Stores take steps to curb cold medicine abuse

With pseudoephedrine off the shelves, placed behind counters to curtail abuse, drug abusers seem to be looking toward other over-the-counter remedies.

Area pharmacists are watching the trend, and in some case, are taking steps to head them off.

Those medicines include Coricidin Cough and Cold, Robitussin, and Dimetapp DM and Vicks NyQuil LiquiCaps, which all contain the drug dextromethorphan. And when abused, they can result in a high.

Many Walgreens locations across the country have voluntarily placed Coricidin behind the pharmacy counter, Walgreens corporate spokeswoman Carol Hively said.

Other medicines were not removed because the company found they were not being abused like Coricidin, she said.

So now the medicine has been disappearing from store shelves accessible to shoppers and reappearing behind counters or glass containers manned by store employees.

Hively said people, many of them teenagers, would enter stores and purchase packages of the medicine and swallow most or all of its red tablets. The high is called “Skittling” after the tablets’ close resemblance to the candy Skittles. The product was moved behind the counter if local law enforcement felt it was a problem.

And at all Walgreens locations, no one younger than 18 can purchase the medicine.

Children as young at 14 have been taken to emergency rooms after overdosing on the medicine, Hively said.

In October, two 16-year-old girls were detained at the Brazoria County Juvenile Detention Center after one of them overdosed on the cold medicine.

One of the girls brought 16 pills into the detention center, which the other took. She was taken to Angleton Danbury Medical Center, where she was treated and released.

Brazoria County Sheriff Charles Wagner said the abuse of other over-the-counter drugs such as Coricidin is rising because of the tracking of pseudoephedrine. But the abuse is not an epidemic, he said.

“It’s nothing like the abuse of hard drugs,” he said. “But we are seeing more of it.”

Brazoria County Sheriff’s Office narcotics investigators are working with local law enforcement to curb over-the-counter drug abuse by trying to track who buys certain over-the-counter drugs — mostly pseudoephedrine — using log books kept at pharmacy counters, Wagner said.

“Everybody’s working on it,” he said.

In 2006, a federal law was passed requiring customers purchasing pseudoephedrine, which can be used to make methamphetamine, to sign a log book so retailers can track who is buying it, how much is being bought and how many times.

For Coricidin, Hively said it’s a store-by-store preference depending on local law enforcement.

“Some stores take it off the shelves and some don’t,” she said. “It depends on the area — if there are trends. It seems isolated, so I can’t say it’s a big problem. It’s sporadic.”

Locally at the Clute Walgreens, Coricidin can be found inside a locked glass case, a store employee said.

J.C. Jackson, a pharmacist who has been running the Alvin Medicine Man pharmacy for two years, said abuse of over-the-counter medicines purchased at his clinic is not common because they have been implementing a system much like Walgreens.

“There was a time when you could buy everything on the shelf,” said Jackson, a Seabrook resident. “But it has curtailed a whole lot.”

Jackson has implemented a log book customers must sign and provide their driver’s license number so the pharmacy can track purchases of items containing pseudoephedrine. And if anything strange arises, they offer the information in the log book to police. They do not track medicines with dextromethorphan.

Meghan Glynn, a spokeswoman for Kroger, said any decisions about product placement or removal are decided depending on the situation at hand. And the supermarket chain removes items following legal guidelines.

“It depends on a lot of factors,” she said of having items protected behind counters or glass. “It depends on the issue.”

Spokesmen at Wal-Mart and Target also said they only remove what federal guidelines say to remove.

Source: The Facts, 11/27/07

Targeting black Friday shoppers

Convenience is driving shoppers to online merchandisers and retailers that are typically located outside the mall.

"You drive up to a Kohl's, you do your shopping, you get back in your car and you're done," Davidowitz said. "You go to a mall and it's a huge pain in the a-- with the parking and everything. You can drive right up to Wal-Mart and do your shopping and leave. Drug stores are performing best in recent years. Who's more convenient than the drug store?"

Malls like Muncie's -- which is a regional center that draws shoppers from several counties -- are strong enough to attract other retailers. When Target relocated its Muncie store in 2003, it chose a spot across the parking lot from Muncie Mall. An out-of-town developer who recently built a strip center, including a Qdoba, near the mall told The Star Press that proximity to the mall was desirable.

Nance said the relative strength of Muncie Mall doesn't make Simon Property Group complacent, however. Mall stores will compete with big box stores by opening as early as 4 a.m. the day after Thanksgiving. For the first time, the mall will coordinate specials and coupons with mall tenants.

"We want to drive traffic in here early," Nance said. "Last year [opening early] was successful and this year we have more partners on board.

"We know people will be going to the Best Buys and Targets and Wal-Marts, and we're letting them know we have specials here."

