• outcomes
  • Experience at our institution and elsewhere 8 has shown that incident reporting tools usually capture minor, clinically insignificant events while missing serious outcomes. (cmaj.ca)
  • Data were synthesized to give a picture of the incidence, types, causes, preventability and outcomes of adverse events in older medical inpatients. (therubins.com)
  • The reports were characterized including symptoms and outcomes reported, and the motivations and incentives in this engagement model for pharmacovigilance are discussed. (springer.com)
  • We present 3 cases of adverse outcomes over a 13-month period-including 1 death-as a result of OTC cough and cold medication use. (aappublications.org)
  • However, despite an increasing emphasis on the scientific basis of medical practice in Europe and the United States in the late 19th Century, data on adverse outcomes were hard to come by and the various studies commissioned collected mostly anecdotal events. (wikipedia.org)
  • 2000
  • 1 The highest rates of cocaine use are in the USA where in 2000 11.2% of Americans over the age of 12 reported that they had used cocaine at some time in their lives and 800 000 (0.4%) were weekly users. (bmj.com)
  • A 2000 Institute of Medicine report estimated that medical errors result in between 44,000 and 98,000 preventable deaths and 1,000,000 excess injuries each year in U.S. hospitals. (wikipedia.org)
  • In 2000 alone, the extra medical costs incurred by preventable drug-related injuries approximated $887 million-and the study looked only at injuries sustained by Medicare recipients, a subset of clinic visitors. (wikipedia.org)
  • effects
  • Because a diagnosis of a mental disorder will almost always prompt managed care companies to take the cheap way out - drugs rather than therapy, no matter how potentially dangerous the long-term side effects, especially on children's growing brains. (drugawareness.org)
  • Currently, doctors and hospitals are not even legally required to report patients' drug side effects to the FDA. (drugawareness.org)
  • But every year 2 million Americans are hospitalized due to drug side effects. (drugawareness.org)
  • 11/21/16)- Here is a list of the top ten health technology hazards that hospitals need to address to lower the chances of adverse effects happening while in a hospital. (therubins.com)
  • Adverse effects are sometimes referred to as "iatrogenic" because they are generated by a physician/treatment. (wikipedia.org)
  • Some adverse effects occur only when starting, increasing or discontinuing a treatment. (wikipedia.org)
  • Using a drug or other medical intervention which is contraindicated may increase the risk of adverse effects. (wikipedia.org)
  • Adverse effects may cause complications of a disease or procedure and negatively affect its prognosis. (wikipedia.org)
  • Adverse effects of medical treatment resulted in 142,000 deaths in 2013 up from 94,000 deaths in 1990 globally. (wikipedia.org)
  • Adverse effects may cause a reversible or irreversible change, including an increase or decrease in the susceptibility of the individual to other chemicals, foods, or procedures, such as drug interactions. (wikipedia.org)
  • In many countries, adverse effects are required by law to be reported, researched in clinical trials and included into the patient information accompanying medical devices and drugs for sale to the public. (wikipedia.org)
  • The Yellow Card Scheme is a United Kingdom initiative run by the Medicines and Healthcare products Regulatory Agency (MHRA) and the Commission on Human Medicines (CHM) to gather information on adverse effects to medicines. (wikipedia.org)
  • However, a small number of children may suffer significant adverse effects from the administration of the very cough and cold formulations they were given in an attempt to relieve their symptoms. (aappublications.org)
  • 15 "Active immunisation" against cocaine produces more persistent changes in the animal's immune system 19, 20 which reduce the locomotor effects of cocaine in rats and markedly attenuate the self administration of cocaine, a model of cocaine addiction in humans. (bmj.com)
  • 7-Keto-DHEA achieves this thermogenic effect without cardiovascular or central nervous system side effects, which are commonly seen with stimulant-associated thermogenic agents. (wikipedia.org)
  • There were no adverse effects in any of these studies. (wikipedia.org)
  • However, due to its stimulating qualities, the topical nasal preparation is more likely to cause adverse effects, including urinary retention. (wikipedia.org)
  • Also, environmental tobacco smoke, or secondhand smoke, has been shown to cause adverse health effects in people of all ages. (wikipedia.org)
