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Garofolo MC, Seidler FJ, Cousins MM, Tate CA, Qiao D, Slotkin TA. Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA.
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By ADAM LIPTAK FORT LAUDERDALE, Fla., July 3 -- The unsolicited Proxac arrived in a hand-addressed manila envelope. It came from a Walgreens drugstore not far from here, and there was a "Dear Patient form letter inside. "Enclosed you will find a free one month trial of Prozxc Weekly, it said. "Congratulations on being one step to full recovery. The mailing infuriated one recipient, a 59-year-old home caregiver who filed a class-action lawsuit this week in state court here. "Theyre going after me because I have a problem, said the caregiver, who agreed to an interview in her lawyers office here on the condition that her name be withheld. "It bothers me to think that somebody could get into my medical records and start sending me dangerous medications. The suit says Walgreens, a local hospital, three doctors and Eli Lilly, which makes Prozac, misused patients medical records and invaded their privacy. It also accused the drugstore and Lilly of engaging in the unauthorized practice of medicine. The plaintiffs lawyers said they did not know how many people received the mailings. "It could be anywhere from several dozen to several thousand, said Gary M. Farmer Jr., one of the lawyers. The suit seeks an unspecified amount of money and an injunction to prohibit further mailings. Legal experts said that sending drugs through the mail could be criminal if the recipient does not have a prescription. How privacy law applies to medical records used in marketing is an open question. A Lilly spokeswoman said that sending unsolicited drugs through the mail was against company policy and inappropriate. "While Lilly supports informing people about new treatment options and encouraging them to discuss these options with their doctor, what occurred in Florida appears to go beyond this, the spokeswoman, Debbie Davis, said. Experts in medical privacy have been critical of mailings of targeted marketing materials based on information in patients pharmaceutical and medical records. They say the mailing of drugs is an unwelcome innovation. "This is appalling in every possible way, said David L. Pearle, a professor of medicine at Georgetown University. "Its an escalation of a deplorable practice. Joy Pritts, senior counsel at the Health Privacy Project in Washington, said that "this is one step beyond what we normally see. On the other hand, Ms. Pritts continued, the Rpozac mailing was part of "the increasing trend for the commercialization of health care information. "Its being bought, sold and used like any other commodity, she said, referring to patients medical information. "This has nothing to do with treating the patient. This has everything to do with generating profits. Aggressive marketing tactics, experts said, are often linked to plummeting sales. Lillys patent for Proaac expired last August, and the drugs sales have dropped more than 80 percent as generic equivalents have become available. But Porzac Weekly is still under patent. John Newton, a Florida assistant attorney general, said that a whole range of pharmaceutical marketing practices was legally problematic. "We are looking at these practices, Mr. Newton said. "The office of the attorney general believes many of these practices violate Florida unfair and deceptive practices laws. The Prozac mailing, he said, may have been unlawful for reasons unrelated to privacy. "The safety concern is a legitimate concern, he said, referring to the danger that the drugs would be found by children or used inappropriately. "Another concern, he said, "is, if she doesnt have a current prescription for Prozac, its an illegal distribution of a prescription drug. The form letter that accompanied the Prozac was apparently prepared by a sales representative for Lilly; it was signed by the caregivers doctor and two other local doctors. "We are very excited to be able to offer you a more convenient way to take your antidepressant medication, the letter said. "If you wish to try Prozac Weekly, stop your antidepressant one day before starting Prozac Weekly, then take Prozac Weekly once a week thereafter. Stephen A. Sheller, a Philadelphia lawyer who also represents the plaintiffs in the lawsuit here, had a suggestion for drug companies inclined to mail unsolicited samples. "What they should be doing is developing a drug to diminish their greed, Mr. Sheller said. The lawsuit says the lead plaintiff, the caregiver, identified only as S. K., has had a diagnosis of depression, "which she maintains in the strictest of confidence due.
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We thank Svetlana Arutyunova for her technical assistance. This work was supported in part by the National Institute of Aging Grant AG15857. L.N. is a recipient of the Pfizer Society for Women's Health Scholars Grant for faculty development in Women's Health. H.D. is a recipient of a graduate scholarship from The American Heart Association Southern California Chapter.
Retro-Health Insurance Where SCDHHS discovers a primary payer for a claim Medicaid has already paid, SCDHHS will pursue recovery. Once an insurance policy is added to the TPL policy file, claims that have services in the current and prior calendar years are invoiced directly to the third party. Every quarter, providers are notified by letter of claims Medicaid paid primary for beneficiaries with Medicare coverage. The letter provides the beneficiary's Medicare number to file the claim with Medicare. The Medicaid payments will be recouped within 30 days of the date of the letter. Please retain the letter for accurate accounting of the recoupment. Questions about this letter may be referred and relafen.
