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HIV-1 subtype C in Brazil
generic substitution is unsafe. The RMI televised advertisements depicting waternow responded to the ministry’s inter- falls ("... if your torrent has turned into a changeable medicines list by running trickle"). These carried a free-phone numadvertisements in medical publications ber for further information. By the end of asking doctors to prescribe brand-name seven weeks, 6000 members of the public medicines and to support research and had responded. It is too early to know development, and has written in a similar whether Merck, Sharp and Dohme has vein to general practitioners. : increased its market share, but the compaThe new ministry initiative invites docny reports that "a lot more men are comtors to sign a form giving the pharmacist ing in to see the doctor and lots of doctors blanket approval for substitution unless a are quite happy about that". : otherwise. The stratit still Proscar not on the so prescription specifies drug tariff, egy is aimed at reducing drug costs. Since consumers must pay NZ$1500 annually
HIV-1
has
medicines in New Zealand are already for its use. The official view of Pharmac, priced according to the cheapest drug in a the government’s pharmaceutical managefield, the main beneficiaries of the new ment agency, is that two already subsidised : policy will be members of the public who drugs are at least as effective as Proscar. often pay premiums for brand-name Advertising prescription drugs drugs. Although the RMI has raised the to the public is not new in New Zealand. spectre of informed consent in substitu-Novo Nordisk recently advertised hor tion, most consumers are unaware that mone-replacement therapy in a publicathere may be cheaper drugs than the tion delivered free to homes. Such brand-name products chosen for them advertising is not illegal, although before their general practitioner. the Proscar campaign no pharmaceutical It remains to be seen how doctors will company had used television as a medium. respond. The ministry concedes there is Advertisers are supposed to spell out the some "residual concern" among profesefficacy and safety of their product but sional groups and has invited them to usually do not; in Proscar’s case this information was flashed on the screen in inspect their evidence. It is engaged in reviewing the medicines legis- letters for about five seconds. The proposed new medicines legislation lation and it is possible that routine substi- : tution by pharmacists may be authorised . could prohibit such advertising and the by any new act. Also being reviewed is the Ministry of Health would prefer this. But issue of advertising prescription drugs the ministry reports that few submissions have supported a ban. In an increasingly directly to the public. weeks and market-driven health environment, adverIn recent Merck, Sharp Dohme has tested the limits of the current tising drugs to the public may become a restrictions with an advertising campaign fact of life. : for Proscar, a treatment for prostatic
directly
by
currently
tiny
hypertrophy. Newspaper advertisements with a clip-out coupon were followed bySandra Coney
Specialist domiciliary
care
in Australia scheme for treating some patients home by general practitioners and salaried staff specialists has been established in Sydney. If successful, the federalgovernmeht-funded scheme could be
A
pilot
at
hour-greater
1354
than the
Medicare
Researchers have identified the first four cases of HIV- type C in Brazil. This subtype of virus is common in India and known in countries of southern Africa. One case was identified in Sao Paulo, and the other three in the southern city of Porto
Alegre.
to Ester Sabino, who detected the Sao Paulo case at the Adolfo Lutz Institute, the finding is important because subtype C might be more easily transmissible heterosexually than other types, in which case it could affect the pattern of AIDS epidemiology in Brazil. In India, where the AIDS epidemic is associated with subtype C, transmission is largely heterosexual, says Jose Esparza, of WHO’s AIDS programme. "In that country, the infection ratio between men and women is 1:1, suggesting that the virus spreads itself much more easily through heterosexual
According
contact",
says
Esparza. According to him,
the ratio in Brazil is 8 or 9 male cases to 1 female. Sabino points out that the likelihood of heterosexual spread is only a hypothesis, and that there might be other factors to explain the transmission pattern in India. "The virus could be spreading itself in this manner because of a high incidence of sexually transmissible disease, which increases HIV infection through sexual contact. There is also the possibility that the Indian population is genetically more susceptible to subtype C".
