![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
brdgtPLEASE, if you do anything, read the first essay!
Essay: Scare Yourself Silly, but the Real Terrors Are at Your Feet
By ABIGAIL ZUGER, M.D., The New York Times, October 25, 2005
Just in time for Halloween, the usual yearly ritual of terror by headline is now playing itself out in medical offices everywhere. Last year it revolved around flu shots; a few years ago it was anthrax and smallpox; a few years before that it was the "flesh-eating bacteria"; and before that it was Ebola virus, and Lyme disease and so on back into the distant past. This year it's the avian flu.
"I was crossing Third Avenue yesterday and I was coughing so hard I had to stop and barely made it across," a patient told me last week. "I'm really scared I'm getting the avian flu."
I just looked at him. What could I say? He has smoked two packs of cigarettes a day for the last 50 years. He has coughed and wheezed and gasped his way across Third Avenue now for the last 10 years. His emphysema is not going to get any better, but it might stop getting worse if he were to stop smoking.
He made it clear long ago that this is not going to happen. When it comes to the whole cigarette/health question, his motto, apparently, is "What, me worry?"
But the avian flu - now there's a health scare a person can sink his teeth into. So scary and yet, somehow, so pleasantly distant. So thrilling, so chilling, and yet, at the same time, so not here, not now, not yet. All in all, a completely satisfying health care fear experience. Unlike his actual illness.
Scary movies give children nightmares. Scary health news gives adults the extraordinary ability to ignore the immediate in favor of the distant, to escape from the real (and the really scary) into a far easier kind of fear.
A few years ago, a young woman waited patiently to be seen in our office after hours. She was a patient of one of my colleagues, but she couldn't wait for their scheduled appointment; she needed to see someone right away.
"I'm worried I have Lyme disease," she said. "I have all the symptoms. I think I need to be treated."
"But you have AIDS," I said.
"I'm tired and weak and I have fevers and sweats. I've lost my appetite. I can't think straight. I'm losing so much weight!"
She had seen a TV news report on Lyme disease, and then she had checked the Internet. All her symptoms were right there.
"But you have AIDS," I said. "And you don't want to take meds. That's why you're feeling so bad."
"I'm really scared about Lyme disease," she said. "I really need to get treated."
"If you want to be scared, how about that untreated AIDS of yours?"
We looked at each other. It was an impasse. The fact that logic was on my side mattered not at all: evidently the real was just a little too real for her. How much better to find another illness to be scared of, obsess over, get treated for, get rid of.
Eventually she coerced my colleague into testing her for Lyme disease and treating her despite negative tests. Then she decided her symptoms might actually be due to a brain tumor, instead. And so it went, until she died of AIDS.
Of four patients I saw in a single hour last week, three announced how scared they were of the avian flu. I reassured them, but there was quite a bit I did not say, and here it is.
I did not say: If you want to be scared, then how about that drug habit of yours you think I don't know about? How about the fact that you are 100 pounds overweight and eat nothing but junk? How about the fact that in a few short months Medicaid is going to stop paying for your very expensive medications and no one knows how just high that Medicare Part D deductible and co-payment are going to be? I did not say: If you want something to be scared of, how about the drug-resistant Klebsiella that is all over this very hospital, an ordinary run-of-the-mill bacterial strain that has become so resistant to so many antibiotics that we've had to resurrect a few we stopped using 30 years ago because they were so toxic.
That Klebsiella is one scary germ. It's in hospitals all over the country, and by now it's probably killed a thousandfold more people than the avian flu.
But you don't hear much about our Klebsiella. Like our bad habits and our dismally insoluble health insurance tangles, our antibiotic-resistant bacteria are with us, right here, right now. Apparently they all lack the drama, the suspense, the titillating worst-case situations that energize our politicians and turn into a really newsworthy health care scare.
They're all just too real.
Q & A: Chancy Chickens
By C. CLAIBORNE RAY, The New York Times, October 25, 2005
Q. How do humans become infected with bird flu? Do I need to avoid bird feeders and chicken dinners?
A. The form of avian influenza that recently broke out in domesticated chickens, ducks and turkeys in Asia and Europe, avian influenza A (H5N1), has not been seen in the United States, and there is no certainty that it will be, medical authorities emphasize. They explain that infected birds shed the flu virus in their saliva, nasal secretions and feces.
