Published in the June/July 2004 issue of Today's Hospitalist
Researchers find few antibiotics in the pipeline
Even as the number of drug-resistant microbes rises, the number of new antibiotics approved by the FDA over the last 20 years has declined, and there are no signs that the number of new drugs in the pipeline is going to improve soon.
An article in the May 1 issue of Clinical Infectious Diseases examined FDA databases of the research and development programs of the world’s largest pharmaceutical and biotechnology companies. Researchers found that FDA approvals of new antibiotics had declined 56 percent when comparing two four-year periods: 1998 to 2002 and 1983 to 1987.
Researchers also found that of the 500-plus new drugs currently being developed, only six were antibiotics. One of those drugs, telithromycin, received FDA approval this spring.
The article speculates that most drug makers are interested in agents that patients must use for the rest of their life, not drugs like antibiotics that are taken for weeks at a time.
What do residents want to know about the drug industry?
An article in the May issue of Academic Medicine found that most residents know relatively little about how the pharmaceutical industry markets drugs. When asked what training programs should teach about drug marketing techniques, residents said the following five areas were most important:
1. Critically and efficiently interpreting promotional materials
2. Spotting potential ethical conflicts of interest
3. Evaluating patient perceptions of relations between doctors and the drug industry
4. Understanding economics of pharmaceutical marketing
5. Evaluating marketing techniques
Source: Academic Medicine, May 2004
More Americans are dying outside of the hospital
Since the early 1980s, more Americans have been dying at home and at nursing homes than the hospital.
According to an article in the May/June issue of Health Affairs, the number of Americans who die outside of the hospital dropped from a high of 54 percent in 1983 to a low of about 41 percent in 1998. Researchers found that in 1998, 45 percent of Americans died at home or in a nursing home.
Between 1990 and 1998, the number of Americans who died at home rose from 17 percent to 22 percent. Nursing home deaths jumped from 16 percent to 22 percent during that time.
About 7 percent of Americans died in outpatient medical facilities, and 4 percent died in unspecified locations.
When researchers tracked the location of death by disease, they found some dramatic differences. Between 1980 and 1998, for example, the rate of inpatient deaths from cancer dropped from 70 percent to 37 percent.
The percentage of Americans with diabetes and COPD who died in the inpatient setting fell by more than 15 percent for each disease.
Researchers noted that no single event triggered the change, which they describe as “evolutionary,” not “revolutionary.”
The article also noted that despite the shift toward death outside of the inpatient setting, the percentage of Medicare spending during the last year of life has not changed significantly.
Are hospital physicians’ neckties a potential source of pathogens?
A simple observation by two medical students could lead to a change in the way physicians dress in the hospital.
After noticing that physicians’ neckties come into contact with patients or their bedding materials in the hospital, two medical students at a hospital in Queens swabbed the neckties of two groups: physicians and hospital workers who don’t have regular contact with patients.
They found that nearly half of the ties worn by physicians carried pathogens including Staphylococcus aureus and Klebsiella pneumoniae. The ties of the nonclinical personnel, by comparison, carried a single pathogen, S. aureus.
To reduce transmission of the pathogens, the researchers said, physicians could wear bow ties or use tie tacks to secure their ties to their shirts. They could also simply stop wearing ties.
The results were presented at the general meeting of the American Society for Microbiology in New Orleans in May.