VOL. 2 ISSUE 14 June 21, 2002

PSORIATIC ARTHRITIS MEDICAL NEWS

DOCTORS SHUNNING PATIENTS WITH MEDICARE - by Robert Pear-Washington

For the first time, significant numbers of doctors are refusing to take new
Medicare patients, saying the government now pays them too little to cover
the costs of caring for the elderly.

Medicare cut payments to doctors by 5.4 percent this year. The government
estimates that under current law, the fees paid for each medical service will
be reduced in each of the next three years, for a total decrease of 17
percent from 2002 to 2005.

For years, doctors have expressed frustration with Medicare, grumbling about
reimbursement and complex federal regulations. But the latest reaction
appears to be different. Doctors are acting on their concerns, in ways that
could reduce access to care for patients who need it.

For example, some doctors are purposely limiting the number of their Medicare
patients. The American Academy of Family Physicians says that 17 percent of
family doctors are not taking new Medicare patients.

The government is continually struggling to control Medicare costs. Total
Medicare spending rose 24 percent in the last five years, to $238 billion in
2001, and the Congressional Budget Office predicts that it will grow faster
in the next five years, to $310 billion in 2006. Spending for doctors'
services accounted for nearly $41 billion of last year's total.

Health policy experts said the cuts could make it more difficult for elderly
people to find doctors just as the need increases with the aging of the
population. Medicare covers 40 million people, and the number of
beneficiaries is expected to double by 2030. Scores of lawmakers have
endorsed legislation to increase Medicare payments to doctors, but the
outlook for the legislation is unclear. Other health care providers like
hospitals, nursing homes and health maintenance organizations - are also
demanding more money.

Though Medicare can barely afford all the benefits promised under current
law, Congress is seriously considering expansion of the program to add
prescription drug benefits. The Bush administration says that any increases
in payments to some providers must be offset by cuts in payments to others.
Moreover, it says, any new money should go to Medicare beneficiaries, for
drug benefits, or to the uninsured, in tax credits to buy private insurance.
Medicaid, which provides care for poor people, usually pays less than
Medicare. Many doctors refuse to participate in Medicaid. In some poor urban
and rural areas, Medicaid recipients have trouble finding doctors.

Many H.M.O.'s have left Medicare or curtailed their participation, dropping
2.2 million patients in the last four years, after concluding that the
federal payments were inadequate.

Martha A. McSteen, president of the National Committee to Preserve Social
Security and Medicare, an advocacy group for the elderly, said, "Many of our
members across the country have told us that they are having difficulty
finding a physician who accepts Medicare."

Dr. Michael J. Marcello, a family doctor in Mathews, La., 40 miles from New
Orleans, said he had decided not to accept new Medicare patients starting in
January, when Medicare payments were cut 5.4 percent.

"Our instinct would be to offer services, but it's just not fiscally
justifiable," Dr. Marcello said. "There's no evidence of any reduction in the
cost of living, utilities or supplies. Malpractice insurance premiums are not
being reduced 5.4 percent."

Dr. Samuel I. Fink, 44, of Los Angeles, a specialist in internal medicine,
expressed the opinion of many doctors: "I fear for when I become a senior. It
will be harder for seniors to find good care. Across the country, Medicare
patients are becoming less and less desirable to physicians."

Dr. Robert L. Hogue, 51, president- elect of the Texas Academy of Family
Physicians, said: "I have a hard and fast rule. I don't take any new Medicare
patients. In fact, I don't take any new patients over the age of 60 because
they will be on Medicare in the next five years." Copyright 2002 The New York
Times Company

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HIGHLIGHT ON DRUGS - NEW FDA LABELING STANDARDS SHOULD HELP THE CONSUMER By
Harold J. DeMonaco, M.S. Massachusetts General Hospital

Over the next few weeks, you should begin to notice an important change in
the way over-the-counter drugs are labeled. Until recently the U.S. Food and
Drug Administration made manufacturers put certain information in the label
of the drugs they produce. But, the FDA didn't have a standard way for
manufacturers to do that. Without standards, manufacturers were free to put
the information on their drug labels in just about anyway they wanted. What
we consumers ended up with were labels that confused us almost as often as
they provided needed information, that is, if you could actually read the
label. Many companies used print so small that few people over the age of 25
years could read it without a magnifying glass.

