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7 June 2005 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians. These highlights are not intended to substitute for articles as sources of information. For an embargoed copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656. Leave fax or e-mail and article topics.

Using Generic Instead of Brand-Name Drugs Could Save $8.8 Billion/Year

U.S. adults could save as much as $8.8 billion per year by using generic drugs rather than brand name drugs, an analysis of data from a 2000 national medical expenditure survey found (Article, p. 891). Using only drugs that had both a brand-name and at least one identical generic formulation, researchers estimated that people younger than 65 years would save an average of $45.89 per year and those older than 65 would save $78.05. The authors note that although the "absolute per person savings would be small," the overall savings would equal about 11 percent of all drug expenditures for adults in the United States each year and could reduce costs without hindering quality of care.

Researchers Find 1991 Gulf War Combatants Have 4 Health Conditions More Often than Non-Combatants

Ten years after the 1991 Gulf War, researchers physically examined a sample group of veterans who had been deployed to the Gulf and a comparable group that were not deployed or had served elsewhere (Article, p. 881). Looking for 12 medical conditions, researchers found only four more common among deployed than nondeployed veterans: fibromyalgia, chronic fatigue syndrome, skin rashes and indigestion or heartburn. Conditions such as high blood pressure, diabetes, hepatitis and obstructive lung disease were not more common among the deployed veterans. An editorial writer says that the four conditions do not constitute a unique syndrome (Editorial, p. 938). But the writer notes that similar symptoms have been reported "after every armed conflict since the Civil War," and no systematic investigation has been made. "A country that sends its young people to war has an obligation to study all illnesses that occur in the aftermath of war, not just traumatic injury," the writer says.

HCV Outbreak in a Cancer Clinic Attributed to Negligent Infection Control

Reuse of disposable syringes in an outpatient cancer clinic between March 2000 and July 2001 infected 99 people with hepatitis C virus, a new study finds (Article, p. 898). Standard infection-control recommendations are to use sterile, disposable needles and syringes for every injection. While hospitals are obligated to implement infection control programs, out-patient, ambulatory or freestanding facilities, where most of today's patients are treated, are generally not subject to similar requirements. The authors say that infection-control programs for outpatient care settings must be developed and implemented. These must include standards for rigorous training and oversight of health care workers, and clear procedures and responsibilities for reporting and investigating outbreaks. Editorial writers call the sharing saline bags and reusing syringes in the study situation "egregious" and the failure of the hospital (in which the for-profit clinic was located) to report early suspected cases to the state health department or to the Centers for Disease Control and Prevention "unconscionable" (Editorial, p. 861). The editorial writers say that this study is a "sobering reminder of the shortcomings in our existing policies, our safety net systems, and our sense of personal responsibility to provide safe care."

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