Sucralfate

By G. Nefarius. Bentley College. 2019.

IgE reactivity to 14-kD and 27-kD natural rubber proteins in latex-allergic children with spina bifida and other congential anomalies purchase 1000mg sucralfate overnight delivery. Cloning discount sucralfate 1000 mg with amex, expression, and characterization of recombinant Hev b 3, a Hevea brasiliensis protein associated with latex allergy in patients with spina bifida. Purified and recombinant latex proteins stimulate peripheral blood lymphocytes of latex allergic patients. The main IgE binding epitopes of a major latex allergens, prohevein is present in its 43 amino acid fragment hevein. IgE from latex-allergic patients binds to cloned and expressed b cell epitopes of prohevein. Allergy to latex avocado, pear, and banana: evidence for a 30 kd antigen in immunoblotting. Crossreactivity between allergens in natural rubber latex and banana studied by immunoblot inhibition. Identification and characterization of avocado chitinase with cross-reactivity to a latex protein. Mutual boosting effects of sensitization with timothy grass pollen and latex glove extract on IgE antibody responses in a mouse model. Basophil histamine release and lymphocyte proliferation tests in latex contact urticaria. Lymphocyte proliferation response to extracts from different latex materials and to the purified latex allergen Hev b 1 (rubber elongation factor). Characterization of T cell responses to Hev b 3, an allergen associated with latex allergy in spina bifida patients. Allergenic and antigenic determinants of latex allergen Hev b 1: peptide mapping of epitopes recognized by human, murine and rabbit antibodies. Murine B-cell and T-cell epitopes of the allergen Hev b 5 from natural rubber latex. Immunological and structural similarities among allergens: prerequisite for a specific and component-based therapy of allergy. A medical-center-wide multi disciplinary approach to the problem of natural rubber latex allergy. Latex gloves with a lower protein content reduce bronchial reactions in subjects with occupational asthma caused by latex. Impact of personal avoidance practices on health care workers sensitized to natural rubber latex. Dyspnea may not be recognized by some patients with asthma, and these poor perceivers may experience acute severe asthma episodes that may be fatal (1). More commonly, patients tolerate or acclimate to decreases in expiratory flow rates. Obtaining spirometry on the initial assessment of a patient with asthma or possible asthma was recommended by the Expert Panel Report 2 of the National Asthma Education and Prevention Program of the National Institutes of Health ( 2). Subsequent measurements are obtained after treatment to demonstrate expected improvement and then at least every 1 to 2 years ( 2). It is often necessary to obtain spirometric values more frequently, depending on the clinical response and severity of asthma. Spirometric results should be considered in terms of accepted parameters and test performance. In addition, a poor seal around the mouthpiece will result in decreased results from air leakage into the environment. Cigarette smokers lose about 45 mL/year, with some more susceptible patients losing as much as 60 mL/year ( 6). Also, a person may be disabled from asthma if there are episodes of severe attacks in spite of prescribed treatment, occurring at least once every 2 months or on an average of at least 6 times a year, and prolonged expiration with wheezing or rhonchi on physical examination between attacks (11). The difference was associated with eosinophil presence in bronchial biopsy specimens but was not explained by differences in neutrophils ( 12). Pulmonary function tests in a 19-year-old man with acute severe asthma The patterns of the expiratory curve and inspiratory loop should be examined. Obstruction on expiration produces a scooping-out pattern or one that is concave upward in appearance (Fig. The expiratory flow tracing (upper quadrant) shows a reduced peak flow, reduced forced vital capacity, and flattened expiratory curve consistent with obstruction. There should not be any major limitation of inspiratory flow in uncomplicated asthma, although it is recognized on the flow-volume loop that peak inspiratory flow rates are typically less than expiratory flow rates. There may be modest decreases of inspiratory flow in some patients with asthma, but not to the extent seen if a patient has a respiratory muscle myopathy that accompanies prolonged high-dose systemic corticosteroid use or systemic corticosteroid combined with muscle relaxants in previously mechanically ventilated patients. If there is a flattened inspiratory loop, causes of extrathoracic obstruction should be considered unless the patient has a restrictive disorder. Such patients may also have self-induced arterial hypoxemia from breath-holding or self-induced reductions in their tidal breathing ( 13). The patient reported acute wheezing after an upper respiratory infection and felt that inhaled fluticasone into the airways helped reduce the cough. The current tracing demonstrates a flattened inspiratory curve ( lower quadrant) and one adequate expiratory tracing in the upper quadrant.