As of today, over-the-counter drugs rolling off the assembly line will have
labeling in line with the new FDA standards. As the products get to the store
shelves, you should see a dramatic improvement in the readability of the
information.

One of the first things you will notice is that the label print is large. The
print size is important because the elderly use more drugs than younger
people, and our eyesight tends to get worse as we age.

The generic name of drug, which is the name of its active ingredient, is
listed first, along with what the drug does. Now you won't have to read an
entire paragraph to figure out what the ingredients are. This is important
for people with drug allergies or who are taking prescription drugs that may
interact with over-the-counter drugs. Many over-the-counter drug preparations
contain a number of different drugs, so it is hard to tell what is in them
just by the name or by the use.

The new label has a list of the drug's uses. With so many sound-alike drug
names, it is sometimes hard to tell if you have the right drug. Now, you can
look not only at the name, but also at its use, so you can make certain you
have picked the right drug.
The "Warnings" section of the label tells you what to watch out for.
Depending on the drug, the warnings may tell you not to take the drug if you
have certain medical conditions or are taking other kinds of drugs. The
warnings will also tell you about things to watch for while you are taking
the drug, such as a new rash or pain.

The "Directions" section will tell you how to take the drug. In some cases,
it will also tell you how much to give to children. Unless you have been told
to take the drug differently by your physician, dentist, podiatrist or other
health-care provider, you should only take the drug according to these
directions. If your doctor asks you to take an over-the-counter drug, make
sure you get the instructions in writing. If they are different from what the
label says, contact your doctor to make sure he or she still wants you to
take it differently. You shouldn't necessarily be worried if you are asked to
take it in a different way by your doctor. But you should make sure that
that's indeed what your doctor wants.

The new labels have a section for other kinds of information, such as how to
store the drug and other kinds of warnings. Make sure you store the drugs
according to the instructions. And the bathroom medicine closet is the last
place you should think about storing drugs, because the humidity in a typical
bathroom can affect the drug's effectiveness.

The label will also tell you about inactive ingredients. These are the
ingredients that have no medicinal purpose but were necessary to make the
tablet or capsules. These can include added dyes and flavorings. Some people
have allergies to some of the dyes or flavorings, so this information will be
very useful to them.
The last section gives you a telephone number to call if you have questions
of complaints about the product.

The new label standard should make it easier for consumers to choose products
that meet their individual needs. But the label should not be a replacement
for asking questions of your pharmacist, physician or nurse practitioner.
Becoming an educated consumer is the best way to get the most from any
product. That is especially true for over-the-counter drugs. The new labels
should help you to become a better-educated consumer.
Harold J. DeMonaco, M.S. Massachusetts General Hospital.

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ONLINE PHARMACY - INTERNET DRUGSTORES ARE FLOURISHING
ALONG WITH THE HAZARDS

The face of pharmacy is changing -- literally. For the countless consumers
flocking to online drugstores, a computer monitor has replaced the
pharmacist's face. Like most business on the Internet, the electronic drug
trade is young. But, it's clearly booming: According to one estimate, there
are 200 pharmacy sites in the United States alone.

The reasons for the explosion are plain. For starters, purchasing drugs
online can be extremely convenient, especially for busy working people as
well as for older or disabled people who may have difficulty leaving home. As
anyone who has done any sort of online shopping knows, ordering products and
arranging payment is generally easy -- sometimes too easy! Prices are often
(though not always) at a discount rate. Then there is the embarrassment
factor: Many people prefer to buy medications for sensitive conditions in the
anonymity of cyberspace, without a personal encounter.

