Interaction Of Non-steroidal Anti-inflammatory Drugs And Hormone Replacement Therapy

Any cardio protective effect of hormone replacement therapy may be inhibited if women are taking a particular type of non-steroidal anti-inflammatory
pain killer, report researchers led by Garret FitzGerald from University of Pennsylvania in a paper published this week in PLoS Medicine.. The
researchers examined the medical records of 1,673 women aged between 50 and 84 years from the UK's General Practice Research Database who had heart
attacks or who died from coronary heart disease and compared them with 7,005 control women. Current use of hormone replacement therapy was associated
with a significantly lower risk of heart attack than non-use; with an odds ratio of 0.78. However, in women who used traditional nonsteroidal
anti-inflammatory drugs (NSAIDs), such as ibuprofen, which variably inhibit both cyclooxygenase (COX)-1 and COX-2, at the same time as hormone
replacement therapy, the chance of heart attack among this group of women, as compared to nonusers of these NSAIDs and hormone replacement therapy,
was 1.5, which was not significantly different.



There is conflicting evidence from previous work about whether hormone replacement therapy protects against heart disease in women. In addition, any
beneficial effect of hormone replacement therapy on the heart might be counteracted by NSAIDs which inhibit COX-2. Inhibition of COX-2 prevents
production of prostacyclin, which has a role in preventing blood clotting. As estrogen acts to increase production of prostacyclin; it is possible
that the effect of hormone replacement therapy on the heart is counteracted by these NSAIDs.



The authors conclude that "these observations, based on small numbers, are provocative rather than conclusive and are not intended to guide clinical
practice, but rather to prompt additional research." Ultimately determination of the clinical implications of these findings will need to be
addressed in future trials.



Garcia Rodr?±guez LA, Egan K, FitzGerald GA (2007)

Traditional nonsteroidal anti-inflammatory drugs and postmenopausal hormone therapy: A drug - drug interaction?

PLoS Med 4(5): e157. doi:10.1371/journal.pmed.0040157

Link here.



About PLoS Medicine


Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of
human health and disease, together with commentary and analysis of important global health issues.


www.plosmedicine



About the Public Library of Science



The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical
literature a freely available public resource.

www.plos

The American College Of Obstetricians And Gynecologists Supports Women's Access To Universal Health Care

During Cover the Uninsured Week, The American College of Obstetricians and Gynecologists reiterates its position that all women should be guaranteed a package of essential benefits that includes primary and preventive care, pregnancy-related and infant care, medically and surgically necessary services, prescription drugs, and catastrophic care. The essential principles for achieving universal care that meets women's lifetime health needs are defined in its Health Care for Women, Health Care for All: A Reform Agenda.


Health insurance is a basic necessity for women, but too many women remain uninsured. Currently, 18 percent of women in the US have no health insurance, a number that is poised to rise if the status quo does not change. As the economy continues to struggle and rising health insurance costs cause more employers to reduce or drop coverage, more women will face the hard decision to either pay for increasingly expensive premiums from already strained household budgets or drop insurance coverage altogether.


Living without insurance can lead to negative health outcomes for women of all ages. Uninsured women are less likely to receive critical preventive health care and screening tests, such as clinical breast exams and Pap tests, than women who have insurance. They are also more likely to receive diagnoses at more advanced disease stages and tend to receive less medical intervention once diagnosed.


Being uninsured also affects the next generation. Thirteen percent of pregnant women are uninsured and, generally, women between the ages of 19-44 are more likely to be living without insurance. Reproductive-age women without health insurance stand to miss out on preconception and prenatal care that can help ensure the best outcomes possible for both mother and baby. And while programs are available to provide insurance to children, nearly 20 percent remain uninsured.


Though coverage may be hard to find, uninsured women should not forgo screening exams, prescribed medications, and ongoing care for preexisting medical conditions. The College encourages women to tap resources that provide health care to the uninsured, such as those listed below:


- The Planned Parenthood Federation of America offers affordable and comprehensive women's health care including contraceptive services, STD screenings, breast exams, and routine physicals (see here).


- The National Breast and Cervical Cancer Early Detection Program (see here) provides free mammograms and Pap tests to uninsured, underinsured, and low-income women who qualify.


- Many pharmaceutical companies offer assistance to patients who can't afford their medication. Women can check with individual drug manufacturers for more details.


