MS Patients, a Vulnerable Population

Multiple sclerosis is a progressive neurological disease affecting a significant portion of the world population specifically the northern latitude nations. Although it is classified as an autoimmune disease, its real cause has not yet been fully known and was hypothesized that an external infectious agent may probably trigger the development of this disease (Finlayson, 2004). This disease is associated with demyelination and axonal damage in the central nervous system which leads to optic neuritis, fatigue, paralysis, spasticity, extreme pain, swallowing difficulties, bowel and bladder troubles, and loss of balance (Finlayson, 2004).

In the long run, these symptoms will result to physical limitations like in self-care functions, mobility, social functions, and productive activities (Finlayson, 2004). As estimated by the National Multiple Sclerosis Society, around 400,000 individuals were affected by this disease in the United States, of which 45% were over 55 years of age (Finlayson, 2004). On the other hand, multiple sclerosis has been prevalent among 15 to 40 year old Canadians and affecting 240 individuals in every 100,000 populace (Multiple Sclerosis of Canada, 2007).

Even though multiple sclerosis causes physical and cognitive disabilities, the life expectancy of the patients are not affected unless in severe cases. The severity of the disease can only occur at 10-15% of the cases and majority of the affected individuals live with the normal life expectancy trend (Finlayson, 2004). At present, individuals who were diagnosed with multiple sclerosis at their twenty’s may still live for more than 50 years (Finlayson, 2004).

Thus, aside from the physical, biological, and psycho-sociological changes, experienced by normal individuals, multiple sclerosis patients need to cope up with the impairments brought by the disease (Finlayson, 2004). Meanwhile, healthcare providers, medical staff, and physicians have crucial roles in giving hope through counsels and medications among the patients (Finlayson, 2004). Medication and Drug Treatment In the disease literature, multiple sclerosis was categorized as primary-progressive, relapsing-remitting, and secondary-progressive.

Almost 85% of the affected individuals have relapsing-remitting type of multiple sclerosis (Finlayson, 2004). This type is characterized by partial or full recovery, non-progression between attacks, and acute attacks (Finlayson, 2004). After 25 years of its manifestations, 90% of the patients experience disease-shifting to secondary-progressive type which is described with the presence or absence of relapse, non-recovery between relapses, and with variable disease progression (Finlayson, 2004).

Prior to the middle part of the 1990s, multiple sclerosis drug treatment was only confined with intravenous corticosteroids, symptom medication, and exacerbation management (Finlayson, 2004). In the discovery of ? -interferon, mitoxantrone, and glatiramer drug formulations, medical experts can now offer several medication treatments for the disability prevention, and the reduction of brain lesions and exacerbation severity (Finlayson, 2004). Also, mitoxantrone is utilized for the treatment of progressive-relapsing and secondary-progressive multiple sclerosis types (Finlayson, 2004).

The development of glatiramer acetate and 1a and 1b ? -interferon drugs has made a leap on the advancement of the drug treatment for multiple sclerosis (Goodin et. al. , 2002). Significant improvements on the medical conditions of the patients were reported and attributed to the physiological actions of these drugs (Goodin et. al. , 2002). After several years of clinical studies, experts concluded that glatiramer acetate and ? -interferon drugs have the capability to reduce disability threats and improve the quality of life for patients with relapsing-remitting cases of multiple sclerosis (Goodin et.

al. , 2002). However, the patients must undergo a continuous drug treatment for several years for withdrawal from the treatment program would result to the reoccurrence of the multiple sclerosis’ symptoms and as well as complications (Goodin et. al. , 2002). Recently, the National Multiple Sclerosis Society acknowledged the initiative of the present president of the United States, Barack Obama in lifting the ban for embryonic stem cell studies (PR Newswire, 2009). The executive official on clinical studies of the said organization, Dr.

John Richert, optimistically stated that this initiative would give them more opportunities to further explore the nature of and the efficient treatment for multiple sclerosis (PR Newswire, 2009). For the last eight years, state policies delayed the intensive clinical researches employing human cells in the search for multiple sclerosis drug medication. In line with this, the Autologous Stem Cell Transplantation or ASCT which was originally utilized for the treatment of leukemia has been employed as a method of multiple sclerosis medication (La Nasa et. al. , 2004).

