Archive for November, 2011

Generic Lipitor: A User’s Guide

Tuesday, November 29, 2011 // Uncategorized

Here is an article from this morning’s Wall Street Journal that reviews some of the new options available for users of atorvastatin or Lipitor.

  • NOVEMBER 29, 2011

Generic Lipitor Goes on Sale This Week: A Users’ Guide

Some 8.7 million Americans take Lipitor for high cholesterol. Starting Wednesday, they might get a different-looking pill when they go to fill a prescription and pay much less for it.

[LIPITORjp] Bloomberg NewsLipitor, the biggest-selling prescription drug of all time, generated sales of $10.7 billion last year.

That’s the day the U.S. patent on Pfizer Inc.’s blockbuster drug expires, allowing generic versions of the statin medication to go on sale. Many patients have been eagerly awaiting the lower insurance copayments that come with a generic medicine. Lipitor, the biggest-selling prescription drug of all time, generated sales of $10.7 billion last year.

The switch is generating confusion among some patients.

Richard Allen, a retired real-estate developer from Bainbridge Island, Wash., says that his 77-year-old wife has been taking Lipitor for years with positive results and worries that the generic won’t work as well as the branded version. He says he has called his Medicare plan, local pharmacy and even Pfizer to find out whether his wife could stay on Lipitor and what the cost would be. “They didn’t know anything,” Mr. Allen says.

Adding to the confusion, Pfizer has embarked on an ambitious plan to keep the brand-name drug’s sales alive after the advent of generic versions, striking bargains with pharmacy-benefit managers to keep dispensing Lipitor for a time at generic prices and starting up a direct-mail service.

Here are some questions facing Lipitor consumers, and some answers about what the switch to a generic version will mean.

Pill Rivals

Pfizer’s U.S. patent on Lipitor expires Wednesday. The cholesterol-lowering drug will then face competition from generic versions in the U.S. market for the first time.

• Lipitor has been on the market since 1997.

• 8.7 million Americans took the medication in 2010.

• World-wide sales of the drug were $10.7 billion last year.

• Lipitor’s biggest competitors in the statin drug market are simvastatin, a generic version of Merck’s Zocor medication, and Crestor, made by AstraZeneca.

Sources: Pfizer; Wolters Kluwer Pharma Solutions

How will I know if I will get Lipitor or the generic?

The generic version will be labeled atorvastatin calcium, the chemical name of Lipitor. Generally, health plans determine which drugs their members receive. Some plans have decided to move immediately to the generic version.

Others have arranged for patients to stay on Lipitor, paying the same price as if it were a generic, for at least the next 180 days—a period during which generic competition is still limited.

A Medicare spokesman declined to comment on what beneficiaries of its prescription drug plan, Part D, might expect.

Drugstore officials say that because of the variation in plans, a pharmacist won’t be able to tell patients whether they’re getting Lipitor or atorvastatin (uh-tour’-vuh-statin) until they fill their prescriptions at the counter.


Will there be a clinical difference between Lipitor and its generics?

Not a meaningful difference, says John Santa, director of Consumer Reports Health Ratings Center, a research arm of Consumer Reports magazine. The color, shape and some inactive ingredients in the pills might be different, but generics must contain the same key ingredient and prove to be equivalent in order to receive approval from the Food and Drug Administration.

Much attention has been given to manufacturing problems at plants run by generic drug makers. But a Consumer Reports analysis found that the FDA was as likely to warn about manufacturing issues at a brand-name drug factory as a generic one, Dr. Santa says. The magazine’s analysis also found that, in general, patients report side effects at a similar rate for brand-name drugs as for generic versions.

Pfizer will be manufacturing one of the no-name Lipitors, the so-called authorized generic, that will be sold by Watson Pharmaceuticals Inc.


What will happen after Nov. 30 when Lipitor patients try to get their pills?

If past experiences with the advent of generics is any guide, it will probably take some time for pharmacy shelves to fill with atorvastatin and for most patients to get on the generic. In the meantime, even patients who might otherwise be switched to generics might keep receiving Lipitor.