  • In the United States, mothers of lower socio-economic status have been found less likely to breastfeed, although this may be partly related to adverse effects of government nutrition supplementation programs that provide subsidies for infant formula. (wikipedia.org)
  • Patient safety is a discipline that emphasizes safety in health care through the prevention, reduction, reporting, and analysis of medical error that often leads to adverse effects. (wikipedia.org)
  • Long-term use of sedative-hypnotics for insomnia lacks an evidence base and is discouraged for reasons that include concerns about such potential adverse drug effects as cognitive impairment (anterograde amnesia), daytime sedation, motor incoordination, and increased risk of motor vehicle accidents and falls. (wikipedia.org)
  • Long-term users of hypnotic drugs for sleep disorders develop only partial tolerance to adverse effects on driving with users of hypnotic drugs even after 1 year of use still showing an increased motor vehicle accident rate. (wikipedia.org)
  • patients
  • The first relates to the difference in risk of in-hospital "adverse reactions" between their study and ours: this risk was 24% among medical patients in 1965/66 but only 6% in our study 5 and approximately 7% in the Canadian Adverse Events Study. (cmaj.ca)
  • The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. (cmaj.ca)
  • Pharmacists and home care/hospice nurses should educate patients and family members to avoid referring to the drug as a "lollipop" or "candy" and to eliminate possible access by anyone other than the patient. (ismp.org)
  • As a result, in one year, from the beginning of June 1997 to the end of May 1998, the agency got only 13,825 such reports even though in hospitals alone approximately 180,000 patients die every year from drug reactions. (drugawareness.org)
  • 12/5/14)- There were 121 hospital-acquired ailments for every 1,000 patients discharged in 2013, down from 145 in 2010, the first year this data was collected, according to a report published by the Department of Health and Human Services. (therubins.com)
  • In 2012, the FDA Center for Devices and Radiologic Health (CDRH) launched a free, public mobile AE reporting app, MedWatcher, for patients and clinicians. (springer.com)
  • Many patients will require more than one drug to achieve blood pressure goals. (bio-medicine.org)
  • Prescriptions May Be Cheaper Without Insurance (Lester Holt, 10-16-17) An NBC News investigation found that a wide variety of generic drugs on certain insurance plans are actually cheaper when you pay out of pocket, but a gag order can prevent some pharmacists from telling patients when they are overpaying. (authorsguild.net)
  • If this is done at all, it should be carefully trialled first, and only after considerable clinical experience has been obtained in using the vaccine to treat voluntary patients. (bmj.com)
  • Introducing exogenous hormones into the body impacts it at every level and many patients report changes in energy levels, mood, appetite, etc. (wikipedia.org)
  • vaccines
  • Although HHE has been less frequently reported to VAERS after increased use of DTaP, HHE does occur after the administration of DTaP and other nonpertussis-containing vaccines. (aappublications.org)
  • Price information for certain drugs covered under Medicare Part B, administered in a doctor s office, hospital, or clinic (e.g., chemotherapy drugs to treat cancer, infused drugs for osteoporosis, steroid injections for joint pain and vaccines. (authorsguild.net)
  • As well as producing hormones, vaccines and other drugs genetic engineering has the potential to cure genetic diseases through gene therapy. (wikipedia.org)
  • Drugs, vaccines and other products have been harvested from organisms engineered to produce them. (wikipedia.org)
  • leads to adverse
  • Research by governments in Australia led to a universal definition for that country which appears to be the only research-based definition not to use diagnostic criteria: "Problem gambling is characterized by many difficulties in limiting money and/or time spent on gambling which leads to adverse consequences for the gambler, others, or for the community. (wikipedia.org)
  • immune system
  • Many parents testified in California Senate public hearings that they have vaccine-injured children or have children with brain and immune system problems that could make them especially susceptible to vaccine harm but are unable to find a doctor willing to write a medical vaccine exemption. (nvic.org)
  • A "cocaine vaccine" is a promising immunotherapeutic approach to treating cocaine dependence which induces the immune system to form antibodies that prevent cocaine from crossing the blood brain barrier to act on receptor sites in the brain. (bmj.com)
  • A "cocaine vaccine" induces the immune system to form antibodies that bind to cocaine. (bmj.com)
