Physicians writing on KevinMD about the drugs they prescribe and the ones they cannot get: prior authorization and step therapy, opioid prescribing and the tapers that followed the CDC guideline, the GLP-1 drugs from Ozempic to oral Wegovy and what happens when patients stop them, shortages, compounded versions, and what a prescription costs the patient. Three maintained records draw on this archive: Opioids: what physicians and pain patients say, in their own words, Prior authorization: what physicians say, in their own words, and GLP-1 drugs: what physicians say about Ozempic and its successors, in their own words.
While the vast majority of measles cases in the U.S. and worldwide are occurring in unvaccinated children, a fair percentage is also occurring in adults. With more-widespread transmission of measles, it’s becoming more important for all of us – yes, that includes parents – to make sure we’re well-protected.
Measles is probably the single most contagious infection that humans face. The key to preventing the return of widespread measles is in …
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Should adults receive another dose of MMR?
A lot of parents ask me about the HPV vaccine, “Isn’t that the optional one?” Well, let me walk you through why my answer to that question is a hard “no.”
Human papillomavirus (HPV) is a virus that causes warts and several types of cancer. There are over 200 different strains of HPV, some of which tend to cause warts on the hands, feet, or face. Other strains …
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No, the HPV vaccine isn’t optional
Much media attention has been paid to the new guidelines from American College of Cardiology/American Heart Association (ACC/AHA) on the primary prevention of cardiovascular disease. Based on new clinical trial data, ACC/AHA no longer recommends that healthy adults without cardiovascular disease — emphasis on without cardiovascular disease — take daily aspirin for the primary prevention of cardiovascular disease.
This change, while significant, is highly nuanced and dependent on …
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The new aspirin guidelines: The media does a disservice to patients
Our community had one of “those” providers — a midlevel who was the local pain person. If you had pain, go to her. She would write you for anything you could want and more. It’s unclear if she was unscrupulous or just inept. But last year, the DEA finally figured out what she was doing and yanked her license. There was nothing in the news. Nothing on the internet. We …
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Why aren’t you treating opioid addiction?
What if I told you that your adolescent child could contract a disease that can never be cured, but only maintained? That it would be a lifelong struggle that could change their personality, compromise their potential and values, destroy their relationships and have a long-term detrimental effect on their overall and mental health? That this disease can even be fatal, when ineffectively maintained? What if I told you that the …
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If your child is ever prescribed an opioid, read this post first
Recently, I was at a health care facility in a semi-urban region, less than 100 miles from a major metro. It had a whiff of industry from good times that have long drifted by.
I tried to locate a Starbucks. Google Maps spotted one and took me towards the local university campus. As I drove there, I noticed several pain management clinics advertising themselves in unusual ways for “relief.”
Once inside the …
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Seeing the effects of the opioid crisis play out live
I recently had a patient whose blood sugar was well controlled until he lost his health insurance. He purchased his diabetes pills because they’re cheap, but he couldn’t afford the insulin. His diabetes had been well controlled. Now, almost a year later, his hemoglobin A1C was 14, or double what it should be. The HbA1C measures sugar control over the last three months.
The bee sting kit or EpiPen cost hike …
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The obscene price of insulin: This is what happens when health care is for profit
In recent years, it feels like we’ve been inundated by stories of greedy pharmaceutical companies jacking up the price of important generic medications. In 2015, “Pharma Bro” Martin Shkreli, recognized that no other generic companies were manufacturing Daraprim, a drug used to treat infections common among people with AIDS, from $13.50 a pill to $750, confident that no generic competitor was around to cut into his market Read more…
Are generic drug price hikes media hype?
When I completed my residency training in 2017 I never imagined so much of my clinical efforts would be directed towards educating patients about controlled substances. As I stepped into clinical practice and took over patients who had long-term relationships with providers that had retired or moved to other positions I began to notice a preponderance of patients, some elderly, taking benzodiazepines daily, frequently at high doses. Often conditions other …
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It’s important to keep tight controls on benzodiazepines
What is CBD?
Cannabidiol or CBD for short is made from either the marijuana plant that contains tetrahydrocannabinol (THC) or hemp which contains little to any THC. “Hemp-derived” means that the CBD generally contains less than 0.3% THC while “marijuana-derived” contains higher amounts of THC. It is THC — and not CBD — is the primary psychoactive or intoxicating component of marijuana. CBD can also be manufactured synthetically.
CBD is routinely sold …
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CBD: What is it? A former DEA agent explains.
On a daily basis, patients of mine come in for office visits complaining of wear and tear injuries, as well as aches and pains, and their methods of dealing with chronic pain. As we all know, aging is a part of the normal life process.
For instance, as we approach 70 years old, we typically lose three-quarters of our functioning kidney cells (nephrons) but do well with our limited reserve as …
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Many questions remain about medical marijuana
In a recent talk I gave for colleagues, I ventured outside the box.
I searched for a metaphor to make cancer treatments easy to understand. Around the same time, it so happened my kids decided we needed to re-watch all of The Avengers movies at home. (In order, of course).
Here’s where you get some insight into an oncologist-mom’s brain. While we watched the movies, another part of my brain cogitated on my upcoming …
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Using the Avengers to explain how cancer treatments work
Last week I took the naloxone challenge. I walked up to a pharmacy window, waited in line, and requested naloxone from the pharmacist. She showed a supportive but knowing look, and I became acutely aware of the four people in line behind me. After giving her my name and date of birth, she was able to pull my insurance info from prior visits, and I left with a dose of …
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Take the naloxone challenge
I often hear the mantra, “You must stay ahead of your pain, or else.” The president of the American Academy of Pain Medicine, states a common mistake people make, is waiting too long to take pain medication. By the time you’re in pain, you’re starting from behind the eight ball. “It takes a lot more medicine to control pain after it’s started as opposed to starting it ahead of time,” he …
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Why staying ahead of your pain with opioids is the wrong advice
As chair of general pediatrics for a large medical group, I knew our HPV vaccination rates back in 2016 were low, but didn’t completely understand why. I’m here to share how we figured it out, and how we improved.
The first task was to understand the barriers, and we went straight to the front line. Our doctors and staff explained reasons why this vaccine can be such a hard sell – …
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How to increase your HPV vaccination rates
Very few things in the universe are 100 percent good or 100 percent bad. Cannabis is perfectly ordinary in having a mixture of good qualities (medical benefits) and bad qualities (medical risks). The people who want to make money – lots of money, by the way – from selling marijuana do a perfectly fine job of pointing out the good. But they don’t educate the public about the possible risks. They know it will …
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America has seen medical marijuana before: This is what we learned (and forgot)
“Try this,” whispers Kate Winslet as I wander past the Lancôme counter. “Your glowing skin will thank you.”
The consequences of a celebrity endorsement are seemingly harmless when it comes to revamping a makeup routine, but what happens when this type of advertisement seeps into the world of health care? It has been proven many times that celebrity endorsements influence decisions about specific political candidates, issues or parties, and the positive …
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The consequences of celebrity endorsements in health care
