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Biomedical subjects

Richard Laing

Publications and source records attributed to Richard Laing.

11 recordsLinked to original sources
PubMed2006

Māori have a much higher incidence of community-acquired pneumonia and pneumococcal pneumonia than non-Māori: findings from two New Zealand hospitals.

To determine the incidence rates of community-acquired pneumonia and pneumococcal pneumonia requiring hospitalisation among Maori and non-Maori, an observational study was conducted in Christchurch and Hamilton. Self-reported data were collected using an interviewer-administered questionnaire. Routine clinical, radiological, and microbiological techniques were used apart from the BinaxNow pneumococcal antigen test for diagnosis of this infection. Census data was used to determine the denominator for statistical analyses. The pneumonia rate overall was 3.03 times higher among Maori than non-Maori (p<0.001). Differences were significant for each 10-year age group from age 45-74 years (p<0.05). The rate of pneumococcal pneumonia was 3.23 fold higher for Maori than non-Maori (p<0.001), but it did not reach statistical significance in the age-related comparisons. These ethnic disparities are of major concern, and policy planners should consider further interventions to improve the efficacy of current anti-smoking campaigns and to undertake studies of conjugate pneumococcal vaccines for Maori.

Adolescent↗
PubMed2005

Non-bacterial thrombotic endocarditis with a negative transesophageal echocardiogram.

Non-bacterial thrombotic endocarditis is a recognised complication of malignancy (occurring in 0.3-9.3% of patients in autopsy series), and is most commonly associated with lung cancer. We describe a fatal case of non-bacterial thrombotic endocarditis associated with stage IIIB adenocarcinoma of the lung in which the transoesophageal echocardiogram was negative. Recommendations for management of such cases are given.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed2003

25 years of the WHO essential medicines lists: progress and challenges.

The first WHO essential drugs list, published in 1977, was described as a peaceful revolution in international public health. The list helped to establish the principle that some medicines were more useful than others and that essential medicines were often inaccessible to many populations. Since then, the essential medicines list (EML) has increased in size; defining an essential medicine has moved from an experience to an evidence-based process, including criteria such as public-health relevance, efficacy, safety, and cost-effectiveness. High priced medicines such as antiretrovirals are now included. Differences exist between the WHO model EML and national EMLs since countries face varying challenges relating to costs, drug effectiveness, morbidity patterns, and rationality of prescribing. Ensuring equitable access to and rational use of essential medicines has been promoted through WHO's revised drug strategy. This approach has required an engagement by WHO on issues such as the effect of international trade agreements on access to essential medicines and research and development to ensure availability of new essential medicines.

Consumer Advocacy↗
PubMed2003

Prescribing practices of rural primary health care physicians in Uzbekistan.

Doctors prescribe medications for therapeutic indications and to meet patient expectations. Understanding the pattern of prescribing is a necessary precursor for any intervention and for improving prescribing practices. Using the WHO standard methodology, we investigated the prescribing practices of doctors in rural primary health care (PHC) clinics in the Ferghana region of Uzbekistan. Doctors in these clinics may have over-prescribed, prescribing 2.9 drugs per patient per encounter. Fifty-seven per cent of these were for injectable drugs, and 57% for antibiotics. Most prescriptions were for name brand (62%) rather than generic drugs.

Adolescent↗
PubMed2003

Paying for pharmaceutical registration in developing countries.

Fees charged by drug regulatory authorities (DRAs) may be used as a policy instrument to speed up regulatory approval, to encourage retention of quality staff and to stimulate introduction of generics versus new chemical entities. Often, the cost recovery function of these registration fees is not related to the true cost of the pharmaceutical regulatory process. In this paper, we scaled new drug registration fees of various DRAs to indices of economic development - the GNP per capita and the total government health expenditure per capita. Based on our analyses of 34 countries, most DRA registration fees for new drug applications for developing/non-OECD countries are less than the current GNP/capita of that country or are about US dollars 5000 for each US dollars 1000 spent per capita on healthcare. At present, each US dollars 1000 new drug registration fee for the developing/non-OECD countries analyzed corresponds to a total pharmaceutical market share of about US dollars 85 million. Our analyses further suggest little relationship between DRA registration fees and drug approval times in developing countries. The situation is complex, however, as policy tradeoffs are important to consider. Differential registration fees, presumably designed to encourage locally produced versus imported products, may violate international trade regulations. Moreover, certain DRA registration fees may provide perverse incentives for the pharmaceutical industry. Developing countries should require that DRA registration fees be based on accurate accounting of the cost of services provided. At present levels, these fees could be increased without disincentive to the pharmaceutical industry. For new drug registration fees, our analyses suggest that developing countries could charge between 1-5 times their GNP per capita or between US dollars 17000 and US dollars 80000 for each US dollars 1000 spent per capita on healthcare.

Developing Countries↗
PubMed2002

Drug development for neglected diseases: a deficient market and a public-health policy failure.

There is a lack of effective, safe, and affordable pharmaceuticals to control infectious diseases that cause high mortality and morbidity among poor people in the developing world. We analysed outcomes of pharmaceutical research and development over the past 25 years, and reviewed current public and private initiatives aimed at correcting the imbalance in research and development that leaves diseases that occur predominantly in the developing world largely unaddressed. We compiled data by searches of Medline and databases of the US Food and Drug Administration and the European Agency for the Evaluation of Medicinal Products, and reviewed current public and private initiatives through an analysis of recently published studies. We found that, of 1393 new chemical entities marketed between 1975 and 1999, only 16 were for tropical diseases and tuberculosis. There is a 13-fold greater chance of a drug being brought to market for central-nervous-system disorders or cancer than for a neglected disease. The pharmaceutical industry argues that research and development is too costly and risky to invest in low-return neglected diseases, and public and private initiatives have tried to overcome this market limitation through incentive packages and public-private partnerships. The lack of drug research and development for "non-profitable" infectious diseases will require new strategies. No sustainable solution will result for diseases that predominantly affect poor people in the South without the establishment of an international pharmaceutical policy for all neglected diseases. Private-sector research obligations should be explored, and a public-sector not-for-profit research and development capacity promoted.

Anti-Infective Agents↗