Meds

There is no oversight for prior authorizations. There should be.

Dinah Miller, MD

Meds

December 6, 2015

The letter from the insurance company was addressed to my patient. The two pages of information boiled down to one simple sentence: “After a thorough review, our decision to not cover the medication Provigil (modafinil) is unchanged.”

The letter went on to explain that there was no further recourse, and that the medication would not be approved because it was not Food and Drug Administration–approved for the condition my patient had: …

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The story of the pot-smoking neurosurgeon is more complicated than you think

Vamsi Aribindi, MD

Meds

September 20, 2015

A brief article recently posted the name and picture of a neurosurgery resident accused of smoking marijuana on the job. Dr. Gunjan Goel, MD is a neurosurgery resident at University of California, San Diego, and the list of her awards and publications alone is almost as long as my entire CV. The article is brief, and rather uninformative. The only facts that are known are this: The …

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Discussing the side effects of medications: How can doctors do better?

Brian J. Secemsky, MD

Meds

September 9, 2015

While studying for a certification exam, I came across a question that stayed with me well after taking the practice test. The case discussed a patient who was prescribed antibiotics by his physician for a presumed bacterial illness and then returned the following week with an antibiotic-associated diarrheal infection. The test question then asked what could be concluded from this case. The answer: informed consent (i.e., patient permission for a …

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Kim Kardashian’s first trimester nausea: The truth behind Diclegis

Jennifer Gunter, MD

Meds

September 2, 2015

It was only a matter of time before Kim Kardashian posted a picture on her Instagram account with a bottle of Diclegis, basically announcing her brand partnership with Duchesnay, the manufacturer of the prescription medication for nausea and vomiting in pregnancy. Duchesnay had been tweeting for ages that they were so relieved Kim had found help with Diclegis — so much so that I was wondering if Ms. …

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Don’t use essential oils for asthma. Here’s why.

Meds

April 22, 2015

Alright, we need to talk. Those of you who follow my blog know that I don’t shy away from controversial topics and that I don’t have a problem speaking my mind. I try to do it in a respectful, informative, and somewhat humorous way. But I saw something this morning that needs to be addressed, and it’s not funny at all.

As I was eating breakfast before work, I saw a …

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How are drug companies making millions from generic drugs?

Meds

April 17, 2015

It is well accepted among health economics wonks that the lion’s share of pharmaceutical company profits come when these companies hold exclusive rights to their products. Once their blockbuster pills go “generic,” competitors enter the marketplace and profits plummet. Consider captopril, a groundbreaking heart failure medication introduced in the early 80s by Bristol-Myers Squibb under the trade name Capoten. After making a fortune for the company, captopril went generic in 1996. …

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What does it mean to live in the age of Abilify?

Steven Reidbord, MD

Meds

March 23, 2015

I learned recently that the antipsychotic Abilify is the biggest selling prescription drug in the U.S. To be a top seller, a drug has to be expensive and also widely used. Abilify is both. It’s the 14th most prescribed brand-name medication, and it retails for about $30 a pill. Annual sales are over $7 billion, nearly a billion more than the next runner-up.

Yes, you read that right: $30 a pill. A little more …

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We are overprescribing statin medications for high cholesterol. Here’s why.

Richard Young, MD

Meds

March 16, 2015

The American Heart Association (AHA) recently proposed new guidelines for all doctors to screen and treat for high cholesterol. For doctors and patients to follow, this would result in a large increase in the number of Americans taking statins.

One of the things I like about the new proposal is that there is no more chasing a number. This was frustrating for doctors and patients to keep having lab draws and medication …

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Don’t be scared: Let’s see what’s really in vaccines

Katie Noorbakhsh, MD

Meds

March 7, 2015

Let’s talk about vaccine ingredients. I am reading less about vaccines causing autism (we all know that theory is utter nonsense, right?) and more about vague concerns regarding the chemicals in vaccines. To begin with, we are surrounded by chemicals. Water (H2O), caffeine (C8H10N4O2), sugar (C12H22O11) are all chemicals. But perhaps it is the unfamiliar ingredients that people find intimidating.

Let’s tackle the ingredients in the measles, mumps, rubella and varicella (MMRV) vaccine …

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A domperidone dilemma: A patient’s perspective on ordering from Canada

Meds

March 5, 2015

Three years ago I received some of the best news of my life — that I have dopa-responsive dystonia. (Yes, a neuromuscular disorder was welcome news.) Painful, life-interrupting muscle contractions had made the dystonia diagnosis likely several years before, despite poor response to standard treatments, and I was fighting through graduate school: trying to compensate for medication-induced memory problems, increasing need to work from bed, and a disappearing social life. …

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Ask for Dilaudid, get Dilaudid. No questions asked.

