Search Results

The role of epidemiology in assessing the potential clinical impact of pharmacogenomics

David L. Veenstra

in Human Genome Epidemiology, 2nd Edition: Building the evidence for using genetic information to improve health and prevent disease

A promising area of genomics is the use of information about genetic variation to guide drug therapy, a field known as pharmacogenomics. Pharmacogenomic applications can be broadly categorized into ... More

A promising area of genomics is the use of information about genetic variation to guide drug therapy, a field known as pharmacogenomics. Pharmacogenomic applications can be broadly categorized into (a) those related to variation in drug metabolism and disposition genes, which affect the levels of active drug or metabolites in the body and thus both effectiveness and side effects; and (b) those related to variation in genes for drug targets, which primarily influence the effectiveness of a drug. These categories can be applied to both inherited and acquired variation. This chapter discusses the role of epidemiology in assessing pharmacogenomic associations, as well as approaches utilizing epidemiologic data to quantify the potential benefits and harms of pharmacogenomic tests in clinical use.Less

Pharmaceuticals Other Than Hormones

LAUREL A. HABEL and GARY D. FRIEDMAN

in Cancer Epidemiology and Prevention

This chapter discusses the link between therapeutic drugs and cancer. Topics covered include chemical carcinogenesis, drug safety, pharmacoepidemiologic studies, methodologic issues in studies of ... More

This chapter discusses the link between therapeutic drugs and cancer. Topics covered include chemical carcinogenesis, drug safety, pharmacoepidemiologic studies, methodologic issues in studies of drugs and cancer, methodologic issues in studies of drugs and cancer, and magnitude of the problem of carcinogenesis due to drugs.Less

Intervention in high risk groups: hypertension

P. S. Sever and N. R. Poulter

in Coronary Heart Disease Epidemiology: From aetiology to public health

This chapter discusses the treatment of hypertension for preventing cardiovascular disease. Topics covered include early trials, unresolved issues in drug treatment, benefits of more contemporary ... More

This chapter discusses the treatment of hypertension for preventing cardiovascular disease. Topics covered include early trials, unresolved issues in drug treatment, benefits of more contemporary drugs over standard therapy, overview and meta-analyses to date, optimal combinations of antihypertensive therapies, thresholds and targets for antihypertensive drug therapy, and concomitant therapy.Less

Polypharmacy: The Problem with Pills

Frederick M. Barken

in Out of Practice: Fighting for Primary Care Medicine in America

This chapter comments on doctors' propensity to overprescribe, a practice known as polypharmacy. Polypharmacy simply means “many drugs,” and may be quite appropriate in certain cases, such as an ... More

This chapter comments on doctors' propensity to overprescribe, a practice known as polypharmacy. Polypharmacy simply means “many drugs,” and may be quite appropriate in certain cases, such as an elderly patient with an end-stage failing heart and requires six or eight medications plus supplemental oxygen therapy. However, too many prescriptions can cause serious allergic reactions and other problems for the patient. The chapter discusses the pitfalls of polypharmacy as well as its implications for the proper usage of pharmacopoeia. It also considers drug therapy as a physician's uniquely tailored form of care for an individual patient, the problem of exorbitant drug prices, the debate over direct advertising by Big Pharma, and the relationship between doctors and “drug reps.” Finally, the chapter emphasizes the important roles of the Food and Drug Administration and primary care physicians in addressing the problems associated with polypharmacy.Less

Drug therapies

Sam H. Ahmedzai and Martin F. Muers

in Supportive Care in Respiratory Disease

This chapter examines different types of drugs used in the management of dyspnoea. It describes palliative drug therapies that are usually turned to when disease-orientated strategies are exhausted. ... More

This chapter examines different types of drugs used in the management of dyspnoea. It describes palliative drug therapies that are usually turned to when disease-orientated strategies are exhausted. The chapter explains that appropriate management of breathlessness requires the careful and individualised use of both non-drug and drug measures and suggests that nebulised opioids should not be considered part of standard practice, and that corticosteroids should only be used for a specific reason. Benzodiazepines and opioids are the main classes of drugs used in the palliation of breathlessness.Less

Tuberculosis Undefeated

Christopher Dye

in The Population Biology of Tuberculosis

This chapter provides an empirical account of the evolutionary and epidemiological history of tuberculosis in populations around the world. Much has happened in the population biology of TB since ... More