- The Bureau of Primary Health Care website allows searches for free or low-cost health care clinics by state and city.


- The Insure Kids Now! website offers links to programs that provide low- or no-cost health insurance coverage for children and pregnant women by state.


- The Robert Wood Johnson Foundation provides state resources for finding insurance (see here).


- The American Academy of Dermatology has a database of dermatologists by state who offer free skin cancer screenings (see here).


- Find free or low-cost eye exams through the American Academy of Ophthalmology hotline service (800-222-EYES).


- Community health fairs often offer free screenings, such as blood pressure and cholesterol tests.


- State and city health departments may have information on locations offering free flu shots.


For more information, visit covertheuninsured.


Source

American College of Obstetricians and Gynecologists

Blogs Comment On Health Reform, Appropriations Bill, Military Abortion Ban

The following summarizes selected women's health-related blog entries.

~ "Shocker: Nelson Rejects Abortion Compromise," Amy Sullivan, Time's "Swampland": Sullivan says that in her efforts to blog about a potential abortion compromise in the Senate, she "couldn't get past one basic fact: there was no possible abortion compromise that could ever win Ben Nelson's vote." She adds, "We could pretend otherwise, but it just wasn't so." A "red flag should have been the fact that Nelson sent [Sen. Robert] Casey's (D-Pa.) proposed language to antiabortion groups in Nebraska for their review," Sullivan writes. Although there is "nothing wrong with running legislative language by people who closely cover the issue," it does "indicate that what's at stake here is not Nelson's personal comfort with the separation of government funds from abortion procedures so much as the comfort of interest groups with his pro-life credentials," she continues. "So now we're back where we started," and "it remains completely unclear" what Senate Majority Leader Harry Reid (D-Nev.) would need to do to gain a Republican vote to offset Nelson's, Sullivan says (Sullivan, "Swampland," Time, 12/17).

~ "The Welcome End of Abstinence-Only Sex Education," Bonnie Erbe, U.S. News & World Report's "Thomas Jefferson Street": "[N]ormalcy is about to return" on the issue of sex education, as the fiscal year 2010 omnibus appropriations bill (HR 3288) " just approved by Congress eliminates funding for abstinence-only education," Erbe writes. "Back to the future we go," she continues, noting that "[t]here was a time in America when there was no such thing as abstinence-only education." According to Erbe, "Biologically accurate sex education has always taught teens that the only completely reliable way" to avoid sexually transmitted infections is "to abstain from sex." She writes, "But can you imagine what would happen if liberals tried to press a version of sex education that only encouraged teens to have sex, without teaching them how to avoid [STIs] and pregnancy?" Erbe says, "That would be the polar opposite of 'abstinence-only' education. And yet the public would be in an uproar" (Erbe, "Thomas Jefferson Street," U.S. News & World Report, 12/16).

~ "Choice in the Military: Crocodiles or Piranhas," Kate Harding, Salon's "Broadsheet": Prohibiting women in the military from receiving abortion services "does not stop women from seeking to end unwanted pregnancies; it drives them to risk their own lives and health to do so," Harding writes, noting that attempts at self-abortion have "continued ... thanks to restrictions on when and where abortions can be performed and who pays for them." Harding discusses Kathryn Joyce's recent article in Religion Dispatches examining the effects of the ban on abortion services at military hospitals, which Joyce says creates "just one more category of women ... who fall into the canyons created by sweeping bans on federal funding for abortion." Antiabortion-rights provisions in health care reform legislation "threaten to add middle-class women to the list -- meaning we'd essentially be right back in 1972, with safe abortion services available only to wealthy women who can afford to skirt the restrictions," Harding writes. While the military ban "may seem like a low-priority issue to pro-choice activists who aren't among the 200,000 female service members ... directly affected by it," it is a "sobering example of how cutting off access to abortion services endangers people's health and lives," she says (Harding, "Broadsheet," Salon, 12/15).














