Valsartan, Losartan and Irbesartan use in the USA, UK, Canada and Denmark after the nitrosamine recalls: a descriptive cohort study.

OBJECTIVES: To examine valsartan, losartan and irbesartan usage and switching patterns in the USA, UK, Canada and Denmark before and after July 2018, when the first Angiotensin-Receptor-Blocker (ARB) (valsartan) was recalled. DESIGN: Retrospective cohort study. SETTING: USA, Canadian administrative healthcare data, Danish National Prescription Registry and UK primary care electronic health records. PARTICIPANTS: Patients aged 18 years and older between January 2014 and December 2020. INTERVENTION: Valsartan, losartan and irbesartan. MAIN OUTCOME: Monthly percentages of individual ARB episodes, new users and switches to another ARB, ACE inhibitors (ACEI) or calcium channel blockers containing products. RESULTS: We identified 10.8, 3.2, 1.8 and 1.2 million ARB users in the USA, UK, Canada and Denmark, respectively. Overall proportions of valsartan, losartan and irbesartan use were 18.4%, 67.9% and 5.2% in the USA; 3.1%, 48.3% and 10.2% in the UK, 16.3%, 11.4% and 18.3% in Canada, 1%, 93.5% and 0.6% in Denmark. In July 2018, we observed an immediate steep decline in the proportion of valsartan use in the USA and Canada. A similar trend was observed in Denmark; however, the decline was only minimal. We observed no change in trends of ARB use in the UK. Accompanying the valsartan decline was an increase in switching to other ARBs in the USA, Canada and Denmark. There was a small increase in switching to ACEI relative to the valsartan-to-other-ARBs switch. We also observed increased switching from other affected ARBs, losartan and irbesartan, to other ARBs throughout 2019, in the USA and Canada, although the usage trends in the USA remained unchanged. CONCLUSION: The first recall notice for valsartan resulted in substantial decline in usage due to increased switching to other ARBs. Subsequent notices for losartan and irbesartan were also associated with increased switching around the time of the recall, however, overall usage trends remained unchanged.

A Rights-based Approach to Information in Humanitarian Assistance.

Crisis-affected populations and humanitarian aid providers are both becoming increasingly reliant on information and communications technology (ICTs) for finding and provisioning aid. This is exposing critical, unaddressed gaps in the legal and ethical frameworks that traditionally defined and governed the professional conduct of humanitarian action. The most acute of these gaps is a lack of clarity about what human rights people have regarding information in disaster, and the corresponding obligations incumbent upon governments and aid providers.  This need is lent urgency by emerging evidence demonstrating that the use of these technologies in crisis response may be, in some cases, causing harm to the very populations they intend to serve.  Preventing and mitigating these harms, while also working to responsibly ensure access to the benefits of information during crises, requires a rights-based framework to guide humanitarian operations. In this brief report, we provide a commentary that accompanies our report, the Signal Code: A Human Rights Approach to Information During Crisis, where we have identified five rights pertaining to the use of information and data during crisis which are grounded in current international human rights and customary law. It is our belief that the continued relevance of the humanitarian project, as it grows increasingly dependent on the use of data and ICTs, urgently requires a discussion of these rights and corresponding obligations.