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Every month, the subjects in Prescrire’s Spotlight.
2006 : 1 | 30 | 60
Type 2 diabetes is currently on the increase in children and adolescents in rich countries, in parallel with the rise in obesity. The treatment of this serious disease is poorly evaluated in children. Prevention is a priority.
1 December 2006
Defining normal levels to assess risk or to decide on drug treatment is of no value unless the effectiveness of prescribing treatment above these levels is proven.
In patients with Alzheimer's-type dementia taking cholinesterase inhibitors, treatment should be halted if falls, difficulties in walking or Parkinsonian symptoms occur, given the limited and short-lived benefits of these drugs.
Citizens need health information that enables them to make informed choices. They do not need ads from pharmaceutical companies disguised as "information".
Many of the drugs donated following the disasters in Pakistan and Indonesia were unusable and had to be incinerated. It is better to help countries to buy the drugs they need.
In cases of stress as a reaction to a serious trauma, listening, moral support and, for some patients, psychotherapy, are the main measures to take.
1 November 2006
The EU Regulation on "orphan drugs" signals progress, but with strong limitations.
Pharmaceutical companies are really not the best people to remind patients to take their medicine. A French proposal for companies to be allowed to run compliance support programmes must be defeated.
By definition, and as long experience has proved, pharmaceutical companies cannot provide impartial information on their products. They advertise them.
Pharmaceutical companies and public authorities sometimes connive to cover up an unfortunate truth: the lack of comparative data on new drugs.
With their "disease information campaigns", pharmaceutical companies have just one aim, and that is to increase their drug sales. Even if it means exaggerating the seriousness of illnesses or going so far as to "invent" new ones.
It is imperative that French drug regulatory agency experts remain impartial in fulfilling their public service role.
Omega-3 fatty acids are thought to help prevent numerous diseases, but their effectiveness in preventing cardiovascular disease, cancer and dementia has not been clinically proven.
1 October 2006
In cardiovascular prevention, pravastatin and simvastatin are the cholesterol-lowering statins that have the longest track record and whose effectiveness is the most convincing.
In people at high risk of type-2 diabetes, the most effective means of prevention are losing weight and increasing physical activity.
The annual French pharmacovigilance conference gives a glimpse of the reports made by health professionals to the regional pharmacovigilance centres, and a peek into the French pharmacovigilance database.
In cardiovascular prevention, simvastatin is a first-line cholesterol-lowering drug. The combination of ezetimibe and simvastatin has no proven additional clinical benefit, but carries an increased risk of muscular damage.
The role of drugs in helping smokers quit remains secondary. If medicinal aid is deemed necessary, it is best to keep to nicotine.
There is an urgent need to evaluate nutritional supplements before they are put on the market.
Capsules containing powdered crushed plants are different from powders for herbal teas and tea bags.
The World Trade Organisation (WTO) stated that it had introduced the necessary flexibility to patent laws to give poor countries access to recent drugs. Three years later, nobody has yet made use of this "flexibility".
1 September 2006
The risk of deep vein thrombosis should be taken into account before deciding to prescribe treatment with neuroleptics, and patients should be monitored.
In children with attention deficit hyperactivity disorder (ADHD) who continue to exhibit disturbed behaviour in spite of non-drug treatment, methylphenidate is a last-resort symptomatic treatment. The usual dose sometimes causes visual and tactile hallucinations. If this occurs, treatment should be halted immediately.
Short- or long-acting nicotinic acid causes too many adverse effects to be used as a treatment for high cholesterol.
Subcutaneous injection remains the standard way of administering insulin to diabetics.
Antidepressants are implicated in the risk of congenital malformation. Given the extent of the risk, especially with paroxetine, the treatment of pregnant women should be carefully weighed.
1 July 2006
The diagnosis of "metabolic syndrome", whose definition varies from one source to another, is of no use when it comes to improving patients' treatment. It is better to tackle each component of the "syndrome": obesity, diabetes, arterial hypertension and lipid disorders.
Rimonabant, widely trumpeted in recent months as the miracle cure for obesity, "metabolic syndrome" and tobacco dependency, has turned out to be much ado about nothing.
Syringes graduated according to the child's weight seem convenient, but they are a source of error. It is time to promote more reliable systems.
By looking for the International Nonproprietary Name (INN) on the packaging or in the patient leaflet, it is possible to identify whether a drug contains several substances or not, irrespective of the commercial name.