~ "While Lieberman Screws Over Public Options, Nelson Still in Control of Abortion Coverage for Millions of Women," Jodi Jacobson, RH Reality Check: Sen. Ben Nelson (D-Neb.) "is back in the saddle" after the Senate rejected his amendment prohibiting federally subsidized insurance plans from covering abortion services, a proposal similar to an amendment by Rep. Bart Stupak (D-Mich.) that the House approved in November, Jacobson writes. Nelson is "apparently negotiating abortion language behind closed doors" with Senate Majority Leader Harry Reid (D-Nev.) and Sen. Robert Casey (D-Pa.), Jacobson says, adding that Nelson recently said on CBS' "Face the Nation" that he "still [has] the unique issue of abortion" and that he cannot support the Senate's bill if the current language is not changed. Jacobson writes, "Actually, no. It is women that have the 'unique' issue of pregnancy, childbirth and the unique choices that come with their biological capacity for reproduction." She adds that the "only 'unique' thing about Nelson (and Stupak) is that it is uniquely disturbing that a bunch of white male senators and congressman who will never be at risk of pregnancy are struggling so hard to impose their religious and ideological views on the entire population of women" (Jacobson, RH Reality Check, 12/16).

~ "Could Ben Nelson Kill Health Care Reform?" Max Fisher, Atlantic Monthly's "The Atlantic Wire": On Tuesday, Nelson told reporters "that he may not support health care reform as it stands now" because he is not satisfied with the provisions regarding abortion coverage under federally subsidized insurance plans, Fisher writes. He asks, "With one vote the difference between passing and failing, ... could the loss of Nelson [be] reform's death knell?" Fisher examines five recent blog postings regarding the issue, including the role of Sen. Olympia Snowe's (R-Maine) vote and rumors that the closure of an Air Force base in Nebraska is being used as a bargaining chip with Nelson (Fisher, "The Atlantic Wire," Atlantic Monthly, 12/16).

~ "Catholic Bishops Hold the Line on Abortion Language," Jordan Fabian, The Hill's "Blog Briefing Room": The U.S. Conference of Catholic Bishops on Tuesday "reiterated its support for the addition of more stringent abortion language into the Senate's health care bill," after sending a letter to senators over the weekend "asking them once again to insert abortion language similar" to Nelson's rejected amendment, Fabian writes. The letter, signed by Cardinal Daniel DiNardo, said, "Health care reform is too urgently needed to be placed at risk by one lobbying group's insistence on changing the law." It also said, "Before the Senate considers final votes on its health care reform legislation, please incorporate into this bill the longstanding and widely supported policies of current law" (Fabian, "Blog Briefing Room," The Hill, 12/15).

~ "How Health Care Reform Means More Access to Abortion, Not Less," Daniel Hemel, Double X: "No one seems to have much noticed, but the health care bills winding their way through Congress will do more to expand abortion access in low-income communities than any single step since the Supreme Court's 1973 ruling in Roe v. Wade," Hemel, a Yale Law School student, writes. Hemel explains how under the Senate (HR 3590) and House (HR 3962) health reform bills, Medicaid coverage will be expanded to more people. Although the Medicaid expansion itself "won't increase abortion access" because of the Hyde Amendment's ban on states' use of federal Medicaid money for abortion services, the fact that Medicaid is a "joint federal-state program" means increased access, he argues. "[I]n 13 states, courts have ordered state governments to use their own money to fund abortions for women who receive Medicaid -- of whom there will be millions more post-health care reform," Hemel says, adding that the Hyde Amendment "doesn't stop the states from paying for abortion on their own." According to Hemel, "30% of Americans live in states under court order to cover abortion costs for Medicaid recipients" (Hemel, Double X, 12/15).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


© 2009 The Advisory Board Company. All rights reserved.

European Commission Approves GARDASIL(R), Merck's Cervical Cancer Vaccine

GARDASIL(R) [Quadrivalent Human Papillomavirus (Types 6, 11, 16, 18) Recombinant Vaccine], the cervical cancer vaccine from Merck & Co., Inc., has been granted a license by the European Commission. GARDASIL has been approved as the first and only vaccine in the European Union (EU) for use in children and adolescents aged 9 to 15 years and in adult females aged 16 to 26 years for the prevention of cervical cancer, high-grade cervical dysplasias/precancers [cervical intraepithelial neoplasia (CIN 2/3)], high-grade/precancerous vulvar dysplastic lesions (VIN 2/3) and external genital warts (condyloma acuminata) caused by human papillomavirus (HPV) types 6, 11, 16 and 18. This license applies to the 25 countries that are members of the EU, including the five largest which are France, Germany, Italy, Spain and the United Kingdom.


