Effect of antihypertensive samples on physician prescribing patterns.

OBJECTIVE: This study evaluated the effect of pharmaceutical samples on the prescribing habits of family practice residents and faculty in the treatment of hypertension. METHODS: Charts from two time periods were reviewed for a diagnosis of hypertension--January and February 1997 when drug samples were available and January and February 1998 when sample distribution was prohibited. Progress notes were assessed for medication prescribed, patient age, and doctor seen. Prescribed antihypertensive medications were defined as first- or second-line drugs based on the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Comparisons were made between the two time periods and between faculty and residents. RESULTS: Overall, faculty were much less likely than residents to prescribe first-line medications: 43% versus 57%. Following prohibition of sample distribution, there was an increase in first-line antihypertensive use from 38% to 61%. CONCLUSIONS: The prescription of first-line drugs for the treatment of hypertension increased after drug sample distribution was prohibited. Studies are needed to determine the extent to which drug sample availability affects prescription practices.

Surveillance and control of zoonotic agents prior to disease detection in humans.

The majority of newly emerging diseases are zoonoses caused by pathogens transmitted directly or indirectly through arthropod vectors to humans. Transmission chains leading to human infection frequently involve intermediate vertebrate hosts, including wildlife and domestic animals. Animal-based surveillance of domestic and wild animals for zoonotic pathogens is a global challenge. Until recently, there has been no scientific, social, or political consensus that animal-based surveillance for zoonotic pathogens merits significant infrastructural investment, other than the fledgling efforts with avian influenza. National institutions charged with strategic planning for emerging diseases or intentional releases of zoonotic agents emphasize improving diagnostic capabilities for detecting human infections, modifying the immune status of human or domestic animals through vaccines, producing better antiviral or antibacterial drugs, and enhancing human-based surveillance as an early warning system. With the exception of human vaccination, these anthropocentric approaches target post-spillover events, and none of these avenues of research will reduce the risk of additional emergences of pathogens from wildlife. Novel schemes for preventing spillover of human pathogens from animal reservoir hosts can spring only from an understanding of the ecological context and biological interactions that result in zoonotic disease emergence. Although the benefits derived from investments to improve surveillance and knowledge of zoonotic pathogens circulating among wildlife reservoir populations are uncertain, our experience with human immunodeficiency virus and the pandemic influenza inform us of the outcomes that we can expect by relying on detection of post-spillover events among sentinel humans. Mt Sinai J Med 76:421-428, 2009. (c) 2009 Mount Sinai School of Medicine.