Medication insufficient for depression due to traumatic head injury

In a large clinical sample of patients with traumatic brain injury with symptoms of major depression, antidepressant medication has been shown to lead to remission of symptoms in a minority of patients.

"Although citalopram treatment was associated with a statistically significant reduction in depressive symptoms, the results of this study show the response rate in the present sample is substantially lower than previously reported in past research," says Dr. Mark Rapoport, lead investigator of the study and geriatric psychiatrist at Sunnybrook Health Sciences Centre. "Our findings suggest that other multidisciplinary treatment modalities will be needed to achieve adequate control of depressive symptoms following traumatic brain injury (TBI)."

The goal of the study was to examine the rates of response and remission in patients treated with a selective serotonin reuptake inhibitor (SSRI), citalopram in this case, for major depression following TBI.
In the past, open-label studies of SSRIs have shown statistically significant reductions on depression, but methodological problems in the studies and the small samples limited the ability to interpret the results.
Therefore the goal of this study was to assess the response of patients in a larger sample of clinical patients with mild-to-moderate TBI.

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Drug-therapy combo best for anxiety in kids -study

A combination of a common antidepressant and a specialized form of talk therapy offer the best treatment for children and youth with anxiety disorders, U.S. researchers said on Thursday.

The findings come from the largest study of anxiety in children yet and offer much-needed guidance about how best to treat young people with separation anxiety, social phobia and generalized anxiety disorder -- conditions that affect as many as 20 percent of children and teenagers in the United States.

The study "clearly showed that combination treatment is the most effective for these children," Dr. John Walkup of Johns Hopkins University in Baltimore, who worked on the study, said in a statement.

But he said either therapy alone or sertraline alone helped well. Sertraline is the generic name of Pfizer Inc's (PFE.N: Quote, Profile, Research, Stock Buzz) Zoloft, which is one of a class of antidepressants called selective serotonin reuptake inhibitors.

READ MORE @ REUTERS

Depression often untreated in black heart patients

African Americans with heart disease are as likely to suffer from depression as their white counterparts, but they are less likely to be on medication for it, a new study suggests.

The study of 864 adults with coronary heart disease found that 35 percent of African Americans and 27 percent of whites had symptoms of depression. Yet black patients were less than half as likely to be on an antidepressant medication.

The findings are important, the researchers say, because depression in people with heart disease has been linked to a two- to four-fold higher risk of complications.

Studies have found that depressed heart disease patients have higher risks of a heart attack or stroke, and may die earlier than those without depression.

READ MORE @ REUTERS

Anti-Inflammatory Medications May Become A Treatment For Schizophrenia

Many of the structural and neurochemical features of schizophrenia are present long before the full syndrome of schizophrenia develops. What processes tip the balance between the ultra-high risk states and the development of schizophrenia? One candidate mechanism is cerebral inflammation, studied by Dr. Bart van Berckel and colleagues in the November 1st issue of Biological Psychiatry.

Using positron emission tomography, or PET, imaging, the researchers provide evidence of a brain inflammatory state that may be associated with the development of schizophrenia. The authors reported increased binding levels of [11C]PK11195, a radiotracer with high affinity for the peripheral benzodiazepine receptor (PBR) in patients who had carried the diagnosis of schizophrenia for five years or less. PBR is a molecular target that is present at higher levels in activated microglia. Microglia are activated during inflammatory states. Drs. van Berckel and Kahn further explain: “It was found that microglia activation is present in schizophrenia patients early after disease onset, suggesting brain cells are damaged in schizophrenia. In addition, since microglia can have either a protective or a toxic role, activated microglia may be the result, but also the cause of damage to brain cells.”

READ MORE @ SCIENCE DAILY

Zyprexa and Seroquel Side Effects May Increase Heart Disease Risk

New research suggests that Zyprexa and Seroquel may increase the risk of heart disease when compared to other antipyschotic medications.

Eli Lilly’s Zyprexa (olanzapine) and AstraZeneca’s Seroquel (quetiapine fumarate) are both blockbuster medications which are part of a class of drugs known as “atypical” antipsychotics. They are commonly used to treat symptoms of schizophrenia, but have also been widely used for other conditions like bipolar disorder, dementia, autism and obsessive-compulsive disorders.