And doctors treating prostate cancer will be able to predict how aggressive a tumor will be discount 1000mg sucralfate visa. For many diseases order 1000mg sucralfate with visa, such genetic information will help patients and doctors weigh the risks and benefits of different treatments. In many cases, this advance warning can be a cue to start a vigilant screening program, to take preventive medicines, or to make diet or lifestyle changes that might prevent the disease altogether. For example, those at risk for colon cancer could undergo frequent colonoscopies; those with hereditary hemochromatosis, a common disorder of iron metabolism, could donate blood periodically to remove excess iron and prevent damage to the body. Some women at risk for breast cancer could benefit from tamoxifen; a young person at risk for developing lung cancer may become particularly motivated to quit smoking; those with familial hypercholesterolemia could begin treatment to lower their cholesterol levels and prevent heart attacks and strokes. Unfortunately, our ability to predict a disease sometimes precedes our ability to prevent or treat it. For example, a genetic test has been avail- able for Huntington disease for years, but no treatment is available yet. Testing 10 Gene-base Genetic Medicine 11 Newborn screening A particular form of predictive testing, newborn screening can sometimes help a great deal. In the past, children with the condition became severely mentally retarded, but the screening program identifies children with the enzyme deficiency, allowing them to grow normally on a diet that strictly avoids phenylalanine. Carrier screening For some genetic conditions, people who will never be ill themselves can pass a disease to their children. Some couples choose to be tested for this risk before they marry, especially in commu- nities where a feared childhood disease is particularly common. For example, carrier testing for Tay-Sachs disease, which kills young children and is particularly common in some Jewish and Canadian populations, has been available and widely used for years. Gene therapy Replacing a misspelled gene with a functional gene has long been an appealing idea. Small groups of patients have undergone gene therapy in clinical trials for more than a decade, but this remains an experimental treatment. Gene-based therapy Great medical benefit likely will derive from drug design that s guided by an understanding of how genes work and what exactly happens at the molecular level to cause disease. For example, the causes of adult-onset diabetes and the resulting complications remain difficult to decipher and, so, to treat. But researchers are opti- mistic that a more precise understanding of the underlying causes will lead to better therapies. In many cases, instead of trying to replace a gene, it will be more effective and simpler to replace the protein the gene would give rise to. Alternatively, it may be possible to administer a small molecule that interacts with the protein as many drugs do and changes its behavior. One of the first examples of such a rationally-designed drug targets the genetic flaw that causes chronic myelogenous leukemia, a form of leukemia that mostly affects adults. An unusual joining of chromosomes 9 and 22 produces an abnormal protein that spurs the uncontrolled growth of white blood cells. Scientists have designed a drug that specifically attaches to the abnormal protein and blocks its activity. In preliminary tests, blood counts returned to normal in all patients treated with the drug. And, compared with other forms of cancer treatment, the patients experienced very mild side effects. Instead of having to rely on chance and screening thousands of mole- cules to find an effective drug, which is how most drugs we use today were found, scientists will begin the process of drug discovery with a clearer notion of what they re looking for. And because rationally designed drugs are more likely to act very specifically, they will be less likely to have damaging side effects. Genomics will hasten the advance of molecular biology into the practice of medicine. As the molecular foundations of diseases become clearer, we may be able to prevent them in many cases and in other cases, design accurate, individualized treatments for them. New drugs, derived from a detailed molecular understanding of common illnesses like diabetes and high blood pressure, will target molecules logically. Decades from now, many potential diseases may be cured at the molecular level before they arise. But access to genome sequence will increasingly shape the practice of health care over the coming decades, as well as shed light on many of the mysteries of biology. Development of Genetic Medicine Drug Therapy Prevention Diseasew ith M ap Identify Genetic Gene(s) Gene(s) Diagnostics Com ponent Pharm acogenom ics Gene Therapy T I M E Written by Karin Jegalian Produced by National Human Genome Research Institute National Institutes of Health www. Technologies for data capture and manage- shown in parentheses below and Annex A) clustered un- ment and development of high quality databases will der fve challenges. Translational research infrastruc- the beneft of patients, citizens and society as a whole (see tures and data harmonisation of structured, semi-struc- the paragraph Looking Forward below). This starts with the integration of all omics data to Innovation approach (27).