  • Although the aging process affects all of the segments of the immune system, investigators have identified abnormalities in the cellular or T-cell mediated immune function in the elderly. (wikipedia.org)
  • physicians
  • The earlier study was based on voluntary reporting by physicians and nurses. (cmaj.ca)
  • Most errors are not caused by stupidity, incompetence or neglect, but by system failures that allow them to occur," said David Lawrence, head of Kaiser Permanente, suggesting that the safety tests done by drug companies are not enough, and that the companies fail to educate physicians and hospital workers on the proper administration of their drugs. (drugawareness.org)
  • Tip No. 1: Most physicians do not have a clue how much various drugs cost (and may have an incentive/​encouragement to prescribe the pricier ones), and don't know how drug prices to the consumer are affected by varying forms of insurance coverage. (authorsguild.net)
  • medicines
  • We're pleased to launch Epaned so quickly after receiving FDA approval," said Frank Segrave , President & CEO, Silvergate Pharmaceuticals, Inc. "Silvergate is happy to take the lead in developing FDA-approved medicines for children - an area of drug development that is often overlooked. (bio-medicine.org)
  • It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. (wikipedia.org)
  • Patient Safety
  • 9/27/16)- A report from the ECRI Institute, a nonprofit research group that studies patient safety, highlighted a growing problem in that patient identification mix-ups are becoming more common, and have resulted in at least two deaths. (therubins.com)
  • Patient-safety researchers at the Michael E. DeBakey VA Medical Center and the Baylor College of Medicine helped advise on the report. (therubins.com)
  • Common functions of patient safety organizations are data collection and analysis, reporting, education, funding and advocacy. (wikipedia.org)
  • At the Fifty-Ninth World Health Assembly in May 2006, the Secretariat reported that the Alliance held patient safety meetings in five of the six WHO regions and 40 technical workshops in 18 countries. (wikipedia.org)
  • The resulting patient safety knowledge continually informs improvement efforts such as: applying lessons learned from business and industry, adopting innovative technologies, educating providers and consumers, enhancing error reporting systems, and developing new economic incentives. (wikipedia.org)
  • Ten years after a groundbreaking Australian study revealed 18,000 annual deaths from medical errors, Professor Bill Runciman, one of the study's authors and president of the Australian Patient Safety Foundation since its inception in 1989, reported himself a victim of a medical dosing error. (wikipedia.org)
  • pediatric
  • 7. Papania MJ, Seward JF, Redd SB, et al: Decreased cerebellar blood ow along the same class of drugs and intravenous pyelography in pediatric trauma. (goswap.org)
  • Approximately half of the prescription drugs commonly given to children do not have information on appropriate pediatric doses on their labels. (bio-medicine.org)
  • In 2014, out of 8,200 pediatric pertussis cases with vaccination records reported in California, 90 percent had been vaccinated. (nvic.org)
  • deaths
  • According to a 2002 Agency for Healthcare Research and Quality report, about 7,000 people were estimated to die each year from medication errors - about 16 percent more deaths than the number attributable to work-related injuries (6,000 deaths). (wikipedia.org)
  • Hospital
  • Egan K. Hospital drug errors a "silent epidemic. (cmaj.ca)
  • The two most prominent core data sets are the Uniform Hospital Discharge Data Set (UHDDS), which is the basis of the hospital discharge data systems in 34 States, and the Uniform Ambulatory Care Data Set (UACDS). (ahrq.gov)
  • The goal of this study was evaluation of clinical pharmacists' interventions in improvement of knowledge, attitude and perception about adverse drug reactions in a referral teaching hospital, Tehran, Iran. (bmj.com)
  • Our results showed that 91.5% of the healthcare workers of the hospital never reported any adverse drug reaction and 49% were not even aware of the Iranian Pharmacovigilace Center. (bmj.com)
  • Regarding the study results, it was suggested that health systems must have training programmes for their workers about importance, detection, analysis, reporting and fallow-up of adverse drug reactions in the hospital and provide online and telephone line accesses to facilitate adverse drug reactions reporting system. (bmj.com)
  • absorption
  • Comparison of a single 25 mg dose in Beagle dogs after subcutaneous and oral administration demonstrated that the dorsoscapular subcutaneous administration results in a slower rate of drug input (as reflected by mean peak observed concentrations) but comparable total drug absorption within a 12 hour dosing interval (as reflected by area under the curve from hours zero to 12 postdose). (drugs.com)