"For some people, shopping for prescription drugs online can be just what the
doctor ordered," says Robert Feroli, Pharm.D., assistant in medicine in the
Johns Hopkins University School of Medicine and assistant director of
pharmacy at Johns Hopkins Hospital. "But naturally there are hazards --
especially at this early stage, when the usual regulatory safeguards
developed for bricks-and-mortar drugstores are just beginning to be applied
to the online variety."

Sidestepping The Risks
"In a perfect world," Dr. Feroli continues, "every online drugstore would
require a doctor's prescription before dispensing medication. If needed, a
licensed pharmacist would call the prescribing physician and the patient for
verification. If the prescription had been submitted by fax or e-mail, the
pharmacy would ensure that the transmitted information was authentic and had
come from an authorized prescriber."

Reputable online pharmacies do all that. But in our less-than-perfect world,
many others fail to meet those standards. They may not require a verifiable
prescription, settling instead for a brief, online medical questionnaire with
no physician oversight. There may be no licensed pharmacist on staff. The
pharmacy itself may not be licensed in the states from which the medications
are dispensed. Medications may not be screened for drug interactions or
dangerous usage trends. Online customers may not receive any drug information
or counseling after purchasing the medication. Personal medical information
may not be kept confidential. Then there are concerns about the drugs
themselves, including such issues as dosage and quality control.

Foreign-based online pharmacies, which can be just as easy to access, pose
all those hazards and more. Drug manufacturing and dispensing standards may
be less strict than those enforced by the U.S. Food and Drug Administration.
And the offerings may include not only FDA-approved drugs (sold without a
prescription) but also nonapproved drugs as well as controlled drugs, such as
opiates and anabolic steroids.

According to Dr. Feroli, you can avoid most of those perils by restricting
your online drug purchases to well-known, U.S.-based companies with a
reputation for reliability. Further reassurance may be forthcoming as the FDA
implements an action plan for curbing online abuses and the industry begins
to police itself. To that end, the National Association of the Boards of
Pharmacy (NABP), a nonprofit trade group that sets operating and safety
standards for its members, has just begun a certification program for online
pharmacies. Certified sites will display a VIPPS seal, indicating that they
are Verified Internet Pharmacy Practice Sites.

In addition to looking for that certification, online-drugstore patrons
should take other precautions. The FDA warns consumers to avoid Web sites
that:

Offer to prescribe drugs outside the context of a doctor-patient
relationship.
Sell unapproved medications.
Require linking to another site to purchase the drug.
Are not registered on a search engine, meaning they cannot be found by
searching for online pharmacies. (Shady online sites are less likely to
subscribe to a search service.)
Do not list a U.S. phone number and address. If you're unsure about an
online pharmacy that interests you, the FDA recommends contacting the NABP to
make sure the company has a valid pharmacy license and meets other legal
requirements. (To contact the group, go to the NABP Web site and select
"VIPPS," or call 847-698-6227.)

Preserving The Personal Touch
Even in this brave new electronic world, some things never change. In this
case, it's your responsibility to manage your own medications responsibly.
"You can follow all these guidelines and still not protect yourself
adequately from drug mishaps," warns Dr. Feroli. "First and foremost is your
responsibility to maintain a healthy relationship with your flesh-and-blood
physician."

Legally, there's nothing to stop a doctor from prescribing drugs for a
patient he or she has never seen or examined. Before the emergence of
Internet pharmacies, however, the issue seldom came up. Make sure you get
examined before you get a prescription. It's also essential to see your
physician for periodic checkups to monitor your condition, watch for side
effects or interactions with other medications, and, if necessary, adjust
your dosage.

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SUPERMARKET CHAIN PULLS OXYCONTIN - QUINCY, Mass. (AP)

The Stop & Shop supermarket chain will no longer stock the painkiller
Oxycontin because of an increasing number of robberies involving the drug.

