Promoting, Prescribing, and Pushing Pills: Understanding the Lessons of Antipsychotic Drug Litigation

Ineffectiveness of prescription drugs, hidden drug hazards, and advertising violations have led to several drug recalls and numerous lawsuits against pharmaceutical companies in recent years. These suits have involved several varieties of medications, but psychoactive medications have figured especially prominently. A recent $1.4 billion settlement by Eli Lilly & Company related to improper promotion of its top-selling drug olanzapine included the largest individual corporate criminal fine in U.S. history. Improper promotion is far from the sole reason why olanzapine and other “second-generation” antipsychotic (SGA) drugs have become so successful. Rather, the widespread adoption of SGAs represents a collective judgment error by the medical profession. For policymakers, the olanzapine litigation is important because it provides an impetus for learning what makes certain drugs successful and for understanding processes that determine medication choices, physicians’ judgments, and expenditures for drugs. Litigation will not solve problems with these processes, so understanding them is crucial if regulatory agencies and other entities wish to avert future medical judgment errors and suboptimal uses of healthcare dollars. To promote this understanding, we first describe the rapid switch from older drugs to SGAs and summarize recent evidence suggesting that the switch was improvident. We then review the lawsuits brought against Lilly, which exemplify the many types of liability claims that drugs may generate. We next describe marketing techniques that drug companies use to get physicians to prescribe their products, the special features of SGAs that have contributed to their huge success, and the ways that pharmaceutical companies exercise virtually total control over the information doctors use to prescribe drugs. We suggest that funding more independent, comparative effectiveness studies and giving pharmaceutical companies incentives to generate and disclose more information about their products’ flaws might produce better medications, help physicians make better treatment decisions, and improve patient safety

Promoting, Prescribing, and Pushing Pills: Understanding the Lessons of Antipsychotic Drug Litigation

Ineffectiveness of prescription drugs, hidden drug hazards, and advertising violations have led to several drug recalls and numerous lawsuits against pharmaceutical companies in recent years. These suits have involved several varieties of medications, but psychoactive medications have figured especially prominently. A recent $1.4 billion settlement by Eli Lilly & Company related to improper promotion of its top-selling drug olanzapine included the largest individual corporate criminal fine in U.S. history. Improper promotion is far from the sole reason why olanzapine and other “second-generation” antipsychotic (SGA) drugs have become so successful. Rather, the widespread adoption of SGAs represents a collective judgment error by the medical profession. For policymakers, the olanzapine litigation is important because it provides an impetus for learning what makes certain drugs successful and for understanding processes that determine medication choices, physicians’ judgments, and expenditures for drugs. Litigation will not solve problems with these processes, so understanding them is crucial if regulatory agencies and other entities wish to avert future medical judgment errors and suboptimal uses of healthcare dollars. To promote this understanding, we first describe the rapid switch from older drugs to SGAs and summarize recent evidence suggesting that the switch was improvident. We then review the lawsuits brought against Lilly, which exemplify the many types of liability claims that drugs may generate. We next describe marketing techniques that drug companies use to get physicians to prescribe their products, the special features of SGAs that have contributed to their huge success, and the ways that pharmaceutical companies exercise virtually total control over the information doctors use to prescribe drugs. We suggest that funding more independent, comparative effectiveness studies and giving pharmaceutical companies incentives to generate and disclose more information about their products’ flaws might produce better medications, help physicians make better treatment decisions, and improve patient safety

Physician Orders for Life-Sustaining Treatment (POLST) Utilization in a Skilled Nursing Facility: An Educational Quality Initiative

According to expert reports and recent research, frequent clinician-patient conversations about individual end-of-life preferences are necessary to avoid unwanted treatment and to ensure that desired treatments are received. The ongoing diffusion of Physician Orders for Life-Sustaining Treatment (POLST) educational initiatives in skilled nursing facilities (SNFs) are vital to success of California’s POLST program, which is now recognized as only 1 of 3 mature POLST programs in the country. The purpose of this evidence-based practice project was to answer the question: Among staff in a skilled nursing facility, does implementing a formal POLST education program compared to current practice improve staff knowledge, comfort level and documentation of the POLST form? A pre- and post-education questionnaire was used. Results indicated a POLST education program significantly improved staff knowledge and promoted much-needed awareness of underutilized POLST educational resources (retrieved from the Coalition for Compassionate Care of California, www.caPOLST.org), available for SNF residents, families, practitioners and staff. As a result, these efforts provide higher quality end-of-life decision making which is essential with future uploading of these order forms into an electronic POLST registry (SB 19: e-POLST Registry Pilot) to be stored during nursing facility resident’s care transitions