Both drugs have previously been linked to a number of serious side effects, including severe weight gain, diabetes and pancreatitis. However, a new study published in the October 2008 issue of the journal Schizophrenia Research raises the potential for concerns about a small increased risk of coronary heart disease associated with the drugs.

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States Taking Pharma to Court for Risky Antipsychotic-Prescribing Spree

Certain antipsychotics are leaving legions of children and elderly in chemical straightjackets for treatment of conditions they didn't even have.

Some state legislators are mad as hell and not going to take it anymore.

They've seen state outlays for controversial antipsychotics like Zyprexa grow as much as twelvefold since 2000, with a corresponding growth in side effects like weight gain, blood sugar changes and cholesterol problems.

In March, Alaska won a $15 million settlement from Eli Lilly in a suit to recoup medical costs generated by Medicaid patients who developed diabetes while taking Zyprexa.

Last year Bristol-Myers Squibb settled a federal suit for $515 million charging that it illegally hawked the antipsychotic Abilify to children and the elderly, bilking taxpayers.

Now Idaho, Washington, Montana, Connecticut, California, Louisiana, Mississippi, New Mexico, New Hampshire, Pennsylvania, South Carolina, Utah, West Virginia, Arkansas and Texas are taking pharma to court over its antipsychotic prescrib-athon that has left the poor and mentally ill in even worse health and legions of children and elderly in chemical straightjackets for treatment of conditions they didn't even have.

The atypical antipsychotics Zyprexa, Risperdal, Seroquel, Abilify and Geodon can be thought of as the credit swaps of the pharmaceutical world.

READ MORE @ ALTERNET

Coping With Depression During Pregnancy

Christine Doherty Ashley, currently six months pregnant, realizes that her first trimester was fraught with depression. Now, with the perspective of an improved mood, Ashley recalls being particularly judgmental of her doldrums, questioning, "Am I allowed to say I'm sad or that I hate how I feel?" Nausea kept her on the couch and logistics kept her isolated: She was a high school teacher on summer break, had just moved to a new town, and she and her husband were not yet sharing the news because, at 41, she was at higher risk of early miscarriage. "It was a perfect storm," she explains.

Depression in pregnancy not only causes mom to suffer; it can also pose health risks to the baby. Research published today in the journal Human Reproduction found that women with symptoms of depression were more likely to experience a preterm birth. The greater the severity of depression symptoms, the greater the likelihood of early delivery. This research adds "strong evidence that depression during pregnancy is bad for the fetus," says lead study author De-Kun Li, reproductive and perinatal epidemiologist at Kaiser Permanente's Division of Research in Oakland, Calif., "This should not be dismissed anymore." Preterm birth, write the study authors, is the leading cause of infant mortality and medical expenditures for newborns.

READ MORE @ U.S. NEWS & WORLD REPORT

Lilly Will Take $1.42 Billion Charge in Zyprexa Probe (Update1)

Eli Lilly & Co. said it is having ``advanced discussions'' to settle investigations by U.S. and state authorities over marketing the antipsychotic Zyprexa and will take a $1.42 billion charge in the third quarter.

The charge will amount to $1.29 a share and reflects Lilly's ``currently estimable exposure'' to investigations into whether it promoted Zyprexa for unapproved uses, the Indianapolis-based company said today in a statement.

Investigations by the U.S. Attorney's Office for the Eastern District of Pennsylvania and more than 30 state Medicaid fraud units focus on Lilly's marketing to U.S. doctors and the drugmaker's payments to consulting physicians and other advisers. The announcement follows Lilly's Oct. 7 settlement of consumer fraud investigations by 32 states and the District of Columbia into the company's marketing of Zyprexa, its top-selling drug.

``The government's investigation of Zyprexa has been ongoing for five years and we now have a heightened sense of responsibility to all our stakeholders to intensify efforts to resolve these issues,'' said Robert A. Armitage, Lilly's general counsel, in the statement. The company is cooperating with the investigations, Lilly said.

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Half of Doctors Routinely Prescribe Placebos

Half of all doctors in the United States regularly prescribe placebos to patients despite clear professional rules that forbid the practice, according to a nationwide survey. The results troubled medical ethicists, who said that more research is needed to determine whether doctors must deceive patients for placebos to work.