This aggressive treatment method, with 5-8% mortality risk, is done by collecting stem cells from the bone marrow of the patient (La Nasa et. al. , 2004). Then, through low dose radiation and chemotherapy, the immune system of the patient is decimated before injecting back the collected stem cells. After this, the stem cells reproduce to regenerate the reset immune system. Issues and Concerns Although the Food and Drug Administration has approved several brands of the aforementioned drugs like Avonex, Copaxone, Rebif, and Betaseron, several barriers in availing these drugs came into the scene.

For instance, neurologists and other health care providers were not properly informed on the existence and utilization of those drugs for multiple sclerosis treatment (Goodin et al. , 2002). Also, the inadequate understanding of state authorities on the advantages and other benefits of these drugs has resulted to limited policy coverage enacted on the utilization of these drugs for treatment of multiple sclerosis patients (Goodin et. al. , 2002).

Inadequate policies resulted to vague provisions on the clinical trials for the drug efficacy studies which eventually led to limited access to these drugs (Goodin et. al. , 2002). Consequently, non-adherence to treatment medication became a problem. Medication adherence refers to the extent in which the patient abides with the treatment schedule and drug dosage (American Pharmacists Association, 2004). Adherence then to any clinical medication requires the active participation of the patients, with proper discretion and prerogative on the improvement of their health conditions.

However, the patient’s adherence to any medical treatment is commonly hindered by the method of drug treatment, healthcare system, patient’s attitude, support from patient’s relatives, socioeconomic factors, and other patient-related factors (American Pharmacists Association, 2004). Specifically, non-adherence to medical treatment includes non-filled or non-refilled prescriptions, drug-doses alterations, inaccurate dosing due to forgetfulness, and dropping out from treatment plan (American Pharmacists Association, 2004).

On the other hand, socioeconomic factors such as cost of treatment, lack of health insurance, support from relatives and friends, self-health assessment, medication phobia, treatment skepticism, complicated medication instructions, false beliefs or insufficient knowledge on the nature of disease and its proper treatment, patient-healthcare provider relationship, and inadequate health policy (American Pharmacists Association, 2004). With these factors, socioeconomic and patient’s attitude towards drug treatment are considered as the most significant hindrances in multiple sclerosis patients (American Pharmacists Association, 2004).

Also, the patient’s poor understanding on the complication of the disease and on the significance of an efficient drug medication aggravates the non-adherence issues. In the United States, multiple sclerosis patients have difficulties in securing medical prescriptions as well as availing disease-modifying therapies. Iezzoni, Ngo, and Kinkel (2008) conducted telephone surveys with more than nine hundred 21-64 year ages affected individuals. They explored health insurance and financial matters which directly affect the multiples sclerosis medication access. Based on their study, 96.

3% of the affected individuals have health insurance while insurance characteristics, disease, and demographic were non-adherence factors as determined by analyses through multivariable logistic regressions (Iezzoni, Ngo, and Kinkel, 2008). Around 10. 8% patients below 40 years of age failed to avail any form of disease-modifying therapy as compared to the 41. 1% individuals aged 60 to 64 (Iezzoni, Ngo, and Kinkel, 2008). Similarly, 36. 8% patients without health insurance never secured any drug treatment as compared to 21. 2% individuals with health insurance (Iezzoni, Ngo, and Kinkel, 2008).

On the other hand, around 16% of patients with health insurance reported the failure of their healthcare firms to take responsibility on their medical treatment (Iezzoni, Ngo, and Kinkel, 2008). Generally, 22. 3% of the affected individuals admitted their personal lapses such as non-filling prescriptions and dividing medication tablet or skipping medicine intake due to financial reasons while 22. 4% of the patients were worried on securing medical treatment and some of them steadfastly faces barriers to avail disease-modifying therapy (Iezzoni, Ngo, and Kinkel, 2008).

On the estimate of the World Health Organization, WHO, about 50% of choric diseases’ patients, specifically those from low-income families, failed to comply on a long-term medical treatment (American Pharmacists Association, 2004). At worse, it was revealed that patients’ non-adherence cases were mostly caused not only by simple forgetting but on their own choice to disregard treatment (American Pharmacists Association, 2004). In relation to this, the patients’ non-compliance to medications would result to choric health conditions and increased health medication cost.

