Ill. high court considers pharmacy rules
Tue, 18 Mar 2008 22:15:16 GMTBy JOHN O'CONNOR, Associated Press Writer
SPRINGFIELD, Ill. - A group of pharmacists asked the Illinois Supreme Court on Tuesday to throw out a rule that forces them to dispense emergency contraception despite moral objections, claiming it amounts to illegal coercion.
Gov. Rod Blagojevich issued the rule in 2005, prohibiting pharmacies from turning away women seeking emergency contraception. The medicine is a higher dosage of typical hormonal contraception, and if taken within three days of having sex it greatly reduces the chance of pregnancy.
Pharmacists who do not want to dispense the drug say it is tantamount to abortion. The closely watched case mirrors concerns raised in other states.
The druggists argued that Illinois law protects them from choosing between violating their consciences and losing their licenses, and that they shouldn't have to wait until they're out of jobs to seek justice.
A lawyer for Blagojevich argued that the pharmacies in the lawsuit don't have standing to sue because they have suffered no repercussions. Laura Wunder, an assistant state attorney general, also said those pharmacies don't even stock so-called "morning-after" medication, so it's unlikely they would violate the rule.
In oral arguments, however, justices bluntly pointed out to Wunder that the pharmacies must get the drug if requested — and that their licenses would be at risk if they failed to comply.
Wunder countered that the pharmacies have been unable to show that they're in jeopardy of state penalties because it's unlikely that a customer would ask a drug store to order a medicine that is needed right away.
The pharmacists' lawyer, Mark Rienzi, said his clients should be able to sue even if they haven't suffered repercussions.
Rienzi argued they are protected by two state laws: one that prohibits forcing health care decisions over moral objections, and one insulating citizens from religious interference.
"They are designed to protect people from coercion and burden," Rienzi said. "They are not only designed to protect people after the ax has fallen, after your license is taken away, after your career is ruined."
Since the pharmacists sued in 2005, a pharmacy owned by one plaintiff closed because no pharmacist would work there under the state's threat of license revocation.
Rienzi said outside of court that generally, customers who are denied the drug have accepted that they had to go elsewhere for it, although they could have complained and forced state sanctions on the stores.
A federal judge suspended a similar requirement in Washington state in November but said pharmacists who refuse to dispense the morning-after pill must refer the customer to another nearby source. That case is on appeal.
The Illinois rule led to several lawsuits, including one in federal court that was settled by a compromise in which objecting pharmacists wouldn't have to participate in filling the prescription. In such cases, a pharmacy employee would contact a pharmacist at another location, then follow his or her directions for dispensing the morning-after pill.
That rule needs approval from the legislative Joint Committee on Administrative Rules, which could decide next month, said Sue Hofer, spokeswoman for the state Department of Financial and Professional Regulation.
Rienzi said approval of that rule would help individual pharmacists, who could opt out. But he said that the rule would require all pharmacies to stock the drug and that his clients are pharmacy owners who don't want the drug in their stores at all.
Boehringer inhaler may raise stroke risk
Tue, 18 Mar 2008 21:50:27 GMTWASHINGTON - Drug maker Boehringer Ingelheim has told regulators that patients using its respiratory inhaler may face a greater risk of stroke.
The Food and Drug Administration said Tuesday that data submitted by the German drug maker show a slightly higher rate of stroke for patients using its Spiriva Handihaler, compared with a placebo. FDA said it has not yet analyzed the figures, which were compiled from 29 patient studies.
According to the company's analysis, two out of every 1,000 patients using Spiriva are at risk for stroke.
Boehringer jointly markets the Spiriva inhaler with Pfizer Inc. The device is approved to treat chronic obstructive lung disease, including chronic bronchitis and emphysema.
Boehringer is expected to report more safety data in June.
Until then, FDA recommends that doctors and patients report any side effects of inhaler use.
Shares of New York-based Pfizer Inc. rose 22 cents Tuesday to $20.79 in afternoon trading.
Cocaine may cause heart attack symptoms
Tue, 18 Mar 2008 21:51:10 GMTBy JAMIE STENGLE, Associated Press Writer
DALLAS - Younger ER patients with heart attack symptoms should be asked if they've recently used cocaine, which can cause similar chest pain, the American Heart Association warns doctors. For these patients, honesty can be a matter of life or death: Some heart attack treatments can be deadly to someone using cocaine.
New guidelines published online Monday in the American Heart Association journal Circulation say that emergency room doctors need to be aware that symptoms of a heart attack in younger patients with no heart disease risk factors may be caused by cocaine use.
The drug can cause chest pain, shortness of breath, anxiety, palpitations, dizziness, nausea and heavy sweating — all symptoms of a heart attack.
"Not knowing what you are dealing with and giving the wrong therapies could mean death rather than benefit," said Dr. James Reiffel, professor of clinical medicine at Columbia University Medical Center/New York Presbyterian Hospital.
The number of cocaine-related users visiting ERs rose 47 percent from 1995 to 2002, increasing from 135,711 to 199,198, according to the government's Substance Abuse and Mental Health Services Administration.
"The symptoms that they get with the cocaine are very similar to a heart attack," said Dr. James McCord, who chaired the statement writing committee.
Cocaine can cause a heart attack, but only about 1 percent to 6 percent of patients with cocaine-associated chest pain actually have a heart attack, the statement says. Still, doctors say it's important for anyone with chest pain to get it checked out.
Cocaine increases blood pressure and the heart rate, constricting arteries into the heart, said McCord, cardiology director of the chest pain unit for the Henry Ford Health System in Detroit.
"Your heart rate goes up because your heart needs more oxygen, then it shrinks the arteries to the heart," McCord said.
The statement says that since most cocaine-associated chest pain isn't a heart attack, such patients should be monitored instead of being admitted to the hospital. They would have an electrocardiogram and other tests to rule out a heart attack.
"If you admit everyone to hospital with chest pain, you use valuable resources," said Reiffel.
Two typical heart attack treatments can be dangerous to those using cocaine:
• Clot-busting drugs carry an extra risk of bleeding into the brain in patients whose blood pressure is high due to cocaine use.
• Betablockers that can lower blood pressure without constricting arteries in typical heart attack patients have the opposite effect in cocaine users, raising blood pressure and squeezing cocaine-narrowed arteries.
Reiffel said doctors should explain why it's important to know if a patient is using cocaine. He said that admitting use of an illegal substance is confidential information that won't be reported to law enforcement. "The caregiver is not here to judge."
The statement also recommends that cocaine users who do have a coronary artery blockage get a bare metal stent instead of a drug-coated one since chronic drug users may not reliably take the medication needed to prevent new blockages.
McCord said that the drug counseling available in observation units varies among hospitals, and that more could to improve the counseling cocaine-using patients get.
"I think an ideal scenario would be someone whose job is to talk to them about this — explain the extent of the health problems, give them information about resources to help them quit cocaine," McCord said.
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On the Net:
American Heart Association, http://www.americanheart.org
