No abstract

Echinacea from retail stores often does not contain the labeled species. A claim of "standardization" does not mean the preparation is accurately labeled, nor does it indicate less variability in concentration of constituents of the herb.

Homeless youths (N = 684) in eight cities participated in this study to understand the rates and correlates of substance use. Rates of lifetime and recent substance use ranged from 66% to 90%. Variability in lifetime and recent substance use was partially explained by being white (ages 14-17); ever attempting suicide (ages 14-17); not being African American (lifetime substance use) or Hispanic (ages 18-24); being male (ages 18-24); identifying as lesbian, gay, or bisexual (ages 18-24); using substances with a parent; beginning substance use at a young age; and having a family history of a substance problem.

PURPOSE Direct-to-consumer advertising (DTCA) has increased tremendously during the past decade. Recent changes in the DTCA environment may have affected its impact on clinical encounters. Our objective was to determine the rate of patient medication inquiries and their infl uence on clinical encounters in primary care. METHODSOur methods consisted of a cross-sectional survey in the State Networks of Colorado Ambulatory Practices and Partners, a collaboration of 3 practice-based research networks. Clinicians completed a short patient encounter form after consecutive patient encounter for one-half or 1 full day. The main outcomes were the rate of inquiries, independent predictors of inquiries, and overall impact on clinical encounters. RESULTSOne hundred sixty-eight clinicians in 22 practices completed forms after 1,647 patient encounters. In 58 encounters (3.5%), the patient inquired about a specifi c new prescription medication. Community health center patients made fewer inquiries than private practice patients (1.7% vs 7.2%, P <.001). Predictors of inquiries included taking 3 or more chronic medications and the clinician being female. Most clinicians reported the requested medication was not their fi rst choice for treatment (62%), but it was prescribed in 53% of the cases. Physicians interpreted the overall impact on the visit as positive in 24% of visits, neutral in 66%, and negative in 10%.CONCLUSIONS Patient requests for prescription medication were uncommon overall, and even more so among patients in lower income groups. These requests were rarely perceived by clinicians as having a negative impact on the encounter. Future mixed methods studies should explore specifi c socioeconomic groups and reasons for clinicians' willingness to prescribe these medications.

Most physicians have negative views of DTC pharmaceutical advertising and see several potential effects of these advertisements on the physician-patient relationship. Many public respondents have similarly negative views, and only a few agree that they change their expectations of or interactions with physicians. While these advertisements may be influencing only a few consumers, it seems that the impact on physicians and their interactions with patients may be significant.