As such, in the United States, it was reported that patients’ non-adherence to medication treatments add $100 billions annually on government expenses on choric disease treatment (American Pharmacists Association, 2004). As well, about 125, 000 deaths every year are ascribed to non-adherence on clinical medications (American Pharmacists Association, 2004). Similarly, since multiple sclerosis affects around 55,000 to 75,000 Canadian populations, the annual cost of Canadian economy as imparted by the disease is about one billion dollars (Multiple Sclerosis of Canada, 2007).

Thus, the Multiple Sclerosis Society of Canada argued that smooth and early access to medications will definitely prevent the progress and complications of multiple sclerosis and will lessen the health care cost allotted for such. The non-compliance on medical treatments has various societal and health implications like aggravated disease conditions, interference on therapy efficiency, relapses, costly intensive care unit or emergency room hospitalization, extraneous diagnostic assessment and laboratory tests, disease exacerbation, and even death (American Pharmacists Association, 2004).

In any type of multiple sclerosis, immediate treatment must be given. As presented in the ECTRIMS of European Committee for Treatment and Research in Multiple Sclerosis, the introduction of ? -interferon-1a to patients immediately after the diagnosis of symptoms decreased the disease progression within five years as compared to the drug treatment employment two years after the diagnosis of symptoms (Agrawal, 2006). The clinical study revealed a 35% relapse reduction among the patients who have undergone immediate ?

-interferon-1a treatment. In addition, the early treatments also suggested the clinical stability of patients for about four to five years (Agrawal, 2006). Based on the 2003 annual Multiple Sclerosis’ consortium, even though multiple sclerosis patients naturally want to stick with the medication treatment, barriers like injection phobia, drug side effects and treatment cost come against their will (Harris et. al. , 2003).

Meanwhile, the president of the Multiple Sclerosis Nurses’ International Organization, Amy Perrin Ross, stated that despite the fact that patients are given different options and assistance for their medication, still non-compliance on treatment is still at hand. In fact, the survey commissioned by Bayer HealthCare Pharmaceuticals among more than 200 patients in Canada and in the United States, 40% developed fear on injections and drug side effects while 27% reasoned for the treatment cost as major barriers to medication (Harris et.

al. , 2003). An expert of clinical neurosciences, Dr. Luanne Metz, from the University of Calgary, stated that to bring down the health care cost and to improve the patients’ conditions barriers to multiple sclerosis medications such as limited access to medical experts, insufficient knowledge about the disease, and economic hindrances must be eliminated (Multiple Sclerosis of Canada, 2007).

Likewise, in their study on the health-related quality of life of multiple sclerosis patients, Wu, Minden, Hoaglin, Hadden, and Frankel (2007) identified that health services, demographic, and disease characteristics are hindrances associated with the quality of life attainment and emphasized as areas of priority for improvement. They concluded that multiple sclerosis patients’ quality of life can further be improved by means of removing the barriers on health care services, employment, daily life activities, and drug medication access (Wu et. al. , 2007).

Even though several brands of drugs on multiple sclerosis treatments have been approved and made available by pharmaceutical firms, clinical studies revealed the doubtful efficacy of these drugs (American Pharmacists Association, 2004). For example, a medical study on Campath-1H drug showed its efficacy on the disability prevention among relapsing-remitting multiple sclerosis patients but failed in the reduction of magnetic resonance imaging or MRI lesion formation and relapse rate in patients with secondary-progressive multiple sclerosis (Coles, 2007).

Furthermore, in the clinical study of Antegren with more than 200 multiple sclerosis patients, it was showed that the disability progression of the control group was statistically the same with that of placebo group (Elan Corporation, 2001). Likewise, the Simvastatin cholesterol-lowering drug was found to have high efficacy than Avonex, Copaxone, Rebif, and Betaseron in reducing MRI lesions but has no significant effect on disability prevention (Tyor et. al. , 2005).