Source: The Star Press, 11/18/07

The Claim: Zinc Can Help You Beat a Cold

As cold season gets under way, countless sneezing and sniffling Americans will turn to zinc as their treatment of choice.

But does it actually work?

More than 100 studies in the past two decades have examined the question. Some have found zinc to be effective, and have proposed various reasons. But many more have found little or no evidence that it works.

One of the most extensive studies appeared in the journal Clinical and Infectious Diseases in 2000. In it, scientists randomly assigned more than 500 people — about half with natural colds, and the other half deliberately infected — to receive placebo or zinc lozenges in various doses. After secluding the subjects in hotel rooms and examining them for five days, the researchers concluded that zinc gluconate lozenges produced “modest” benefit, while zinc acetate lozenges did nothing.

Another study, published this year by researchers at Stanford Medical School, collected and analyzed data from 14 previous placebo-controlled studies of zinc. Over all, the scientists determined, the effectiveness of zinc lozenges “has yet to be established,” while there was some slight evidence for zinc nasal gels.

For those who do insist on zinc, it is worth knowing that the studies that endorse it have found that it should be taken within 24 hours of the onset of symptoms to be most effective.

THE BOTTOM LINE

The research on zinc as a cold fighter is mixed.

Source: New York Times, 11/06/07

Natural, organic beauty

For Flavia Kawaja, an interior designer in Manhattan, a trip to the beauty department at Whole Foods Market comes not with a shopping list but with a mental list of what synthetic ingredients to avoid.

Ms. Kawaja won’t use antiperspirant made with aluminum derivatives, in case the urban legend that they could cause diseases like Alzheimer’s turns out to be true. She also steers clear of skin-care products with parabens, common antibacterial agents used as preservatives in some cosmetics, drugs and foods.

Although there have been no rigorous large-scale prospective clinical trials to show that parabens in cosmetics represent a risk to beauty consumers, a few studies have shown that exposure to parabens can cause reproductive changes in lab rodents.

By choosing cosmetics marketed as natural or organic, Ms. Kawaja errs on the side of caution. Even so, she admits that she’s unsure whether her careful choice of natural shampoos and sunscreens translates into health benefits.

“I don’t assume that organic automatically means good for you,” she said. “I mean, if you fry an organic potato, it’s still a French fry.”

Organic connoisseurs have long made a practice of reading food labels to weed out those grown with pesticides or that contain synthetic colors, flavors or preservatives. Now, in the wake of recent health scares over tainted pet food and toothpaste, some beauty mavens are seeking synthetic-free cosmetics in the belief that products made without industrial ingredients like petrochemicals ought to be healthier for you.

These newly minted label inspectors are fueling a boom in so-called natural and organic personal care products. Natural cosmetics market themselves as containing plant or mineral ingredients; organic products say they are made with agricultural ingredients grown without pesticides.

During the 12 months through Sept. 9, Americans spent $150 million on the top three mass-market natural personal care brands, including Burt’s Bees, Jason Natural Cosmetics and Tom’s of Maine, an increase of $51 million over the year before, according to Information Resources Inc., a market research firm. Meanwhile, sales of organic personal care items reached $350 million last year, an increase of $68 million over 2005, according to manufacturers’ data compiled by the Organic Trade Association, an industry group.

“We’re seeing an increased consciousness that what you put on your body is as important as what goes in your body,” said Jeremiah McElwee, the senior coordinator in charge of personal care at Whole Foods, which is the company’s fastest-growing department. “The biggest impetus for buying natural or organic body care is the perceived health benefit.”

It would seem logical to assume that common ingestible ingredients like olives or soy would naturally be healthier for the skin and body than hard-to-pronounce, multisyllabic industrial cosmetic ingredients like the preservative methylchloroisothiazolinone. But representatives for the government and the beauty industry, as well as some environmental activists, acknowledge that there is no published scientific proof to support the notion that plant-based cosmetics are safer, healthier or more effective for people.

“Consumers should not necessarily assume that an ‘organic’ or ‘natural’ ingredient or product would possess greater inherent safety than another chemically identical version of the same ingredient,” Dr. Linda M. Katz, the director of the Food and Drug Administration’s Office of Cosmetics and Colors, wrote in an e-mail message to this reporter. “In fact, ‘natural’ ingredients may be harder to preserve against microbial contamination and growth than synthetic raw materials.”

The confusion over the “truthiness” of the natural personal care market also stems from the lack of national standards.

The F.D.A., which regulates cosmetics, has never imposed standard definitions for marketing terms like natural and organic as they apply to grooming products, Dr. Katz said via e-mail. So manufacturers are free to use such terms on everything from a synthetic-based shampoo with one plant derivative to a synthetic-free face powder formulated with only minerals.

The agency requires manufacturers to ensure that cosmetics are safe for their intended use. But the agency leaves it up to manufacturers to decide which safety and efficacy tests to perform on ingredients and finished products.