In response to three separate questions included as part of the larger survey, about half of 679 internists and rheumatologists chosen randomly from a national list of doctors reported recommending placebos on a regular basis.

The most common placebos the doctors reported using were headache pills and vitamins, but a significant number also reported prescribing antibiotics and sedatives. Although these drugs are not all inert, the usual definition of placebos, doctors reported using them for their effect on patients’ psyches, not their bodies.

READ MORE @ NY TIMES

Magnet device aims to treat depression patients

The government has approved the first noninvasive brain stimulator to treat depression - a device that beams magnetic pulses through the skull.

If it sounds like science-fiction, well, those woodpecker-like pulses trigger small electrical charges that spark brain cells to fire. Yet it doesn't cause the risks of surgically implanted electrodes or the treatment of last resort, shock therapy.

Called transcranial magnetic stimulation or TMS, this gentler approach isn't for everyone. The Food and Drug Administration approved Neuronetics Inc.'s NeuroStar therapy specifically for patients who had no relief from their first antidepressant, offering them a different option than trying pill after pill.

"We're opening up a whole new area of medicine," says Dr. Mark George of the Medical University of South Carolina in Charleston, who helped pioneer use of TMS in depression. "There's a whole field now that's moving forward of noninvasive electrical stimulation of the brain."

While there's a big need for innovative approaches - at least one in five depression patients is treatment-resistant - the question is just how much benefit TMS offers.

READ MORE @ WINSTON SALEM JOURNAL

Certain Antipsychotic Medications May Increase Risk for Heart Disease

Certain atypical antipsychotic medications may raise the risk for heart disease in people with schizophrenia, according to an analysis of data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study published in the October 2008 issue of Schizophrenia Research.

Heart disease is prevalent among people with schizophrenia. Patients with schizophrenia also have higher rates of diabetes and high blood pressure, and lower levels of high-density lipoprotein or "good" cholesterol. Although factors such as smoking and lack of access to quality medical care may be 2 reasons for higher heart disease rates, atypical antipsychotics are known to be associated with cardiovascular side effects as well.

READ MORE @ DOCTOR'S GUIDE

Providing safe, daily doses helps addicts, study finds

Most of the hardened heroin addicts who were given free, daily doses of the illegal drug over a 12-month period underwent a positive transformation, committing far fewer crimes while their physical and mental health steadily improved, according to researchers.

Addicts also cut their illegal heroin use by 70 per cent, on average, according to researchers from the North American Opiate Medication Initiative.

The results of the trial, said Martin Schechter, the project's main investigator, show that hard-core addicts - those with the dimmest chances of recovery - can stabilize their lives when heroin is made free and administered by teams of health-care professionals.

"Heroin-assisted therapy is a safe and effective treatment for people with chronic heroin addiction who have not benefited from previous treatment," Dr. Schechter told a news conference in Vancouver.

The federally funded clinical trial began three years ago with researchers at Vancouver's University of British Columbia and the University of Montreal scouring both cities for heroin addicts, eventually finding 251 drug users who had previously tried - and failed - to overcome their addictions.

READ MORE @ GLOBE AND MAIL

Not Enough Research on SSRIs and Pregnancy

Kerri T. wants women to know that antidepressants and pregnancy don't mix. Kerri says that she was never told about the link between SSRIs and birth defects and she believes her daughter's health problems are the result of exposure to an SSRI antidepressant.

"During my whole pregnancy, I took 300 mgs of Effexor XR," Kerri says. "My psychiatrist never told me about any of the warnings and I never saw any of the sample packets where it said that if the baby was exposed to Effexor in the third trimester there could be problems and longer hospital stays.

"I delivered Caroline at full term. She had no seizures during the pregnancy. She was born via C-section and immediately after birth started having seizures. The doctor took her out and took her right to NICU (neonatal intensive care unit). I couldn't even hold Caroline right away; they just took her away. She was put on 4 seizure medications and on the ventilator.

"At 3 days old, Caroline basically died. They had tried to take her off the ventilator and she died. The doctors did 2 minutes of chest compressions and intubated her. She was hypotonic from the medicine. Luckily, they brought her back. The following week they tried to take her off the ventilator again and she coded again."