This chapter provides an empirical account of the evolutionary and epidemiological history of tuberculosis in populations around the world. Much has happened in the population biology of TB since 1960, and despite the development of highly efficacious drug therapy to prevent and cure TB, the disease remains the largest cause of death from a single, curable infectious agent. The challenge we face in the twenty-first century is to control—and ultimately eliminate—a pathogen that has inhabited human populations for tens of thousands and possibly millions of years. To begin to understand how TB control and elimination could be achieved, this chapter defines the problem. It describes the essential characteristics of Mycobacterium tuberculosis and the collection of diseases it causes, its origins and distribution in human populations, the dominant trends through time, and the burden of disease today.Less

Human Immunodeficiency Virus: AIDS, the Current Plague

Michael B. A. Oldstone

in Viruses, Plagues, and History: Past, Present, and Future

This chapter explores acquired immunodeficiency syndrome (AIDS), a lethal disease cause by the human immunodeficiency virus (HIV). Of the more than 75 million people HIV has infected in the 36 years ... More

This chapter explores acquired immunodeficiency syndrome (AIDS), a lethal disease cause by the human immunodeficiency virus (HIV). Of the more than 75 million people HIV has infected in the 36 years (1983–2019) since the initial case report, nearly one-half of them have died. Not only the victims of this infection but also their families, communities, countries, and even continents endured years of suffering as AIDS proceeded on its long course of physical destruction. Today, however, the enormous advance in antivirus drug therapy has dramatically reduced the death rate and altered the portrait of this disease from an acute lethal disease to a chronic persistent infection. In 2019, the combination antiretroviral therapy has enabled those infected to survive at roughly the same rate as the general non-infected population. However, this increased longevity includes an upsurge in the former group’s medical problems caused by the side effects of antiretroviral therapy. Despite an outlay of $1 billion per year for AIDS research, no vaccine is on the horizon for preventing this medical catastrophe.Less

Drug Therapy and Nutrition

Marshal Shlafer and Rebecca J. Shlafer

in Pediatric and Adult Nutrition in Chronic Diseases, Developmental Disabilities, and Hereditary Metabolic Disorders: Prevention, Assessment, and Treatment

This chapter discusses the interactions of drug therapy and nutrition, including biochemical abnormalities; pharmacokinetics; and the absorption, distribution, and elimination of drugs by metabolism ... More

This chapter discusses the interactions of drug therapy and nutrition, including biochemical abnormalities; pharmacokinetics; and the absorption, distribution, and elimination of drugs by metabolism and excretion. Adverse and other nutritional effects of psychoactive drugs (e.g., anticonvulsants, neuroleptics, central nervous system stimulants, antidepressants), adrenal corticosteroids, vitamins used in pharmacological doses, and complementary and alternative medicines are described. Factors to be considered in nutritional assessment and dietary supplementation and management are discussed.Less

Paul Ehrlich's Colonial Connections: Sleeping Sickness Drug Therapy Research, 1903–1914

in Networks in Tropical Medicine: Internationalism, Colonialism, and the Rise of a Medical Specialty, 1890–1930

This chapter looks more closely at sleeping sickness drug therapy research, specifically the collaborative network created by Paul Ehrlich in Africa. It focuses specifically on his relationships with ... More

This chapter looks more closely at sleeping sickness drug therapy research, specifically the collaborative network created by Paul Ehrlich in Africa. It focuses specifically on his relationships with researchers in London, Entebbe, Paris, and Brazzaville, and then assesses the impact that this research had on African patients.Less

Therapeutic Innovation at the End of the Asylum Era

Richard P. Bentall

in Doctoring the Mind: Is Our Current Treatment of Mental Illness Really Any Good?

This chapter explores the treatments developed during a period of innovation that followed the Second World War. The discoveries of this period revealed a constant dialectical tension in the history ... More

This chapter explores the treatments developed during a period of innovation that followed the Second World War. The discoveries of this period revealed a constant dialectical tension in the history of mental health care: between those who seek technical remedies for psychiatric problems, and those who argue that empathy and warmth are the most powerful therapeutic tools available to the clinician. The emergence of the new therapies coincided with the end of the asylum system. The most common term given to this trend is deinstitutionalization, a term that acknowledges the harm that long-term incarceration does to those contained within the asylum walls. The chapter demonstrates how the availability of new drug therapies played an important role in establishing psychiatric treatment in the community, and that, without crucial advances in pharmacology, the closure of the asylums would not have been possible.Less

Drug therapy: reviewing the evidence

Michael Soyka

in Alcohol: Science, Policy and Public Health

This chapter reviews studies on drug therapy for alcohol addiction. The basic principle for treating withdrawal from alcohol is adequate sedation and seizure prophylaxis. Second-choice drugs, which ... More