John Bailey, the executive vice president for science of the Cosmetic, Toiletry and Fragrance Association, a trade group in Washington, said cosmetics are safe, whether their formulas contain synthetics or plants.

“On the most fundamental level, they are held to the same legal and regulatory standards,” said Dr. Bailey, who has a Ph.D. in chemistry.

But Jane Houlihan, the vice president for research of the Environmental Working Group, a nonprofit group in Washington, said the lack of established federal standards is responsible for consumer confusion over whether natural products provide tangible advantages or are simply a sop to green mind-sets.

“Even if a beauty product claims it is purely from the earth, you need to read the ingredient label,” Ms. Houlihan said.

Ms. Houlihan said increased consumer interest in natural products is driving a few manufacturers to include exotic plants in formulas that lack an established track record in the beauty industry. For example, she said, her group could not find published safety data on newer cosmetic ingredients like West Indian rosewood bark oil and white peony flower extract.

“Just because an ingredient comes from a plant does not necessarily make it safe to use in a cosmetic,” Ms. Houlihan said. “Tobacco, hemlock and poison ivy are all examples of plants that can be hazardous.”

Indeed, some dermatologists said that even natural ingredients that seem benign can cause skin allergies. For example, Dr. David A. Kiken, a chief dermatology resident at the school of medicine at the University of California, San Diego, said he had seen skin irritation caused by tea tree oil, chamomile and green tea in cosmetics.

“Although the term natural botanical extracts inherently purports to have beneficial and benign properties, these extracts can cause adverse reactions in individuals,” Dr. Kiken wrote in a paper published in the American Journal of Contact Dermatitis.

In the absence of F.D.A. standards, dozens of beauty companies and stores are using words like botanical, herbal, natural, pure and organic to market brands, each using its own in-house definition.

For example, on www.sephora.com, the company distinguishes between botanical brands that use some plant ingredients; natural brands that eschew synthetic preservatives, colors and fragrances; and organic brands that employ some plant ingredients grown without pesticides.

Other brands style themselves as organic to signal ultimate wholesomeness. Even then, definitions vary widely. Some beauty companies simply employ organic in their brand names. Others promote certain ingredients that have been vetted by private companies that inspect organic foods.

A few brands — including Origins and Nature’s Gate — have even received certification for some products from the National Organic Program, the division of the Department of Agriculture whose logo appears on certified organic food products. Cosmetics are eligible to use such food seals if they contain at least 95 percent of certified organic ingredients that are agricultural products made from livestock or crops, grown and processed without chemical fertilizers, pesticides, growth hormones and antibiotics.

But people should not interpret even the U.S.D.A. Organic seal — www.ams.usda.gov/nop/FactSheets/Backgrounder.html — on cosmetics as proof of health benefits or of efficacy, said Joan Shaffer, a department spokeswoman. Government-accredited certifiers simply vet the manner in which these food ingredients are grown and processed, just as they would for a jar of organic tomato sauce, she said.

“The National Organic Program is a marketing program, not a safety program,” Ms. Shaffer said, likening the department’s organic seal to its grading system for beef. “Steak may be graded prime, but that has no bearing on whether it is safe or nutritious to eat.”

Source: New York Times, 11/1/07

Fatal prescription errors becoming more common

When Chanda Givens found out she was pregnant, she did what most expectant mothers would do: She went out to fill her prescription for prenatal vitamins.

When she miscarried within a few weeks of taking the drug, Givens said it never occurred to her the prescription might be the cause. She later learned that instead of being given a prescription for Materna, a prenatal vitamin, she received one for Matulane, a chemotherapy drug used to treat Hodgkin's disease, according to a lawsuit filed this month in federal court.

The drug is intended to interfere with cell growth and DNA development, according to the lawsuit.

Givens said her prescription was filled at a Walgreens pharmacy near her suburban St. Louis, Missouri, home. Walgreens said it's reached a resolution with the family and declined further comment.

Every year in the United States, 30 million dispensing errors out of 3 billion prescriptions occur at outpatient pharmacies, according to the National Patient Safety Foundation. Some errors are minor. Some patients catch easily. But others can be serious.

"There's been a tremendous increase in fatal pharmacy errors over the past 20 years," said David Phillips, a sociology professor at the University of California-San Diego who has studied this issue. "And the increase is much bigger for outpatient pharmacies than for inpatient pharmacies."

Why the increase? Phillips said more health care is happening outside hospitals, putting more of a burden on outpatient pharmacists. Here, from Phillips and other experts, are ways to avoid becoming a victim:

* Don't get a prescription filled at the beginning of the month.

Phillips' research shows that in the first few days of each month fatalities due to medication errors rise by as much as 25 percent above normal. The reason: Social Security checks come at the beginning of the month.

