Drug benefits policy-making for seniors in British Columbia has been increasingly influenced by research since 1993. The "evidence-based medicine" paradigm, which emphasizes the primacy of direct evidence from randomized control trials, inspired key policy-makers and influenced policy concerning coverage of new and existing drugs. New drugs, if more expensive than existing similar drugs, are not covered unless published randomized control trials show superior effectiveness. Indirect evidence of effectiveness, based on surrogates, is given less weight, and non-randomized studies are rarely considered. Evidence of cost-effectiveness of new drugs is reviewed separately. For existing drugs, a new reimbursement policy, Reference Based Pricing (RBP), was introduced, based on both direct and indirect evidence of comparative effectiveness of drugs. Implementation of RBP was complex and necessarily rapid, which meant that independent systematic review of evidence relevant to implementation issues was infeasible, particularly in regard to rapid prior authorization of exemptions to RBP. Contrasts between the processes for new and existing drugs provide insights into the difficulties of applying the idea of direct evidence-based policy-making in practice.

Escalating medication prices are forcing drug benefit programs worldwide to change their payment policies. Physicians object that this intrudes on their long established authority to prescribe medications they judge best for their patients. This paper reports data from focus groups and a large random sample of seniors in British Columbia who were asked for their views towards Pharmacare's reference based pricing (RBP) policy. Seniors expressed the desire for physicians to be more knowledgeable and more involved in all aspects of medical care including policy changes. They have confidence in physicians as a credible source of information, but they also have as much confidence in pharmacists and almost as much in the Ministry of Health. Seniors overwhelmingly accept, and the majority support government's efforts with their cost-saving Pharmacare policies. Furthermore, those who know more about the policy are more likely to support it. The paper closes with a discussion of the feedback process with decision-makers.

American pediatricians are now bearing the brunt of massive increases in demand for treatment of mental illness in children and adolescents, areas in which many pediatricians have not been well trained. It would be logical to encourage policy measures to increase pediatricians’ expertise in this area to improve access to care. But the expanses in demand for services are about much more than increased incidence of biologically-based illnesses. Instead, pediatricians are caught juggling between their traditional focus on health and prevention and a rapid rise in broad socially, culturally, and economically mediated distress among young people and their families. This article explores the historical context of pediatricians’ engagement with mental health and the hazards of the push toward treatment for mental illness. The historical perspective can help us develop policy more directed to broader goals of improving the mental health of our nation’s children and adolescents.

A 53-year-old male presents with cough, fever, and myalgias for 7 days. Vitals include temperature, 38.0°C; heart rate, 110; blood pressure, 118/70 mm Hg; respiration rate, 28; and oxygen saturation 83% on room air. His only past medical history is hypertension. Your community is in the midst of the coronavirus disease 2019 (COVID-19) pandemic. The patient is hypoxic but responds to oxygen supplementation with nasal cannula and a face mask. His chest x-ray demonstrates multifocal infiltrates. Are there any therapeutic agents currently available for COVID-19?

In recent decades, clinical trials in Alzheimer’s disease (AD) have failed at an unprecedented rate. The etiology of AD has since come under renewed scrutiny, both to elucidate the underlying pathologies and to identify novel therapeutic strategies. Here, diet has emerged as a potential causative/protective agent. A variety of nutrients, including lipids, minerals, vitamins, antioxidants and sugars as well as broader dietary patterns and microbiotal interactions have demonstrated associations with AD. Although clinical trials have yet to definitively implicate any singular dietary element as therapeutic or causative, it is apparent that dietary preferences, likely in complex synergies, may influence the risk, onset and course of AD. This review catalogs the impact of major dietary elements on AD. It further examines an unexplored reciprocal association where AD may modulate diet, as well as how potential therapeutics may complicate these interactions. In doing so, we observe diet may have profound effects on the outcome of a clinical trial, either as a confounder of a drug/disease interaction or as a generally disruptive covariate. We therefore conclude that future clinical trials in AD should endeavor to control for diet, either in study design or subsequent analyses.

Background: Medications are frequently prescribed for neuropsychiatric symptoms (NPS) associated with dementia, although information on the efficacy and safety of medications for NPS specifically in long-term care (LTC) settings is limited. The objective of this study was to provide a current review of the efficacy and safety of pharmacological treatments for NPS in LTC.