Direct contact with infected poultry, or surfaces and objects contaminated by their feces, is now considered the main route of human infection, the World Health Organization says. So far, most human cases have occurred in rural or semirural areas where many households keep small free-roaming poultry flocks that sometimes enter homes.
Exposure is considered most likely during slaughter, defeathering, butchering and preparation of poultry for cooking, the health organization says, and no evidence suggests that properly cooked poultry or eggs can be a source of infection.
The W.H.O. said it was aware of concern over the possibility that the virus could spread through contact with contaminated poultry products or contact with live infected animals and is working to see if this could happen.
To date, however, there is no epidemiological information to suggest that the disease can be transmitted through contaminated food or that products shipped from affected areas have been the source of infection in humans.
The Consumer: And Now, a Warning About Labels
By DEBORAH FRANKLIN, The New York Times, October 25, 2005
Open your medicine cabinet, and take a close look at every prescription pill bottle you've got. Chances are, each vial is plastered with at least one colorful warning sticker that contains a bold but strangely ambiguous phrase or two — accompanied, perhaps, by a cryptic drawing. You might see, for example, a red sticker depicting a gushing faucet, with a message in fine print that reads, "MEDICATION SHOULD BE TAKEN WITH PLENTY OF WATER." But, how much is plenty? Would a cup of coffee be acceptable instead?
Another common sticker urges, "DO NOT CHEW OR CRUSH, SWALLOW WHOLE," next to a diagram that looks at least as much like an arrow chasing a nickel down the throat of a bota bag as it resembles a drug tablet falling into a stomach.
These insistent little strips of paper or plastic — hundreds of them — are designed and manufactured by a number of well meaning companies, each according to its own format, symbology and color scheme. The warning stickers on prescription bottles have not traditionally been deemed important contributors to patient education.
Compared with the package insert prepared by the drug's manufacturer under the hot breath of the Food and Drug Administration or the one-page consumer summaries that pharmacists add, the warning stickers are just fluffy little extras.
As such, they are not standardized, regulated or even reviewed by the F.D.A. Nor are they generally tested for effectiveness before they hit the market.
But some health literacy experts worry that many patients, overwhelmed by a proliferation of paper warnings — often written in turgid prose — are relying instead on the stickers to tell them how to take medications.
Ambiguous wording and artwork, combined with nonintuitive color selections, are among the problems that can make prescription drugs confusing to take.
"What I'm hearing from patients is that they don't really much use these handouts that are stapled to the bag," said Dr. Ruth Parker, an internist who treats patients at the large public hospital associated with Emory University in Atlanta. "What they will sometimes do is look at the label."
Dr. Parker recently completed two studies on the topic with Dr. Terry Davis of Louisiana State University at Shreveport and Dr. Michael Wolf of Northwestern's Feinberg School of Medicine in Chicago. The scientists said that, so far, they had not heard of anyone who was harmed by over-reliance on the little stickers as medication guides.
Still, their results, not yet published but already being talked about in health literacy circles, suggest that a risk does exist. And patients with reading skills that do not stretch beyond sixth or seventh grade seem likely to be the most vulnerable.
To explore the problem, the researchers interviewed a few hundred healthy, English-speaking adults in three states to identify a group with a broad cross section of reading skills. About a third of those enrolled in one of two studies tested below a sixth-grade reading level. Another third of the group read at a level higher than 12th grade.
The researchers showed the volunteers samples of real warning stickers, one at a time, and asked them individually to explain what action the label was urging. The high number of errors across the board was startling.
For example, when the volunteers saw the sticker with the little pill-popping bota bag, some participants in the studies inverted the meaning completely, and thought that it meant they should chew the pill and crush it before swallowing. Others thought the stomach was a bladder. Still others decided the label meant the drug was "just for your stomach."
Many people seemed to guess at a sticker's meaning instead of reading the tiny type, making leaps that often got them into trouble.
For example, common misinterpretations of a yellow label bearing an icon of the sun with a slash through it were, "Don't take medicine if you've been in the sunlight too long," "Don't leave medicine in the sun," and "Don't leave medicine in the sun, but in a cool place." The extremely fine print of that label actually read, in all capital letters: "YOU SHOULD AVOID PROLONGED OR EXCESSIVE EXPOSURE TO DIRECT AND/OR ARTIFICIAL SUNLIGHT WHILE TAKING THIS DRUG."
The "FOR EXTERNAL USE ONLY'' sticker stumped 25 percent of even those who could read every word, and misled 90 percent of the adults in the lowest literacy group.