READ MORE @ LAWYERS & SETTLEMENTS

Most Psychiatrists Unlikely To Use Depot Antipsychotics

Innovative strategies to train more psychiatrists and their staff in the use of depot antipsychotics may help promote their use in different settings and in patients whoare less severely ill but are still medication nonadherent.

Less than 20 percent of psychiatrists prescribed a long-acting depot antipsychotic medication for patients with schizophrenia who were nonadherent with the original medication.

That was the finding of a nationwide survey by researchers with the American Psychiatric Institute for Research and Education (APIRE), Columbia University College of Physicians and Surgeons, and the University of Pennsylvania School of Social Policy and Practice. The study was conducted between September 2003 and January 2004.

Moreover, the decision to use depot medications appears to be a function of patient, physician, and practice-setting characteristics. For instance, initiation of depot medication was significantly and positively associated with public insurance, prior inpatient admission, proportion of time nonadherent, average or above average intellectual functioning, and living in a mental health residence. Psychiatrists who were optimistic about managing nonadherence were also more likely to prescribe long-acting antipsychotics for nonadherent patients.

READ MORE @ PSYCHIATRIC NEWS

Treatment on a plate - A dietary approach to treating addiction seems worth investigating

PEOPLE are programmed for addiction. Their brains are designed so that actions vital for propagating their genes—such as eating and having sex—are highly rewarding. Those reward pathways can, however, be subverted by external chemicals (in other words, drugs) and by certain sorts of behaviour such as gambling.

In recent years, neuroscientists have begun to understand how these reward pathways work and, in particular, the role played by message-carrying molecules called neurotransmitters. These molecules, notably serotonin, dopamine and gamma-aminobutyric acid (GABA), hop between nerve cells, carrying signals as they go. Some drugs mimic their actions. Others enhance them. Either way, the body tends, as a result, to give up making them. At that point the person needs the drug as a substitute for the missing transmitter. In other words, he is an addict.

READ MORE @ THE ECONOMIST

Prozac on the Playground - The dangers of off-label use of psychiatric medications in children.

Problem: We are now more aware of emotional illness in children and much more likely to diagnose and treat conditions like attention deficit disorders. But as difficult and expensive as it is to test new medications on adults, it's even harder to do the testing on children. Many treatments applied to children reflect "off-label" use of medications that have been specifically approved for adults—but not for kids. When the FDA grants a license to a new prescription medication, it lists its permitted uses ("indications") and the patients for whom it is intended (including their age range), usually reflecting the population it was tested on—children with strep throat, women with breast cancer. If a drug company even mentions a use not specifically approved, it has violated FDA rules and can be fined or otherwise punished. However, once a drug has received FDA approval, physicians are free to use it for applications or populations for which it was not formally approved. After (usually adult) FDA approval has been obtained, manufacturers often don't bother with expensive testing that would allow them to request a label extension for use in kids, since they'll have the (off-label) market, anyway. Off-label use accounts for somewhere between half and three-quarters of all medications used in children and is also commonly used for adult treatment. Pediatricians are often uncomfortable with this practice, but they consider it the lesser of two evils when confronting an illness with effective adult treatment but nothing for children. Most medications behave similarly in children and adults, but that rule has exceptions, as we sometimes discover too late. Aspirin can lead to a horribly dangerous liver and brain disease in children or teens. Tetracycline, a common antibiotic, can damage the teeth of children under 8 years old. The problem is particularly troublesome when it comes to prescribing psychiatric medications to kids, which is increasingly common.

READ MORE @ SLATE

Teen suicides have risen alarmingly. It doesn't have to be that way.

Yet the view persists that adolescents are somehow immune to the debilitating clinical depression that afflicts many adults. And such carefree-days-of-youth thinking on the part of some parents and caregivers can yield tragic results.

Teen suicides, which had been on a downward trajectory for the previous two decades, showed an 18 percent rise in 2004 over the previous year, according to a recent report by Journal of the American Medical Association. Although the rate dipped slightly in 2005, the most recent year charted, the number remains well above predicted levels.

As for depression, the World Health Organization reports that one in 33 children and, among them, one in eight teens, is clinically depressed. The organization predicts those numbers could double by 2020.