No reports of significant adverse immunologic events have been published with these agents buy 1000mg sucralfate overnight delivery. Polyclonal sheep antidigoxin antibodies have proved useful when administered to patients with digoxin overdose cheap sucralfate 1000mg overnight delivery. Unfortunately, significant hypersensitivity reactions, including severe anaphylaxis, have been described. There are also reports of localized reactions and generalized maculopapular eruptions. The immunopathogenesis of the latter reactions has not been well characterized (64). Soluble Type 1 Interleukin-1 Receptor Interleukin-1 is a cytokine important in many types of inflammation. Erythropoietin Although hypersensitivity reactions have not yet been reported with erythropoietin, antibodies, including neutralizing antibodies, have been reported. In one patient, antibody development was actually associated with red blood cell aplasia that resolved when erythropoietin was discontinued and the antibody titers declined ( 66). A rapid serologic method for detecting antirecombinant human erythropoietin antibodies has been published as a tool for the diagnosis of erythropoietin resistance ( 67). Antibody production against erythropoietin should be considered in the evaluation of patients whose anemia becomes refractory to erythropoietin therapy. In one study, the development of antibodies was associated with a relapse of their disease ( 69). It has been reported that the epitopes, which are recognized by neutralizing antibody, are located in the N-terminal function domain of rife-a ( 71). Chronic granulomatous disease has been reported to be treated safely and effectively with rife-a ( 72). Follicle-stimulating Hormone With the increasing number of infertile couples deciding to pursue in vitro fertilization, the use of a variety of hormones has increased. There are other documented hypersensitivity reactions to urine-derived preparations while subsequently tolerating the recombinant protein ( 76). When that patient suffered another episode of hemorrhage, desensitization with pretreatment was attempted, but a moderately severe reaction occurred. Several investigators predicted that the incidence of inhibitors in patients treated only with the recombinant product would be higher ( 82,83). However, the studies suggest that the prevalence is about the same, with most patients having a low level of inhibitor that does not significantly affect the efficacy ( 84). Other Recombinant Proteins Hirudin is a thrombin inhibitor found in the salivary glands of leeches. In a trial of use of recombinant hirudin as an anticoagulant, an IgE-mediated hypersensitivity reaction was reported (85). A second risk of immunization is the possibility of reactions to vaccine components, such as eggs, gelatin, and neomycin. Finally, as happened with killed rubeola and respiratory syncytial virus vaccines, the protective immunity declined with time. When natural exposure resulted in infection, it was often atypical and actually more severe than in individuals who had never been immunized ( 91,92,93 and 94). Tetanus Toxoid Although minor reactions, such as local swelling, are common after tetanus toxoid or diphtheria-tetanus (dT) toxoid vaccinations, true IgE-mediated reactions are rare. However, the Institute of Medicine Report 1994 concluded that there was a causative relationship between anaphylaxis and administration of tetanus toxoid with or without diphtheria (95). A number of case reports have been published (96,97 and 98), but surveys estimate the risk for a systemic reaction to be very small, 0. Because diphtheria toxoid is not available as a single agent, it is impossible to separate the true incidence of diphtheria-associated reactions from those due to tetanus toxoid. When it appears necessary to administer tetanus toxoid to a patient with a history of a previous adverse reaction, a skin test graded challenge may be performed (100,101). One recommended approach is to begin with a skin-prick test using undiluted toxoid. After that, the balance of full-strength material may be given for a final total dose of 0. Pertussis and Rubella The Institute of Medicine analyzed adverse effects of pertussis and rubella vaccines ( 102). Encephalitis and other neurologic sequelae were once thought to be a consequence of pertussis vaccine, but the evidence does not report a causal association. Rubella vaccination results in arthritis and arthralgia in a significant percentage of adult and adolescent females.