That, Dr. Wolf said, was probably because its icon was so strange. The label depicted an oddly-stretched human shape encased in what looked like a series of ghostly shrouds. Take this pill to stop hallucinations? To start them?
"A lot of people thought that icon meant the drug was radioactive," Dr. Wolf said.
At a loss to make out the image, many people in the study seized on the red color as signaling danger or urgency. "Use extreme caution in how you take it," one person said the warning meant. Another interpreted it to mean, "Take only if you need it." Indeed.
"These labels can pose problems for all patients, not just those with low literacy skills," Dr. Wolf said. "But our research showed that those with low skills are hit harder because they are more likely to rely on a sticker's color and its icon."
Dr. Davis said she had noticed that in most cases, the label designers seemed to have chosen the colors of the stickers without any regard to content. She says she believes that is a mistake.
"There's nothing intrinsic to the shape or color of a stop sign that means stop," she said, "but we all learn really early on, long before we can read, that we're supposed to stop when we come to a red octagon with white letters, and we're to go when we see a green light."
One bright red label said, "THIS DRUG IS AVAILABLE IN A COST SAVING GENERIC," but a "NOT TO BE SWALLOWED" warning was printed on a blue sticker.
"Designers need to realize that patients are imputing meaning to the color of those labels," Dr. Davis said, "whether it was intended or not." In theory, the researchers said they thought that using crisp, pre-tested icons, intuitive colors and other innovations on the stickers could actually help curb medication mistakes by patients who do not read well or who are led by age, infirmity or more transient conditions like pregnancy, grief or exhaustion to reach for the wrong bottle.
Last spring, Target announced a redesign of the prescription bottles used in all its pharmacies to, among other things, improve the legibility of the labels. The company is in the midst of redesigning its prescription warning labels, as well.
But innovation alone is not the answer, Dr. Parker said. "The last thing we need are 400 new and improved icons, any more than we need 400 new and improved stop signs," she said. "What we need is clarity and consistency about which warnings to use when."
She added, "I believe we absolutely need some sort of regulation about this, because we need standardization." Ray Bullman, executive vice president of the National Council on Patient Information and Education in Bethesda, Md., knows firsthand that the warning labels are used inconsistently.
"When I pick up my prescription drug, the number of stickers on it depends on which pharm tech is on that night," Mr. Bullman said. "There's usually one for dizziness, a warning not to take it with grapefruit juice, and some others lined up around the bottle like those tall, thin cookies around a cake."
More are not necessarily better, he said, and added, "Sometimes it gets almost to the point that you can't read the prescription."
In Philadelphia, Jean Krause, the chief executive of the American College of Physicians Foundation, said that even within her office she had noticed inconsistency in the way the warning labels were used. Ms. Krause and two colleagues all take the same cholesterol-lowering drug, but they buy it from three different pharmacies.
"My bottle says 'Do not take with grapefruit juice or grapefruit products,' " Ms. Krause said. "But neither of my colleagues' bottles say a word about that. I have to wonder why not."
Ms. Krause is hoping that, coincidentally, the work of her foundation might soon help resolve that question. At the end of November, a team of researchers from Harvard Medical School and the RAND Corporation that is leading the foundation's Prescription Bottle Labeling Project is scheduled to report back on, among other things, the problems that have arisen in regard to warning labels and any potential solutions.
"I don't know what they're going to say, but I'm pretty sure it won't simply be, 'More research is needed.' '' Ms. Krause said. "We're ready to take action, if that is what's called for.
"I could see us going to every single state in the nation to work with state pharmacy boards and make sure we get some regulation to standardize these things."
Adequate Supply of Flu Vaccine Is Predicted
By GARDINER HARRIS, The New York Times, October 25, 2005
WASHINGTON, Oct. 24 - Top federal health officials acknowledged Monday that there were some spot shortages of flu vaccine this year but said that overall supplies should be adequate.
Some doctors and public health clinics have said they have limited supplies of flu vaccines this year. But Health and Human Services Secretary Michael O. Leavitt and other top health officials said this situation should change in the coming weeks.
"We expect that where they lack vaccines, the situation will improve," said Dr. Julie L. Gerberding, director of the Centers for Disease Control and Prevention. "This is the same pattern that we see every year, and over time we will catch up."
Eight states have reported flu cases, a normal level at this point, Dr. Gerberding said. Flu season usually peaks in January and February, she said, and so people have many weeks to be vaccinated.
Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said flu vaccine supplies were tight because the country was in a "transition" period. As more people decide to be vaccinated against the flu every year, vaccine supplies will become more abundant and reliable, Dr. Fauci said.
This change will also help if a pandemic were to strike, he said.
In the wake of a supply crunch last year, federal health officials had told doctors that through this past Sunday they were to vaccinate only the elderly, the very young, the sick and health care providers. On Monday, however, vaccines were made available to all.
Federal officials said 70 million to 88 million doses of flu vaccines should be available this year, with much of the supply being rolled out in the coming weeks. In the past, interest in being vaccinated has declined sharply after the second week in December, so vaccine supplies that arrived late in the season have sometimes been discarded. Thus, the timing of flu vaccine shipments is crucial.
Mr. Leavitt also took care to distinguish between fears of a bird flu that could cause millions of deaths worldwide and the annual effects of the seasonal flu.
He said the Bush administration was in the midst of revising its long-awaited plan for dealing with an outbreak of a pandemic of avian flu. But he pointed out that the seasonal flu was also dangerous.
"It kills an average of 36,000 Americans a year, leads 200,000 Americans to be hospitalized and causes countless lost school and work days," he said. "Much of this can be prevented by simply getting a flu shot."
Dr. Andrew C. von Eschenbach, the acting commissioner of the food and drugs, also announced that he had formed a "rapid response team" to work with industry, academia and government agencies to speed the manufacturing of antiviral drugs like Tamiflu and the study of vaccines against bird flu.
Dr. von Eschenbach also said the F.D.A. was on the lookout for counterfeit supplies of Tamiflu, although he said none had been spotted so far. He warned people against buying drugs from unlicensed pharmacies or Web sites that had not been certified by the National Association of Boards of Pharmacy.
Essay: Scare Yourself Silly, but the Real Terrors Are at Your Feet
By ABIGAIL ZUGER, M.D., The New York Times, October 25, 2005
Just in time for Halloween, the usual yearly ritual of terror by headline is now playing itself out in medical offices everywhere. Last year it revolved around flu shots; a few years ago it was anthrax and smallpox; a few years before that it was the "flesh-eating bacteria"; and before that it was Ebola virus, and Lyme disease and so on back into the distant past. This year it's the avian flu.
"I was crossing Third Avenue yesterday and I was coughing so hard I had to stop and barely made it across," a patient told me last week. "I'm really scared I'm getting the avian flu."
I just looked at him. What could I say? He has smoked two packs of cigarettes a day for the last 50 years. He has coughed and wheezed and gasped his way across Third Avenue now for the last 10 years. His emphysema is not going to get any better, but it might stop getting worse if he were to stop smoking.
He made it clear long ago that this is not going to happen. When it comes to the whole cigarette/health question, his motto, apparently, is "What, me worry?"
But the avian flu - now there's a health scare a person can sink his teeth into. So scary and yet, somehow, so pleasantly distant. So thrilling, so chilling, and yet, at the same time, so not here, not now, not yet. All in all, a completely satisfying health care fear experience. Unlike his actual illness.
Scary movies give children nightmares. Scary health news gives adults the extraordinary ability to ignore the immediate in favor of the distant, to escape from the real (and the really scary) into a far easier kind of fear.
A few years ago, a young woman waited patiently to be seen in our office after hours. She was a patient of one of my colleagues, but she couldn't wait for their scheduled appointment; she needed to see someone right away.
"I'm worried I have Lyme disease," she said. "I have all the symptoms. I think I need to be treated."
"But you have AIDS," I said.
"I'm tired and weak and I have fevers and sweats. I've lost my appetite. I can't think straight. I'm losing so much weight!"
She had seen a TV news report on Lyme disease, and then she had checked the Internet. All her symptoms were right there.
"But you have AIDS," I said. "And you don't want to take meds. That's why you're feeling so bad."
"I'm really scared about Lyme disease," she said. "I really need to get treated."
"If you want to be scared, how about that untreated AIDS of yours?"
We looked at each other. It was an impasse. The fact that logic was on my side mattered not at all: evidently the real was just a little too real for her. How much better to find another illness to be scared of, obsess over, get treated for, get rid of.
Eventually she coerced my colleague into testing her for Lyme disease and treating her despite negative tests. Then she decided her symptoms might actually be due to a brain tumor, instead. And so it went, until she died of AIDS.
