dogjones
Graduate Poster
- Joined
- Oct 3, 2005
- Messages
- 1,303
I place liability insurance for US Healthcare institutions. I have started to get these emails from a publication called "GP Notebook" - they are basically aimed at GPs. The format appears really quite insidious. For instance, they sent this article:
Seems like a reasonably objective article, yes? This is all in column one of the email. In column 2, right next to it, is this:
Yuk. Here's another one, this time for depression. Column one:
Column 2:
I can't help wondering if the "objective" articles in column 1 are also paid for by the sponsor in column 2.
Assuming this is not a new thing, I would imagine the fact these emails are being sent would indicate the advertising works. I find it rather disturbing that my GP could be influenced by this stuff. Thoughts?
Obesity
Obesity in the UK is a growing problem. The latest Health Survey for England (HSE) data show that in 2008, 61.4% of adults (aged 16 or over), and 27.3% of children (aged 2-10) in England were overweight or obese, of these, 24.5% of adults and 13.9% of children were obese. The Foresight report, Tackling Obesities: Future Choices project, published in October 2007, predicted that if no action was taken, 60% of men, 50% of women and 25% of children would be obese by 2050.1
Shocking statistics, but what can be done to slow the epidemic? The Government suggests that health professionals in all primary care settings should ensure that preventing and managing obesity is a priority, at both strategic and delivery levels, and that dedicated resources should be allocated for action.2
GPs have a number of treatment options available to them, including pharmacological treatments and physical therapies. Before discussing options with patients it is good practice to be realistic about patients’ perception of their own condition and lifestyle. In a survey carried out by the NHS Information Centre adults were asked to recall how much physical activity they had done over the previous four weeks. Based on this self-report survey, 39% of men and 29% of women aged 16 and over met the Chief Medical Officer's (CMO) minimum recommendations for physical activity. These are that adults should be active at moderate or greater intensity for at least 30 minutes a day on at least five days a week (either in one session or through shorter bouts of activity of 10 minutes or longer). The percentages of both men and women who met these recommendations generally decreased with age. A sub-sample of adults then wore a device called an accelerometer for a week following the survey; this device provides an objective measure of physical activity. Based on the week of accelerometry, only 6% of men and 4% of women met the CMO's recommendations for physical activity. Men and women aged 16-34 were most likely to have met the recommendations (11% and 8% respectively), and the percentages of both men and women meeting the recommendations were lower in the older age groups.3
NICE, who are due to revise their guidelines on obesity in 2011, states that multicomponent interventions are the treatment of choice. Weight management therapies should include behaviour change strategies to increase physical activity and improve diet. The decision to start drug treatment, and the choice of drug, should be made after discussing with the patient the potential benefits and limitations, including the mode of action, adverse effects and monitoring requirements and their potential impact on the patient’s motivation. Information about patient support programmes should also be provided.2
References
1. Department of Health, Obesity General Information. Updated 22nd December 2009. Accessed on 7th Jan 2010.
2. NICE Clinical Guidelines for Obesity: CG43. Accessed on 7th January 2010.
3. Health Survey for England, Physical Activity and Fitness, 2008.
Further reading
GPnotebook: Obesity
GPnotebook: Management of obesity
Seems like a reasonably objective article, yes? This is all in column one of the email. In column 2, right next to it, is this:
Reductil (sibutramine) obesity resource now available
Welcome to this online resource which will cover the following:
• It has been estimated that by 2025, 47% of males and 36% of females could be obese in the UK1
• NICE guidance recommends pharmacotherapy in certain circumstances after evaluation of exercise, diet and behavioural therapy2
• There are 216 existing QOF points influenced by managing weight3
This resource will explore these issues in more detail as well as covering:
• Learn how Reductil (sibutramine) (Prescribing Information) can help your patients learn to eat less
• Ability to order a ‘Change For Life Online’ pedometer for your patients*
*To order this item right away, click here
It is not necessary to grant an Abbott representative an interview in order to receive these items
References
1. Butland B, Jebb S, Kopelman P, McPherson K, Thomas S, et al. Foresight tackling obesities: Future choices – project report. 2nd edition. London: Department for Innovation, Universities and Skills; 2007.
2. National Institute for Clinical Excellence. Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. December 2006.
3. Quality and Outcomes Framework guidance for GMS contract 2009/10.
AXRED092966
Date of Preparation: December 2009
Reductil (sibutramine) obesity resource now available
Welcome to this online resource which will cover the following:
• It has been estimated that by 2025, 47% of males and 36% of females could be obese in the UK1
• NICE guidance recommends pharmacotherapy in certain circumstances after evaluation of exercise, diet and behavioural therapy2
• There are 216 existing QOF points influenced by managing weight3
This resource will explore these issues in more detail as well as covering:
• Learn how Reductil (sibutramine) (Prescribing Information) can help your patients learn to eat less
• Ability to order a ‘Change For Life Online’ pedometer for your patients*
*To order this item right away, click here
It is not necessary to grant an Abbott representative an interview in order to receive these items
References
1. Butland B, Jebb S, Kopelman P, McPherson K, Thomas S, et al. Foresight tackling obesities: Future choices – project report. 2nd edition. London: Department for Innovation, Universities and Skills; 2007.
