Regular readers, if indeed there are any, will recall a recent abstract which was less than enthusiastic about the results achieved by the use of cholinesterase inhibitors, including galantamine and donepezil, in the management of dementia.

And now, NICE (National Institute of Clinical Excellence), the NHS prescribing watchdog for England and Wales, has retracted its previous guidance—issued in 2001 which said that these drugs should be prescribed for Alzheimer’s disease—after reviewing the latest evidence on efficacy and cost effectiveness.

On the other hand, a spokesperson for the Royal College of Psychiatrists says “on average, drugs for Alzheimer’s disease delay the decline associated with the illness by six to nine months. This is a degree of benefit which patients value.”

Theophylline is commonly used with benefit in the management of asthma in both children and adults, but its role in the management of COPD has not been defined.

An international team has recently reported on their review of 20 randomized-controlled trials comparing oral theophylline with placebo for a minimum of 7 days in people with stable COPD. FEV1, FVC, VO2 max, PaO2, and PaCO2 all showed significant improvement in the theophylline treatment arms, and the patients preferred theophylline over placebo. Theophylline increased the risk of nausea compared with placebo and unfortunately the more serious adverse effects of theophylline (e.g. supraventricular arrhythmias) were not found in this review.

The three FOOD (feed or ordinary diet) trials, which have involved more than 4000 stroke patients in hospital, have recently been reported. One trial evaluated oral nutritional supplements, the second the merits of early nasogastric tube feeding, and the third the outcome of percutaneous gastrostomy feeding.

In the first trial, supplementation did not have a significant effect on death or poor outcome. In the second trial, early tube feeding was associated with a non-significant reduction in risk of death, but at the expense of severe disability in those who would otherwise have died, In the third trial, the rate of death and poor outcome was higher with percutaneous endoscopic gastrostomy than with nasogastric feeding.

An accompanying commentary advised that oral food supplements should be reserved for undernourished patients, and that enteral feeding for dysphagic patients should be via the nasogastric route if possible.

India has a significant problem with AIDS. India also has a large generic drug industry. No doubt the latter has helped in the management of the former.

The WTO has been pressurising India for years to change its anomalous patent laws, which have allowed generic companies to grab a market of any new drug simply by changing a step in its patented synthetic pathway.

In March, the Indian parliament approved a bill to bring national patent rules in line with international norms. By requiring a product, rather than a process, to be patentable, the bill effectively wipes out the country’s generic drug industry.

And presumably many Indians as well?

In April, Health Canada reclassified the morning-after pill (levonorgestrel 0.75mg) as a nonprescription drug, thus permitting pharmacists to dispense this postcoital oral contraceptive directly to women.

This move has generally been well regarded, presumably with the exception of a minority religious group. However, some are less pleased with the need for a required consultation with a pharmacist. They point out that few pharmacies offer the privacy necessary for such a conversation. This fact, together with the professional fees attached to the consultation, represents a needless barrier to access.

Yes, two pertinent points.