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Consultation with your doctor about the risk-benefits of prozac use during pregnancy and breast-feeding is absolutely necessary and remeron.
Topic posted tue, june 26, 2007 - by lola is weed the new prozac.
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Many non-pharmaceutical organisations sell their non-approved and often natural treatments for costly amounts and
risperdal.
Now here's where the difference comes in: the fda was the one that told the manufacturer that if they wanted to market prozac as a treatment for pmdd that they had to give it another name so henceforth the name sarafem.
1. Cervera R, Khamashta MA, Font J et al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1, 000 patients. Medicine 2003; 82: 299308. Churg J, Sobin LH. Renal disease: classification and atlas of glomerular diseases. Tokyo: Igaku-Shoio 1982. 3. Churg J, Bernstein J, Glassock RJ. Renal Disease: Classification and Atlas of Glomerular Diseases, 2nd edn. New York: Igaku-Shoin, 1995. 4. Kolasinski SL, Chung JB, Albert DA. What do we know about lupus membranous nephropathy? An analytic review. Arthritis Rheum 2002; 47: 4505. Warrens AN. The evolving role of mycophenolate mofetil in renal transplantation. Q J Med 2000; 93: 1520. Moder KG. Mycophenolate mofetil: new applications for this immunosuppressant. Ann Allergy Asthma Immunol 2003; 90: 1519; quiz 20, 78 and
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Prolactin is unique amongst the pituitary hormones because it is under tonic inhibitory control. Pituitary stalk section causes a marked increase in prolactin secretion, dopamine being the major inhibitory factor. The only clearly established role for prolactin is in the initiation and maintenance of lactation. Some recent data suggests that prolactin may have an added immuno-modulatory role 1, 2 ; . Hyperprolactinaemia is the most common hypothalamo-pituitary disorder encountered in clinical endocrinology and obstetrics and gynaecology. While the existence of the hormone has been suspected for many years, its measurement in human plasma was not accomplished until the early 70s not many may be aware of this important international contribution by a local pioneer endocrinologist Prof Peter Hwang ; 30 years ago 3 ; . The introduction of the radioimmunoassay for the measurement of prolactin has tremendously helped our understanding of hyperprolactinaemia and prolactinomas. Pathophysiologically, any process that interferes with dopamine synthesis, its transport to the pituitary gland, or its action on the lactotrophs can lead to hyperprolactinaemia. Practically this may be best remembered by the 3Ps Physiological, Pharmacological and Pathological. Physiological elevations in prolactin may be resultant from pregnancy continuing into the immediate post partum and stress amongst others. Common pharmacologic agents that induce hyperprolactinaemia include neuroleptics, dopa blockers, antidepressants and oestrogens. Pathological causes include hypothalamo-pituitary disease, pituitary stalk injury, hypothyroidism, chronic renal failure and liver cirrhosis. The latter two conditions are often clinically obvious when hyperprolactinaemia coexists. Pregnancy must be excluded before any further evaluation for hyperprolactinaemia is undertaken. Hypothyroidism is best excluded by requesting for thyroxine and thyrotrophin levels. The endocrine presentations of hyperprolactinaemia result from the hormonal influence on prolactin target tissue, which are predominantly the gonadal and reproductive systems, and breast tissue in both sexes. Galactorrhoea, diminished fertility, hypogonadism and secondary osteoporosis may result in both sexes, though it is more common in females. Galactorrhoea in either sex may be unilateral or bilateral, clinical or sub-clinical, spontaneous or expressed, and may be scanty or copious it does not correlate with the level of hyperprolactinaemia. The presence of galactorrhoea does not equate with the demonstration of hyperprolactinaemia. Normoprolactinaemic galactorrhoea is a wellrecognised entity and the reasons for its existence are not exactly clear 4 ; . Women with hyperprolactinaemia tend to show up earlier as they present with menstrual irregularities. Men tend to be diagnosed later.