2. National Institute for Clinical Excellence. Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. December 2006.
3. Quality and Outcomes Framework guidance for GMS contract 2009/10.
AXRED092966
Date of Preparation: December 2009
Yuk. Here's another one, this time for depression. Column one:
Depression
Depression qualifies as a major public health problem – not only because the devastating impact on quality of life is comparable to that associated with chronic physical conditions, but also because the economic consequences are enormous, estimated at over £9bn each year in England alone.1
Depression is the third most common reason for consultation in general practice in the UK. Between 5% and 10% of people consulting their GP meet the criteria for major depression.2 However, under-recognition and under-treatment remain key obstacles to effective management.3
For people with persistent subthreshold depressive symptoms or mild to moderate depression who have not benefited from a low-intensity psychosocial intervention, discuss different interventions with the person and provide an antidepressant (normally a selective serotonin reuptake inhibitor [SSRI]) or a high-intensity psychological intervention.4
Choice of intervention should be influenced by the:
– duration of the episode and trajectory of symptoms
– previous illness course and response to treatment
– likelihood of adherence and potential adverse effects
– person’s preference
– course and treatment of any chronic physical health problem.4
For people with moderate or severe depression combine antidepressants with a high intensity psychological intervention (CBT or IPT).
When an antidepressant is to be prescribed, normally a generic form of an SSRI will be considered initially. If a patient fails to respond to the first antidepressant after 2–4 weeks, adherence should be checked. Then consideration should be given to gradually increasing the dose in line with the Summary of Product Characteristics (SPC) if there are no significant side effects or switching to another antidepressant if there are side effects or if the patient prefers.4
When switching antidepressants, consider initially, a different SSRI or a better tolerated newer-generation antidepressant and subsequently, an antidepressant of a different class that may be less well tolerated (such as venlafaxine, a tricyclic antidepressant or a monoamine oxidase inhibitor).4
A recent, independent, multiple-treatments meta-analysis by Cipriani et al, published in the Lancet, compared the efficacy and patient acceptability of 12 new-generation antidepressants. This study included data from 117 randomised controlled trials, including almost 26,000 patients. The study found that ‘clinically important differences exist between commonly prescribed antidepressants for both efficacy and acceptability in favour of escitalopram and sertraline’.5
Links
Pulse: What you need to know about depression
GPnotebook: Depression
References
1 Thomas CM and Morris S. Cost of depression in England in 2000. British Journal of Psychiatry 2003;183:514-9.
2 Clinical Knowledge Summaries. Depression. http://www.cks.nhs.uk/depression/background_
information/prevalence [last accessed 24 September 2009]
3 Mitchell AJ, Vaze A, Rao S. Clinical diagnosis of depression in primary care: a meta-analysis. Lancet 2009;374:609-19.
4 NICE (October 2009). Clinical Guideline 90: Depression in adults (update). October 2009.
5 Cipriani A, Furukawa TA, Salanti G et al. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet 2009;373:746-758.
Column 2:
www.challengingdepression.co.uk
In a given practice, GPs are more likely to see patients with major depressive disorder (MDD) than any other condition with the exception of hypertension.1 In 2007, in England alone, 1.24 million people were suffering from MDD. This figure is projected to rise to 1.45 million by 2026, representing an increase of 17 %.2
In addition to being highly prevalent, MDD is also associated with a significant negative impact on the health of sufferers. In a large-scale survey conducted by the World Health Organization with 245,404 participants from 60 countries in all regions of the world, MDD was associated with a decrement in health that was significantly greater than that associated with asthma, angina, arthritis or diabetes.3 In another large population-based study, depression predicted mortality from nearly all major causes of death, not just cardiovascular disease.4
In a recent study, GPs identified only approximately half of true cases of MDD. Furthermore, documentation of MDD in medical notes occurred for only one in three depressed individuals.5 And of course, the next important question that arises following diagnosis pertains to treatment. Given the wide range of generic and branded selective serotonin reuptake inhibitors (SSRIs) and the more recently developed ‘third generation’ antidepressants that are available, how can the different treatment options be assessed?
Lundbeck, in association with Pulse, has developed an online resource that provides useful information on the key areas of depression management: diagnosis, treatment and referral.
Click here to visit the resource and save it to your favourites.
The site also contains a section devoted to the Cipriani et al meta-analysis, which was described by Bandolier – the e-Journal about evidence-based healthcare – as a “watershed” and “terrific stuff”.6 In this study, the efficacy and tolerability of 12 frequently prescribed “new-generation” antidepressants were compared using a multiple, or mixed treatments comparisons meta-analysis.7 Results of the study are clearly interpreted on the website, thus explaining the rationale for why Cipralex or sertraline might be the antidepressants of choice when starting medication for moderate to severe MDD.
Multiple choice questions at the end of each section allow you to test your knowledge and print a Pulse-branded certificate of learning to show you have completed the resource.
Finally, an interactive section allows you to learn about Cipralex and its unique mechanism of action as an allosteric modulator of the serotonin transporter.8 The interactive section will also allow you to evaluate the evidence for the superior efficacy of Cipralex over citalopram,9 its effectiveness in the real-life setting and how its clinical benefit could potentially translate into meaningful personal and societal benefit.10,11, 12, 13
Click here to view references
Click here to view prescribing information
0809/ESC/572/077
Date of Preparation: October 2009
I can't help wondering if the "objective" articles in column 1 are also paid for by the sponsor in column 2.
Assuming this is not a new thing, I would imagine the fact these emails are being sent would indicate the advertising works. I find it rather disturbing that my GP could be influenced by this stuff. Thoughts?