"Stop & Shop is committed to providing the needs of our customers, but not at
the expense of the safety of our customers and associates," the company said
in a press release. A spokeswoman declined to comment further. Stop & Shop
has 226 pharmacies and 322 stores in Massachusetts, Connecticut, Rhode
Island, New Jersey and New York.

The company said it would advise customers who are taking the drug of the new
policy, and would continue to order Oxycontin from wholesalers for customers
with prescriptions, though the individual deliveries may take several days to
arrive.

Last month, Scarborough, Maine-based chain Hannaford Bros. Co. pulled
Oxycontin from its pharmacies after a man robbed one of its Shop 'n Save
stores of several tablets of OxyContin and Dilaudid, another addictive pain
reliever.

James Heins, a spokesman for Purdue Pharma, which manufactures Oxycontin,
said Stop & Shop and Hannaford Bros. are the only chains to implement such a
policy. He said Purdue Pharma hoped to meet with Stop & Shop officials to
negotiate a solution.

"We understand Stop & Shop's concerns about pharmacy and customer safety,"
Heins said. "But we're also very concerned about the well-being of patients
who need this medication for pain. It's a situation where criminal activity
is determining the medical care of patients with pain. We as a company are
not going to tolerate that." Copyright 2002 The Associated Press.

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ASPIRIN STEPS UP AS ANTI-INFLAMMATORY FOR ARTERIES
DALLAS (American Heart Association) --

Americans with heart disease may have yet another reason to use aspirin,
according to a report in the rapid access Circulation: Journal of the
American Heart Association. Researchers found that aspirin can protect the
blood vessels from dysfunction caused by even mild inflammation.

Aspirin is often given to people with heart disease to help thin the blood,
but other effects could make it useful to prevent heart disease. Blood
vessels with atherosclerosis become inflexible and inflamed. Researchers
wanted to know if aspirin might protect against inflammation.

"Aspirin is widely used to prevent heart attacks and strokes, but it is
assumed that its effects are solely attributable to its blood-thinning
actions. But our research turns the clock back on aspirin, and suggests that
some of aspirin's effects really are due to its anti-inflammatory properties,
which people have known about for 100 years or more," says Patrick J. T.
Vallance, M.D., FRCP study author and professor of clinical pharmacology at
University College London, in England.

Even mild inflammation, which occurs from common ailments such as a cold,
causes changes in blood vessels similar to those seen in people at high risk
for heart disease.

Researchers used a typhoid vaccine to cause inflammation in 17 healthy
volunteers to determine if aspirin would prevent changes to blood vessel
function. Twelve of these people randomly received either 1.2 grams of
aspirin or an inactive pill (placebo) two hours before vaccination. The
remaining five patients received aspirin after the vaccination.

The researchers measured an inflammatory factor called Interluekin-1 (IL-1)
to determine the level of inflammation. In the placebo group, IL-1 peaked at
three hours and remained elevated until 8 hours after vaccination. This
corresponded to a 30-fold increase in baseline values. In the group treated
with a single oral dose of aspirin before the vaccine, the concentration of
IL-1 did not differ from baseline.

In a second test, researchers measured endothelial function, which is the
ability of the blood vessels to expand. Researchers did that by infusing
drugs that affect the endothelium into the artery of one arm and measuring
blood flow in that arm. The six participants who received placebo had
decreased forearm blood flow eight hours after vaccination compared to
baseline, indicating a temporary stiffening of their blood vessels. However,
the six who received aspirin showed an increase in forearm blood flow 8 hours
after vaccination, indicating a protective effect from aspirin.

"There is an exciting opportunity to rethink how we use aspirin and whether
there are situations in which we should be giving aspirin to reduce
cardiovascular risk," he says.

