Does pharmacogenomics provide an ethical challenge to the utilisation of cost-effectiveness analysis by public health systems?

Pharmacogenomics promotes an understanding of the genetic basis for differences in efficacy or toxicity of drugs in different individuals. Implementation of the outcomes of pharmacogenomic research into clinical practice presents a number of difficulties for healthcare. This paper aims to highlight one of the unique ethical challenges which pharmacogenomics presents for the utilisation of cost-effectiveness analysis by public health systems. This paper contends that pharmacogenomics provides a challenge to fundamental principles which underlie most systems for deciding which drugs should be publicly subsidised. Pharmacogenomics brings into focus the conflict between equality and utility in the context of using cost-effectiveness analysis to aid distribution of a limited national drug budget.     

Carfentanil on the darknet: Potential scam or alarming public health threat?

BackgroundIn an age of global insecurity, highly potent synthetic drugs have become a major public health issue. Their online advertisement and sale are facilitated by surface web, darknet markets and social media fuelling substance abuse and addiction, as well as various types of new criminal activities and their growth in sophistication. This study presents a systematic analysis of the darknet sale of one of the most potent synthetic opioids: Carfentanil. With an equianalgesic potency of 10.000 times a unit of morphine, its toxicity is comparable to traditional nerve agents, and it has been previously used as a chemical weapon, causing human fatalities.MethodsDigital trace data was collected retrospectively from all the darknet marketplaces, which have been active in the past five years. Data on vendors offering Carfentanil on Agartha, Empire and Yakuza marketplaces were analysed with regard to items sold and sellers’ features as these were the only active markets at the time of search. Searches were carried out in the English language only.Results63 Cartfentanil vendors operating on 19 darknet marketplaces were identified. Contacts and payments were facilitated with end-to-end encryption messaging mobile applications and content-expiring messages. Although it is known that Agartha is a scam market, and no operative sellers were found on Yakuza, several sellers promoting Carfentanil sales were active in the Empire marketplace with a number of transaction ranging from 4 to 1223.ConclusionThe availability of highly potent drugs such as Carfentanil on the darknet requires the urgent development of novel scientific methods and tools able to monitor and to predict such new threats, while informing policymaking and protecting the health and the security of citizens.     

Does the health status of intimate partner violence victims warrant pharmacies as portals for public health promotion?

ObjectivesTo explore whether the health status of intimate partner violence (IPV) victims warrants pharmacies to be portals for public health promotion. Specific objectives included (1) identifying prevalence of IPV including domestic violence (DV) and sexual assault (SA) in a community sample, (2) describing characteristics and correlates of DV/SA between participants who reported and did not report DV/SA, and (3) exploring whether DV/SA status is related to mental health medication use.DesignCross sectional.SettingUpstate New York during 2006.ParticipantsEnglish- and Spanish-speaking respondents younger than 65 years of age answering four questions to assess DV/SA.InterventionSecondary analysis of a countywide random telephone survey, the 2006 Monroe County Adult Health Survey, which collects prevalence data on health behaviors and health status indicators.Main outcome measureTo determine whether those reporting DV/SA are at increased odds for mental health medication use, controlling for other sociodemographic- and health-related variables.ResultsThe survey response rate was 30.3%, with 1,881 respondents meeting inclusion criteria. Those reporting DV/SA were almost twice as likely to use mental health medications. However, when controlling for other variables, only poor mental and physical health were significant in increasing the odds of mental health medication use.ConclusionThe analyses reported here suggest that DV/SA victims in a community sample use mental health medications. When controlling for other variables, survey respondents reported worse physical and mental health. If pharmacies are suitable portals for DV/SA outreach, curricula would need to provide the knowledge and skills needed to take an active role in this public health promotion.     

How effective is the revised regulatory code for alcohol advertising in Australia?

INTRODUCTION AND AIMS: Australia, like several other countries, has a self-regulatory approach to advertising. However, in recent years the effectiveness of the regulatory system has been questioned, and there have been increasing public calls for an overhaul of the system. Following a formal review in 2003, the Ministerial Council on Drug Strategy proposed a revised Alcoholic Beverages Advertising Code (ABAC), which came into operation in 2004. DESIGN AND METHODS: The purpose of the present study was to examine the effectiveness of this revised system. From May 2004 until March 2005 television and magazine advertising campaigns were monitored for alcohol products. Over this period 14 complaints against alcohol advertisements were lodged with the self-regulatory board, and the authors recruited an independent expert panel to assess the advertisements and complaints. RESULTS: In eight of the 14 cases a majority of the judges perceived the advertisement to be in breach of the code, and in no cases did a majority perceive no breach. Conversely, however, none of the complaints were upheld by the Advertising Standards Board (ASB) and only one by the ABAC Panel. DISCUSSION AND CONCLUSIONS: The results of this study suggest that the decisions made by the ASB in relation to complaints against alcohol advertisements are not in harmony with the judgement of independent experts, and that the ASB may not be performing an adequate job of representing community standards or protecting the community from offensive or inappropriate advertisements. Further, it appears that the revisions to the ABAC code, and associated processes, have not reduced the problems associated with alcohol advertising in Australia.     