Despite the obvious public health importance of nding effective ways to treat sepsis buy sucralfate 1000 mg online, researchers have been frustratingly unsuccessful buy sucralfate 1000mg line. Kevin Tracey of the North Shore-Long Island Jewish Research Institute in Manhasset, New York, has identied an unusual suspect in the deadly crime of sepsis: the nervous system. Tracey and his coworkers have discovered an unexpected link between cytokines, the chemical weapons released by the immune system during sepsis, and a major nerve that con trols critical body functions such as heart rate and digestion. Further serious public health problem, causing more deaths research has led Tracey to conclude that produc annually than heart disease. The most severe form tion of the neurotransmitter acetylcholine underlies of sepsis occurs when bacteria leak into the blood the inammation-blocking response. Tracey is stream, spilling their poisons and leading to a investigating whether stimulating the vagus nerve dangerous condition called septic shock. Blood can be used as a component of therapy for sepsis pressure plunges dangerously low, the heart has and as a treatment for other immune disorders. The clich could not be more apt for biologists trying to understand how a complicated enzyme works. For decades, researchers have isolated and puried individual enzymes from cells, performing experi ments with these proteins to nd out how they do their job of speeding up chemical reac tions. But to thoroughly understand a molecule s function, scientists have to take a very, very close look at how all the atoms t together and enable the molecular machine to work properly. Tremors, increased Give two examples of heart rate, and problems with sexual function immunotherapy. Plants have for sure what the earliest humans did to treat also served as the starting point for countless drugs their ailments, but they probably sought cures in on the market today. Drug discovery scientists often refer to these ideas as leads, and chemicals that have desirable properties in lab tests are called lead compounds. Natural Cholesterol-Buster Having high cholesterol is a signicant risk factor and his coworker David Moore of Baylor College for heart disease, a leading cause of death in the of Medicine in Houston, Texas, found that guggul industrialized world. This research, part of which rst identied cholesterol receptors, led to the development of the popular cholesterol-lowering statin drugs such as Mevacor and Lipitor. New research from pharmacologist David Mangelsdorf, also at the University of Texas Southwestern Medical Center at Dallas, is pointing to another potential treatment for high cholesterol. The new substance has the tongue-twisting name guggulsterone, and it isn t really new at all. Guggulsterone comes from the sap of the guggul tree, a species native to India, and has been used in India s Ayurvedic medicine since at least 600 B. Medicines By Design I Drugs From Nature, Then and Now 29 Relatively speaking, very few species of living only a few of these organisms to see whether they things on Earth have actually been seen and harbor some sort of medically useful substance. Many of these unidentied Pharmaceutical chemists seek ideas for new organisms aren t necessarily lurking in uninhab drugs not only in plants, but in any part of nature ited places. This includes identied a brand-new species of millipede in a searching for organisms from what has been called rotting leaf pile in New York City s Central Park, the last unexplored frontier: the seawater that an area visited by thousands of people every day. Scientists estimate that Earth is home to at least 250,000 different species of plants, and that up to 30 million species of insects crawl or y some where around the globe. Despite these vast numbers, chemists have tested Cancer Therapy Sees the Light A novel drug delivery system called photodynamic therapy combines an ancient plant remedy, modern blood transfusion techniques, and light. Some forms of cancer Photodynamic therapy has been approved by the can be treated with Food and Drug Administration to treat several photodynamic therapy, in which a cancer-killing cancers and certain types of age-related macular molecule is activated degeneration, a devastating eye disease that is the by certain wavelengths leading cause of blindness in North America and of light. Photodynamic therapy is also being tested as a treatment for some skin and immune disorders. The key ingredient in this therapy is psoralen, a plant-derived chemical that has a peculiar prop erty: It is inactive until exposed to light. To an untrained eye they look recognized the potential use of this chemical like nothing more than small, colorful blobs, but weaponry to kill bacteria or raging cancer cells. They found this chemical, a staple for treating One tunicate living in the crystal waters of leukemia and lymphoma, in a Caribbean sea West Indies coral reefs and mangrove swamps sponge. In recent years, scientists have discovered turned out to be the source of an experimental dozens of similar ocean-derived chemicals cancer drug called ecteinascidin. PharmaMar, a pharmaceutical company For example, scientists have unearthed several based in Spain, now holds the licenses for promising drugs from sea creatures called tunicates. Ehrlich discovered salvarsan after screening seems perfectly obvious now, 605 different arsenic-containing compounds. Later, it was considered very strange researchers around the world had great success in at the time. He proposed that developing new drugs by following Ehrlich s meth every disease should be treated ods. For example, testing of sulfur-containing dyes with a chemical specic for that led to the 20th century s rst miracle drugs the disease, and that the pharma sulfa drugs, used to treat bacterial infections. Medicines By Design I Drugs From Nature, Then and Now 31 Yondelis is an experimental cancer drug isolated from the marine organism Ecteinascidia turbinata. Lab tests species of snail found in the reefs surrounding indicate that Yondelis can kill cancer cells, and Australia, Indonesia, and the Philippines. The the rst set of clinical studies has shown that the animals, called cone snails, have a unique venom drug is safe for use in humans.