As well, there were other substances reported which function similarly to Simvastatin action. First in the list, longitudinal studies proved that absorption of appropriate amount of sunlight lessens the probability of multiple sclerosis development in an individual (Embry, 2004). Lately, clinical trials on vitamin D supplementation in women showed 40% reduction on multiple sclerosis threat for those who received vitamin D supplements as compared with women who did not undergo supplementation (Embry, 2004).

As similar to other drugs, the progression of multiple sclerosis can hardly be lessened by vitamin D. It was hypothesized that the disease progression can be possibly hindered by vitamin D but in a dose that poses human toxicity (Embry, 2004). In addition, clinical studies theorized the multiple sclerosis and hormones in women. During their period of pregnancy, where progesterone is at elevated level, women with multiple sclerosis have lower relapse rate as compared low progesterone level condition after delivery (Voskuhl, 2005).

Moreover, estriol supplementation on women with relapsing-remitting multiple sclerosis, significantly decreased MRI lesions and improved cognitive functions (Voskuhl, 2005). However, this finding was failed to be observed on women with secondary-progressive multiple sclerosis (Voskuhl, 2005). Lastly, the Minocycline antibiotic, based on research, has efficacy on multiple sclerosis therapy (Brundula et. al. , 2002). In Finland, Minocycline has been employed both as neuroprotective and anti-inflammatory agents.

On the other hand, Canadian experts utilized Minocycline in a three-year clinical trial for multiple sclerosis therapy. They found that Minocycline halted MMPs or matrix metalloproteinases which is an extracellular matrix enzyme (Brundula et. al. , 2002). Recently, the experts reported that the antibiotic has prevented the development of MRI lesions on their patients for about nine-month study period (Brundula et. al. , 2002). In some cases, the application of ASCT in their treatment has resulted to stabilization of symptoms while the others experience continuous deterioration (La Nasa et.

al. , 2004). There were also exceptional cases such as the case of a man, with progressive multiple sclerosis and leukemia, who wet through an allogeneic stem cell transplantation at the age of 57 (La Nasa et. al, 2004). Three years after operation, complete leukemia remission and improved neurological condition were observed. On the other hand, the exclusive utilization of chemotherapy in six cases of progressive multiple sclerosis improved the patients’ conditions (La Nasa et. al. , 2004).

These entail then that any of the two treatment forms has significantly affected the unknown stressor of the disease. On February 23, 2004, the online publication of Annals of Neurology, the team of Scottish researchers argued on the clinical basis of the existing theory on multiple sclerosis (Newswire, 2004). They contended that the Experimental Autoimmune Encephalomyelitis or the animal brain-inflammation model can hardly explain the demyelination and axonal damage in the central nervous system. Along with this, the issues on the efficacy of the ?

-interferon and glatiramer drug formulations on clinical trials were left unresolved (Newswire, 2004). This published report was denounced by the multiple sclerosis society and organizations for several years until similar studies were undertaken which resulted to the same findings. For instance, the research conducted in Australia reported that any activity of the immune system was not detected on twelve cases of multiple sclerosis upon death (Newswire, 2004). The study concluded that prior to inflammation, the death of myelin producing cells has occurred (Newswire, 2004).

As compared with normal individuals, multiple sclerosis patients are much worried on their senescence stage for their disease is progressive which may give too much burden of their future caregivers. Finlayson (2004) revealed that older patients were not only worried for physical burden that they may give to their respective caregivers but also on the emotional, psychological, and financial implications of their disease on their families, friends, and relatives. The lifetime cost for the disease treatment is approximately $1. 6 millions per affected person (Multiple Sclerosis of Canada, 2007).

Patients expressed their will to be active and independent as much as possible; hence, supports and aids must be properly addressed which may encompass health services, long-term care planning, financial and emotional counseling, housing and recreation programs, and leisure activities (Finlayson, 2004). Also, the multiple sclerosis patients identified managing performance and expectations as their prime needs for employment. As such, job difficulties can be properly addressed by making the necessary adjustments on the nature of work and working environment, and by symptoms treatment (Sweetland et.

al. , 2007). These can be done by efficient management on the interaction among the working environment, the multiple sclerosis impairments, and the job demand. In addition, the working environment should be oriented on the nature and complications of the disease as supported by adequate government policy while the affected employee must be provided with counseling and advocacy for the attainment of job equality (Sweetland et. al. , 2007). Health education or literacy is also a determinant of medication non-adherence.