Some pharmacies should have atorvastatin available on Wednesday, though they may not have their full supplies. Watson expects to provide a full supply by Friday, a spokesman says. It’s unclear whether there will be another generic version available Wednesday. Ranbaxy Laboratories Ltd., another company authorized to sell a generic in the first 180 days after the patent expiration, didn’t respond to requests for comment.

Most patients should expect to eventually switch to atorvastatin, if not right away. Pfizer is making a big push to keep patients on Lipitor during the 180 days following the drug’s loss of patent protection, when there will be few generic competitors available. But the company hasn’t decided whether to continue its efforts past that point.


What if a patient wants to stay on the branded version?

Some patients will be able to stay on Lipitor for the first 180 days, as a result of deals that Pfizer has negotiated for health plans to provide Lipitor at the same price as generics. Medco Health Solutions Inc., a pharmacy-benefit manager, will supply Lipitor through its direct-mail service. Pfizer is also setting up a direct-mail service, via its website.

Patients can talk with their doctors about getting prescriptions for the branded version or working with their health plan to stay on Lipitor.

But some plans require patients to take less-expensive generic versions of cholesterol drugs except in special circumstances, and many states require pharmacies to fill prescriptions with lower-priced generics. Medicare and Massachusetts won’t allow shipments from Pfizer, a company spokesman says.


How much cheaper will generic Lipitor be?

Insurance copayments should drop considerably, if patients are getting Lipitor or atorvastatin on the generic tier of their health plans.

Currently, Lipitor has been on a higher, branded tier for prescription drugs. Copays for branded drugs average either $29 or $49, depending on the tier, according to the Kaiser Family Foundation. Copays for generics average $10.


How can patients get Pfizer’s copayment promotion?

The company has been offering to help cut the copays of eligible patients to as little as $4 a prescription for branded Lipitor. Under the offer, Pfizer will cover up to $50 of a copayment for every prescription through December 2012. Patients can sign up at the website and then receive a copay card that they present at their pharmacy. Patients in Massachusetts or on a federal or state-sponsored program, including Medicare, aren’t eligible.

Write to Jonathan D. Rockoff at [email protected] and Timothy W. Martin at [email protected]


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Top Ranked Diets

Thursday, November 17, 2011 // Uncategorized

To me diet is a four letter word.  It implies that there is a beginning and an end.I prefer lifestyle modification.  In any event,   here is the  list of diets compiled by US News and World Report.  It has expert recommendations as well as the votes of users.  DASH diet which is a diet high in complex carbohydrates and low in processed foods gets the highest rating.

Best Diets Overall

U.S. News evaluated and ranked the 20 diets below with input from a panel of health experts. To be top-rated, a diet had to be relatively easy to follow, nutritious, safe, and effective for weight loss and against diabetes and heart disease. The government-endorsed Dietary Approaches to Stop Hypertension (DASH) snagged the top spot.



(3.9 out of 5.0)

DASH was developed to fight high blood pressure—not specifically as an all-purpose diet. But it certainly looked like an all-star to our panel of experts, who gave it high marks for its nutritional completeness, safety, ability to prevent or control diabetes, and role in supporting heart health. Though obscure, it beat out a field full of better-known diets.

Did this diet work for you?
Yes 347
No 1180


Mediterranean Diet

(3.8 out of 5.0)

With its emphasis on fruits and vegetables, olive oil, fish, and other healthy fare, the Mediterranean diet is eminently sensible. And experts’ assessments of it were resoundingly positive, giving this diet an edge over many competitors.

Did this diet work for you?
Yes 297
No 999


TLC Diet

(3.8 out of 5.0)

Therapeutic Lifestyle Changes, or TLC, is a very solid diet plan created by the National Institutes of Health. It has no major weaknesses, and it’s particularly good at promoting cardiovascular health. One expert described it as a “very healthful, complete, safe diet.” But like the diets above, it requires a “do-it-yourself” approach, in contrast to the hand-holding provided by some commercial diets.