Meds

February 28, 2015

shutterstock_140803288

A local hospital is trying a new, controversial but more efficient approach to medical care. “We have changed our guidelines, if you want Dilaudid you get Dilaudid, if you want Valium, you get Valium. No questions asked,” CEO Michael Shoemaker told reporters Wednesday.

In what experts are calling pure genius, emergency …

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How the advent of propofol changed the meaning of the term “sedation”

Karen S. Sibert, MD

Meds

February 19, 2015

“Twilight! She has to have twilight,” insisted the adult daughter of my frail, 85-year-old patient. “She can’t have general anesthesia. She hasn’t been cleared for general anesthesia!”

We were in the preoperative area of my hospital, where my patient — brightly alert, with a colorful headband and bright red lipstick — was about to undergo surgery. Her skin had broken down on both legs due to poor circulation in her veins, …

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The truth about Miralax in children

Natasha Burgert, MD

Meds

February 12, 2015

Parents are appropriately expressing concern about the safety of Miralax®, a commonly used stool softener in kids, after a recent New York Times article exposed a potential association with long-term use of the drug and undesired behavioral side effects. As the article explains, the FDA has awarded a research grant to a team at the Children’s Hospital of Philadelphia (CHOP) to directly address these concerns.

Miralax® has been used …

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Scared of the flu vaccine? Let’s see what’s really inside it.

Jennifer Gunter, MD

Meds

January 14, 2015

Dangerous ingredients, like toxins, antifreeze, and mercury, are touted by many as reasons to decline vaccination against influenza. However, toxin is an inaccurate term regarding vaccines (a toxin is a poisonous substance made by cells or organisms and is definitely not in any vaccine), mercury is a non-issue (see below), and there is no antifreeze in vaccines (although some contain propylene glycol, …

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Why do drugs cost so much?

Janice Boughton, MD

Meds

November 12, 2014

Drug prices are a difficult issue to write about because real data about the workings of pharmaceutical companies is very difficult to uncover. Still, I came face to face with something that seemed extremely not right and so I feel I should at least make some comment. It started when I prescribed a patient sumatriptan for her recently more frequent migraines. …

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The era of trial and error medicine needs to be over

Corey A. Siegel, MD

Meds

November 7, 2014

We always want to get it right the first time when treating patients, but the truth is this is difficult. When there is uncertainty of disease course and prognosis, multiple treatment options, and variable responses to therapy this becomes even more challenging. Our typical strategy to making it “just right” isn’t too different from Goldilocks. We have mild treatments (too cold), and aggressive treatments (too hot), and even in the …

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Why your doctor won’t refill prescriptions over the phone

Michael Kirsch, MD

Meds

October 13, 2014

Giving prescription refills is not quite as fun as it used to be. Years ago, we doctors would whip out our prescription pads — often sooner than we should have — and we’d scribble some coded language that pharmacists were trained to decipher. I’m surprised there were not more errors owing to doctors’ horrendous penmanship. On occasion, the Food and Drug Administration (FDA) would require a pharmaceutical company to change …

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7 common reasons for refusing vaccines

Claire McCarthy, MD

Meds

October 3, 2014

The Centers for Disease Control and Prevention (CDC) reported that between January 1 and May 23 of this year, there were 288 cases of measles reported in the US. That’s more than the total number of cases in any year since 2000, when measles was eliminated in the U.S..

We have got to get more people immunized.

Essentially all of the cases were linked to “importations,” cases brought in from other countries …

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Are you a medical liberal or a conservative?

Michael Kirsch, MD

Meds

August 9, 2014

Our nation is highly polarized today, and often bitterly so. Democrats rail against the GOP. Pro-lifers face down pro-choicers. Fox News disses MSNBC. Isolationists push back against expansionists. Traditionalists disdain the politically correct. Free marketers duel against government advocates. Carnivores deride the gluten-free crowd. Martin Bashir trashes Sarah Palin, two proxies in a culture war.

There’s a philosophical divide among physicians also. Would you prefer a liberal physician or a conservative …

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Why are doctors still prescribing Zetia?

Janice Boughton, MD

Meds

July 10, 2014

A health research company just released a list of the 100 top drugs in America according to sales. 29th on the list, with sales of over $1.8 billion, is the cholesterol lowering drug ezetimibe, brand name Zetia.

This drug was released over 10 years ago because it worked really well in combination with statin drugs such as Zocor (simvastatin) to lower LDL cholesterol levels. It was released as a single agent and combined …

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