Clinical Consumption of Compound Opioid Analgesics in China: A Retrospective Analysis of National Data 2015-2018.

Compound opioid analgesics (COA) are widely used for cancer pain relief, but few studies investigated the use of that. We aimed to report the characteristics and trend of COA consumption in different regions and health facilities in China. The procurement data of two types of COA, compound codeine phosphate (CCP) and oxycodone and acetaminophen (OAA), in all medical institutions of 20 provinces from 2015 to 2018 were used. Data were presented as defined daily dose for statistical purpose (SDDD) and expenditures per million inhabitants per day. The annual consumption of COA and ratio of two combinations were compared among regions and institutions. We found, during 2015-2018, COA consumption increased at an average rate of 7.32% in SDDD and 19.19% in expenditures, while OAA accounted for most of the consumption. Highest COA consumption appeared in Northern China, with 121.72 SDDD and 1689.87 RMB (2015), whereas the lowest COA consumption was only 11.28 SDDD appearing in Southern China. The ratio of OAA and CCP (in SDDD) was highest in Southern China (53.14 in 2018), whereas lowest in West North (0.37 in 2018). In terms of institutions, tertiary had the highest COA consumption, with 16.74 SDDD and 292.73 RMB (2018). The SDDD of OAA was 27.44 times of that of CCP in tertiary, while it was only 0.11 in primary. Overall, COA consumption is on an upward trend and different among regions and health institutions in either amount or types of COA. These findings call for establishment of COA management regulations.

Was William Harvey's commitment to experimentation reflected in his clinical practice?

The physician and physiologist Dr William Harvey is known for having discovered that the heart pumps arterial blood round the whole body and receives venous blood from the periphery, which it forwards to the lungs for reoxygenation. Harvey's discovery was based on anatomical and physiological evidence and experiments using ligatures of varying tensions. As a clinician, however, Harvey does not appear to have appreciated the value of experiments in assessing treatment effects. Although he criticised Galenic views about the clinical value of experience and authority in the absence of accompanying empirical evidence, two handwritten prescriptions that he wrote for his friend and future biographer John Aubrey provide evidence that he conformed with Galenic theory when it came to drug therapy in clinical practice. This was consistent with his senior position in the College of Physicians, whose Pharmacopoeia Londinensis was based on Galenic principles, an appreciation of which was required for entry into the College. Harvey's prescriptions reflect this and open a window onto 17th-century therapeutic practice and the personal elements on which such practice was sometimes based.

The British Pharmacological Society's WDM Paton Memorial Lecture 2019: How doctors were informed about pharmaceutical products through advertising in the British Medical Journal from 1955/6 to 1985/6.

We have reviewed pharmaceutical advertisements in every available issue of the British Medical Journal (BMJ) in 12-month periods during 1955/6, 1965/6, 1975/6, and 1985/6. We have determined the amount of advertising, the therapeutic areas covered, and whether adverts reflected the large number of New Chemical Entities (NCEs) launched during that time. For each product we recorded the therapeutic indications, the marketing company, and the number of adverts appearing. The total number of products advertised fell from 340 in 1955/6 to 260 in 1965/6, 70 in 1975/6, and 16 in 1985/6. Advertisement numbers and companies advertising also fell. Antimicrobial drugs and cardiovascular drugs were the top products advertised over the 30 years, with respiratory, analgesic, and gastrointestinal drugs also in the top five. The number of different drugs advertised by individual companies fell from around eight per company in 1955/6 to one or two in 1985/6. There was good concordance between the most advertised therapeutic areas and NCEs entering the market. From the 1950s to the 1980s prescribers were extensively informed about pharmacological advances in therapeutics through BMJ advertisements. Many novel drugs that were advertised proved to be of lasting value. The Medicines Act 1968 introduced product licensing, regulations requiring demonstration of quality, efficacy, and safety, and restrictions on advertising. Subsequently many companies reduced their advertising or stopped altogether. Since advertising influences prescribing, and since antimicrobial drugs were the most commonly advertised products during 1955-86, we speculate that advertising, resulting in excess use, may have, at least partly, driven bacterial drug resistance.

Antibiotic resistance and antibiotic prescribing by dentists in England 2007-2016.

The early prescribers of penicillin realised that antibiotics should be used wisely and as an adjunct to traditional surgical provision. They predicted that inappropriate use would increase sensitisation to the drug. National Health Service dentists prescribed almost 10% of antibiotics issued in NHS general practice in 2016 and an audit shows that many of these may have been prescribed inappropriately. One of the causes of antimicrobial resistance is over prescription of the drugs. This paper recalls the recommendations of some early users of penicillin, reports on the current prescription patterns of dentists in England, describes the mechanism of acquisition of anti-microbial resistance and discusses dentists' role in attempting to reduce the problem.