Of four patients I saw in a single hour last week, three announced how scared they were of the avian flu. I reassured them, but there was quite a bit I did not say, and here it is.
I did not say: If you want to be scared, then how about that drug habit of yours you think I don't know about? How about the fact that you are 100 pounds overweight and eat nothing but junk? How about the fact that in a few short months Medicaid is going to stop paying for your very expensive medications and no one knows how just high that Medicare Part D deductible and co-payment are going to be? I did not say: If you want something to be scared of, how about the drug-resistant Klebsiella that is all over this very hospital, an ordinary run-of-the-mill bacterial strain that has become so resistant to so many antibiotics that we've had to resurrect a few we stopped using 30 years ago because they were so toxic.
That Klebsiella is one scary germ. It's in hospitals all over the country, and by now it's probably killed a thousandfold more people than the avian flu.
But you don't hear much about our Klebsiella. Like our bad habits and our dismally insoluble health insurance tangles, our antibiotic-resistant bacteria are with us, right here, right now. Apparently they all lack the drama, the suspense, the titillating worst-case situations that energize our politicians and turn into a really newsworthy health care scare.
They're all just too real.
Q & A: Chancy Chickens
By C. CLAIBORNE RAY, The New York Times, October 25, 2005
Q. How do humans become infected with bird flu? Do I need to avoid bird feeders and chicken dinners?
A. The form of avian influenza that recently broke out in domesticated chickens, ducks and turkeys in Asia and Europe, avian influenza A (H5N1), has not been seen in the United States, and there is no certainty that it will be, medical authorities emphasize. They explain that infected birds shed the flu virus in their saliva, nasal secretions and feces.
Direct contact with infected poultry, or surfaces and objects contaminated by their feces, is now considered the main route of human infection, the World Health Organization says. So far, most human cases have occurred in rural or semirural areas where many households keep small free-roaming poultry flocks that sometimes enter homes.
Exposure is considered most likely during slaughter, defeathering, butchering and preparation of poultry for cooking, the health organization says, and no evidence suggests that properly cooked poultry or eggs can be a source of infection.
The W.H.O. said it was aware of concern over the possibility that the virus could spread through contact with contaminated poultry products or contact with live infected animals and is working to see if this could happen.
To date, however, there is no epidemiological information to suggest that the disease can be transmitted through contaminated food or that products shipped from affected areas have been the source of infection in humans.
The Consumer: And Now, a Warning About Labels
By DEBORAH FRANKLIN, The New York Times, October 25, 2005
Open your medicine cabinet, and take a close look at every prescription pill bottle you've got. Chances are, each vial is plastered with at least one colorful warning sticker that contains a bold but strangely ambiguous phrase or two — accompanied, perhaps, by a cryptic drawing. You might see, for example, a red sticker depicting a gushing faucet, with a message in fine print that reads, "MEDICATION SHOULD BE TAKEN WITH PLENTY OF WATER." But, how much is plenty? Would a cup of coffee be acceptable instead?
Another common sticker urges, "DO NOT CHEW OR CRUSH, SWALLOW WHOLE," next to a diagram that looks at least as much like an arrow chasing a nickel down the throat of a bota bag as it resembles a drug tablet falling into a stomach.
These insistent little strips of paper or plastic — hundreds of them — are designed and manufactured by a number of well meaning companies, each according to its own format, symbology and color scheme. The warning stickers on prescription bottles have not traditionally been deemed important contributors to patient education.
Compared with the package insert prepared by the drug's manufacturer under the hot breath of the Food and Drug Administration or the one-page consumer summaries that pharmacists add, the warning stickers are just fluffy little extras.
As such, they are not standardized, regulated or even reviewed by the F.D.A. Nor are they generally tested for effectiveness before they hit the market.
But some health literacy experts worry that many patients, overwhelmed by a proliferation of paper warnings — often written in turgid prose — are relying instead on the stickers to tell them how to take medications.
Ambiguous wording and artwork, combined with nonintuitive color selections, are among the problems that can make prescription drugs confusing to take.
"What I'm hearing from patients is that they don't really much use these handouts that are stapled to the bag," said Dr. Ruth Parker, an internist who treats patients at the large public hospital associated with Emory University in Atlanta. "What they will sometimes do is look at the label."