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DENTAL X-RAYS CAN SPOT RISK OF HEART DISEASE AND STROKE
By Nancy Volkers - InteliHealth News Service

Dental X-rays not only identify decay, but also may become a new tool to
screen for a person's risk of heart conditions and stroke.

Research presented at the 54th annual meeting of the American Academy of
Neurology shows that panoramic dental X-rays can be used to spot carotid
artery calcification (CAC) - a condition that can contribute to stroke. In
CAC, calcium deposits line the walls of the carotid arteries, the blood
vessels that supply blood to the brain.

"Our study shows that patients with calcification of the carotid arteries had
a higher risk for both serious cardiac events and strokes," said Stanley N.
Cohen M.D., who presented the study and is director of the Stroke Program in
the Division of Neurology at Cedars-Sinai Medical Center, Los Angeles. "Now,
we recommend that when dentists see CAC on an X-ray, they refer their
patients to the appropriate specialists for further evaluation and
treatment."

Investigators examined the panoramic dental X-rays of male veterans seen over
a 15-year period at the Veterans Affairs Greater Los Angeles Healthcare
System. Panoramic radiographs show the entire mouth area - all teeth on both
upper and lower jaws - on a single X-ray. Forty-six patients with CAC were
identified and compared with a second group of 46 patients without CAC. The
two groups were similar in age and in risk factors for heart disease and
stroke. The researchers then examined medical records to see how many heart
conditions and strokes occurred in each group in the years after the dental
X-rays were taken. In the first group, 20 heart-related conditions -
including heart attack, stroke, blood-vessel obstruction and angina -
occurred in 12 of the patients with CAC. In the second group (without CAC),
six heart-related conditions occurred in five patients.

Patients with CAC experienced some type of cardiac event or stroke 2.9 years
after their X-rays were taken, while patients without CAC experienced an
occurrence 3.9 years later.

"Although CAC does not indicate that the arteries are blocked, it does
indicate a patient at higher risk to develop potentially life threatening
vascular complications," said Dr. Cohen. "Therefore, finding CAC on a dental
X-ray can help us to identify and begin early intervention in these high-risk
patients."

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NEW STUDIES ADD TO VIOXX DEBATE - CHICAGO (AP)

Three new studies are adding to a raging debate over whether the popular
arthritis pain reliever Vioxx increases the risk of heart attack.

The editor of the Archives of Internal Medicine, which published the studies
in its May 27 edition, says the results offer reassuring evidence that drugs
like Vioxx and Celebrex are not bad for the heart.

But a cardiologist and a co-author of one of the studies said the safety
issue is not resolved.

The new studies involved the older arthritis painkiller naproxen, not the
newer class of pain relievers to which Vioxx and Celebrex belong. Vioxx maker
Merck & Co. conducted or funded two of the three studies.

According to the Archives report, the studies all found that patients taking
naproxen had a lower heart attack risk than those who did not use the drug.

One of the studies, involving 4,425 heart attack patients and 17,700 others,
linked naproxen use to a 16 percent to 20 percent reduction in heart attack
risk.

Vioxx maker Merck has argued its product is not bad for the heart, and that
naproxen's apparent heart-protective benefits are the result of thinning the
blood.

The three studies "support what Merck scientists have been saying," said Dr.
Alise Reicin, Merck's head of clinical research.

Archives editor Dr. James E. Dalen also called the studies "good news for the
millions of users of cox-2 inhibitors."

Vioxx and Celebrex both belong to the group of drugs, called cox-2
inhibitors, that work by blocking the action of an enzyme involved in the
inflammation process.

But cardiologist Dr. Eric Topol of the Cleveland Clinic said the Food and
Drug Administration's order last month for new precautions on Vioxx's label
is still warranted. Topol took part in an analysis last year of data that
showed Vioxx users faced double the risk of serious cardiovascular problems,
including stroke and heart attack. He said the newest research leaves the
question "far from settled."

Dr. Daniel Solomon of Harvard's Brigham and Women's Hospital, co-author of
one of the Archives studies, agreed.