Did this diet work for you?
Yes 85
No 756


Weight Watchers Diet

(3.8 out of 5.0)

Weight Watchers is a smart, effective diet. It surpassed other commercial diet plans in multiple areas, including short- and long-term weight loss and how easy it is to follow. It’s also nutritionally sound and safe, according to experts. Among its pluses: An emphasis on group support, lots of fruits and vegetables, and room for occasional indulgences.

Did this diet work for you?
Yes 4298
No 2014


Mayo Clinic Diet

(3.7 out of 5.0)

This is the Mayo Clinic’s take on how to make healthy eating a lifelong habit. It earned especially high ratings from our experts for its nutrition and safety and as a tool against diabetes. Experts found it moderately effective for weight loss.

Did this diet work for you?
Yes 99
No 824


Volumetrics Diet

(3.7 out of 5.0)

Volumetrics is an effective diet, outperforming its competitors in many categories. It earned particularly high marks for being safe and nutritious, and experts said it could have a positive effect on heart health and diabetes. “This is an eating plan that everyone can benefit from,” one expert said.

Did this diet work for you?
Yes 75
No 870


Jenny Craig Diet

(3.6 out of 5.0)

Jenny Craig’s overall rating wasn’t enough to bump it up to the top. The diet drew praise from experts for being easy to follow and for offering dieters emotional support. But these experts had less enthusiasm about its potential to bolster heart health or help diabetics. Experts also noted that Jenny Craig’s cost could be a roadblock for some.

Did this diet work for you?
Yes 339
No 1508


Ornish Diet

(3.5 out of 5.0)

The Ornish diet got a mixed reaction from experts. On one hand, it’s nutritionally sound, safe, and tremendously heart-healthy. On the other, it’s not easy for dieters to adhere to the severe fat restriction the diet demands.

Did this diet work for you?
Yes 173
No 1015


Vegetarian Diet

(3.4 out of 5.0)

As a health diet, vegetarianism is solid but not outstanding. While it’s not much good at producing rapid weight loss, according to experts, it’s strong in several areas, including nutrition and safety, that are arguably more important. That assumes, in selecting foods to eat, you’re health-conscious—not just meat-averse.

Did this diet work for you?
Yes 17768
No 1486


Slim-Fast Diet

(3.2 out of 5.0)

Slim-Fast is a reasonable approach to dieting, experts concluded. It outscored a number of competitors on weight loss and as a diabetes diet, and being highly structured, it’s fairly easy to follow. But it scored lower than other diets on heart health.

Did this diet work for you?
Yes 204
No 2023


Nutrisystem Diet

(3.1 out of 5.0)

Nutrisystem sits near the middle of the standings. It’s fairly safe, easy to follow, and nutritionally adequate, according to experts. But they gave it less-than-stellar marks for its potential to deliver weight loss and its usefulness against diabetes and heart disease.

Did this diet work for you?
Yes 292
No 1389


Vegan Diet

(3.0 out of 5.0)

Overall, health experts were lukewarm on veganism, despite its strengths against diabetes and heart disease and its proven ability to produce weight loss. That’s because it’s extremely restrictive, doesn’t come with built-in social support, and may not provide enough of some nutrients.

Did this diet work for you?
Yes 15500
No 1498


South Beach Diet

(2.9 out of 5.0)

Although the South Beach Diet earned positive ratings for being able to produce rapid weight loss, its restrictions make it difficult for dieters to keep the pounds off, experts said. Most were unenthusiastic about its nutritional profile and its ability to combat diabetes or heart disease.

Did this diet work for you?
Yes 594
No 8964


Eco-Atkins Diet

(2.8 out of 5.0)

Eco-Atkins, as an expert described it, is a “healthier version of the Atkins diet, but compliance is likely to be more difficult.” That’s because it’s restrictive and little guidance is available. This relatively new diet is “not yet ready for prime time,” said another expert.

Did this diet work for you?
Yes 10736
No 761


Zone Diet

(2.8 out of 5.0)

The Zone Diet lagged behind most other ranked diets in nearly all ratings categories, including weight loss, how easy it is to follow, and its effect on diabetes and heart health. It’s “unnecessary and tedious to structure every meal around specific macronutrient thresholds,” according to one expert; another stated there is “no magic with the diet.”