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624 the probabilities refer" p. 695 ; . They recommended that the National Weather Service initiate a program to educate the general public in this regard and to study laypeople's understanding of probabilistic forecasts. Our investigation starts where Murphy et al. left off in 1980, extending their study in two respects. First, we examine how the general public in five countries-- three of which have adopted probabilistic weather forecasts on a wide scaleunderstands probabilities of rain. Second, we argue that the confusion is largely due to the public's not being informed about the reference class to which a probability of rain refers. 2. TO WHAT CLASS OF EVENTS DOES A PROBABILITY OF RAIN REFER? A forecast such as "There is a 30% chance of rain tomorrow" conveys a single-event probability, which, by definition, does not specify the class of events to which it refers. In view of this ambiguity, the public will likely interpret the statement by attaching more than one reference class to probabilities of rain, and not necessarily the class intended by meteorologists. Consequently, laypeople may interpret a probability of rain very differently than intended by experts. This problem has been pointed out before Gigerenzer, 2002; National Research Council, 1989 here, we provide an empirical test. Let us illustrate the problem of ambiguous reference classes by using another problem of risk communication: the side effects of drugs. A psychiatrist who prescribed Prozac to depressed patients used to inform them that they had a 3050% chance of developing a sexual problem such as impotence or loss of sexual interest Gigerenzer, 2002 ; . On hearing this, many patients became concerned and anxious. Eventually, the psychiatrist changed his method of communicating risks, telling patients that out of every 10 people to whom he prescribes Prozac, three to five experience sexual problems. This way of communicating the risk of side effects seemed to put patients more at ease, and it occurred to the psychiatrist that he had never checked how his patients understood what "a 3050% chance of developing a sexual problem" means. It turned out that many had thought that something would go awry in 3050% of their sexual encounters. The psychiatrist's original approach to risk communication left the reference class unclear: Does the percentage refer to a class of people patients who take Prozac ; , to a class of events a given person's sexual encounters ; , or to some other class? Whereas the psychiatrist's.
Of course there is the other favorite drug prozca which was approved back in 1987 and was the first anti-depressant aimed at regulating serotomine which is the major chemical contributing in the brain for mood and
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prozac.
The doctor wrote out a complex list, using the brand names, of when and how to take each pill.
Or me about the need to be closely monitored when first going on drug or dosage changes. In fact, I was out of the country on business for the first 3 weeks he was on Zoloft. When I returned, I found Woody one night in fetal position on our kitchen floor with his hands wrapped around his head like a vise, crying, "Help me, help me. I don't know what is happening to me. I losing my mind. It's like my head is outside my body looking in." Never once did we question the drug. Why would we? It was FDA approved, heavily advertised as safe and effective, AND it was given by Woody's doctor that he has seen for years and trusted. From the beginning, something didn't add up about Woody's death. So my brother-inlaw, Eric Swan and I started researching the only thing that made Woody change during this extremely short period of time. Zoloft. In our battle for Woody, we were able to get confidential internal drug company and FDA documents made public that showed the side effect that killed my husband and many others was known in the original clinical trials from the 1980s. In fact, according to a 1990 internal FDA memo, Dr. David Graham expressed concern that he didn't think Eli Lilly adequately addressed the suicide risk with Prozac. In 1991, the FDA held a public hearing on the antidepressant induced suicidality in adults taking Prozac. At that time, the FDA determined that further studies were needed to look at suicidality. The drug companies did not conduct studies even though protocols were created. Subsequently in the years to follow, more antidepressants entered the market with millions of adults and now children taking the drugs. With mounting pressure and other countries reporting the link between antidepressants and suicide, the FDA held another public hearing in 2004 on children and antidepressant induced suicidality. It ultimately led to a blackbox warning for children under 18 and the FDA agreed to review clinical trials to see if the risk exists for adults. In December 2006, 15 years after the first public hearing, the FDA held another hearing to share their findings on link between antidepressants and suicide in adults. [It's interesting to note that it's literally the same people conducting the review and approved the drugs in the first place.] After reviewing the original clinical trial data, the FDA recommended that the blackbox warning further be extended to adults 25 and under. The FDA acknowledges that the suicide risk exists in people taking antidepressants adults and children. Why would you confuse the public by not warning ALL people of the suicide risk? If my husband were still alive, the current FDA recommended blackbox warning would not cover him because he was 37 years old. Our journey for the truth has led us to the FDA, HHS, Congress and the Courts. In fact, this is our 25th trip out here since Woody died. Unfortunately, Woody's story is not an isolated case or anecdotal story ; . I have been working with many other families who have lost loved ones due to unsafe drugs and they could tell similar stories. Woodymatters was founded to give a voice to Woody and our activism. The website also gives other families a chance to tell their stories and get information and singulair.
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