Dr. Parker recently completed two studies on the topic with Dr. Terry Davis of Louisiana State University at Shreveport and Dr. Michael Wolf of Northwestern's Feinberg School of Medicine in Chicago. The scientists said that, so far, they had not heard of anyone who was harmed by over-reliance on the little stickers as medication guides.
Still, their results, not yet published but already being talked about in health literacy circles, suggest that a risk does exist. And patients with reading skills that do not stretch beyond sixth or seventh grade seem likely to be the most vulnerable.
To explore the problem, the researchers interviewed a few hundred healthy, English-speaking adults in three states to identify a group with a broad cross section of reading skills. About a third of those enrolled in one of two studies tested below a sixth-grade reading level. Another third of the group read at a level higher than 12th grade.
The researchers showed the volunteers samples of real warning stickers, one at a time, and asked them individually to explain what action the label was urging. The high number of errors across the board was startling.
For example, when the volunteers saw the sticker with the little pill-popping bota bag, some participants in the studies inverted the meaning completely, and thought that it meant they should chew the pill and crush it before swallowing. Others thought the stomach was a bladder. Still others decided the label meant the drug was "just for your stomach."
Many people seemed to guess at a sticker's meaning instead of reading the tiny type, making leaps that often got them into trouble.
For example, common misinterpretations of a yellow label bearing an icon of the sun with a slash through it were, "Don't take medicine if you've been in the sunlight too long," "Don't leave medicine in the sun," and "Don't leave medicine in the sun, but in a cool place." The extremely fine print of that label actually read, in all capital letters: "YOU SHOULD AVOID PROLONGED OR EXCESSIVE EXPOSURE TO DIRECT AND/OR ARTIFICIAL SUNLIGHT WHILE TAKING THIS DRUG."
The "FOR EXTERNAL USE ONLY'' sticker stumped 25 percent of even those who could read every word, and misled 90 percent of the adults in the lowest literacy group.
That, Dr. Wolf said, was probably because its icon was so strange. The label depicted an oddly-stretched human shape encased in what looked like a series of ghostly shrouds. Take this pill to stop hallucinations? To start them?
"A lot of people thought that icon meant the drug was radioactive," Dr. Wolf said.
At a loss to make out the image, many people in the study seized on the red color as signaling danger or urgency. "Use extreme caution in how you take it," one person said the warning meant. Another interpreted it to mean, "Take only if you need it." Indeed.
"These labels can pose problems for all patients, not just those with low literacy skills," Dr. Wolf said. "But our research showed that those with low skills are hit harder because they are more likely to rely on a sticker's color and its icon."
Dr. Davis said she had noticed that in most cases, the label designers seemed to have chosen the colors of the stickers without any regard to content. She says she believes that is a mistake.
"There's nothing intrinsic to the shape or color of a stop sign that means stop," she said, "but we all learn really early on, long before we can read, that we're supposed to stop when we come to a red octagon with white letters, and we're to go when we see a green light."
One bright red label said, "THIS DRUG IS AVAILABLE IN A COST SAVING GENERIC," but a "NOT TO BE SWALLOWED" warning was printed on a blue sticker.
"Designers need to realize that patients are imputing meaning to the color of those labels," Dr. Davis said, "whether it was intended or not." In theory, the researchers said they thought that using crisp, pre-tested icons, intuitive colors and other innovations on the stickers could actually help curb medication mistakes by patients who do not read well or who are led by age, infirmity or more transient conditions like pregnancy, grief or exhaustion to reach for the wrong bottle.
Last spring, Target announced a redesign of the prescription bottles used in all its pharmacies to, among other things, improve the legibility of the labels. The company is in the midst of redesigning its prescription warning labels, as well.
But innovation alone is not the answer, Dr. Parker said. "The last thing we need are 400 new and improved icons, any more than we need 400 new and improved stop signs," she said. "What we need is clarity and consistency about which warnings to use when."
She added, "I believe we absolutely need some sort of regulation about this, because we need standardization." Ray Bullman, executive vice president of the National Council on Patient Information and Education in Bethesda, Md., knows firsthand that the warning labels are used inconsistently.
"When I pick up my prescription drug, the number of stickers on it depends on which pharm tech is on that night," Mr. Bullman said. "There's usually one for dizziness, a warning not to take it with grapefruit juice, and some others lined up around the bottle like those tall, thin cookies around a cake."
More are not necessarily better, he said, and added, "Sometimes it gets almost to the point that you can't read the prescription."