Does the doctrine of double effect apply to the prescription of barbiturates? Syme vs the Medical Board of Australia.

The doctrine of double effect (DDE) is a principle of crucial importance in law and medicine. In medicine, the principle is generally accepted to apply in cases where the treatment necessary to relieve pain and physical suffering runs the risk of hastening the patient's death. More controversially, it has also been used as a justification for withdrawal of treatment from living individuals and physician-assisted suicide. In this paper, I will critique the findings of the controversial Victorian Civil and Administrative Tribunal (VCAT) hearing Syme vs the Medical Board of Australia In that hearing, Dr Rodney Syme, a urologist and euthanasia advocate, was defending his practice of prescribing barbiturates to terminally ill patients. Syme claimed that he prescribed the drugs with the intention of relieving their existential suffering and not to assist in suicide; he argued that the DDE could be applied. Pace VCAT, I argue that this is an illegitimate application of DDE. I argue that a close scrutiny of Syme's actions reveals that, at the very least, he intended to give patients the option of suicide. He furthermore used what on a traditional definition of DDE would be considered a 'bad' means-the prescription of Nembutal-to achieve a 'good' end-the relief of suffering. The case demonstrates the crucial importance of analysing an agent's 'intention' and the 'effects' of their actions when applying DDE. Ethicists and, indeed, the judiciary need to attend to the ethical complexities of DDE when they assess the applicability of DDE to end of life care. If they fail to do this, the doctrine risks losing its legitimacy as an ethical principle.

[Criticism of physicians by Johannes Gregorius Macer Szepsius (1530-after 1579)]. / Johannes Gregorius Macer Szepsius (1530-1579 után) kritikája az orvosokról.

Humanist author J. G. Macer Szepsius (1530-after 1579) born in Szepsi, Upper Hungary (today Slovakia, Moldava and Bodvou) lived in Krakow and was a typical author of Latin occasional poetry. In a part of his work De vera gloria libellus (Booklet on the true glory) published in 1562 he deals with certain professions and criticizes them. Physicians are described as being garrulus (loquacious), mendicus (beggar), and having a big belly due to a luxury. The Physician doesn´t read books, is lazy and not characterized by his knowledge, but rather by ignorance, arrogance and pride. Physicians prescribe medications without knowing their effects. Such a criticism is surprising, because Macer Szepsius was probably closely related to medicine.

The medical treatment of Maria, Dowager Empress of the Russian Empire: an analysis of her prescription book from 1807 and 1808.

This study analyzes the medicines that were used to treat the Dowager Russian Empress Maria, widow of Tsar Paul I, and describes the doctors who cared for her health in 1807 and 1808. The source for this research was the imperial court pharmacy prescription book 1807-1811. Hypotheses about the diseases and medical problems of the Empress and how treatment for her differed according to circumstances, particularly after the loss of her granddaughter Princess Elizabeth, have been made based on the prescriptions recorded in the book. The content of the prescriptions suggests that the Empress suffered from gastrointestinal tract disorders, skin and eye diseases, neuralgic pains and insomnia. Foreign physicians educated in European universities worked at the imperial court and implemented European medical traditions. They took high positions in the administration and the medical education system, and gradually spread their experience and modern knowledge to Tsarist Russian society.

Mistress Joyce Jeffreys and her physician, Dr Bridstock Harford (1607-1695).

The notebooks of Joyce Jeffreys, a wealthy Hereford businesswoman in the mid-17th century, provide information about the medicines she purchased and the fees she paid to her medical advisors. Her physician, Dr Bridstock Harford, was a successful doctor but a troublesome neighbour, who was often the subject of litigation. As an ardent parliamentarian, he held public offices during the Commonwealth. Later his opinions mellowed and he ended his days as a loyal subject of the king and a benefactor to his city.

[Removal of weremit from the abdomen. Interpretation and efficacy of an ancient Egyptian prescription by the newest scientific results]. / A weremit kiuzése a hasból. Óegyiptomi recept hatásosságának értelmezése az újabb kutatási eredmények alapján.

