From TIME:

On a recent afternoon in Charleston, S.C., a food fight began again. Not a fight, really, but a disagreement among the leaders of the state's SCORxE program — designed to educate physicians with unbiased and accurate information about prescription drugs. The basic issue: should representatives of the program bring the doctors pizza for lunch? Sarah Ball, the indefatigable pharmacist who leads SCORxE, says no. The whole point of SCORxE, after all, is to counteract Big Pharma's hard-sell drug marketing. But sometimes you have to fight fire with fire, says Dr. Robert Malcolm, a psychiatrist and adviser to SCORxE. "We are competing with people who bring food," he says.

Patients rarely question the drugs their doctors prescribe. But the truth is that doctors don't always prescribe the best or cheapest treatment. Actually, they don't always know what that is, given that they lack the time to keep up with the latest drug journal articles, pore over research on the Web or attend medical conferences. One of doctors' most convenient sources of new-drug information is, therefore, also the most biased: the chipper, gift-laden pharmaceutical salespeople who come to doctors' offices bearing free samples, prescribing tips and copies of the latest study that shows how great their new drug is. They also bring food — pizza, doughnuts, chalupas, cookies — to help their sales pitches go down easier.

Drug companies say the visits keep doctors educated about important new trends. But harried doctors are often persuaded to prescribe expensive new drugs, even though older drugs or generics would be just as effective. A Harvard model projects that every dollar spent on better information would yield $2 in drug savings. That's a big deal to cash-strapped states that pay a large chunk of Medicaid patients' drug costs. Thus SCORxE — South Carolina Offering Prescribing Excellence — a joint program between the state's Medicaid program and the South Carolina College of Pharmacy, which trains its pharmacist-reps to visit doctors' offices armed with unbiased studies.

Programs like SCORxE (pronounced score), which launched last October with a budget of about $1 million for the first year, are not without controversy. They represent an unusual and, at least initially, somewhat expensive new role for government. A few other states have similar programs, and the idea has also taken hold in Australia and Canada.

There are no data yet from South Carolina, but the measure seems to be working in other places. In Pennsylvania, the state calculated that among just one subgroup of patients — seniors in a prescription-relief program — the state saves $572,000 a year on acid-reflux drug costs alone, simply by reminding doctors that pricey Nexium, the "purple pill," often has cheaper, equally effective generic alternatives. It's a model that may soon go nationwide. On July 31, the Independent Drug Education and Outreach Act of 2008 was introduced in both houses of Congress. If it passes, it could fund programs like SCORxE around the country.

From The Australian (Sydney, Australia):

Drug experts have warned that sleeping pills such as Stilnox carry more risks than benefits with longer-term use and should ideally not be taken for more than two weeks running.

The advice, issued by the government-funded National Prescribing Service, recommends people first try non-drug treatments if they have trouble falling asleep.

In a position statement on the use of Stilnox and similar drugs, the NPS says people who experience side effects such as walking, eating or even driving a vehicle while asleep -- all of which have been reported by people taking Stilnox -- should stop taking the medicine.

"The risks associated with (Stilnox and other) hypnotics generally outweigh any benefits they provide with continuous long-term use," the NPS says in its summary of the new position. While the NPS has previously advised a two-week maximum for people taking Stilnox and similar drugs, that is still half the four-week limit recommended in the official product information included inside each Stilnox packet.

Stilnox is just one of at least a dozen brand names for the sleeping drug zolpidem.

The drug attracted controversy last year after regulators publicised reports of patients walking and operating machinery during sleep. A closely related drug, zopiclone, has also come under scrutiny and the warnings in the latest NPS position statement also apply to it.

"There is no convincing evidence that the benefit-harm profile of zolpidem or zopiclone is more favourable than that of short-acting benzodiazepines (such as temazepam)," the NPS position statement says. "Tolerance, dependence, withdrawal symptoms and morning sedation have also been reported with zolpidem and zopiclone."


Also, from iTWire (Australia):

The National Prescribing Service says insomnia drug zolpidem has more risks than benefits. Zolpidem is found in such trade-named products as Ambien, Hypnogen, Myslee, Nimadorm, Nitrest, Sanval, Stilnoct, Stilnox, Zoldem, Zolfresh, and Zolt.

Zolpidem is a prescription medication that is used for the short-term treatment of insomnia (sleeplessness), along with jet lag and shift-work.

Medically, the drug is a short-acting nonbenzodiazepine hypnotic that “potentiates gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, by binding to benzodiazepine receptors which are located on the gamma-aminobutyric acid receptors.” [Physiology and Behavior: “The sleep–wake cycle and sleeping pills”]

The article within the journal Physiology and Behavior also states, “Today, benzodiazepines and the so-called “non-benzodiazepines”, such as zolpidem, which both act on benzodiazepine receptors, are drugs of first choice and they are substitutes for barbiturates.”

The drug zopiclone is similar to zolpidem and, thus, is also under scrutiny by authorities.

It is sold in Europe and Canada under the trade names of Imovane and Zimovane and in the United States under the trade name Lunesta.

In Canada, the United States, and many European countries, any drug containing zopiclone is considered illegal to possess without a valid prescription.

Dr. Blunden, who is associated with the Centre for Applied Behavior Science at the University of South Australia, "The difficulty with any pill, not just Stilnox, is that the risk of dependency is related to the fact that stopping them abruptly can lead to 'rebound sleep problems' -- meaning the sleep can be worse than it was in the first place, because your body has got used to the pill.”