In Philadelphia, Jean Krause, the chief executive of the American College of Physicians Foundation, said that even within her office she had noticed inconsistency in the way the warning labels were used. Ms. Krause and two colleagues all take the same cholesterol-lowering drug, but they buy it from three different pharmacies.
"My bottle says 'Do not take with grapefruit juice or grapefruit products,' " Ms. Krause said. "But neither of my colleagues' bottles say a word about that. I have to wonder why not."
Ms. Krause is hoping that, coincidentally, the work of her foundation might soon help resolve that question. At the end of November, a team of researchers from Harvard Medical School and the RAND Corporation that is leading the foundation's Prescription Bottle Labeling Project is scheduled to report back on, among other things, the problems that have arisen in regard to warning labels and any potential solutions.
"I don't know what they're going to say, but I'm pretty sure it won't simply be, 'More research is needed.' '' Ms. Krause said. "We're ready to take action, if that is what's called for.
"I could see us going to every single state in the nation to work with state pharmacy boards and make sure we get some regulation to standardize these things."
Adequate Supply of Flu Vaccine Is Predicted
By GARDINER HARRIS, The New York Times, October 25, 2005
WASHINGTON, Oct. 24 - Top federal health officials acknowledged Monday that there were some spot shortages of flu vaccine this year but said that overall supplies should be adequate.
Some doctors and public health clinics have said they have limited supplies of flu vaccines this year. But Health and Human Services Secretary Michael O. Leavitt and other top health officials said this situation should change in the coming weeks.
"We expect that where they lack vaccines, the situation will improve," said Dr. Julie L. Gerberding, director of the Centers for Disease Control and Prevention. "This is the same pattern that we see every year, and over time we will catch up."
Eight states have reported flu cases, a normal level at this point, Dr. Gerberding said. Flu season usually peaks in January and February, she said, and so people have many weeks to be vaccinated.
Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said flu vaccine supplies were tight because the country was in a "transition" period. As more people decide to be vaccinated against the flu every year, vaccine supplies will become more abundant and reliable, Dr. Fauci said.
This change will also help if a pandemic were to strike, he said.
In the wake of a supply crunch last year, federal health officials had told doctors that through this past Sunday they were to vaccinate only the elderly, the very young, the sick and health care providers. On Monday, however, vaccines were made available to all.
Federal officials said 70 million to 88 million doses of flu vaccines should be available this year, with much of the supply being rolled out in the coming weeks. In the past, interest in being vaccinated has declined sharply after the second week in December, so vaccine supplies that arrived late in the season have sometimes been discarded. Thus, the timing of flu vaccine shipments is crucial.
Mr. Leavitt also took care to distinguish between fears of a bird flu that could cause millions of deaths worldwide and the annual effects of the seasonal flu.
He said the Bush administration was in the midst of revising its long-awaited plan for dealing with an outbreak of a pandemic of avian flu. But he pointed out that the seasonal flu was also dangerous.
"It kills an average of 36,000 Americans a year, leads 200,000 Americans to be hospitalized and causes countless lost school and work days," he said. "Much of this can be prevented by simply getting a flu shot."
Dr. Andrew C. von Eschenbach, the acting commissioner of the food and drugs, also announced that he had formed a "rapid response team" to work with industry, academia and government agencies to speed the manufacturing of antiviral drugs like Tamiflu and the study of vaccines against bird flu.
Dr. von Eschenbach also said the F.D.A. was on the lookout for counterfeit supplies of Tamiflu, although he said none had been spotted so far. He warned people against buying drugs from unlicensed pharmacies or Web sites that had not been certified by the National Association of Boards of Pharmacy.
![[identity profile]](https://www.dreamwidth.org/img/silk/identity/openid.png){kind=small}
no subject
Date: 2005-10-25 06:58 pm (UTC)no subject
Date: 2005-10-25 07:20 pm (UTC)Plus we get the fun info leaflet as well. Which I actually do read. Then I look up the drug on The BNF to find out more about them. I am a real nerd about medication ever since a doctor failed to tell me that you should never take asprin if you are on steroids and the pharamcy supplied a three month supply in a regular brown with no drug information leaflet. One bleding stomach ulcer* later and I am aaaallll about taking an interest in my medication.
*might have been coincidence, but then again it might not
no subject
Date: 2005-10-25 09:34 pm (UTC)I'm not, however, worried about the bird flu. Not too many chickens running in and out of my apartment.