The Canadian Medical Association s Code recommended and reasonable treatment sucralfate 1000 mg without a prescription, such as medications sucralfate 1000mg online, of Ethics states that physicians are ethically bound to report safety precautions or a leave of absence. A dilemma may arise to the appropriate authority any unprofessional conduct by in these circumstances between the treating physician s duty of colleagues. The In determining whether to report, the resident must assess report should then be made as promptly as possible. Concerns whether the surgeon can properly perform surgery even regarding a colleague s ftness to practice, incapacity or disrup- if they do not drink or take drugs before a procedure. Where the risks of blackouts, tremors or lapses in judgment re- appropriate, the resident might offer advice about access to main, a duty to report may arise. The physician who is the subject of the should advise the surgeon that there is an obligation to report may be counselled to cease practising in the interim. The resident should keep detailed colleague and demonstrating support or empathy will assist in records of the reasons for reporting and of discussions easing the tension in these circumstances. Concerns about exposure to liability and/or college complaints The failure to report when relevant circumstances exist may Physicians in every jurisdiction also have an ethical duty to result in disciplinary proceedings against either or both phy- report unprofessional conduct by colleagues. It could also result in a legal action, especially where an individual is allegedly harmed as a result of a physician s Residents should be familiar with the various legal and col- incapacity, health status or behaviour. Since these requirements vary between Although a decision to report may cause considerable angst jurisdictions, it is important that residents consult the specifc to a resident, it may be reassuring to know that legislation and provision or policy document before making a report. The stress can be greater in cases where the report concerns the conduct or health of a supervisor. A resident in these cir- Documentation cumstances may wish to consider seeking confdential advice It is important to keep detailed records of relevant information from a trusted third party, such as their program director or an leading up to a report being made, including the outcome of offcial of the provincial residents association. The appropri- discussions with the physician patient or colleague about whom ate person with whom to discuss concerns will depend on the a report is made, with the college, and with public health off- circumstances. A contemporaneous record may be helpful if it is alleged generally be anonymous and respectful of the confdential that the report was not made in good faith or on reasonable nature of any patient information and the physician s personal grounds. Some jurisdictions have enacted statutes and/or college poli- cies that create a mandatory duty to report where a physician s health might compromise their ability to practise medicine or put the public s health at risk. All jurisdictions have legislation that requires certain communicable diseases to be reported. Canada has discuss barriers to seeking help, and become a world leader in the approach to physician health. Although most, if not all, physician support programs were initially created to assist physicians with addictions, there has been a tremendous expansion in the support they provide and Case the breadth of their services. Each program offers a slightly A frst-year resident is feeling overwhelmed by the stress different array of services, but all provide access to the advice associated with moving to a new city, starting residency, and assistance physicians might need. In spite of this, the resident feels unable to seek care from family physicians in this city. Through discussion at this table physician needs are assessed, resources and services are en- Introduction hanced, and support is given to programs in the early stages of Although the reader may never need the resources of Canada s their development. Centre for Physician Health and Well-being to provide national coordination and raise the profle of this important issue for The scenario described in the case example is common. In fact, most physicians feel overwhelmed to note, however, that the Centre does not provide personal at certain points in their career. The Centre spent the frst few physicians affected by stress or other health issues to be aware years building partnerships, creating awareness and defning of the confdential resources that are available to them and to needs. Physician health services: A concerted effort The success of the physician health community in building Over the past two decades, Canadian pioneers in physician awareness of the importance of physician wellness is based on health have led a charge to educate physicians about coping making the link between physician health on the one hand and with the unique challenges they face in marrying a demanding quality of care and the sustainability of our health care system career with the personal vulnerabilities that allow them to excel on the other. We know that being healthy ourselves to broach their own health issues, refusing to accept the reali- leads to better care for our patients and that losing even a single ties of the stress and anxiety related to practice. The Centre is acutely aware that, for students Physician Health and Well-being (www. There, the resident is comforted to learn that this to debt load, support for career decision-making, reasonable experience is not at all unusual and that there are lots of work hours and a safe and supportive training and practice resources available. The resident calls the provincial physician health program The Centre also offers a variety of educational resources, and shares their concerns about confdentiality and privacy including podcasts, face-to-face courses, national and interna- with the intake staff. The resident fnds the explanation tional conferences and access to an online physician health cur- of policies in this regard very reassuring. This portal builds insight into their own behaviour and learns new also provides ready access to contact information for all of the coping skills. The resident remains in the program and physician health programs across the country and other related has a refreshed outlook upon their career. Both of these organizations were early leaders working at the national Key references level and with their provincial counterparts to develop policies Canadian Association of Interns and Residents.