Significant percentage of today's knowledge of ancient Egyptian medicine has been acquired from papyri left behind from various periods of Egyptian history. The longest and the most comprehensive is the Ebers papyrus, kept at the University Museum of Leipzig, which was written more than one thousand years before Hippocrates (c. 460-377 BC). One of the riddles among the prescriptions of the Ebers papyrus Eb20 has been used in order to remove the so called "wemyt" weremit from the abdomen with the help of a drink, which consists of "jnnk", Conyza dioscoridis in milk or sweet beer. The authors assume that the disease could be an infection of Schistosoma haematobium and/or Schistosoma mansoni. Nowadays the tea of Conyza dioscoridis is widely used as an important part of traditional medicine against rheumatism, intestinal distention and cramps, as well as an antiperspirant, and with external use for wound healing. The authors' intent is to interpret the efficacy of the above-mentioned ancient prescription with the help of modern medical and pharmaceutical knowledge.

[Mining analysis on composition and medication of menstruation prescriptions in Fu Qingzhu's Obstetrics and Gynecology].

In this paper, menstruation prescriptions were selected from "Fu Qingzhu's Obstetrics and Gynecology" and analyzed by using GRI algorithm, correlation analysis, hierarchical clustering method through SPSS, Clementine and traditional Chinese medicine (TCM) inheritance auxiliary systems, in order to screen out 15 menopathy prescriptions, which involve 45 traditional Chinese medicine herbs. In the study, blood-tonifying and qi-tonifying herbs were found to be frequent in the prescriptions. The most frequent single herb was white paeony root, accounting for 9.6% in the total number of prescriptions; The most frequent herb pairs were white paeony root-radix rehmanniae preparata and paeony root-angelica sinensis. Among Fu Shan's menopathy prescriptions, 61 herbal pairs showed a correlation coefficient exceeding 0.05, which evolved into 16 pairs of core combinations. The analysis showed that menopathy prescriptions in volume 1 of "Fu Qingzhu's Obstetrics and Gynecology" focused on tonic traditional Chinese medicines involving liver, spleen and kidney and were adjusted according to changes in qi, blood, cold, hot and wet, which could provide a specific reference for further studies on Fu Shan's academic thoughts and traditional Chinese medicine clinical treatment of menopathy.

[Chinese classical formulas for treatment of essential hypertension].

Essential hypertension is one of the most prevalent and important public health concerns in both westernized and developing countries. Recent studies have demonstrated that successful long-term treatment of hypertension has a significant impact on morbidity and mortality from cardiovascular diseases (CVDs) and stroke. Chinese classical formulas, which are important components of traditional Chinese medicine (TCM), have been increasingly accepted by patients with CVDs worldwide. According to TCM theory and syndrome differentiation, hypertension could be categorized into 3 patterns including fire syndrome, fluid retention syndrome, and deficiency syndrome. Chinese classical formulas, including Chaihu Jia Longgu Muli tang, Tianma Gouteng yin, Zhen Gan Xifeng tang, Banxia Baizhu Tianma tang, Liu Wei Dihuang wan, etc, play an important role in the treatment of essential hypertension, which could be further research priorities.

Medicines produced in Telsiai pharmacy (Vilnius governorate): analysis of prescription book from 1830.

The Museum of the History of Lithuanian Medicine and Pharmacy has a prescription book by a pharmacist Teodor. Geldner from Telsiai (the tsarist Russia's Lithuanian Vilnius Governorate), dated 1830. Each medication that was produced at the pharmacy had to be registered in this book. The entries included the composition of the drug, its form, usage, price, the physician's name, and (sometimes) the method of production. This paper presents the content analysis of this book. The study revealed which medicines were used for the treatment of patients back then, which principles of therapy predominated, and what the social status of the patients was.

[Regularity of drugs compatibility of anti-hepatoma traditional Chinese medicine ancient prescriptions and risk evaluation of anti-hepatoma new drug research and development].

Traditional Chinese ancient prescriptions have been used for treatment of liver cancer for a long history and the scientific and rational compatibility is a great wealth for modern research and development (R&D) of new drugs. The research and development of new drugs are often accompanied with a large investment, a long cycle and a high risk, especially for the anti-tumor drugs R&D which are facing more risks and lower successful rate. In this research, the regularity of compatibility of drugs was analyzed from 124 anti-hepatoma ancient prescriptions by computer program. The results can offer help to the R&D of anti-hepatoma new drugs and reduce the risk of drug screening. In addition, we surveyed 22 companies in this field from six provinces such as Beijing, Shanghai, Tianjin and so on and obtained 240 risk assessment questionaires. Then we used qualitative analysis method to interpret the greatest impacts for the risks in the process of R&D, production and sales of anti-hepatoma new drugs. The study provides a basis for anti-liver cancer drugs R&D researchers, who can take effective measures to reduce the R&D risks and improve successful rate.