"None of the studies contain a patient who is on a cox-2 agent, so it's
impossible really to comment on the safety" of drugs like Vioxx, Solomon
said.

Solomon said naproxen users might have other traits or health habits that
would explain the findings. A pharmaceutical company did not fund Solomon's
study. Copyright 2002 The Associated Press.

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RESEARCH SHOWS PROMISE FOR NEW CLASS OF ANTI-INFLAMMATORY DRUG FOR ARTHRITIS
June 14, 2002 - LONDON (AP)

A new type of anti-inflammatory painkiller is showing promise in experiments
on people with arthritis in their knees.

Research presented at a conference in Stockholm this week indicated that the
drug works just as well for arthritis as do traditional nonsteroidal
anti-inflammatory drugs such as aspirin and ibuprofen but are gentler on the
stomach.

Experts say the medication, licofelone, could offer an alternative to newer
arthritis drugs such as Vioxx and Celebrex, which have recently come under
suspicion of increasing certain people's heart risks.

Licofelone, being developed by German pharmaceutical manufacturer Merckle,
works in a slightly different way from other anti-inflammatory painkillers
and some scientists suspect it might have benefits beyond pain-relief.

"It's extremely encouraging and it will provide another option for treatment
for arthritis patients, which we desperately need," said Dr. Jean-Pierre
Pelletier, head of the osteoarthritis research unit at the University of
Montreal's Central Hospital who was not connected with the research.

Conventional non-steroidal anti-inflammatories work by shutting off
production of prostaglandins, inflammation-causing substances. They do this
by blocking the action of the enzyme cox, which produces prostaglandins.

In the late 1980s, scientists discovered that there were two varieties of the
cox enzyme. They found that while cox-2 causes pain and inflammation as part
of the body's repair process, cox-1 protects the lining of the stomach.

That explained why the painkillers caused stomach upsets. The discovery led
to drugs designed to relieve pain but spare the stomach.

That type of pill, including Vioxx and Celebrex, does that by blocking only
cox-2, rather than both cox enzymes and are known as cox-2 inhibitors.

However, recent studies have suggested that some cox-2 blockers might
increase the risk of blood clots. Scientists speculate it may be because the
two cox enzymes are out of balance. As well as protecting the stomach lining,
cox-1 plays a role in blood clotting.

The new drug, licofelone, blocks both cox-1 and cox-2, like the older
painkillers, but also interferes with the action of another enzyme involved
in pain and inflammation, called 5-lox.

The study, presented at the European Congress of Rheumatology in Stockholm,
found that licofelone worked as well as the older drugs, was gentle on the
stomach and showed no trace of side effects that could cause heart problems.

It involved 710 people with arthritic knees, followed for a year. One third
of them got a low dose of the new drug, another third got a high dose and the
others got naproxen, a conventional nonsteroidal anti-inflammatory.

The study's lead investigator, Dr. Jean-Yves Reginster of the University of
Liege, said the new drug was as effective as the old one; that in each of the
three arms of the study, two-thirds of the patients had significant
improvements in pain and inflammation.

Those on the new drug were 80 percent less likely than the others to get a
stomach ulcer.

Reginster said the study did not directly address heart safety, but that
swelling in the feet and ankles, and elevated blood pressure - both side
effects suggested in studies of cox-2 blockers - did not affect patients
taking the new drug.
Pelletier said he doesn't expect to see any heart problems with the new drug
because its cox enzyme blocking action is balanced. The fact that the new
drug also blocks the enzyme 5-lox may give it extra appeal, There is
preliminary evidence that 5-Lox may play a role in deterioration of the
joints and licofelone is being investigated as a possible disease-slowing
drug, he said. Copyright 2002 The Associated Press.

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Good Health to All
Jack Nicholas

Newsletter Editor
Cornishpro@aol.com

Issue2002 6/19/2002-14