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Spite some inconsistent findings, psychophysiologic research has suggested that Type A behavior and, more recently, Type A may contribute to the developphysiologic reactivity to stress have been ment of coronary disease because of its implicated as potential behavioral risk fac- association with enhanced cardiovascular tors for coronary heart disease 1, 2 ; . De- and catecholamine reactivity to stress [35 ; . The most common explanation for relationships between Type A and reactivity is that situations perceived as stressful or From the Department of Medical Psychology, Uniformed Services University of the Health Sciences challenging provoke pathogenic cardio D.S.K., D.R.H. ; , Department of Psychology, Rutgers vascular and neuroendocrine responses in University R.J.C. ; , Department of Psychology, Uni- susceptible individuals. This reasoning has versity of Miami L.A.D. ; , and Pfizer, Inc. J.D.L. ; . The opinions or assertions expressed herein are led to therapeutic efforts to decrease Type those of the authors and are not to be construed as A behavior and associated coronary disreflecting those of the USUHS or the Department of ease risk through behavior modification Defense. Address reprint requests to: Dr. David S. Krantz, techniques 6, 7 ; . Department of Medical Psychology, Uniformed SerHowever, several recent reports have vices University of the Health Sciences, 4301 Jones suggested a psychobiologic basis for Type Bridge Road, Bethesda, MD 20814-4799. Received January 12, 1988; revision received April A behavior. That is, Type A physiologic 19, 1988. correlates in patients with cardiovascular and remeron.
Interpreted this as a justication for some sort of price restrictions on drugs licensed to industry under the terms of Bayh-Dole. In addition, the research institutions were supposed to keep the government informed of all patents they obtained on nih-funded work. Together, Bayh-Dole and Stevenson-Wydler contained provisions that would allow the public to recoup a portion of prots under certain limited circumstances. In practice, virtually all of these provisions have been ignored or revoked. In 1995, the nih itself advised against requiring "reasonable pricing, " and in a report last year, it argued against trying to recoup a portion of prots. It emphasized that only four of forty-seven drugs with yearly sales above $500 million were known to have been developed with nih funding. What was not emphasized was the fact that there was no way of knowing about the other forty-three drugs, since the nih had not required the medical centers to fulll their obligation to supply information about patents they had obtained on taxpayer-funded work. The chief effect of the Bayh-Dole Act has been to increase dramatically the number of partnerships between academic institutions and the pharmaceutical industry. There were many reasons why the drug industry wanted closer collaboration with medical institutions, but one was the need for companies to obtain human subjects for the clinical trials they needed to get fda approval. Drug companies have money to support clinical research, but they don't have patients, so they need to look for them elsewhere. As the number of drugs being tested grows, so does the number of clinical trials, and human subjects are becoming increasingly difcult to nd. Teaching hospitals are an important source, although no longer the only one.
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Understanding the Dynamics of HIV Transmission Our capacity to deal with the future starts with better understanding the present. We need to better grasp the dynamics of HIV transmission. What is the distribution of HIV in Phayao villages and towns? Are there geographical factors of vulnerability, making some communities more vulnerable to HIV than others? What is the rate of migration in Phayao? Are women and men migrating less or more, and why? What is the relative contribution of various factors of risk and vulnerability to HIV transmission? How prevalent is the practice of anal sex among Phayao people? How prevalent is injecting drug use? What proportion of current HIV infections are acquired inside and outside Phayao Province? Getting to grips with costs We have seen the need to identify unit and total costs of the core health service, including health-care procedures for HIV symptomatic patients. We also saw that patients are charged very different prices, depending on the financing scheme they belong to. These differences in price might just reflect crosssubsidization from users of the more liberal schemes to those of the less lib.
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The pharmaceutical industry no longer commands the respect that once made it a beacon of innovation and achievement. Examine some recent headlines. GlaxoSmithKline agrees to pay US$25 million to fend off charges that it suppressed research showing the antidepressant Paxil was harmful to children. Pfizer pays $430 million to end claims concerning off-label uses of Neurontin. Bristol-Myers Squibb promises to pay $300 million to discontinue a lawsuit brought against it by shareholders. GlaxoSmithKline again ; pays $75 million for allegedly overcharging patients and insurers for its anti-inflammatory drug, Relafen. Bayer settles, at a cost of $800 million, over 2000 cases brought by patients who took Baycol. A court confirms a $1 billion jury verdict against Wyeth over its diet drug, Pondimin. GlaxoSmithKline once more ; agrees to pay $92 million, this time to end lawsuits over its antibiotic, Augmentin. These stains on the reputation of a powerful and important industry come when some of the biggest pharma companies are limping towards stagnation. Global sales for AstraZeneca fell by 06% in 2003. GlaxoSmithKline grew by only 39%; Bristol-Myers Squibb by only 40%. The fastest growing company was little-known Schwarz, which benefited from the patent expiry of AstraZeneca's version of omeprazole. Worse, the rate of US market growth-- half of global pharma sales occur in the USA--slowed, thanks largely to fewer blockbuster drug launches. 2004 has been no better. Merck has forecast a fall in share earnings. Stock prices for AstraZeneca and GlaxoSmithKline have been extraordinarily volatile. As big pharma feels the squeeze, it seems its chief executives will risk litigation and court settlements to extract the maximum revenue from increasingly unforgiving markets.
