4/4/2013. Mike Rizo, Pharm D, MBA, ABAAHP THE PHARMACIST OF THE FUTURE? METABOLIC SYNDROME AN INTEGRATIVE APPROACH

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1 METABOLIC SYNDROME AN INTEGRATIVE APPROACH AN OPPORTUNITY FOR PHARMACISTS TO MAKE A DIFFERENCE Mike Rizo, Pharm D, MBA, ABAAHP THE EVOLUTION OF THE PHARMACIST 1920s 1960s 2000s THE PHARMACIST OF THE FUTURE? 1

2 AMERICAN ASSOCIATION OF DISPENSING PHYSICIANS SAYS Patient Compliance and Care Monitoring Studies have estimated that 30-40% of prescribed medications go unfilled. By implementing in-office dispensing you will be able to monitor a patient s treatment and prescription compliance. Inoffice dispensing respects patients time and will increase patient compliance with medication regimens. Safety and Accuracy Physician dispensing allows for a higher level of safety and accuracy. Six to eight percent of patients who receive medication from a pharmacy receive incorrect dosages or drugs. State regulatory boards have imposed harder restrictions for in-office dispensing which has resulted in a reduction of error rates in comparison to filling medication at a retail pharmacy. Source: EMBRACE CHANGE OR BECOME IRRELEVANT Product vs Service? 2

3 DO YOU KNOW WHAT THE NET PROFIT IS IN PHARMACY? 2.9% Source: NCPA Digest 2012 NET PROFIT FOR PHARMACY OVER LAST 10 YEARS Series PHARMA IS NOT PHARMACY, MAKE NO MISTAKE 3

4 NICHE MARKETS ACHIEVEMENTS IN PUBLIC HEALTH, : DECLINE IN DEATHS FROM HEART DISEASE AND STROKE -- UNITED STATES, Despite remarkable progress, heart disease and stroke remain leading causes of disability and death. Source: CDC IT WAS A PROBLEM THEN Landmark epidemiologic investigations, including the cross-country comparisons of Ancel Keys and the Framingham Heart Study, established the major risk factors of high blood cholesterol, high blood pressure, and smoking and dietary factors (particularly dietary cholesterol, fat, and sodium). Source: CDC August 6,

5 STILL A PROBLEM NOW 600,000 people die of heart disease in the US every year That s 1 in every 4 deaths Leading cause of death for both men & women 935,000 Americans have a heart attack every year Coronary heart disease costs over $108.9 billion a year in healthcare services, medications, & lost productivity. Data from 2012 Source: CDC.gov IT WORKED FOR SOME PEOPLE Lipitor, the cholesterol-lowering drug, has become the bestselling pharmaceutical in history. Within the next few years it could very well become the world's first $10- billion-a-year drug. By John Simons January 20, 2003 Source: CNN money TURBO DRUG Lipitor is the biggest selling drug of all time, with cumulative global sales of $131 billion 5

6 WRONG TARGET MAYBE??? TAKE A LOOK AT THIS STATS 1 in 10 U.S. adults has type 2 diabetes. 1 in 400 to 600 children and adolescents in U.S. have type 1 diabetes million new cases of diabetes are diagnosed in the U.S. each year. The cost of diabetes in the U.S. is $220 billion a year and rising. The Centers for Disease Control and Prevention, or CDC, projects that if trends continue, 1 in 3 Americans will have diabetes by UnitedHealth Group projects that half of Americans could have diabetes or prediabetes by 2020, costing $3.35 trillion over the next decade 663f-f24d-443f dfdc97cedc5 US SUGAR CONSUMPTION

7 DIABETES IN U.S. ADULTS FROM WHO IS LIKELY TO HAVE A HEART ATTACK? Source: West Virginia Department of Health & Human Resources GLOBAL WEIGHT MANAGEMENT MARKET BY PRODUCT THROUGH 2014 ($BILLIONS) Source: MarketsandMarkets 7