Did this diet work for you?
Yes 248
No 8585


Glycemic-Index Diet

(2.7 out of 5.0)

Experts were less than impressed with the glycemic-index diet, which distinguishes “good” carbs from “bad.” They scored it particularly low on long-term weight loss, heart benefits, and ease of adherence. Although nutrition and safety measures were relatively strong, they couldn’t generate enough oomph to push this diet beyond the mediocre range.

Did this diet work for you?
Yes 295
No 882


Medifast Diet

(2.7 out of 5.0)

Experts were lukewarm toward Medifast. It scored above average on its effectiveness for short-term weight loss but was dragged down by lower marks in all other categories.

Did this diet work for you?
Yes 1802
No 858


Raw Food Diet

(2.4 out of 5.0)

Overall, the raw food diet received low marks. Experts were impressed with its ability to deliver weight loss, but concerned about its nutrition, safety, and how difficult it is to follow. “Doing it well involves considerable commitment and effort, knowledge, and sacrifice,” one expert said. “And there are diets that require less of all these that are likely to be just as healthful.”

Did this diet work for you?
Yes 345
No 981


Atkins Diet

(2.3 out of 5.0)

Many of our experts found the popular low-carb Atkins diet leaves much to be desired, at least as an all-purpose diet. Although our expert panel concluded that it could outperform nearly all of its competitors in short-term weight loss, unfavorable marks in other measures—including long-term weight loss, nutrition, safety, and heart health—yanked down Atkins in the standings.

Did this diet work for you?
Yes 2191
No 18408


Paleo Diet

(2.0 out of 5.0)

Experts took issue with the Paleo diet on every measure. Regardless of what a dieter’s goal is—weight loss, heart health, or finding a diet that’s easy to follow—most experts concluded he or she is better off looking elsewhere. In one expert’s words: “A true Paleo diet might be a great option: very lean, pure meats, lots of wild plants. The modern approximations … are far from it.”

Did this diet work for you?
Yes 5884
No 23994


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Is Estrogen Good for the Brain?

Wednesday, November 16, 2011 // Uncategorized

  • Millions of women take estrogen at the time of menopause to prevent menopausal symptoms.  This can increase the risk of uterine cancer if not combined with progesterone.  The benefits of taking hormones were touted as maintaining bone density, reducing cognitive decline and reducing the risk of heart disease. Unfortunately, taking estrogen with progesterone slightly increases the risk of breast cancer AND  dementia. Some people think that the timing of the administration of estrogen that may be important.  Taking estrogen early may have positive effects without the negative. This article from the Wall Street Journal adds fuel to that discussion.
  • November 14, 2011, 9:14 AM ET


Study Suggests Estrogen Is Good For the Brain

Short-term estrogen treatments increase the brain’s gray matter among women who have gone through menopause, a time when the brain works measurably harder to focus on simple memory tasks, researchers reported Sunday.

To assess the cognitive benefits of the controversial hormone therapy, researchers at Vanderbilt University and the University of Vermont studied two dozen healthy, post-menopausal women by giving 12 of them a standard daily dose of estrogen for three months and giving the other 12 a placebo.

Using magnetic resonance brain scanning, the scientists found that the hormone treatment had a significant effect on brain anatomy, by increasing the volume of gray matter in the brain’s cortex, where attention, decision-making and memory are centered.

“We are seeing actual differences in gray matter density,” said Paul Newhouse, director of Vanderbilt’s Center for Cognitive Medicine, who reported the group’s findings Sunday at the annual meeting of the Society for Neuroscience in Washington, D.C.

The researchers said that the structural brain changes are evidence that women might only have to take estrogen for a relatively short time to prevent the mental lapses that often accompany menopause, avoiding the risk of serious adverse side effects associated with long-term hormone therapy.

“It’s going out on a limb, but this change in gray matter density might be important in helping to preserve cognitive function,” Newhouse said. “That could be good news.”

For now, I think that if women want to take hormone replacement, they should consider doing it for several years and not for forever.