  • Food
  • The Food and Drug Administration has recently approved Effexor XR, a drug for "generalized anxiety disorder" - the garden-variety free-floating anxiety that has plagued humanity since the expulsion from Eden. (drugawareness.org)
  • 2/6/14)- The official Food and Drug Administration s site to report and get info on adverse drug reactions is fda.gov/safety. (therubins.com)
  • MedWatch is the main reporting center, operated by the Food and Drug Administration. (wikipedia.org)
  • Preparing and submitting a voluntary adverse event (AE) report to the US Food and Drug Administration (FDA) for a medical device typically takes 40 min. (springer.com)
  • For example, the Food and Drug Administration recently issued an advisory to remove phenylpropanolamine (PPA)-a common constituent of OTC decongestants-from those products because of concern for increased risk of hemorrhagic stroke. (aappublications.org)
  • Objective To determine if drugs approved through the Food and Drug Administration's expedited development and review pathways have different rates of safety related label changes after approval compared with drugs approved through standard non-expedited pathways. (bmj.com)
  • The Food and Drug Administration reviews the data and approves the drug if its benefits outweigh the risks. (bmj.com)
  • In the US, lindane pesticide products were regulated by the U.S. Environmental Protection Agency (EPA), while lindane medications are regulated by the Food and Drug Administration (FDA). (wikipedia.org)
  • A 2001 World Health Organization (WHO) report found that infant formula prepared in accordance with applicable Codex Alimentarius standards was a safe complementary food and a suitable breast milk substitute. (wikipedia.org)
  • In 1973, the U.S. Food and Drug Administration (FDA) first published standards for making, using and storing AVA. (wikipedia.org)
  • Food policies are designed to influence the operation of the food and agriculture system. (wikipedia.org)
  • In 1906, the Pure Food and Drug Act and the Federal Meat Inspection Act (FMIA) were both signed into law. (wikipedia.org)
  • Both prevent production and sale of adulterated or misbranded foods, the Pure Food and Drug Act focusing on general foods, and FMIA focusing on meats. (wikipedia.org)
  • The Bureau of Chemistry, which was charged with enforcing the Pure Food and Drug Act, was reorganized in 1927, becoming the Food, Drug, and Insecticide Administration, and eventually came to be called the Food and Drug Administration (FDA) in 1931. (wikipedia.org)
  • In 1938, the Federal Food, Drug, and Cosmetic Act was passed by Congress, giving the FDA authority to set food safety standards. (wikipedia.org)
  • In 1958, the Food, Drug and Cosmetic Act of 1938 was amended to include the Food Additive Amendment, addressing concerns over invisible hazards from chemicals added to the foods. (wikipedia.org)
  • health
  • this report was submitted to the HHS Data Council on August 21, 1996, and continues to be under review within HHS in the context of adopting standards under the Health Insurance Portability and Accountability Act of 1996. (ahrq.gov)
  • The Surgeon General's report on the state of the nation's mental health found that 22 percent of the population has a diagnosable mental disorder. (drugawareness.org)
  • At the same time, a study by the National Institute of Mental Health concluded that we are under-medicating our children and that for those diagnosed with attention-deficit hyperactivity disorder, drugs - specifically Ritalin - are more effective than therapy. (drugawareness.org)
  • It's doubly tragic that these reports have arrived at a time when we're facing a crisis in managed health care. (drugawareness.org)
  • The report analyzed 7,613 cases of wrong-patient identifications errors at 181 health-care organizations from January 2013 to July 2015. (therubins.com)
  • Consumer complaints about aspartame were collected by the FDA and in a rare slip, the U.S. Department of Health and Human Services in February of 1994 released a listing of adverse reactions. (newmediaexplorer.org)
  • Facebook Live: The Prescription Drug Pricing Pipeline (video, Kaiser Health News, archived 30-minute conversation with knowledgeable journalists). (authorsguild.net)
  • In 1999, the Institute of Medicine (IOM) of the National Academy of Sciences released a report, To Err is Human: Building a Safer Health System. (wikipedia.org)
  • hospitals
  • The Myth of Drug Expiration Dates ( Marshall Allen, Pro Publica, 7-18-17) Hospitals and pharmacies are required to toss expired drugs, no matter how expensive or vital (or that they routinely give you way more than you need). (authorsguild.net)