A Time-Domain Analysis of Intracardiac Electrograms for Arrhythmia Detection

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73045/1/j.1540-8159.1991.tb05116.x.pd

A Knob for Changing Light Propagation from Subluminal to Superluminal

We show how the application of a coupling field connecting the two lower metastable states of a lambda-system can produce a variety of new results on the propagation of a weak electromagnetic pulse. In principle the light propagation can be changed from subluminal to superluminal. The negative group index results from the regions of anomalous dispersion and gain in susceptibility.Comment: 6 pages,5 figures, typed in RevTeX, accepted in Phys. Rev.

Mindfulness-based interventions for young offenders: a scoping review

Youth offending is a problem worldwide. Young people in the criminal justice system have frequently experienced adverse childhood circumstances, mental health problems, difficulties regulating emotions and poor quality of life. Mindfulness-based interventions can help people manage problems resulting from these experiences, but their usefulness for youth offending populations is not clear. This review evaluated existing evidence for mindfulness-based interventions among such populations. To be included, each study used an intervention with at least one of the three core components of mindfulness-based stress reduction (breath awareness, body awareness, mindful movement) that was delivered to young people in prison or community rehabilitation programs. No restrictions were placed on methods used. Thirteen studies were included: three randomized controlled trials, one controlled trial, three pre-post study designs, three mixed-methods approaches and three qualitative studies. Pooled numbers (n = 842) comprised 99% males aged between 14 and 23. Interventions varied so it was not possible to identify an optimal approach in terms of content, dose or intensity. Studies found some improvement in various measures of mental health, self-regulation, problematic behaviour, substance use, quality of life and criminal propensity. In those studies measuring mindfulness, changes did not reach statistical significance. Qualitative studies reported participants feeling less stressed, better able to concentrate, manage emotions and behaviour, improved social skills and that the interventions were acceptable. Generally low study quality limits the generalizability of these findings. Greater clarity on intervention components and robust mixed-methods evaluation would improve clarity of reporting and better guide future youth offending prevention programs

Learner control in animated multimedia instructions

The interactivity principle in multimedia learning states that giving learners control over pace and order of instructions decreases cognitive load and increases transfer performance. We tested this guideline by comparing a learner-paced instruction with a system-paced instruction. Time-on-task and interactive behavior were logged, and were also related to interest, prior knowledge, and cognitive involvement. We successfully replicated the interactivity principle in terms of better transfer. However, this coincided with a large increase in time-on-task. Also, large individual differences existed in the use of learner control options, which were mostly unrelated to the other variables. Thus, the benefits of introducing learner control in multimedia learning are at the expense of learning efficiency, and it remains unclear for whom the interactivity principle works best

Narrowband Biphotons: Generation, Manipulation, and Applications

In this chapter, we review recent advances in generating narrowband biphotons with long coherence time using spontaneous parametric interaction in monolithic cavity with cluster effect as well as in cold atoms with electromagnetically induced transparency. Engineering and manipulating the temporal waveforms of these long biphotons provide efficient means for controlling light-matter quantum interaction at the single-photon level. We also review recent experiments using temporally long biphotons and single photons.Comment: to appear as a book chapter in a compilation "Engineering the Atom-Photon Interaction" published by Springer in 2015, edited by A. Predojevic and M. W. Mitchel

Longitudinal Scaling of Elliptic Flow in Landau Hydrodynamics

This study presents generalization of the Landau hydrodynamic solution for multiparticle production applied to non-central relativistic heavy ion collisions. Obtained results shows longitudinal scaling of elliptic flow $v_2$ as a function of rapidity shifted by beam rapidity ($y-y_{beam}$) for different energies ($\sqrt{s_{NN}}=62.4$ GeV and 200 GeV) and for different systems (Au-Au and Cu-Cu). It is argued, that the elliptic flow and its longitudinal scaling is due to the initial transverse energy density distribution and initial longitudinal thickness effect.Comment: 7 pages 1 figur

The Bin Area Method: A Computationally Efficient Technique for Analysis of Ventricular and Atrial Intracardiac Electrograms

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74901/1/j.1540-8159.1990.tb02028.x.pd