READ MORE @ SACRAMENTO BEE

Antidepressants Could Improve Symptoms of Irritable Bowel Syndrome: Presented at ACG

Antidepressants are an effective treatment for patients with irritable bowel syndrome (IBS), according to results presented here at the American College of Gastroenterology (ACG) 73rd Annual Scientific Meeting.

Alexander Ford, MD, McMaster University Medical Centre, Hamilton, Ontario, reported the results of a systematic review in a poster session here on October 5.

"I think the most exciting finding [of our study] is that this hasn't been shown before. It's probably the first time that a systematic review and meta-analysis has shown that antidepressants are a benefit in treating irritable bowel syndrome," said Dr. Ford.

"Previous meta-analyses have not demonstrated such an effect for a number of reasons. Obviously, there's more data now but also [researchers] haven't quite looked at all of the eligible studies for various reasons. I think one of [the studies] should have been able to demonstrate this benefit 3 or 4 years ago, but just didn't manage to."

READ MORE @ DOCTOR'S GUIDE

The long, wild ride of bipolar disorder - A severe childhood mood disorder often lasts into young adulthood

Children who grow up with the psychiatric ailment known as bipolar disorder rarely grow out of it. Almost half of youngsters who suffered from bipolar’s severe, rapid-fire mood swings at around age 11 displayed much of the same emotional volatility at ages 18 to 20, even if the condition had improved for a while during their teens, according to the first long-term study of children diagnosed with the disorder.

Bipolar disorder took off with a vengeance in these kids. Initial episodes, often periods of frequent, dramatic mood swings, lasted for up to three years. Second episodes lasted for slightly more than one year, while third episodes continued for roughly 10 months.

During these periods, youngsters can veer back and forth several times a day between a manic sense of euphoria and a serious, even suicidal depression, say psychiatrist Barbara Geller of Washington University in St. Louis and her colleagues. Manic euphoria typically includes grandiose delusions or hallucinations.

READ MORE @ SCIENCE NEWS

Millions with mental disorders in the developing world are deprived of necessary treatment and care

More than 75% of people suffering from mental disorders in the developing world receive no treatment or care. A new WHO programme launched today, on World Mental Health Day 2008 highlights the huge treatment gap for a number of mental, neurological and substance use disorders. Across Africa for example, nine out of ten people suffering from epilepsy go untreated, unable to access simple and inexpensive anticonvulsant drugs which cost less than US$5 a year per person.

WHO is now calling on governments, donors and mental health stakeholders to rapidly increase funding and basic mental health services to close this huge treatment gap. The programme, Mental health Gap Action Programme (mhGAP): Scaling up care for mental, neurological and substance use disorders asserts that with proper care, psychosocial assistance and medication, tens of millions could be treated for diseases such as depression, schizophrenia, and epilepsy and begin to lead healthy lives, even where resources are scarce.

“Governments across the world need to see mental health as a vital component of primary health care. We need to change policy and practice. Only then can we get the essential mental health services to the tens of millions in need”, said Dr Margaret Chan, Director-General of the World Health Organ.

READ MORE @ WORLD HEALTH ORGANIZATION

Side-Effects of Antipsychotics

A new federally funded study will examine ways to control the metabolic side effects associated with the use of the newer atypical antipsychotic medications in children with schizophrenia or bipolar disorder.

The use of atypical antipsychotic medications to treat children and adolescents with schizophrenia or bipolar disorder is relatively common, but the side effects associated with them are troubling.

The recent NIMH-funded Treatment of Early Onset Schizophrenia Study (TEOSS) found that two atypical medications were associated with more metabolic side effects than an older generation antipsychotic.

The new grant will test ways in which the metabolic side effects, such as weight gain, insulin sensitivity and other factors that can lead to type 2 diabetes and heart disease, may be controlled or reduced.

READ MORE @ PSYCHCENTRAL

Bailout Provision Provides Equal Coverage for Mental and Physical Ailments

More than one-third of all Americans will soon receive better insurance coverage for mental health treatments because of a new law that, for the first time, requires equal coverage of mental and physical illnesses.

The requirement, included in the economic bailout bill that President Bush signed on Friday, is the result of 12 years of passionate advocacy by friends and relatives of people with mental illness and addiction disorders. They described the new law as a milestone in the quest for civil rights, an effort to end insurance discrimination and to reduce the stigma of mental illness.