  • According to the study, 400,000 preventable drug-related injuries occur each year in hospitals, 800,000 in long-term care settings, and roughly 530,000 among Medicare recipients in outpatient clinics. (wikipedia.org)
  • 1996
  • More than 40 000 VAERS reports received between 1996 and 1998 were screened for HHE by a computer algorithm and reviewed, and a telephone follow-up questionnaire was administered to the witness of HHE. (aappublications.org)
  • From 1996 to 1998, the number of HHE reports decreased from 99 to 38, when the predominant pertussis vaccine administered to infants changed from whole-cell to acellular. (aappublications.org)
  • nervous system
  • Quinolones with γ-aminobutyric acid (GABA) type-A receptor antagonist properties can impair inhibition and act as excitatory compounds in central nervous system circuits, resulting in abnormal hyperkinetic movement disorders like dystonia. (ajpp.in)
  • 2013). Quinolones, such as levofloxacin, have γ-aminobutyric acid (GABA) type-A receptor antagonist properties, and can thus impair inhibition and act as excitatory compounds in central nervous system (CNS) circuits (Tsuji et al. (ajpp.in)
  • This vitamin is important for the facilitation of glucose use, thus ensuring the production of energy for the brain, and normal functioning of the nervous system, muscles, and heart. (wikipedia.org)
  • Metabolism and coenzyme function of the vitamin suggest a distinctive function for thiamin within the nervous system. (wikipedia.org)
  • However, zopiclone increases the normal transmission of the neurotransmitter gamma-aminobutyric acid in the central nervous system, via modulating benzodiazepine receptors in the same way that benzodiazepine drugs do. (wikipedia.org)
  • It works by causing a depression or tranquilization of the central nervous system. (wikipedia.org)
  • Daily or continuous use of the drug is not usually advised, and caution must be taken when the compound is used in conjunction with antidepressants, sedatives or other drugs affecting the central nervous system. (wikipedia.org)
  • cough
  • Because no cases of death or heart failure attributable to OTC cough and cold preparations have been reported in recent literature, these cases are presented to serve as points for additional discussion on the risks of OTC cough and cold preparations in children. (aappublications.org)
  • According to one study, pseudoephedrine may show effectiveness as an antitussive drug (suppression of cough). (wikipedia.org)
  • intravenous
  • We report a case of reversible multifocal dystonia associated with intravenous levofloxacin therapy in a patient with gentamycin induced acute kidney injury. (ajpp.in)
  • medical
  • ICD is the official medical classification for disease reporting in the United States. (ahrq.gov)
  • If you or a loved one has been harmed by a #Medical #device please report this to the FDA. (goswap.org)
  • Reports received via the mobile app were considered "well documented" 55.9 % of the time, compared with an international average of 13 % for all medical products. (springer.com)
  • Numerous exceptions to this standard pathway are open to drugs meeting unmet medical needs or for treating serious or life threatening conditions. (bmj.com)
  • reporting by medical professionals and consumers is voluntary. (wikipedia.org)
  • One in five Americans (22%) report that they or a family member have experienced a medical error of some kind. (wikipedia.org)
  • According to a report from Harvard Medical School's division on addictions, there was an experiment constructed where test subjects were presented with situations where they could win, lose, or break even in a casino-like environment. (wikipedia.org)
  • However, subsequent reports emphasized the striking prevalence and consequences of medical error. (wikipedia.org)
  • reversible
  • A diverse reversible hyperkinetic movement phenomenology has been reported in relation to levofloxacin- tremor, chorea and dystonia. (ajpp.in)
  • Several
  • Several cases have been reported where amoxicillin was reconstituted with 50% alcohol solution, methadone, or formalin instead of water. (ismp.org)
  • Carprofen has also been shown to inhibit the release of several prostaglandins in two inflammatory cell systems: rat polymorphonuclear leukocytes (PMN) and human rheumatoid synovial cells, indicating inhibition of acute (PMN system) and chronic (synovial cell system) inflammatory reactions. (drugs.com)
  • year
  • What the ad doesn't mention is that drug company profits (Pfizer's last year were $3.35 billion) are often spent not on finding cures for serious diseases but for "lifestyle" maladies - baldness, toenail fungus, and of course any interruption to a perpetually sunny mood. (drugawareness.org)