HIV-1 subtype
Country
: A Central Africa South America : B : (including Brazil), US, reimbursement for eligible house calls.: Europe, Thailand Dr Michael Mira, director of the: C Brazil, India, southern CSAHS’s division of general practice, says: Africa that the scheme will benefit GPs, who will: D Central Africa obtain first-hand clinical experience with: E Thailand, Central African Republic specialists because they would be visiting: Brazil, Romania, Zaire patients together, thereby eliminating: F Zaire, Gabon, Taiwan communication problems between GP,: G Zaire, Gabon specialist, and patient. Mira adds that: H 0 Cameroon, Gabon patients would also benefit because of the more personalised and higher standard of : The finding, which Sabino expects to care, and that later admission of these present at an AIDS conference in Washpatients should also be minimised, along: ington on Jan 28, also bears implications with the$300 bed cost.
introduced nationally. : The 12-month A$30 000 pilot programme to be conducted within the innercity Central Sydney Area Health Service’s (CSAHS) division of general practice per day allows general practitioners (GPs) to A concurrent 12-month$100 000 pilot request joint visits with specialists to the programme involves the broader concept homes of patients, who would otherwise of GPs visiting their patients in hospital at: : be transported to hospital by ambulance, the invitation of any specialist. : at considerable cost. : These two schemes are separate from Eligible patients are elderly or have the evaluation of "hospital in the home": complex medical, physical, or social prob- arrangement, whereby community nurses : lems. The hospital-based specialists, mainand GPs collaborate to provide domicilly geriatricians, psychogeriatricians, and iary care of various types-for example,: rehabilitationists, would not be paid any for people who require intravenous antimore for these home visits. However, GPs biotics. It remains to be seen how much would be paid travelling time and for support these innovations receive from . time spent in telephone consultations GPs : with specialists at a flat rate of$91.55 per
subtype C in Brazil
Peter
Harrigan
for vaccine programmes. "The majority of vaccines being tested in the world are against subtype B, which is the most common form of the virus in the USA, Europe, and Brazil", says Sabino. Even though it is unknown whether HIV subtypes are relevant for vaccine efficacy, Sabino says it would be best for a population to be vaccinated against the virus that attacks it (panel). The three cases identified in Porto Alegre are to be published by WHO in AIDS Research and Human Retrovirus.
Clåudio Csillag
HIV-1
has
medicines in New Zealand are already for its use. The official view of Pharmac, priced according to the cheapest drug in a the government’s pharmaceutical managefield, the main beneficiaries of the new ment agency, is that two already subsidised : policy will be members of the public who drugs are at least as effective as Proscar. often pay premiums for brand-name Advertising prescription drugs drugs. Although the RMI has raised the to the public is not new in New Zealand. spectre of informed consent in substitu-Novo Nordisk recently advertised hor tion, most consumers are unaware that mone-replacement therapy in a publicathere may be cheaper drugs than the tion delivered free to homes. Such brand-name products chosen for them advertising is not illegal, although before their general practitioner. the Proscar campaign no pharmaceutical It remains to be seen how doctors will company had used television as a medium. respond. The ministry concedes there is Advertisers are supposed to spell out the some "residual concern" among profesefficacy and safety of their product but sional groups and has invited them to usually do not; in Proscar’s case this information was flashed on the screen in inspect their evidence. It is engaged in reviewing the medicines legis- letters for about five seconds. The proposed new medicines legislation lation and it is possible that routine substi- : tution by pharmacists may be authorised . could prohibit such advertising and the by any new act. Also being reviewed is the Ministry of Health would prefer this. But issue of advertising prescription drugs the ministry reports that few submissions have supported a ban. In an increasingly directly to the public. weeks and market-driven health environment, adverIn recent Merck, Sharp Dohme has tested the limits of the current tising drugs to the public may become a restrictions with an advertising campaign fact of life. : for Proscar, a treatment for prostatic
directly
by
currently
tiny
hypertrophy. Newspaper advertisements with a clip-out coupon were followed bySandra Coney
Specialist domiciliary
care
in Australia scheme for treating some patients home by general practitioners and salaried staff specialists has been established in Sydney. If successful, the federalgovernmeht-funded scheme could be
A
pilot
at
hour-greater
1354
than the
Medicare
Researchers have identified the first four cases of HIV- type C in Brazil. This subtype of virus is common in India and known in countries of southern Africa. One case was identified in Sao Paulo, and the other three in the southern city of Porto
Alegre.
