Many researchers, few clinicians, using drug that may slow, even prevent, Parkinson's

Article Abstract:

Deprenyl (selegiline hydrochloride) is a new drug that appears to slow the progression of Parkinson's disease (a progressive disease of the central nervous system), but it has not yet found widespread acceptance among physicians and patients. Results from a study of 800 Parkinson's disease patients indicated that the drug almost doubled the time before severe functional disability appeared. The drug may exert its effects by increasing brain levels of dopamine (a chemical important for electrical transmission between some nerve cells) as a result of inhibiting monoamine oxidation (MAO), a chemical reaction. MAO inhibition could also underlie prevention of Parkinson's disease, and this may become the most important use of deprenyl, since the disease does not become obvious until 80 percent of the cells in the substantia nigra (the brain area most affected) are destroyed. Overall, a large number of clinical researchers are prescribing deprenyl for their patients. Surprisingly few other physicians, however, use it. This may be due, in part, to the inaccessible writing style used by authors of the main research article that reported success with the drug. In addition, the drug is expensive ($105 per month), and was only approved last summer by the Food and Drug Administration. Deprenyl is much cheaper in other countries. Its manufacturer, Somerset Pharmaceuticals, maintains that stricter approval criteria in the US necessitate the steep prices. In addition, it costs less than other drugs used against Parkinson's that are taken in higher doses, and patients who cannot pay will receive it free if the physician requests it. Improvement does not appear quickly with deprenyl, especially early in the disease; rather, the drug slows the rate of progression. Critics have stated that deprenyl does not really prevent deterioration. Evaluation of whether the drug exerts a protective effect on degenerating brain cells must wait for sufficient autopsy evidence to accumulate. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Economic aspects, Product information, Parkinsonism, Selegiline, Somerset Pharmaceuticals Inc.

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Glaucoma: detection before damage, fewer side effects may be possible

Article Abstract:

Glaucoma is a disorder of the eye associated with increased pressure within the eyeball (intraocular pressure), which can lead to optic nerve damage and blindness. A report on this disease from a seminar called Research to Prevent Blindness is presented. The drug commonly used to treat primary open-angle glaucoma (the most common form), L-timolol (timolol maleate), causes unwanted side effects, and earlier diagnosis would almost certainly produce better therapeutic results. The ways increased intraocular pressure and glaucoma are related are not understood, but lowering pressure is usually beneficial. More accurate assessment of the treatment-related improvements will be possible with newer techniques, such as laser scanners that produce three-dimensional maps of the optic nerve, now under development. D-timolol, a new drug that is related to L-timolol, does not produce the same problematic side effects as the standard agent. Other drugs being tested inhibit enzymes that facilitate the entry of fluid into the eye, reducing intraocular pressure in that way. Prostaglandins (a group of chemicals with a wide range of biological activities) may ultimately be effective for treating glaucoma. Researchers hope to eventually offer glaucoma patients a choice of therapies from an assortment of effective, safe drugs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Conferences, meetings and seminars, Diagnosis, Complications and side effects, Physiological aspects, Glaucoma, Timolol maleate

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'Basic benefits' have many variations, tend to become political issues

Article Abstract:

Most plans for health care reform contain a list of basic benefits that would be covered under the plan, but many are not based on scientific evidence of the treatments' effectiveness. Oregon's controversial restructuring of its Medicaid program led the Bush administration to reject it because it allegedly discriminated against the disabled. Minnesota, Illinois, Kentucky, Arkansas and Washington State have all implemented basic benefits packages for the uninsured. Hawaii's State Health Insurance Program provides insurance to the 5% of the population that is not covered by an employer health insurance package. It provides them with primary and preventive care, which has reduced costs and eliminated the need to ration health care. Several organizations, including the American Medical Association, the American Academy of Pediatrics and the American Association of Retired Persons, have proposed a basic benefits package.

Planning, Social policy, Health insurance, Terminology, Health care reform, Oregon, Hawaii, Minnesota

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