GARDASIL will be marketed by Sanofi Pasteur MSD (SPMSD), a joint venture between Sanofi Pasteur and Merck & Co., Inc, in 19 European countries including 15 in the EU. In the remaining Central and Eastern European countries, GARDASIL will be marketed by Merck Sharp & Dohme as either GARDASIL or SILGARD(R).


Cervical cancer is the second most common cause of death from cancer (after breast cancer) among young women (15 to 44 years) in Europe. Approximately 33,500 women are diagnosed with, and 15,000 women die from cervical cancer each year (40 each day) in Europe.


Worldwide Availability of GARDASIL


On June 8, the U.S. Food and Drug Administration approved GARDASIL to prevent cervical cancer and vaginal and vulvar pre-cancers caused by HPV types 16 and 18 and to prevent low-grade and pre-cancerous lesions and genital warts caused by HPV types 6, 11, 16 and 18. GARDASIL is approved in the United States for 9- to 26-year-old girls and women. GARDASIL is also approved for use in several countries throughout the world including Mexico, Australia, Canada, New Zealand, Brazil and two countries in Africa. Additional applications for GARDASIL are currently under review with regulatory agencies in more than 50 countries around the world. Additionally, Merck is actively working to accelerate the availability of GARDASIL in the developing world: in December, Merck announced a partnership with India's Council of Medical Research to study GARDASIL. Merck is also working with PATH and the Gates Foundation to develop HPV vaccination programs that will facilitate the introduction of GARDASIL to the most impoverished nations. Merck will make our new vaccines, including GARDASIL, available at dramatically lower prices to developing world countries.















Selected important information about GARDASIL


GARDASIL is contraindicated in individuals who are hypersensitive to the active substances or to any of the excipients of the vaccine. As with any vaccine, vaccination with GARDASIL may not result in protection in all vaccine recipients. GARDASIL is not intended to be used for treatment of active genital warts; cervical cancer; CIN, VIN, or VaIN. GARDASIL has not been shown to protect against disease due to non-vaccine HPV types. The health-care provider should inform the patient, parent or guardian that vaccination does not substitute for routine cervical cancer screening. Women who receive GARDASIL should continue to undergo cervical cancer screening per standard of care.


Vaccine-related adverse experiences that were observed in clinical trials at a frequency of at least 1.0 percent among recipients of GARDASIL and also greater than those observed among recipients of placebo, respectively, were pain (83.9 percent vs. 75.4 percent), swelling (25.4 percent vs. 15.8 percent), erythema (24.6 percent vs. 18.4 percent), fever (10.3 percent vs. 8.6 percent), nausea (4.2 percent vs. 4.1 percent), pruritis (3.1 percent vs. 2.8 percent) and dizziness (2.8 percent vs. 2.6 percent).


Other Information about GARDASIL


In 1995, Merck entered into a license agreement and collaboration with CSL Limited relating to technology used in GARDASIL. GARDASIL also is the subject of other third-party licensing agreements.


About Merck


Merck & Co., Inc. is a global research-driven pharmaceutical company dedicated to putting patients first. Established in 1891, Merck currently discovers, develops, manufactures and markets vaccines and medicines to address unmet medical needs. The Company devotes extensive efforts to increase access to medicines through far-reaching programs that not only donate Merck medicines but help deliver them to the people who need them. Merck also publishes unbiased health information as a not-for-profit service. For more information, visit merck.


Forward-Looking Statement


This press release contains "forward-looking statements" as that term is defined in the Private Securities Litigation Reform Act of 1995. These statements are based on management's current expectations and involve risks and uncertainties, which may cause results to differ materially from those set forth in the statements. The forward-looking statements may include statements regarding product development, product potential or financial performance. No forward-looking statement can be guaranteed, and actual results may differ materially from those projected. Merck undertakes no obligation to publicly update any forward-looking statement, whether as a result of new information, future events, or otherwise. Forward-looking statements in this press release should be evaluated together with the many uncertainties that affect Merck's business, particularly those mentioned in the cautionary statements in Item 1 of Merck's Form 10-K for the year ended Dec. 31, 2005, and in its periodic reports on Form 10-Q and Form 8-K, which the Company incorporates by reference.




GARDASIL(R) and SILGARD(R) are registered trademarks of Merck & Co., Inc., Whitehouse Station, N.J., U.S.A.


About Merck

merck


View drug information on Gardasil.