As reported by the Institute of Medicine or IOM, about half of the adult populations in the United States can hardly read and understand medical information (American Pharmacists Association, 2004). Medication adherence then is affected by the patients’ understanding on the medication instructions in every drug label. Hence, health care providers and other medical staff must be conscientious enough on the root cause of non-adherence so as to create an effective action plan for medication-adherence promotion.

In the six current drug treatment methods, four of which involve self-injection with side effect accompaniments. Castello, Kennedy, and Scanzillo (2008) found that patients’ non-adherence were primarily caused by injection phobia, forgetfulness, complacency and fatigue in treatment, drug side-effects, and perception of the efficacy of the drug. They suggested that the relationship between the patient and the healthcare provider is a strong determinant of patients’ motivation and treatment-adherence (Castello, Kennedy, and Scanzillo, 2008).

In line with this, continuous patient education and reinforcement on the importance of medication are crucial components of adherence on long-term therapy (Castello, Kennedy, and Scanzillo, 2008). In search for the means of alleviating the non-adherence tendency of patients to any medical treatment, pharmacy-counseling was launched. This program aimed to create patient-pharmacist harmonious relationship, giving an opportunity to the patients to gain understanding on the nature of drug treatment specific to his or her medical case (American Pharmacists Association, 2004).

In such way, any inquiry of the patient concerning the medication treatment would properly addressed by the pharmacist. Although the implementation of pharmacist consultation was reported to be efficient in the reduction of treatment non-adherence, this type of counseling has mainly depended on the patients’ accurate medical records, availability of licensed or professional pharmacist, and the existing state regulations on pharmacist consultation (American Pharmacists Association, 2004).

Nevertheless, on the basis of the positive results of the program, pharmaceutical groups implemented therapy or disease management projects which aimed to properly train pharmacists, clinical staff, and other health care providers in their respective roles in the reduction of non-adherence rate (American Pharmacists Association, 2004). As the cases of multiple sclerosis inevitably grow, the market drug demand for treatment medication continuously rises. In fact, the seven major markets had a 14. 7% increased in 2005 that resulted to $4. 6 billions in 2006 (Health and Wellness Choices, n.

d. ). This big leap was attributed to the high demand for ? -interferon and Tysabri drugs for multiple sclerosis treatment (Health and Wellness Choices, n. d. ). Presently, the market still offers great opportunities for pharmaceutical firms as the most efficient drug for multiple sclerosis medication has not yet been produced. Thus, to establishe their firms in the market, every pharmaceutical company finds a way to entice every patient and make connection to health care organization in order to secure high investment returns (Health and Wellness Choices, n. d. ).

In relation to this, neophyte firms tend to invest more on marketing strategy to introduce their new products in the market through novel therapy advertisements (Health and Wellness Choices, n. d. ). Analysis and Conclusion The abovementioned barriers to medication adherence among multiple sclerosis patients denoted the vulnerability of affected individuals due to non-compliance with the long-term therapy. With those barriers, the roles of the government, physician, healthcare providers, family, friends, and relatives are crucial for the assurance of the patients’ commitment to any medication therapy.

As such, healthcare providers should link patients into rehabilitation and homecare services for interaction among affected individuals may create an environment with a more positive atmosphere for the development of coping strategies, quality of life improvement, and maintenance of well-being (Finlayson, 2004). In line with this, medical staff, physicians, and other healthcare providers must be familiar with the available services and programs for multiple sclerosis care so as to refer their patients to such community or programs.

In addition, the government officials must enact state policies on the control and regulation of clinical researches and drug medication for multiple sclerosis. They must ensure that each citizen with multiple sclerosis can avail and receive proper treatment medication free from the treachery of any organization and pharmaceutical company. References Agrawal, J. P. (2006). Alternative Therapies for Multiple Sclerosis. Nepal Journal of Neuroscience, 3, 66. American Pharmacists Association. (2004 October). Enhancing Patient Adherence. Highlights Newsletter, 7(4), 1-12.

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