes ranging from highly consistent with the information being presented to highly inconsistent—maybe something like a buff couple relaxing in bathtubs positioned for sunset-watching on a beach.

After being shown the sham ads, study participants will be quizzed about what was said regarding the risks and benefits of the drug.

The FDA requires that DTC ads strike a “fair balance” in presenting risks and benefits and worries that visual images can distract viewers to a point where they’re unable to retain information about risk.

“Do images of people frolicking on a beach counteract the risk information being presented?” Allan Coukell, policy director at the Prescription Project asked MedPageToday.

Rhetorically, we can only assume.

“The concern is that every ad ends with the litany of risks–you sort of discount it,” Coukell continued.

The FDA study also plans to assess whether the addition of text describing the risks, in addition to the announcer’s scripted remarks, might impact recall.

In this post, we continue to summarize key findings from a December report by the Commonwealth Fund on the status of retail clinics in the US. An earlier post on the subject appears directly below.

The most common reason (48%) for visiting a retail clinic between 2006 and 2008 was for diagnosis and treatment of a new symptom or illness. Childhood ailments such as earache, sore throats and upper respiratory infections topped the list.

About half as many (23%) retail clinic visitors needed a vaccination and 14% visited the facility to obtain a physical exam required for school, camp or employment.

When asked why they visited a retail clinic over a traditional care setting, 64% of respondents said the clinic’s lengthy hours of operation were a major factor. Roughly the same percentage indicated that the location was more convenient. The ability to walk-in without an appointment was cited by 53%.

Just under half the visitors to retail clinics cited low costs as a principal reason for choosing the venue, while a third indicated they had no other source of care.

It appears that the brief period of unbridled growth in the number of retail clinics has ended. In the first 5 months of 2008 for example, 70 clinics in 15 states were shut down, and the nation’s largest clinic operator, MinuteClinic, announced it would pare back its expansion plans.

That may be so, but the expanding insurance coverage for services provided at retail clinics and rising problems accessing care at traditional venues assure that these convenient providers won’t be disappearing anytime soon.

In its recent report on the status of retail-based health clinics, the Commonwealth Fund suggests that overall utilization remains low, but a recent slowdown in new openings may disproportionately impact uninsured Americans who lack affordable primary care alternatives.

This post and another tomorrow provide a quick update on key findings from the Commonwealth Fund’s report on retail clinics.

Retail clinics are located inside supermarkets, pharmacies and retailers. They provide simple preventive services such as vaccinations and are equipped to diagnose and treat simple health conditions like sore throats and minor rashes.

They are usually staffed by nurse practitioners and remain open during evenings and weekends. Their fee schedules are easy to see and understand, and they tend to keep prices low. They work almost exclusively on a walk-in basis; no appointments are required.

The number of retail clinics exploded from 60 in mid-2005 to more than 1,100 by mid-2008, but virtually all this growth occurred in the first half of this period.

About 3.4 million families have used a retail clinic at least once. That’s 2.3% of all US families. There are wide variations in retail clinic utilization across states however. Minnesota boasts the highest utilization: 6.4% of families in that state have used retail clinics at least once.

Uninsured families (those with at least one member who lacks insurance) comprise 27% of retail clinic users. Overall, 17% of US families are uninsured, meaning that uninsured families use retail clinics more frequently than those with insurance.

Insured families report that half the time their carriers paid for at least some of the fees they incurred during a visit to a retail clinic. Fully 85% of retail clinics now accept insurance, a marked change from the cash-only business model that dominated just a few years ago.

As Big Pharma celebrates the tenth anniversary of the direct to consumer advertising bonanza in the US, there may be more good news for the industry coming out of Europe.

The European Commission had steadfastly prohibited the practice on the continent, but last week its officials proposed legislation allowing drug companies to provide consumers “objective and non-promotional information” about their drugs in magazines and on Web sites.

The legislation would allow drug companies to provide “medicinal, product-related information” that “does not go beyond the elements” of the inside drug packaging.

The information could cover for example side effects, prices or anything that “presents the medicinal product in the context of the condition to be prevented or treated,” according to Commission documents reviewed by the Wall Street Journal.

No one’s holding their breath of course because this is Europe: the legislation must be approved by the European Parliament and the Council of Ministers, and that could take years.

The Commission, which is the Executive arm of the European Union, believes the current ban is woefully out of date in an era when consumers are heavily involved in their care and routinely seek out medical information on the Web.

Speaking for the Commission, Gunter Verheugen VP of enterprise and industry emphasized the EU is not relaxing its ban on drug advertising. “There will be strict rules regarding content and these will be tightly monitored,” he told the Journal.