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OCCUPATIONAL THERAPY Devlin, C; Burnside, L; Akroyd, L. 2006 ; . Mental health vocational rehabilitation: an overview of occupational therapy service provision in Northern Ireland. British Journal of Occupational Therapy; 69 7 p. 334-338. Gutman, SA. 2006 ; . Why addiction has a chronic, relapsing course. The neurobiology of addiction: implications for occupational therapy practice. Occupational Therapy in Mental Health; 22 2 p. 1-30. Labelle, K-L; Mihailidis, A. 2006 ; . The use of automated prompting to facilitate handwashing in persons with dementia. American Journal of Occupational Therapy; 60 4 p. 442-450. PERSONALITY DISORDERS Duff, S; Kinderman, P. 2006 ; . An interacting cognitive subsystems approach to personality disorder. Clinical Psychology and Psychotherapy; 13 4 p. 233-245. Emmelkamp, PMG et al. 2006 ; . Comparison of brief dynamic and cognitivebehavioural therapies in avoidant personality disorder. British Journal of Psychiatry; 189 1 p. 60-64. Available online via Ovid. PHARMACOLOGY Otis, HG; King, JH. 2006 ; . Unanticipated psychotropic medication reactions. Journal of Mental Health Counseling; 28 3 p. 218240. Available online via ProQuest. PHYSICAL ENVIRONMENT Andes, M; Shattell, MM. 2006 ; . An exploration of the meanings of space and place in acute psychiatric care. Issues in Mental Health Nursing; 27 6 p. 699-707. Available online via Swetswise. PHYSICAL HEALTH CARE Jensen, LW; Decker, L; Andersen, MM. 2006 ; . Depression and health-promoting lifestyles of persons with mental illnesses. Issues in Mental Health Nursing; 27 6 p. 617-634. Available online via Swetswise.
The PAAB Annual General Meeting of Directors will be held held Friday, April 20, 2001 at the College of Family Physicians in Mississauga, Ontario. At the last General Meeting, the directors agreed to seek consultation from doctors, pharmacists and the pharmaceutical industry on the subject of using abstracts and poster presentations as references for advertising claims. Commissioner Chepesiuk will present a recommendation for a Code revision, that is based on the responses, to the Board.
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HYPERINSULINEMIA AND INSULIN RESISTANCE IN ALZHEIMER'S DISEASE Dr. Craft presented her work in a symposium on The Link Between Alzheimer's and Diabetes. Recent studies suggest that diabetes and pre-diabetes are associated with about a 75% increased risk of developing Alzheimer's disease AD ; . For 15 years, she has been studying the possibility that insulin resistance, and the hyperinsulinemia that accompanies it, contributes to the cause of AD. She has previously shown that insulin plays a role in normal memory function and modulating levels of proteins that accumulate in the brains of people with AD. Further, she has demonstrated that hyperinsulinemia increases levels of inflammatory markers and neurotoxic peptides in the central nervous system. She theorized that these were two pathways through which conditions associated with insulin dysregulation, such as type 2 diabetes, may increase the risk of AD in older adults. Today she presented new data from research that examined specific mechanisms through which this risk may be elevated in individuals with impaired glucose tolerance and type 2 diabetes. The research demonstrated that adults with insulin resistance show a pattern of reduced cerebral glucose metabolism characteristic of patients with early Alzheimer's disease. Twenty-three newly diagnosed individuals with impaired glucose tolerance or type 2 diabetes, and 11 healthy older adults all cognitively normal underwent PET scanning of their brains, and their brain glucose metabolism was compared. "Reduced glucose metabolism was observed in brain regions associated with early Alzheimer's disease in the insulin-resistant adults, " said Dr. Craft. "The pattern was characteristic of that seen in people with Alzheimer's years before they show any clinical symptoms of dementia, and it is considered a pattern of vulnerability to dementia." This pattern has never been reported before in people with diabetes, although it has been observed and wellestablished as existing in people at high risk for Alzheimer's due to genetic risk factors. The pattern has also been seen in studies of people tracked over long periods, and those with it are much more likely to develop AD. - more National Office 1701 North Beauregard Street Alexandria, VA 22311 Tel: 703-549-1500 Diabetes Information call 1-800-DIABETES 1-800-342-2383 ; online diabetes.
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In 2004, a focus of our attention will be on the delivery of preventive care and the provision of recommended care for acute and chronic conditions. Look for future articles in this publication about the methods we will use to achieve and communicate this focus and ultimately to reduce the value deficit, thus maximizing the provision of recommended care. november 2003, no. 68 3.
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