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Chalenges Faced By HIV Patients Living Longer Lives Due To New Therapies
New HIV therapies have prolonged lives and improved health for patients with HIV, but the treatments have also brought the longer-term effects of the disease into sharper focus.
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Vermont Legislature Passes Law Regulating All Drug/Device Company Marketing, Requiring Disclosure Of Gifts To Doctors
The Vermont Legislature has passed legislation (S 48) that bans nearly all gifts from pharmaceutical and medical device companies to health care providers, administrators and facilities in the state, the New York Times reports. The legislation specifically would prohibit drug and device makers from giving providers no-cost meals. Vermont"s legislation would go further than similar laws in other states like Massachusetts and Minnesota by requiring drug and medical device manufacturers who give gifts to health providers to publicly disclose recipients" names and dollar amounts of payments and gifts. The measure would not require manufacturers to disclose payments for clinical research of products undergoing FDA review, the Times reports. The legislation also would eliminate a loophole that allows manufacturers to conceal certain expenses by claiming them as trade secrets. In a recent report, the Vermont Office of the Attorney General said that medical product makers spent about $2.9 million on promotional efforts to the state"s health care providers in fiscal year 2008 and that nearly half of the state"s 4,573 licensed providers had received some type of incentive from drugmakers in the same year. The report, which was developed prior to passage of the new legislation, offers only aggregate data, as 83% of the manufacturer-declared payments were deemed to be trade secrets, the Times reports.Gov. Jim Douglas (R) is expected to sign the law, which would take effect July 1. Several state medical groups -- including the Vermont Association for Mental Health and the Vermont Medical Society -- have indicated support for the legislation.Marjorie Powell, a senior lawyer for the Pharmaceutical Research and Manufacturers of America, said the requirements under the new law appear redundant with new voluntary guidelines the group has issued on physician gifting practices. She said, "We think this is unnecessary, and it is not going to improve patient care," adding, "It makes it onerous not only for the company but also for the physician in Vermont, because this is going to be on a Web site" (Singer, New York Times, 5/20).
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A Catalyst For Public Debate: Promoting Openness, Full Disclosure, And Accountability
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The Importance Of Preventing Congestion In Heart Failure

Preventing vascular congestion is an important mediator in heart failure, reports a study in the June issue of the Journal of Cardiac Failure, published by Elsevier. The authors previously demonstrated that venous endothelium is a key regulator of central blood volume, organ perfusion and hemostasis in heart failure (HF). The present study demonstrates that in venous endothelium, inflammatory/oxidative and hemostatic programs were significantly activated in HF dogs compared to normal dogs. In normal dogs, fluid loading significantly activated these same programs to levels that approached those seen in dogs with HF. These findings suggest that biomechanical stress (i.e. vascular stretch) may be an important mediator of these endothelial responses, and highlight the importance of preventing congestion. Further investigation is needed to clarify whether the venous endothelial phenotype in unique individuals may ultimately allow us to track the vascular impact of subsequent environmental (i.e. biomechanical and biochemical) stressors, as well as the potential response to therapeutic interventions. "This important study is consistent with a growing literature, indicating that congestion itself may mediate many of the physiological abnormalities in heart failure, such as vascular dysfunction, inflammation, renal dysfunction and hypercoagulability," commented Barry M. Massie, M.D., Editor-in-Chief of the Journal of Cardiac Failure. Notes: The study, "Activation of Endothelial Cells in Conduit Veins of Dogs with Heart Failure and Veins of Normal Dogs Following Vascular Stretch by Acute Volume Loading," authored by Paolo C. Colombo, Sharad Rastogi, Duygu Onat, Valerio Zacē , Ramesh C. Gupta, Ulrich P. Jorde, and Hani C. Sabbah (DOI: 10.1016/j.cardfail.2008.12.006) was supported by a research grant from the National Heart, Lung and Blood Institute. It appears in the Journal of Cardiac Failure, Volume 15, Issue 5 (June 2009) published by Elsevier.com Maureen Hunter Elsevier


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