Most employers and group health plans provide less coverage for mental health care than for the treatment of physical conditions like cancer, heart disease or broken bones. They will need to adjust their benefits to comply with the new law, which requires equivalence, or parity, in the coverage.

READ MORE @ NY TIMES

Seeking Treatment for Mental Disorders Has Lasting Effect

Middle-age patients taking medication for anxiety or depression are less likely to have mental disorders a decade later, a population-based study showed.

Among 157 patients who had a mental disorder at age 43, those who took antidepressants, anxiolytics, or both were 70% less likely to have a disorder 10 years later (OR 0.3, 95% CI 0.1 to 1.0), Ian Colman, Ph.D., of the University of Alberta here, and colleagues reported in the October issue of the British Journal of Psychiatry.

"What this tells us is that, if people get treated initially, they are less likely to have a relapse in the future," Dr. Colman said.

Because only 24.2% of those taking medications at age 43 were still being treated at age 53, the researchers said, the lasting benefits of taking antidepressants and anxiolytics "may be because of a demonstrated willingness to seek help rather than long-term maintenance therapy."

They said the lasting benefit may be "explained by an initial willingness to be treated, potential successful initial treatment, and an increased likelihood that these patients would seek and accept help when encountering symptoms of depression and anxiety in the future."

READ MORE @ MEDPAGE TODAY

Long-term psychotherapy is superior, study finds

Psychotherapy lasting for at least one year is more effective than shorter periods of therapy for people with complex mental disorders, such as personality and chronic disorders, according to a study published today in the Journal of the American Medical Assn. The success of dedicated psychotherapy may matter little, however, because fewer doctors are offering the service and fewer insurers are covering it.

In long-term psychodynamic psychotherapy, the therapist provides continued, close support for the patient while the pair work through problems and interventions. The JAMA study, from researchers in Germany, was an examination of 23 studies on the success of psychotherapy. It found that longer-term therapy (one year or longer) was superior to shorter-term methods in regard to overall outcome and personality functioning. On average, patients with complex mental conditions who were treated long-term were better off than 96% of the patients in the comparison groups.

READ MORE @ LOS ANGELES TIMES

Depression linked to higher death rates from all causes among elderly with diabetes

2-year study looked at more than 10,000 Medicare beneficiaries with diabetes

In a large group of Medicare beneficiaries with diabetes, depression was associated with a higher death rate from all causes during a two-year study period. The findings are published in the October 2008 Journal of General Internal Medicine.

Lead author Dr. Wayne Katon, professor of psychiatry and behavioral sciences at the University of Washington (UW), noted that previous research indicates that depression and diabetes is a potentially lethal mix among young to middle-aged patients. Depression also puts patients at greater risk of complications from their diabetes. This more recent study suggests that depression is also a risk factor for mortality in older patients with diabetes. Most Medicare beneficiaries, like the ones in this study, are over age 65. The mean age of the participants was 75.6 years.

The study tracked 10,704 Medicare beneficiaries with diabetes who were enrolled in a disease management program in Florida. They were surveyed at the start of the study with a health assessment questionnaire. Evidence of depression among members of the group came from physician diagnosis, patient reports of having a prescription for an antidepressant in the year before the survey, or patient answers to a brief screening test. For the next two years, the research team recorded the death and cause of death of participants through bi-monthly checks of Medicare claims and eligibility files, or from phone calls with the participants' families.

READ MORE @ EUREKALERT

AHRQ Study: Conventional Antipsychotics May Pose Risk To Elderly

Elderly patients who are prescribed a conventional, or first-generation, antipsychotic medication are at an increased risk of death from cardiovascular or respiratory diseases, as compared to those who take an atypical, or second-generation, antipsychotic medication, according to a study funded by the Agency for Healthcare Research and Quality.

The new study, "Potential Causes of Higher Mortality in Elderly Users of Conventional and Atypical Antipsychotic Medications," which was recently posted online in the Journal of the American Geriatrics Society, adds to growing evidence that conventional antipsychotics may not be safer than atypical anitpsychotics for the elderly. Researchers had previously identified that such second-generation medications may pose increased mortality. The new study compares specific causes of death among elderly patients newly started on conventional versus atypical antipsychotics.

READ MORE @ U.S. MEDICINE