to Ester Sabino, who detected the Sao Paulo case at the Adolfo Lutz Institute, the finding is important because subtype C might be more easily transmissible heterosexually than other types, in which case it could affect the pattern of AIDS epidemiology in Brazil. In India, where the AIDS epidemic is associated with subtype C, transmission is largely heterosexual, says Jose Esparza, of WHO’s AIDS programme. "In that country, the infection ratio between men and women is 1:1, suggesting that the virus spreads itself much more easily through heterosexual
According
contact",
says
Esparza. According to him,
the ratio in Brazil is 8 or 9 male cases to 1 female. Sabino points out that the likelihood of heterosexual spread is only a hypothesis, and that there might be other factors to explain the transmission pattern in India. "The virus could be spreading itself in this manner because of a high incidence of sexually transmissible disease, which increases HIV infection through sexual contact. There is also the possibility that the Indian population is genetically more susceptible to subtype C".
HIV-1 subtype
Country
: A Central Africa South America : B : (including Brazil), US, reimbursement for eligible house calls.: Europe, Thailand Dr Michael Mira, director of the: C Brazil, India, southern CSAHS’s division of general practice, says: Africa that the scheme will benefit GPs, who will: D Central Africa obtain first-hand clinical experience with: E Thailand, Central African Republic specialists because they would be visiting: Brazil, Romania, Zaire patients together, thereby eliminating: F Zaire, Gabon, Taiwan communication problems between GP,: G Zaire, Gabon specialist, and patient. Mira adds that: H 0 Cameroon, Gabon patients would also benefit because of the more personalised and higher standard of : The finding, which Sabino expects to care, and that later admission of these present at an AIDS conference in Washpatients should also be minimised, along: ington on Jan 28, also bears implications with the$300 bed cost.
introduced nationally. : The 12-month A$30 000 pilot programme to be conducted within the innercity Central Sydney Area Health Service’s (CSAHS) division of general practice per day allows general practitioners (GPs) to A concurrent 12-month$100 000 pilot request joint visits with specialists to the programme involves the broader concept homes of patients, who would otherwise of GPs visiting their patients in hospital at: : be transported to hospital by ambulance, the invitation of any specialist. : at considerable cost. : These two schemes are separate from Eligible patients are elderly or have the evaluation of "hospital in the home": complex medical, physical, or social prob- arrangement, whereby community nurses : lems. The hospital-based specialists, mainand GPs collaborate to provide domicilly geriatricians, psychogeriatricians, and iary care of various types-for example,: rehabilitationists, would not be paid any for people who require intravenous antimore for these home visits. However, GPs biotics. It remains to be seen how much would be paid travelling time and for support these innovations receive from . time spent in telephone consultations GPs : with specialists at a flat rate of$91.55 per
subtype C in Brazil
Peter
Harrigan
for vaccine programmes. "The majority of vaccines being tested in the world are against subtype B, which is the most common form of the virus in the USA, Europe, and Brazil", says Sabino. Even though it is unknown whether HIV subtypes are relevant for vaccine efficacy, Sabino says it would be best for a population to be vaccinated against the virus that attacks it (panel). The three cases identified in Porto Alegre are to be published by WHO in AIDS Research and Human Retrovirus.
Clåudio Csillag