8 SOME ARE MAKING SURE THE MARKET KEEPS GROWING INTENSIVE LIFESTYLE CHANGES FOR REVERSAL OF CORONARY HEART DISEASE (JAMA DECEMBER 16, 1998, VOL 280, NO. 23) (P=.001 between groups. Twenty-five cardiac events occurred in 28 experimental group patients vs 45 events in 20 control group patients during the 5-year follow-up (risk ratio for any event for the control group, 2.47 [95% confidence interval, ]). Conclusions. More regression of coronary atherosclerosis occurred after 5 years than after 1 year in the experimental group. In contrast, in the control group, coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred WHAT IS METABOLIC SYNDROME? Group of risk factors that occur and increase the risk of coronary artery disease, stroke, and type 2 diabetes Often characterized by excess abdominal fat & insulin resistance 8

9 DIAGNOSIS OF METABOLIC SYNDROME When 3 of 5 of the listed characteristics are present: Abdominal obesity, recognized by increased waist circumference raised triglycerides reduced HDL cholesterol elevated blood pressure raised plasma glucose Probably a large portion of our patients OB Cardiometabolic syndrome from an Integrative approach CARDIOVASCULAR RISK Obesity impacts visceral fat accumulation and metabolic markers in the cardio-endocrine systems. 9

10 HYPERINSULINEMIA Disrupts sodium metabolism; promotes water retention and hypertension Increases oxidative stress(fr) that can initiate atherosclerosis & cancer Decreases daily production of Growth Hormone and decreases conversion of T4 to T3 (functional hypothyroidism) Increases cortisol, poor stress response, decreases immunity Eventually exhausts beta cells of the pancreas Chahwala V, Arora R. Cardiovascular manifestations of insulin resistance. Am J Ther Sep-Oct;16(5):e CORTISOL STRESS TO PANCREAS Cortisol mobilizes glycogen from liver Cortisol decreases insulin sensitivity of receptor cells, decreasing glucose uptake Cortisol increases insulin secretion Cortisol increases TNF alpha directly increasing insulin resistance at the receptor site. Cortisol increases carb craving patterns and neurotransmitter imbalances Morton NM. Obesity and corticosteroids: 11beta-hydroxysteroid type 1 as a cause and therapeutic target in metabolic disease.mol Cell Endocrinol Mar 25;316(2): Epub 2009 Oct 3. Review. THYROID FUNCTION Production of thyroxine dependent on estrogen and cortisol Conversion of T4 to T3 influenced by insulin, selenium, iodine, zinc, and cortisol Low T4 levels, iodine associated with Breast Cancer Garnerone L, Iorio L, Zelaschi R, Delnevo A, Tufano A, Ambrosi B. Thyroid function and obesity. Minerva Med Oct;101(5):

11 WHAT WE NEED TO BECOME Integrative Clinical Consultant Pharmacist (vision) RPH who has obtained additional training in Integrative and functional medicine in order to assist patients, physicians, and other health care providers with conventional and integrative therapies to enhance patient care. Prioritizing safety and the appropriate use of evidence based clinical information SOME STARTING AREAS FOR INTEGRATIVE PHARMACISTS Weight loss / weight management Nutraceuticals / supplements programs Educational events on preventive approach Exercise programs MEDITERRANEAN DIET STUDY RECENTLY PUBLISHED IN NEJM In conclusion, in this primary prevention trial, we observed that an energy-unrestricted Mediterranean diet, supplemented with extravirgin olive oil or nuts, resulted in a substantial reduction in the risk of major cardiovascular events among high-risk persons. The results support the benefits of the Mediterranean diet for the primary prevention of cardiovascular disease. Source: NEJM 11

12 This is more like it WHERE DO PATIENTS GO TO GET THEIR SUPPLEMENTS? Source: AccentHealth YOU MUST GET EXPOSED, ENOUGH HIDING BEHIND THE COUNTER. Added value to me and my customers 12

13 THE BUSINESS LIFE CYCLE, INNOVATE OR DISAPPEAR THE DEVOLUTION OF THE PHARMACIST 1920s 1960s 2000s THANK YOU You have to take risks. We will only understand the miracle of life fully when we allow the unexpected to happen. Paulo Coelho 13

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