This chapter reviews studies on drug therapy for alcohol addiction. The basic principle for treating withdrawal from alcohol is adequate sedation and seizure prophylaxis. Second-choice drugs, which can also be given in combination, primarily include substances to prevent blood pressure spikes, e.g., atenolol or clonidine. For a long time, disulfiram was the only drug used for relapse prevention, although evidence for its efficacy is relatively limited. Disulfiram blocks the enzyme acetaldehyde dehydrogenase, so that acetaldehyde accumulates when alcohol is consumed. The almost inevitable intolerability reactions are supposed to prevent the person from drinking alcohol again. A few new substances are also available that have a somewhat better evidence base than disulfiram and do not make use of “punishment” strategies. These include acamprosate, opiate antagonists, baclofen, gabapentin, and quetiapine.Less

Contributions to change: treatment

H. Tunstall-Pedoe

in Coronary Heart Disease Epidemiology: From aetiology to public health

This chapter considers the impact of treatment on cardiovascular disease. It argues that for the first two decades of the last half century, it is unlikely that treatment had much impact on coronary ... More

This chapter considers the impact of treatment on cardiovascular disease. It argues that for the first two decades of the last half century, it is unlikely that treatment had much impact on coronary heart disease which followed its own natural history. The development of powerful new pharmacological agents along with the discovery of new uses for old ones, coupled with really large randomized controlled trials (RCTs), enabled effective treatments to be introduced, firstly in the acute phase, but probably more effectively for secondary prevention.Less

My Personalized Disease Cells

Sheldon Krimsky

in Stem Cell Dialogues: A Philosophical and Scientific Inquiry Into Medical Frontiers

In this dialogue, Dr. Rebecca Franklin is having a conversation with Dr. Leonard Phillips, a pediatric cardiologist, and Dan Henderson, a cell biologist, regarding the promise of the “disease in the ... More

In this dialogue, Dr. Rebecca Franklin is having a conversation with Dr. Leonard Phillips, a pediatric cardiologist, and Dan Henderson, a cell biologist, regarding the promise of the “disease in the dish” approach in speeding up research on many different diseases, leading to faster, more efficient screening of potential drug therapies. Franklin is treating a young child with an unusual arrhythmia, while Henderson is conducting research on cardiac electrolyte abnormalities, one of the causes of arrhythmia. Henderson has embraced using stem cells as a revolutionary approach to evaluating drug therapies for electrolyte abnormalities that have a genetic etiology. Here they talk about research on personalized stem cells; the use of human cell culture as a substitute for animal studies; and the ethics of pretesting a drug on humans and animals.Less

The management of fistulae

Robin Crawford

in Palliative Care Consultations in Gynaeoncology

This chapter discusses the management of fistulae, which poses a significant problem to a patient dying of gynaecological cancer. Fistulae often develop as complications of treatment in patients ... More

This chapter discusses the management of fistulae, which poses a significant problem to a patient dying of gynaecological cancer. Fistulae often develop as complications of treatment in patients undergoing curative therapy. They can be treated aggressively to restore normal functions and to avoid uncontrolled loss of malodorous or corrosive fluids. In patients with advanced cancer, a fistula is a reminder of the incurable nature of her disease. In such patients, the management of these complications through surgical intervention is inappropriate. However, the symptoms caused by a fistula can be managed in various ways to improve the quality of life of the patient for the remaining days of her life. Among the management strategies to address fistulae are physical methods such as colonic and ureteric stents; drug therapies; and surgical interventions.Less

Stanley Kubrick’s A Clockwork Orange as Art Against Torture

Carolyn Strange

in Screening Torture: Media Representations of State Terror and Political Domination

This chapter examines the relevance of Stanley Kubrick’s 1971 film A Clockwork Orange in light of the revival of torture during the global war on terror. The film’s casting choices, musical ... More

This chapter examines the relevance of Stanley Kubrick’s 1971 film A Clockwork Orange in light of the revival of torture during the global war on terror. The film’s casting choices, musical inventiveness, and cinematic experimentation made it a complex, multilayered text without crudely drawn lines between good and evil. Some questioned the clarity of its message, whereas others welcomed Kubrick’s critique of the liberal state’s capacity to justify rights violations. This chapter argues that A Clockwork Orange operates as “art against torture” and that it indicts state terror. It describes the Ludovico Technique—used to domesticate the film’s main character Alex DeLarge—as an example of techniques employed by the state (including drug therapy) to “control the deviant, the criminal, and the mentally ill”.Less