New Study Sheds Light on Why People Don't Pick Up Prescriptions

Every pharmacy has prescriptions ordered but left uncollected. It's a small but growing problem, and now a new study in the Annals of Internal Medicine sheds some light on why this is happening. It turns out cost is the biggest reason. Prescriptions with copayments of $40 to $50 and prescriptions costing more than $50 were 3.40 times and 4.68 times more likely, respectively, to be abandoned than prescriptions with no copayment. The second biggest group of prescription deadbeats was new users of medications, who had a 2.74 times greater probability of abandonment than prevalent users. New users were, perhaps, in denial about needing  the drug. The third category of abandonment was prescriptions sent in electronically, which were, no doubt, forgotten.

Money, denial and abandonment--sounds like the chorus of a country song titled, "The Healthcare Debate, 2010."

Denial Linked to Treatment Delay in Skin Cancer

Denial is not just a river in Egypt, as they like to say in addiction circles, and, according to a new study, it is the top reason patients delay treatment of skin cancer.Oh, I'll think about that later....

In an article published in the Journal of the American Academy of Dermatology, dermatologist Murad Alam, MD, MSCI, FAAD, chief of cutaneous and aesthetic surgery, and associate professor of dermatology, otolaryngology, and surgery at Northwestern University, Chicago, presented results of a study examining why patients delay seeking medical attention for suspicious growths and the consequences of their procrastination.

"Studies show that various patient-specific factors appear to be responsible for the delay in the treatment of cancers in general, and skin cancer in particular," said Dr. Alam. "The purpose of this study was to determine the patient- and physician-specific reasons, including physical, financial, social, intellectual, and psychological factors, to which patients attribute delays in the diagnosis and treatment of nonmelanoma skin cancers."

Patients reported that denial was the most frequent reason for waiting to see a doctor about a suspicious lesion – accounting for 71 percent of all cases. Specifically, the two most commonly listed reasons why patients waited to see their doctor were "thought it would go away" (36 percent), and "thought it wasn't important" (24 percent).

"Denial may be a normal response to health concerns, with patients minimizing the psychological burden of their illness, or it may be a learned coping mechanism," said Dr. Alam. "But denial can interfere with obtaining treatment and result in more serious or advanced skin cancers."

When analyzing the association of delay with the size of a skin cancer from the time patients first realized that they had a problematic lesion to the time they saw a physician, Dr. Alam found that there was a significant increase in tumor size in patients who waited an average of six months to see a physician. On average, skin cancers grew during this delay period, with the average lesion enlarging from the size of a pimple (2-3 mm) to between the size of a pimple and a dime (10 mm). The longest reported delays were associated with relatively greater increases in tumor sizes.

"Delayed treatment of skin cancer may result in tumor enlargement, loss of function in affected areas, and the need for larger excisions that may impact a person's appearance and mobility," Dr. Alam said. "That is why dermatologists encourage everyone to perform regular skin exams and report suspicious lesions to a dermatologist as soon as possible."

To borrow a slogan from the Metropolitan Transit Authority: If you see something, say something.

Alcohol-Energy Drinks' Allure? It's the Dopamine

There's an explanation for the addictive quality of the spate of new caffeine-laced alcoholic beverages like Associated Brewing's Axis, United Brands's Max and Phusion Projects's Four Loko (the drink of record when nine Central Washington University students were hospitalized--some with lethal alcohol blood levels--after a party last month.) It turns out it all comes down to dopamine, the wily little neurotransmitter responsible for feelings of reward and motivation, and which is intimately tied up in cocaine and heroin addiction.

We think this excerpt from a Scientific American interview with Thomas Gould, associate professor of Psychology at Temple University in Philadelphia, neatly sums up what's happening when kids drink these cocktails in a can, which are already banned in Michigan, Oklahoma and by the Chicago City Council (New York is considering the same.) A single can of an alcohol energy drink can deliver a six pack of beer's worth of alcohol along with a caffeine dose equal to 3 cups of espresso. A far cry from the old rum and Coke, the lethal potency of these drinks gave a heart attack to one young kid in the state of Washington.

Scientific American: What effect does the simultaneous consumption of alcohol and caffeine have on the body?
Dr. Gould: "Alcohol is a sedative. It works in part by potentiating the GABAergic neurotransmitter system. GABA [gamma-aminobutyric acid] is an inhibitory neurotransmitter. When the neurons in the brain release GABA, it acts to slow down or inhibit other neural processes. This can reduce anxiety, increase relaxation while sedating a person. With higher levels of alcohol, problems can arise as important neural and other bodily systems become overinhibited and shut down.

Compared to alcohol, caffeine is on the other end of the spectrum of psychoactive drugs in that it is a stimulant. Caffeine is an antagonist for the neurotransmitter adenosine. Adenosine is an inhibitory neurotransmitter; so similar to GABA,adenosine can dampen or inhibit other neural processors. With caffeine, we have a double negative in that it inhibits an inhibitory neurotransmitter and thus increase levels of arousal and alertness—but higher doses can produce nervousness, anxiety and tachycardia.

One thing both drugs do is increase dopamine levels. Dopamine is a neurotransmitter associated with reward. One thing all drugs of abuse have in common is the ability to activate the dopamine system. The ability of alcohol and caffeine to stimulate the dopamine system may be one factor contributing to their use.

Because the drugs in a sense have opposite effects, one might expect that simultaneous consumption may reduce the effects that are seen when each drug is administered alone, but it really is not as simple as that. Some effects may be reduced while others are increased, and this may vary as the doses of the drugs vary."

Read the entire interview in Scientific American.

Update on Thursday, November 11, 2010 at 9:13AM by Kathy

Buying Rush Follows Ban on Four Loko: Students rushed to stock up on the alcohol energy drink, Four Loko, when a ban was announced in the state of Washington. Read the story in The Seattle Times.

Making the Brain Better at Math

British scientists have accomplished the neat little trick of finding out exactly where to send an electrical current into the brain to make people better at math. Apparently the key lies in the parietal lobe. Only one hitch, it would be awfully hard to sneak electrodes into an exam.

Read the story from the BBC.

Study: Ecstacy May Be Useful in PTSD Therapy

Researchers believe they have found the next step in PTSD therapy: MDMA--commonly known as ecstacy--usage in therapeutic environments. In a recent Phase II study published in Journal of Psychopharmacology, psychologists found using MDMA during PTSD therapy sessions allowed patients to better manage and understand their emotions than with traditional therapy methods alone.

"PTSD treatment involves revisiting the trauma in a therapeutic setting, but many patients become overwhelmed by anxiety or numb themselves emotionally, and so they can't really successfully engage," says study lead researcher Dr. Michael Mithoefer, a psychiatrist in Charleston, S.C. "But what we found is that the MDMA seemed to temporarily decrease fear without blunting emotions, and so it helped patients better process their grief." After the study completed, 10 of the 12 patients treated with MDMA and therapy no longer suffered from clinical PTSD, compared with two of eight placebo patients.

The intense therapy programs included two all-day therapy sessions and overnight visits in the therapy clinic. A long-term follow-up study of the patients is already under way.

Read the source article.