European consumer protection groups do not support the Commission’s decision, because they don’t believe Big Pharma can be trusted.

“It’s just a disguised way of giving pharmaceutical companies greater flexibility to provide the information they want on prescription medicines,” Monique Goyens told the Journal.

It’s safe to say that Goyens, director of the European Consumers’ Organization, would not encounter many in the US who disagree with that.

In the decade since the FDA began permitting Big Pharma to market drugs directly to consumers, the ads have become ubiquitous on TV and radio and in print media.

The industry spends $5 billion per year on DTC and no one argues the ads move mountains. For example, ads for the highly effective cholesterol-lowering statins have increased their utilization and almost certainly saved lives as a result.

But it’s galled more than a few folks that DTC ads have been equally effective promoting lifestyle drugs that line Big Pharma’s pockets without doing much to improve overall population health.

Rep. Bart Stupak (D-Mich.) for example, never did warm to the DTC concept. In May, he called out Pfizer for Lipitor ads featuring Robert Jarvik, the well-known inventor of the artificial heart because Jarvik is not a practicing physician.

So Big Pharma knew what to expect from Stupak when PhRMA, its trade group announced last week it was tightening its own guidelines governing DTC practices.

The new “voluntary guiding principles” include halting the practice of using actors to role-play physicians on DTC ads, requiring that celebrities cease claiming they use drugs unless they actually do, and ceasing the promotion of drugs for indications not approved by the FDA.

The guidelines also limit ads with adult-oriented DTC content (that would be Viagra and congeners) to programs that normally draw adult audiences.

Stupak offered lukewarm praise and quickly added that the guidelines don’t go far enough.

He wants Big Pharma to wait 2 years after drugs are marketed before releasing ads DTC to assure all drug effects are fully understood.  He also wants the FDA’s toll-free number to appear on DTC ads to facilitate reporting of side effects.

Industry spokespeople indicated they’d be happy to review the issue in a few years if critics remained unsatisfied. There’s no chance the issue remains quiet that long.

More than 11% of US children and teens take herbal supplements or another type alternative medicine, according to a study by the Centers for Disease Control and Prevention.

The study is the first to assess utilization of oral supplements, acupuncture, meditation and chiropractic care among children. The same study concluded that adult utilization of these treatments remained stable since 2002 at about 37%.

Herbal supplements were the most frequently used alternative therapy in all age groups. Children were particularly common users of Echinacea, fish oil, combination herb pills, flaxseed oil, and prebiotics or probiotics.

The most common symptoms triggering use of herbal supplements were head or chest colds, anxiety/stress and back or neck pain. Insomnia, attention deficit hyperactivity disorder and body aches made the top 10.

Kids were 5 times more likely to use alternative therapies if a parent or relative used them. Those with higher incomes and education, and those covered by private health insurance were more likely to use them than children who were uninsured or covered by public programs.

It’s hard to say whether this degree of utilization is useful or harmful since few of the therapies have been tested rigorously according to Richard Nahin, a study author head of the National Center for Complementary and Alternative Medicine.

The study relied on a 2007 survey of 23,000 adults representing themselves and 9,000 other adults who spoke for a child in their home.

The study did not examine use of vitamin and mineral supplements, folk medicine practices or religious healing.

Use of alternative therapies is likely much higher in immigrant communities, particularly those from China, Africa and the Caribbean.

Atlas Sports Genetics claims to have a test that predicts which kinds of sports match your child’s innate abilities. You can buy it right now for $149.

The test determines ACTN3 gene expression. ACTN3 is one of 20,000 human genes.

The so-called R variant of ACTN3 instructs the body to produce alpha-actinin-3. This protein component of fast-twitch muscles provides forceful, quick contractions required to excel in power and speed sports like football and sprinting. The X variant suppresses the production of alpha-actinin-3.

Children inherit one copy of the ACTN3 gene from each parent, so they can be “RR,” “RX,” or “XX.”

Atlas Sports claims that power and speed sports are best suited to RR offspring, whereas endurance sports like marathons and distance swimming are best suited for XX offspring. Apparently RX offspring can do anything.

If this sounds dicey to you, you’re not alone.

Dr. Theodore Friedmann, the director of the gene therapy program at UCSD for example, told the New York Times the test amounted to “an opportunity to sell new versions of snake oil.” He elaborated, “I don’t deny that these genes have a role in athletic success, but it’s not that black and white.”

There is no doubt the science being commercialized here is compelling, if not ready for prime time.