Methods: We searched MEDLINE, EMBASE, PsychINFO, and the Cochrane Library for randomized controlled trials comparing medications with either placebo or other interventions in LTC. Study quality was described using the Cochrane collaboration risk of bias tool. The efficacy of medications was evaluated using NPS symptom rating scales. Safety was evaluated through rates of trial withdrawals, trial withdrawals due to adverse events, and mortality.

Results: A total of 29 studies met inclusion criteria. The most common medications evaluated in studies were atypical antipsychotics (N = 15), typical antipsychotics (N = 7), anticonvulsants (N = 4), and cholinesterase inhibitors (N = 3). Statistically significant improvements in NPS were noted in some studies evaluating risperidone, olanzapine, and single studies of aripiprazole, carbamazepine, estrogen, cyproterone, propranolol, and prazosin. Study quality was difficult to rate in many cases due to incomplete reporting of details. Some studies reported higher rates of trial withdrawals, adverse events, and mortality associated with medications.

Conclusions: We conclude that there is limited evidence to support the use of some atypical antipsychotics and other medications for NPS in LTC populations. However, the generally modest efficacy and risks of adverse events highlight the need for the development of safe and effective pharmacological and non-pharmacological interventions for this population.

To identify which medications were most commonly taken by non-pregnancy-related listeriosis patients prior to illness, we compared the medications reported by 512 cases identified via national surveillance in England between 2007 and 2009 with national prescription data, using British National Formulary (BNF) coding. Relative risks and corresponding confidence intervals were calculated, as appropriate, for BNF chapters and sections. Among listeriosis cases, the rates for cytotoxic drugs, drugs affecting the immune response and corticosteroids were significantly higher than for other medications. However, interactions between medications and how medications might confound or be confounded by concurrent medical conditions need to be investigated further. Nevertheless our findings suggest that targeting food-safety advice to prevent this foodborne disease in certain treatment groups is warranted.

Excessive consumption of acidic drinks and foods contributes to tooth erosion. The aims of the present in vitro study were twofold: (1) to assess the erosive potential of different dietary substances and medications; (2) to determine the chemical properties with an impact on the erosive potential. We selected sixty agents: soft drinks, an energy drink, sports drinks, alcoholic drinks, juice, fruit, mineral water, yogurt, tea, coffee, salad dressing and medications. The erosive potential of the tested agents was quantified as the changes in surface hardness (ΔSH) of enamel specimens within the first 2 min (ΔSH2–0 = SH2 min − SHbaseline) and the second 2 min exposure (ΔSH4–2 = SH4 min − SH2 min). To characterise these agents, various chemical properties, e.g. pH, concentrations of Ca, Pi and F, titratable acidity to pH 7·0 and buffering capacity at the original pH value (β), as well as degree of saturation (pK − pI) with respect to hydroxyapatite (HAP) and fluorapatite (FAP), were determined. Erosive challenge caused a statistically significant reduction in SH for all agents except for coffee, some medications and alcoholic drinks, and non-flavoured mineral waters, teas and yogurts (P < 0·01). By multiple linear regression analysis, 52 % of the variation in ΔSH after 2 min and 61 % after 4 min immersion were explained by pH, β and concentrations of F and Ca (P < 0·05). pH was the variable with the highest impact in multiple regression and bivariate correlation analyses. Furthermore, a high bivariate correlation was also obtained between (pK − pI)HAP, (pK − pI)FAP and ΔSH.

Les cliniques « Brown Bag » permettent aux pharmaciens participants de rencontrer les personnes âgées afin d'examiner les médicaments en leur possession et de corriger les situations qui pourraient mener à des réactions toxiques (DRAPEs — drug-related adverse patient events). Cent vingt-trois patients ont été en contact avec 30 pharmaciens lors des cliniques pilotes tenues dans sept communautés de la Colombie-Britannique. En moyenne, chaque patient a apporté plus de neuf médicaments (prescrits ou non-prescrits) et les cliniciens ont identifié 482 problèmes potentiels de médication (les médecins traitants de 39 patients ont été immédiatement contactés). Plus de 80 pour cent des patients ont considéré les cliniques « Brown Bag » comme étant utiles et ont manifesté le désir de participer à nouveau lors de futures cliniques. Les pharmaciens cliniciens, bien qu'en faveur des cliniques, sont cependant réticents à ré-offrir leur services de façon bénévole. Lors des cliniques de rappel conduites de six à 11 mois plus tard, les patients avaient oublié une bonne partie de l'information obtenue lors des premières sessions.