"Quite a number of people can't afford to get their medicines until the Social Security check comes in, so at the beginning of the month they turn up in abnormally large numbers and swamp the pharmacists," Phillips said. "When pharmacists are busy, they make more mistakes."

Of course, it's not always possible to wait a week or two to get a prescription, but Phillips advises to do so if you can.

* Open the bottle at the pharmacy.

Mitch Rothholz, a spokesman for the American Pharmacists Association, said pharmacy errors aren't common, but that there are things patients can do to make sure the medicine inside a bottle is the right drug.

He said opening the bottle right at the pharmacy and showing the pills to the pharmacist is one safeguard. Another: If it looks different than the medicine you've taken before, or you have any questions, don't be afraid to ask the pharmacist.

* Don't be in a rush.

"When picking up drugs, patients want to get in and out quickly," said Hedy Cohen, a spokeswoman for the Institute for Safe Medication Practices. "We care if our food has butter or margarine on it. We really should be much more careful about the medications we put in our mouths."

Cohen said patients should take the time to get detailed instructions about how to take a drug. Errors happen not just when the wrong medicine is dispensed, but when the right medicine is taken at the wrong dosage.

Cohen added that pharmacies can take additional steps, too. For example, many drug names look alike.

Cohen suggests writing in capital letters the portions of drug names similar to other medications to make distinctions more clear and to prevent errors. Commonly confused drugs

The Institute for Safe Medication Practices has suggestions for making abbreviations clearer, too. For example, when a doctor writes "q.o.d." on a prescription, that means the pharmacist should instruct the patient to take the medicine every other day. That abbreviation could be mistaken for "q.d.", which means daily. The solution: Physicians should write out "every day" or "every other day."

Source: CNN, 10/25/07

Ahead of the Bell: Cold medicine makers

One week after the nation's largest over-the-counter drug makers pulled cold medicines designed for infants off the market, companies will make the case Thursday that the treatments are safe and effective for toddlers.

The Food and Drug Administration will ask a panel of outside experts Thursday and Friday whether popular cold medicines are medically appropriate for young children. After a review of data, FDA scientists recently said the treatments should not be given to children under two because of the risk of accidental overdose. The agency will ask its advisers whether current labeling advising parents to "consult your physician" should be replaced with the instructions "do not use in children under two."

In response to the safety concerns, Johnson & Johnson, Wyeth and others withdrew products last week that target infants. However, public health advocates are expected to tell FDA that the companies haven't gone far enough.

The American Academy of Pediatrics, whose president will speak at the meeting, has said there is no evidence cold medicines are effective in children up to six years old -- and product labeling should state that. The pediatrics group and others also want FDA to prohibit companies from using images of toddlers to market their cold medications.

Scientists from Johnson & Johnson and other industry representatives are expected to argue that the treatments are effective in toddlers, while acknowledging that additional studies are needed to prove this.

FDA agreed to have its panel of experts review data on cold medicines at the request Baltimore city officials, who reported 900 Maryland children under four overdosed on the products in 2004.

FDA is not required to follow the recommendations of its panelists, though it usually does.

Source: Business Week, 10/18/07

FDA: Kids' Medicines NOT Recommended

They are widely available in drugstores across the country -- over-the-counter cold and cough remedies, with fruity flavors specifically marketed for kids.

But, there's a growing consensus that these medicines may not always be safe — and for young children, aren't worth the risks.

In a report released last week, safety experts within the Food and Drug Administration said they would recommend NO level of dosage for children under the age of two, "due to the lack of evidence of efficacy and safety concerns."

"There are a variety of problems that can occur, and there have been some deaths associated with cough and cold preparations," says Dr. Janet Serwint, who signed a petition, asking the FDA to warn parents about the dangers of these medicines.

Even more amazing, the industry itself — while insisting its medicines are safe — now agrees they should not be given to very young children.

"Parents should not use these products for children under 2," says Linda Suydam, president of the Consumers Healthcare Products Association.

Suydam says the real problem is "misuse" and "overdose." The labels on most boxes suggest that parents "consult with a doctor" about the appropriate dosage for children under the age of 2. The FDA review called that warning "confusing," and said it appeared to be contributing to "medication errors, which can result in fatal overdoses."

Overall, the review found 54 reported deaths from decongestants over the past four decades, most in children under the age of 2.

Experts say they believe the FDA may finally take action when it meets to discuss the matter next month.

Josslyn Goldner knows how dangerous over-the-counter medication can be. Her son, Max, wound up in the emergency room after he took the prescribed dose of a popular kids' medicine — one that isn't even under FDA review.

She says she has learned to be wary.

"I'm trying to be a little bit more selective and proactive, and not assume that companies that are in the business to make money, are going to actually be worrying so much about my child," Goldner says.

Source: ABC News, 9/30/07