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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

HPV vaccine agreed in principle

The Department of Health has announced that it has agreed, in principle to accept Joint Committee on Vaccinations and Immunisations (JCVI) advice that Human Papilloma Virus vaccines should be introduced routinely for girls aged around 12-13 years, subject to independent peer review of the cost benefit analysis.

The JCVI has issued advice that the vaccine is clinically beneficial. It has now commissioned an analysis of cost-effectiveness and will make a formal announcement based upon this in October 2007. Depending on the outcome of this analysis it is expected that vaccinations could start in Autumn 2008 as part of the routine vaccination programme.

Currently, there is one HPV vaccine on the market (Gardasil®) although there is another product in the process of being licensed (Ceravix®).

Until this vaccine is adopted into the national programme any prescriptions issued will be charged at a local level. A complete course of three doses administered at 0, 2 and 6 months currently costs the NHS approximately £250 per patient. It would seem prudent to wait for a complete national programme unless there are clear clinical benefits to prescribing the vaccine now.

Action: Announcements such as this are likely to increase demand for this vaccination. Until the national programme is fully implemented, the decision to prescribe should include consideration of clinical benefit to the patient and assessment of the overall cost incurred at local level.

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Non Sequitur

Non sequitur, translated from Latin to English, means "it does not follow". Non sequiturs are often used in advertising both overtly and covertly.

An example of an overt use would be placing two statements next to each other so that the reader correlates the two statements despite no correlation existing. For example:

  • Drug X exhibits high affinity for the target receptor
  • Drug X has no known side effects

While these two statements may be factually correct they are not related to each other and there is no cause and effect. Despite this, on first reading, you may have been inclined to believe that Drug X had no side effects because it has a high affinity for the target receptor.

A more covert use of non sequiturs is to involve pictorial or graphical representations. For example, many adverts depict tropical or exotic locations or idealistic situations. These locations and situations often have no direct link with product being advertised.

Action: Clinicians should be aware of the potential influence of non sequiturs in advertising. Careful analysis of promotional materials will ensure that incorrect conclusions are not formed based on unrelated statements.

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NHS Choices

The Department of Health has announced the launch of NHS Choices, a new website that "empowers the public to make informed choices about their own health, including when and where they receive treatment".

This resource is also intended to be used by voluntary sector workers, patient advocates and carers as a source in information for patients who do not have access to the Internet. The site provides information on healthy living, a wide range of conditions and treatments and provides a directory of NHS services.

Action: NHS Choices will be a useful source of information that clinicians can direct patients to and it may be direct use to clinicians.

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NRT works in the "real world"

Nicotine Replacement Therapy (NRT) works in the "real world" according to a paper published in Thorax.

The paper describes a prospective cohort study of smokers aged 35 to 65 who were planning to stop smoking in the next three months. The study was a multinational study conducted over 2 phases. The first in recruited patients in the UK, USA, Canada and France and the second recruited patients in these same countries and Spain. This study was conducted after doubts were raised over the efficacy of NRT outside the highly supportive environment of a randomised controlled trial.

Quit attempts (as measured by six month abstinence rates) were three times more likely to be successful if NRT was used in phase 1 and twice as likely to be successful in phase 2. The authors conclude that self-initiated quit attempts, even without formal behavioural support, are associated with long-term abstinence from smoking. NRT therefore continues to be a highly cost-effective option to aid smoking cessation.

Action: Clinicians can be confident in using NRT as the first line choice to aid smoking cessation in motivated individuals.

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European regulators to re-examine rimonabant

According to several news sites, including the BBC and PharmaTimes, the European Medicines Agency (EMEA) will review the safety of rimonabant (Acomplia®) next week following the drugs rejection by the FDA, as reported yesterday.

Several of these stories have highlighted the fears about suicide identified by the FDA. This coverage is likely to increase the number of queries from patients already on treatment.

Action: Until the EMEA clarify the European position, it would seem prudent to suspend use of rimonabant in new patients. Patients who are already taking rimonabant and who are concerned about the safety of rimonabant should have treatment stopped and be changed to an alternative therapy if appropriate.

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