Journal of the New Zealand Medical Association, 04-April-2008, Vol 121 No 1271
Drug appraisal is done through the National Institute for Health and Clinical Excellence (NICE) in the UK, the Pharmaceutical Benefits Advisory Committee (PBAC) in Australia, and the Pharmaceutical Management Agency of New Zealand (PHARMAC) in New Zealand. Each use different criteria for public funding of pharmaceuticals, but all include estimates of clinical effectiveness and cost-effectiveness.
Interestingly of the 10 drugs deemed least cost-effective by NICE between 1996 and 2005, all were approved for funding in the UK, 6 were approved in Australia, and 5 were approved in New Zealand. It should be noted, however, that the drug companies involved did not seek funding in New Zealand for 3 of the drugs rejected in Australia.
So the PHARMAC scoresheet is 5 approvals and 2 rejections.
Med J Aust 2008;188:26–8.
Combination OCs with low-dose oestrogen are hailed as the very best form of contraception. It has been suggested that they may also low the risk of subsequent ovarian cancer.
This paper from the Oxford Epidemiology Unit seems to confirm this. They collected data for 23,257 women with ovarian cancer (cases) and 87,303 without ovarian cancer (controls) from 45 epidemiological studies in 21 countries. The relative risk of ovarian cancer in relation to oral contraceptive use was estimated, stratifying by study, age, parity, and hysterectomy. Their conclusion was that use of oral contraceptives confers long-term protection against ovarian cancer. These findings suggest that oral contraceptives have already prevented some 200,000 ovarian cancers and 100,000 deaths from the disease around the world.
Very good news as ovarian cancer is common and usually diagnosed when well advanced and incurable.
Two papers in a recent BMJ compare the value of a topical NSAID (ibuprofen gel) with oral use of the same drug for osteoarthritis of the knee. And it seems that topical NSAIDs may be a useful alternative to oral NSAIDs as the pain relief was about equal for both treatments except for those with the most severe symptoms.
It would be expected that adverse effects would be less with topical treatment but in these trials significant adverse effects were not seen with either treatment.
An editorial commentary was favourable and pointed out that a systematic review of a different topical NSAID found similar results and also established that topical treatments are cost-effective.
On the other hand it also offered the opinion that placebo effects explain most of the value of topical agents in osteoarthritis.
BMJ 2008;336:105–6 & 138–42 & 142–5.
Acute otitis media (AOM) is a very common problem in childhood with the majority of children having had the condition at least once by their third birthday.
The routine administration of antibiotics for AOM has recently come under scrutiny. The 2004 Cochrane review of antibiotics for AOM suggests minimal benefit from early use, with no reduction in pain for 24 hours and only a 30% reduction at 2–7 days. This report concerns a placebo-controlled trial comparing the topical use of 2% lignocaine or saline eardrops.
The results—rapid pain relief in the lignocaine group at 10 and 30 minutes. Sounds good, but would probably require repeated treatments and should be avoided in those with perforated eardrums.
Arch Dis Child 2008;93:40–4.
The World Medical Association is proposing to again update its cornerstone statement of ethical principles regarding human experimentation.
The main issue prompting this are the ethical problems surrounding drug safety trials. One trial in particular resonated around the world. It was a trial involving HIV-positive women in the developing world. It gave one-half of all participants the drug azidothymidine to determine if a shorter-course treatment would be as, or almost as, effective as the proven longer-course treatment, and the other half a placebo, even though an existing treatment was available.
The fault is obvious but some ethicists defended the trial by arguing that the women would likely have received no treatment had the trial not been conducted.
No easy solution here.
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