In 2003, Australian scientists studied 429 world class athletes including 50 Olympians. They found that 50% of the 107 sprint athletes were RR. That’s twice the frequency of RR in the general population. And not one female sprinter was XX. What is more, every male Olympian involved in power sports had inherited an R variant from at least one parent.

So where does the XX Spanish long jumper fit in?

It’s hard to know but Carl Foster, a co-author of the study and director of the human performance laboratory at the University of Wisconsin-La Crosse has devised another way to see whether your 6th grader will excel at power and sprint sports:

“Just line them up with their classmates for a race and see which ones are the fastest,” he said.

Honey, what should we do with the Ginkgo biloba?

How many people are asking that question after scientists at the University of Virginia proved the popular plant supplement does not reduce the risk of developing dementia of any kind nor Alzheimer’s disease specifically.

Ginkgo also did not impede progression to dementia in those having mild cognitive difficulties to begin with.

Subgroup analyses of younger patients, older patients, both sexes and those with all degrees of baseline cognitive impairment all came up dry, and there was no impact on overall mortality.

Pretty much, the stuff didn’t work.

Steven T. DeKosky and colleagues randomized 3,069 community-dwelling people who were at least 75 years of age to receive either 120 mg Ginkgo twice a day or a placebo. 482 study participants had mildly impaired cognition at study onset. Participants were evaluated twice yearly during the 6-year study.

The results were just published in the Journal of the American Medical Association. 

Annual US sales of Ginkgo products are $250 million, driven by some bench research showing neuroprotective effects that have been attributed to flavonoids contained in Ginkgo, an animal study showing mild protective effects during a stroke, and good old-fashioned hope that it could improve or at least maintain memory.

The present study did not exclude the possibilities that starting the extract at a younger age or continuing it longer than 6 years might have beneficial effects, though these seem unlikely.

A second large, randomized trial of Ginkgo biloba is nearing completion. We’ll try to remember to look for it.

In the Jurassic period of the information age, otherwise known as the late 1970s, there were no cable-ready TVs, electronic games or cell phones and of course there was no Internet. Times were good for TV marketers. They could reach 90% of US households with prime-time ads on just 3 networks.

In 2008, they would be happy to reach 30% with such a strategy, and DVRs mean viewers can skip the ads anyway.

But now things might be looking up for TV ad sellers. Researchers from the Carroll School of Management at Boston College have found that TV advertisements can influence brand preferences even when viewed in fast forward mode.

James Gips and Adam Brasel tracked the eye-movements and subsequent brand selections of participants watching a nature documentary on TV. The scientists showed that viewers focus intensely on the screen while fast forwarding commercial sequences so they don’t miss the start of normal programming.

In fact they’re paying closer attention than when ads are displayed at normal speed.

This explains why fast-forwarded brand images displayed for just a third of a second influenced future preferences, but only if they were centered on the screen and surrounded by little clutter. 

The scientists had inserted ads for Flake and Aero, two UK chocolate bars unfamiliar to most US viewers. Study participants fast-forwarding though ads in which the brand logo was displayed simply and on center screen were twice as likely to choose that brand during follow-up. Such preferences were not observed when ad lay-out deviated from the centered, uncluttered presentation.

So get ready to see brand images parked squarely and simply in mid-screen next time you’re leaning on fast forward.

No one needs to hear more bad news about the economy, but it keeps coming anyway.

Last week Circuit City, the nation’s second largest electronics retailer filed for Chapter 11 bankruptcy protection. 8,000 jobs will be lost.  It’s the latest of 14 major retail chains, including Steve & Barry’s, Mervyn’s and Linens ‘n Things to file for bankruptcy protection in the last 12 months.

And since most can’t line up financing to reorganize and come out swinging, they simply liquidate and disappear.

A tenth of the American workforce works in retail, but in the last year a quarter of all US job losses—320,000 according to the Wall Street Journal—have been in this sector. This doesn’t include another 200,000 workers whose employment has been switched from full- to part-time.

The pummeling of retail speaks volumes about the severity of the Great Economic Crisis of 2008. In mild recessions such as the one linked to the dot com collapse and the terrorist attacks of 2001, retail employment hangs in there for a long time because consumers continue to spend, maybe not as much but at least some.

Not so this time. Job losses in retail are already more severe than in financial services, automotive manufacturing and hospitality, and experts think the worst is yet to come.

Now for the bad news. Retail jobs have traditionally served as an economic safety net for Americans. If we needed a second job to make ends meet, we found it in retail. If we got laid off from a manufacturing job, we ended up in retail. If we were fresh out of college and couldn’t get a dream job, we headed for retail. Same thing if we didn’t go to college in the first place.

Forget that.