Does expectancy affect alcohol absorption?

Many factors influence alcohol absorption, yet few studies have addressed the issue of whether or not experimental manipulations themselves may affect alcohol absorption. The current balanced placebo design study comparing the expectancy effects of root beer and non-alcoholic beer vehicles resulted in significantly lower blood alcohol levels in the root beer condition than in the beer condition even though alcohol doses were the same. Two possible explanations are discussed; differences in expectancy may have affected absorption, or fructose in the root beer may have slowed absorption of alcohol relative to the maltose in beer. The literature does not provide strong evidence for either of the hypotheses. The implication of this study's results is that alcohol absorption rate may be an important source of confounding effects in behavioral research in the laboratory, because it may be affected by beverages or other experimental conditions.     

Does maternal MDR1 C1236T polymorphism have an effect on placental arsenic levels?

To detect whether maternal MDR1 C1236T polymorphism has an effect on placental arsenic levels, 112 mother–placenta pairs were examined. Venous blood samples from mothers were collected to investigate the C1236T polymorphism which was detected by standard PCR–RFLP technique. Placentas were collected to measure arsenic levels by GF-AAS. The MDR1 C1236T genotype frequencies of mothers were found as 30.3% homozygote typical (CC), 51.8% heterozygote (CT) and 17.9% homozygote atypical (TT). The mean placental arsenic level was 62.36 ± 30.43 μg/kg. It was observed that the placental arsenic concentrations were higher in mothers with TT genotype than those with CC and CT genotypes, but this was not statistically significant (p = 0.702). This finding was indicated that fetuses of mothers with TT genotype may be more susceptible to arsenic toxicity as compared to those of with CC and CT genotypes. We believe that this difference warrant further studies with larger study subjects.     

Can google trends search inform us about the population response and public health impact of abrupt change in alcohol policy? A case study from India during the covid-19 pandemic

BackgroundSudden alcohol prohibition in India during the COVID-19 pandemic presented an opportunity to test whether Google Trends data could indicate population responses and the public health impact of alcohol policy. We hypothesized, following prohibition: there would be a significant change in the relative search volumes (RSV) of alcohol-related queries; that temporal analysis of the trends would reflect a public response to policy changes; and that geospatial analysis of RSV would correlate with the prevalence of alcohol use.MethodsThree different search periods were used to test the hypotheses. The search inputs were based on potential public response to alcohol prohibition, as evidenced by the literature, newspaper articles, and consensus. We used RSV as the unit of analysis. Mean RSV of search queries, pre-post implementation of prohibition, were compared. Smoothing of scatter plots examined the temporal association of trends with policy measures. Multiple linear regression tested the relationship of state-wise RSV and alcohol use prevalence.ResultsPost-implementation of prohibition, a significant increase in the RSV was observed for searches related to alcohol withdrawal (p<0.001), how to extract alcohol from sanitizer (p = 0.002), alcohol home delivery online (p<0.001), alcohol home delivery (p<0.001), and sleeping pills (p = 0.006). The trends suggested a decrease in general interest in alcohol but increased demand, and a possible connection with changes in policy measures. State-level RSV and alcohol use prevalence did not reveal a significant relationship.ConclusionGoogle trend is a potential source of rapid feedback to policymakers about population responses to an abrupt change in alcohol policies.     

Social roles among recruits in Switzerland: Do social roles relate to alcohol use and does role change have an impact?

IntroductionYoung men are likely to report high levels of alcohol use. Previous studies found a reduction in alcohol use when adopting adult social roles. This study examines the frequency of parenthood, partnership and stable employment among young men in Switzerland. It tests whether the alcohol use of those with adult social roles differs from those without and whether changes in social roles relate to changes in alcohol use.MethodsData was available from 5025 men (20.0 years) at baseline (August 2010 to November 2011) and 15 months later. Changes in social roles and their impact on alcohol use were examined in multiple regression models.ResultsAt baseline, 15.8% had a job and 4.9% a stable partner, and 1.5% had a child or were expecting one (30.5%, 6.1% and 2.2% at follow-up). Having a partner was associated with a significant decrease in annual frequency of drinking and weekly risky single-occasion drinking (RSOD) at follow-up. A higher number of social roles at follow-up was associated with a significant decrease in weekly RSOD. Apart from a significant decrease in weekly RSOD among those remaining in a stable partnership, role development was not found to have significant effects on alcohol use between baseline and follow-up.ConclusionsIn Switzerland, an early engagement in permanent social roles is uncommon. Nevertheless, holding single or multiple social roles was commonly associated with reduced alcohol use, although not always significantly so. In western European countries, the engagement in adult social roles is postponed to later ages.     