  • Over the past year and a half, the agency has banned only five drugs that it previously had approved but now deems dangerous. (drugawareness.org)
  • The report concluded that as many as 50,000 fewer people died while hospitalized over this three-year period of time. (therubins.com)
  • The relative rate of safety related label changes per year for expedited pathway and non-expedited pathway drugs was compared by forming matched pairs of drugs in the same therapeutic class that were approved within three years of each other. (bmj.com)
  • Expedited pathway drugs were characterized by a rate of 0.94 safety related label changes for each drug per year, compared with 0.68 safety related label changes per year for non-expedited pathway drugs (rate ratio 1.38, 95% confidence interval 1.25 to 1.52). (bmj.com)
  • vaccine
  • Out of 136 measles cases reported in the state in 2015, only 18 percent were in school-aged children while 55% were in adults and 30 percent of all cases with vaccine records had been vaccinated. (nvic.org)
  • A successful phase 1 trial of a human cocaine vaccine has been reported. (bmj.com)
  • safety
  • Patient community outreach was conducted to administrators of the group "Essure Problems" (approximately 18,000 members as of June 2015) to gather individual case safety reports (ICSRs). (springer.com)
  • Main outcome measures The number of times a particular safety section of a label (boxed warning, contraindication, warning, precaution, or adverse reaction) was changed during a drug's time on the market. (bmj.com)
  • Compared with non-expedited pathway drugs, expedited pathway drugs had a 48% higher rate of changes to boxed warnings and contraindications, the two most clinically important categories of safety warnings (1.48, 95% confidence interval 1.07 to 2.06). (bmj.com)
  • Conclusions Expedited development and regulatory review pathways can accelerate the availability of new drugs, but drugs approved through these pathways are associated with increased safety related label changes after approval, particularly for the types of changes representing the highest risk warnings. (bmj.com)
  • Before a new drug can be marketed in the US, the manufacturer must first conduct clinical trials that demonstrate substantial evidence of efficacy and adequate safety. (bmj.com)
  • In addition, the effectiveness and safety of long-term use of nonbenzodiazepine hypnotic drugs remains to be determined. (wikipedia.org)
  • Guidelines
  • This is in accord with ICH guidelines, which do not require carcinogencity testing in nongenotoxic drugs intended for administration for less than six months. (wikipedia.org)
  • cause
  • 1988). Levofloxacin have been rarely reported to cause abnormal hyperkinetic movement disorders. (ajpp.in)
  • includes
  • Rimadyl Injectable is a sterile solution containing carprofen, a non-steroidal anti-inflammatory drug (NSAID) of the propionic acid class that includes ibuprofen, naproxen, and ketoprofen. (drugs.com)
  • partial
  • The 3 children reported as not returning to their prevaccination state all had VAERS reports submitted after they developed conditions (autism, complex partial epilepsy, and developmental delays with infantile spasms) that are not known to be causally associated with immunization. (aappublications.org)
  • Medicare
  • Prescriber Checkup (ProPublica) Medicare s popular prescription-drug program serves more than 42 million people and pays for more than one of every four prescriptions written nationwide. (authorsguild.net)
  • California
  • The authors concluded, "The California experience suggests elimination of pharmaceutical lindane produced environmental benefits, was associated with a reduction in reported unintentional exposures and did not adversely affect head lice and scabies treatment. (wikipedia.org)
  • Study
  • that study also recommended that if the drug in an expired device has not started to precipitate (if the solution is not cloudy and has no particles in it) using the expired device is better than no injection at all in an emergency situation. (wikipedia.org)
  • include
  • Other Z-drugs include zaleplon (Sonata) and zolpidem (Ambien and AmbienCR) and were initially thought to be less addictive or habit-forming than benzodiazepines. (wikipedia.org)
  • often
  • Dystonia is a hyperkinetic movement disorder characterized by typically patterned, sustained or intermittent muscle contractions producing abnormal, often repetitive, movements, postures, or both, often precipitated or worsened by voluntary action and associated with overflow muscle activation (Albanese et al. (ajpp.in)
  • Often the d/l system (with small caps) and the d/l system (with lower-case) are confused. (wikipedia.org)
  • 1997
  • Cocaine is one of the most widely used illicit drugs in the world, with 13 million people reported to have used it globally in 1997. (bmj.com)