Drugs and devices

Dr Jennifer Walsh
Podcasts iconPodcasts

A study showed that medicinal cannabis helped improve sleep subjectively and in duration with no deterioration of sleep architecture

Dr Nicole Highet
Podcasts iconPodcasts

The prevalence of mental health issues in the perinatal period

Dr Linda Calabresi
Clinical Articles iconClinical Articles
Dr Linda Calabresi
Clinical Articles iconClinical Articles
Greg Merlo
Clinical Articles iconClinical Articles

Prominent GP and former member of parliament Kerryn Phelps has entered the turf war between doctors and pharmacists over who gets to prescribe. Pharmacy groups have long called for changes to allow pharmacists to prescribe specified medications, such as the oral contraceptive pill and antibiotics for urinary tract infections. But Phelps argues allowing pharmacists to prescribe will lead to perverse incentives – where pharmacists prescribe inappropriately – because they have a financial interest in the sale of medicines. Phelps has a point. Studies in countries where doctors have dispensing roles have found evidence of financial profits influencing prescribing behaviour. A Swiss study, for instance, found physician dispensing leads to a 34% increase in drug costs per patient, as doctors overprescribe and prescribe more expensive medications.

Expert/s: Greg Merlo
Dr Linda Calabresi
Clinical Articles iconClinical Articles
Dr Linda Calabresi
Clinical Articles iconClinical Articles
Dr Linda Calabresi
Clinical Articles iconClinical Articles
Dr Linda Calabresi
Clinical Articles iconClinical Articles

This resource is a little different to the usual guideline or website that is commonly discussed in this newsletter. This is a product that was recommended by a number of patients and has the potential to really improve the quality of someone’s life. Quite simply it’s a waterproof protector that goes over a patient’s plaster or dressing. Called Blocc’s protectors, these covers are made of a type of rubber that stretches over the cast or dressing to make a waterproof seal. And apparently they are excellent at keeping the dressing or plaster dry.

Dr Linda Calabresi
Clinical Articles iconClinical Articles

Recognise this scenario? You prescribe an inhaler for the patient. You educate the patient on why they need the inhaler. You draw diagrams. You demonstrate the technique on the placebo inhaler. You write the script. And then… you cross your fingers.

Dr Linda Calabresi
Clinical Articles iconClinical Articles

While the ‘opioid epidemic’ might be grabbing all the headlines at the moment, Australian toxicologists are reminding us that paracetamol is the most common drug used in overdoses in this country. What’s more the numbers of both paracetamol-related hospital admissions and liver injury have been increasing over the past decade at a rate that far exceeds the rate of population increase. According to a retrospective study recently published in The Medical Journal of Australia, there has been an average 3.8% annual increase in the number of paracetamol-related hospital admissions since 2007, and a mean 7.7% annual increase in paracetamol-related liver injury cases, whereas the population has been increasing at a rate of only 1.6% annually.

Dr Linda Calabresi
Clinical Articles iconClinical Articles

Glucosamine’s effectiveness in treating arthritis remains controversial, however a study suggesting that the supplement, when taken regularly, will help prevent heart attacks certainly adds to its appeal. According to findings from a large prospective study just published in The BMJ, habitual glucosamine use is associated with a 15% lower risk of cardiovascular events. Breaking that down a bit further, it appears regular glucosamine lowered the risk of dying from a cardiovascular event by 22%, lowered the risk of coronary heart disease by 18% and lowered the risk of stroke by 9%. All statistically significant results. The research involved over 440,000 people from the UK biobank who didn’t have cardiovascular disease at the outset. Courtesy of an initial questionnaire, researchers knew who was taking glucosamine and how often. Interestingly about 20% of the cohort, reported they took the non-vitamin, non-mineral supplement daily – a figure the researchers said was representative in other adult populations around the world – including Australia. The cohort was then followed for a median of seven years. Over this time there were over 10,000 CVD events including heart attacks and strokes, with over 3,000 of these resulting in death. Even though the study was basically observational, the size of the sample strengthens its value. As does the fact that the researchers obtained a wealth of information about the patient’s diet, medical history and lifestyle at the initial questionnaire, which was all utilised in the final analysis. Consequently the 15% lower risk of a cardiovascular event associated with taking glucosamine can’t be easily written off as caused by another confounder. The researchers were able to conclude the association was “independent of traditional risk factors, including sex, age, income, body mass index, physical activity, healthy diet, alcohol intake, smoking status, diabetes, hypertension, high cholesterol, arthritis, drug use, and other supplement use.” So how does it work? How does glucosamine positively affect the cardiovascular system? According to the study authors, there are a number of plausible mechanisms that could explain the link. One relates to the anti-inflammatory properties of glucosamine. There already exists evidence that regular glucosamine reduces CRP levels, a marker of systemic inflammation. Another theory relates to how glucosamine affects metabolism. “[A] previous study found that glucosamine could mimic a low carbohydrate diet by decreasing glycolysis and increasing amino acid catabolism in mice; therefore, glucosamine has been treated as an energy restriction mimetic agent,” they said. But while the study findings appear very exciting, the study authors themselves suggest caution, claiming their study had some limitations. Among these limitations was the fact that details about the dose, duration of use, type of glucosamine supplement was not recorded. Obviously further research is needed to test this association. Nonetheless, the trial is destined to fuel on-going interest in the supplement, albeit for a totally different condition from the one we’re used to.  

References:

Ma H, Li X, Sun D, Zhou T, Ley SH, Gustat J, et al. Association of habitual glucosamine use with risk of cardiovascular disease: prospective study in UK Biobank. BMJ. 2019 May 14; 365: l1628. DOI: 10.1136/bmj.l1628