Does omethoate have the potential to cause insulin resistance?

Persistent organic pollutant exposure is strongly associated with the development of diabetes. The development of diabetes or alteration in blood glucose levels is associated with insulin resistance that precedes diabetes for many years. Omethoate is a commonly used insecticide in most developing countries. The present study was designed to elucidate the potent role of omethoate in developing insulin resistance in rats. Male Wistar rats were exposed to omethoate at the concentration of 1.5 mg/kg body weight (1/40 LD₅₀), 3 mg/kg body weight (1/20 LD₅₀) and 6 mg/kg body weight (1/10 LD₅₀) through gastric injection for 60 days; control group rats received PBS through gastric injection. The results showed that the levels of MDA, TNF-α and IL-6 were increased and the activities of SOD and GSH-Px were decreased in the right thigh muscles of rats exposed to omethoate. However, JNK, p38 MAPK and NF-κB in right thigh muscles of rats exposed to omethoate were activated. This study suggested that omethoate had a potential to cause insulin resistance.     

Has dry/cold weather an impact on the skin condition of cleanroom workers?

ABSTRACT

In previous epidemiological studies irritant skin changes were reported significantly more frequently under dry/cold ambient air conditions. The aim of this study was to assess whether a similar effect might be observed in cleanroom workers, occupationally exposed to strictly controlled ambient conditions. This investigation examined 690 employees of a semiconductor production company in Germany, one half in winter (n = 358) and the other half in spring (n = 332). In both waves, both cleanroom workers, who used occlusive gloves predominantly during the entire shift, and employees in the administration, serving as the control group, were included. Ambient outdoor temperature and relative humidity (RH) were measured and absolute humidity (AH) was calculated. Hands were dermatologically examined with quantitative clinical skin score HEROS, supplemented by transepidermal water loss (TEWL) and stratum corneum hydration measurements. Temperature ranged from –5.41 to 6.51°C in winter (RH 71.04–92.38%; AH 2.85–6.7 g/m³) and from 6.35 to 10.26°C in spring (RH 76.17–82.79%; AH 5.66–7.92 g/m³). Regarding HEROS, TEWL, and corneometry, no marked consistent pattern regarding an enhanced or decreased risk of irritant skin changes was found. Work in a strictly controlled environment with prolonged wearing of occlusive gloves, with clean hands and without exposure to additional hazardous substances, did not seem to negatively affect the skin. In this particular setting, meteorological conditions also did not appear to adversely affect the skin. It is conceivable that wearing of gloves and air conditioning in the plant protect skin of the hands from adverse effects due to dry and cold air encountered when not working.     

Non‐advertising alcohol promotions in licensed premises: does the Code of Practice ensure responsible promotion of alcohol?

Introduction and Aims . Binge drinking is a major public health issue in Australia, particularly among young people. There has been a considerable focus on alcohol advertising, among both researchers and policy makers, resulting in efforts to bring about some level of regulation of unacceptable advertising practices. However—despite the existence of a Code of Practice for Responsible Promotion of Liquor Products which provides ‘a framework of practices which are considered acceptable and reasonable’ for licensed premises—there are few, if any, data on the nature and extent of promotions which could arguably fall under either ‘acceptable’ or ‘unacceptable’ practices. Design and Methods . Over an 8‐week period we monitored promotions offered by licensed venues (pubs, bars and clubs) in the Wollongong central area. Seventeen venues were identified, and each venue was visited daily for 1 week. Trained research assistants took notes on all promotions/events in visited venues, including both manufacturer‐ and management‐initiated. Results . We identified a range of different types of promotions, including low cost and free drinks. Some of the promotions identified could be seen to have a positive public health impact, such as free food and free transport. However, the majority of promotions were of a nature likely to increase the likelihood of excessive drinking. Discussion and Conclusions . It is evident from this review that there are numerous examples of promotions which breach both the spirit and the letter of the Code. It is equally evident that the system for monitoring compliance with the Code is fundamentally inadequate.