Embargoed news from Annals of Internal Medicine

November 15, 2010

1. Hormone Therapy Does Not Deter Prostate Growth in Middle-Aged Men

The size of the prostate gland increases as men age, resulting in a condition called benign prostatic hypertrophy, or BPH. While not life-threatening, BPH causes troublesome urinary symptoms that often require surgery. Since surgery has risks and is costly, an alternative treatment option would be preferred. Researchers sought to determine if testosterone replacement therapy could reduce prostate growth in middle-aged men. The researchers randomly assigned 114 men older than 50 with no known prostate disease to receive either placebo or transdermal dihydrotestosterone each day for two years. They found that average prostate size increased over time in all men, with no significant difference between the two treatment groups.

2. Presumed Consent Policy May Not Increase Overall Rates of Kidney Donation

Kidneys are the most frequently transplanted organs and the need for organs surpasses supply. While kidneys can be transplanted from living donors, deceased donors are an important source of kidneys. As such, policymakers consider various strategies for increasing donation at the time of death. Some countries allow organs to be taken from people when they die, as long as they did not expressly request not to be considered for donation. This policy is called presumed consent. Other countries require people to agree ahead of time whether or not they would donate an organ after death. This is called explicit consent. Researchers reviewed kidney donation rates for 44 nations performing the transplants between 1997 and 2007 to determine whether one method increased donation rates over another. Twenty-two nations had presumed consent and 22 nations had explicit consent policies. The researchers found that deceased kidney donation rates were higher in nations with presumed consent, but living donations were lower than in countries with explicit consent. For this reason, presumed consent may not help to bolster overall kidney donations as much as expected unless donation from living donors is also encouraged.

3. Co-pay "Sticker Shock" May Cause Patients to Abandon Prescriptions at Pharmacy

Electronic Prescriptions, Brand Name Drugs, and New Medications Also Likely to be Abandoned

Abandoned prescriptions are those that have been ordered but not picked up at the pharmacy. Aside from costing pharmacies about $500 million annually, prescriptions that are abandoned cannot be taken as prescribed, leading to patient nonadherence. Past studies on prescription nonadherence have focused on refill rates, patient self-reporting, or electronic pill bottles. No studies have been conducted to determine the rate of prescription abandonment and factors that contribute to it. Researchers identified prescriptions bottled at a national pharmacy chain and linked them to claims data from a national pharmacy benefits manager (PBM) to determine how often prescribed medications were not picked up at the pharmacy. The researchers found that while the overall percentage of prescriptions that were not filled was low, first-time prescriptions, those for expensive drugs, and those that required high co-payments were significantly more likely to be abandoned than others. Prescriptions that were submitted to the pharmacy electronically were also significantly less likely to be picked up than were those delivered in person. According to the author of an accompanying editorial, physicians should be mindful of prescription costs and aim to prescribe or recommend less expensive alternatives whenever feasible.

"On Being a Doctor" Essay:

4. Physician Shares Personal Story of Workplace Weight Discrimination, Calls for Greater Understanding of Obese Patients' Struggles

Annals publishes physician essays sharing a personal anecdote about the practice of medicine. In the latest issue, an obese physician writes about the prejudice he experienced from colleagues and patients. According to the author, other physicians openly stated that they would never refer a patient to him because he was obese and he believed that his colleagues' attitudes were not unique to him. Some studies have shown that physicians tend to stereotype obese patients as being lazy, weak-willed, or sloppy. The author believes that physicians must not blame the patient for their obesity and writes, "Professionalism and sensitivity toward obese patients must start with physicians."

American College of Physicians

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