Gilead publishes its policy ical trial conduct or takes disciplinary action in all countries relevant to the Index where its positions related to access cheap sucralfate 1000mg without prescription, in particular those when ethical violations occur generic 1000 mg sucralfate visa. Gilead has not recalled 110 Access to Medicine Index 2016 a product for a relevant disease in a country in all of its hepatitis C portfolio. Notably, it did so Monitoring mainly the responsibility of part- scope during the period of analysis. Gilead contractually requires that donation it does make recall information publicly available. The com- fovir disoproxil fumarate and efavirenz/emtric- environmental conditions, demographic or cul- pany builds manufacturing capacity in coun- itabine/tenofovir disoproxil fumarate each year tural needs. In April 2015, Gilead launched an with equitable pricing strategies that target the capacity. Gilead makes a general commitment innovative donation programme with the goal of majority of priority countries (disease-specifc to building manufacturing capacity in relevant eliminating hepatitis C virus in Georgia. In the period of analysis, the com- gramme includes universal screening and treat- to relevant products). Together, these strategies pany undertook a number of technology trans- ment, prevention and surveillance. Gilead now has more products with equitable will provide 20,000 free courses of sofosbuvir/ pricing strategies than in 2014. Gilead routinely updates safety Best practice: high transparency of products labels for its products in countries in scope. The company discloses one relevant initiative HiV- Maintains top rank in Patents & Licensing. Gilead did not dis- close any relevant activities to build R&D capac- Continuing engagement in voluntary licens- ity or strengthen supply chains in countries in ing. It main- Best practice: licensing all on-patent prod- tains its long-term donation programmes for vis- ucts in scope for high-burden diseases. Once again, it was not found to have breached to more products than in 2014, only half target high-burden laws or regulations. It is building pharmacovigilance capacity, mainly in Latin management, and its approach to transparency in market- America. A structured approach would AbbVie can further develop its access AbbVie can strengthen its identifcation and tar- entail setting clear registration targets within a approaches into a strategy and clearly align it geting of local skills gaps in low- and middle-in- fxed timeframe, tied to decision-making crite- with its corporate strategy. This can help AbbVie ensure new products wider availability of high-need products for pop- ing (for example, to increase local R&D capac- are brought to markets in low- and middle-in- ulations in need. The company can also demonstrate that it come countries as soon as possible upon leav- cally using more equitable pricing and reponsible has a clear process in place for mitigating con- ing the pipeline. AbbVie can expand more high-need countries such as China and the geographic scope of licences agreed for for- Indonesia: combination ombitasvir/paritaprevir/ mulations of ritonavir (Kaletra ) in its licens- ritonavir (Technivie ) and dasabuvir/ombitas- ing activities. Rest of world Japan Europe North America *AbbVie Inc became an independent company on 1 January 2013. The company has gained fve market AbbVie s R&D projects have progressed along Communicable Multiple categories approvals since 2014: including, in Q4 2014, the pipeline. It has several features intended to development, plus atrasentan for diabetic nephropathy. Commitment to R&D partnerships, but no Drops two places due to a lack of improvement policy. AbbVie discloses a list of trade associa- compounds for screening and technical exper- all areas of measurement. It is not transparent tions from around the world in which one of its tise to outside partners. However, it does not regarding its access targets, the performance of employees is a board member. Nevertheless, it report an ofcial policy of ensuring access-ori- its access activities and its stakeholder engage- does not publish its policy positions on topics ented measures are systematically included in its ment selection process. Takes strategic approaches to access but these Takes measures to ensure ethical clinical trial do not align with business strategy. However, AbbVie has not specifed how marketing or corruption anywhere in the world High transparency around clinical trials. AbbVie these components are connected, nor how they during the period of analysis. Has a centralised performance management AbbVie has strong procedures for holding all AbbVie manages requests for data in-house. AbbVie has assigned board- employees and business partners accountable Rejections based on scientifc merit are for- level responsibility for access issues and has for their behaviour. It does not disclose specifc access-related to and including termination of employment.