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Yoga and Back Pain

Wednesday, November 2, 2011 // Uncategorized

I did yoga weekly for back pain for about 5 years on the advice of a spinal surgeon.  I liked it, but gradually certain positions began to aggravate some arthritis in a facet joint and I quit.  Since then I’ve worked with a trainer on core strength and balance with good results.This is an article from The ACP Observer which excerpts two recent studies that demonstrate that yoga can be helpful in people with chronic low back pain.

Yoga may be beneficial in chronic low back pain

Yoga improved chronic low back pain compared to usual care, a new randomized trial has shown.

Researchers in the United Kingdom performed a parallel-group randomized, controlled trial from April 2007 to March 2010 at 13 facilities not affiliated with the U.K.’s National Health Service. Three hundred thirteen adults with chronic or recurrent low back pain were randomly assigned to receive yoga (n=156) or usual care (n=157). All participants were given an educational booklet on back pain, and the intervention group was offered a 12-class yoga program given by 12 teachers over a three-month period. The yoga classes were adapted for low back pain and became more challenging as time progressed (a video is available online). Outcome measures, assessed via mailed questionnaire, were Roland-Morris Disability Questionnaire (RMDQ) scores (ranging from 0, indicating best, to 24, indicating worst) as well as pain, pain self-efficacy, and general health measures at three, six and 12 months. The results appear in the Nov. 1 Annals of Internal Medicine.


Seventy-seven percent of participants had current low back pain at randomization. Of the 156 patients assigned to yoga classes, 93 (60%) went to three or more of the first six sessions and at least three of the remaining sessions. Back function was significantly better in the yoga group than in the usual care group at three, six, and 12 months (adjusted mean RMDQ scores, 2.17 points, 1.48 points, and 1.57 points lower for yoga vs. usual care, respectively; P<0.001, P=0.011, and P=0.007, respectively). Back pain was similar in both groups at all three time points, while pain self-efficacy scores were higher in the yoga group at three and six months but not at 12 months. Adverse events, most commonly increased pain, were reported by two of the 157 usual care participants and 12 of the 156 yoga participants.

The authors noted that data were missing for the primary outcome (i.e., three-month RMDQ scores) in both groups and cautioned against comparing their findings directly with those from other randomized trials of exercise and manipulation for low back pain. However, they concluded that a 12-week yoga program in adults with chronic or recurrent low back pain yielded greater improvement than did usual care.

Another study, published early online Oct. 24 by Archives of Internal Medicine, compared the effects of yoga, stretching, and a self-care book on chronic low back pain in adults. In that study, 228 adults were assigned to 12 weekly yoga classes (n=93), stretching exercises (n=91), or a self-care book (n=45). The primary outcomes were back function as measured on a modified 23-point version of the Roland Disability Questionnaire and bothersomeness of pain on an 11-point scale at 12 weeks, with outcomes assessed at baseline and at six, 12, and 26 weeks. All patients were recruited from the Puget Sound area of Washington state.

At 12 weeks, after adjustment for baseline values, the yoga group had better outcomes in function and symptoms (mean differences, −2.5 points and −1.1 points, respectively) than the self-care group (P<0.001 for both comparisons). The yoga group continued to have better function at 26 weeks than the self-care group (mean difference, −1.8 points; P<0.001), but yoga was never found to be superior to stretching. The authors noted that because yoga and stretching yielded similar outcomes, the benefits of yoga were probably due to its physical rather than mental aspects. Limitations of the study included its use of participants from a single site and the lack of follow-up past 26 weeks. However, the authors concluded that compared to self-care, yoga can improve function and symptoms for several months in patients with low back pain.

An invited commentary accompanying the Archives article said the results show that exercise in patients with low back pain is “safe and moderately beneficial” and that clinicians can safely refer such patients to yoga classes or physical therapy. The commentary author called for more comparative effectiveness research on low back pain to help guide recommendations on policy and clinical practice.

The American College of Physicians recently published a guideline on diagnostic imaging for low back pain as part of its high-value, cost-conscious care initiative

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