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.
As a pediatrician, I am asked by worried parents about what they should give their child with a fever, Motrin (ibuprofen), or Tylenol (acetaminophen) to bring down the temperature daily.
This question always requires more than a one-word response to the choice between anti-fever medications. An explanation of medication even being necessary for the fever and to clarify many long-standing fever phobia misconceptions.
Mainly, it is not necessary to treat the number …
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Motrin vs. Tylenol for children: A pediatrician explains
We have embarked upon a unique strategy to assess and manage pain. “Opioids Rarely Help Bodily Pain” is not a catchy phrase but a mnemonic related to educational learning which serves as the cornerstone of a new acute-pain management paradigm. As is known, the evaluation of pain is extremely difficult due to its subjective nature. However, this new evaluation not only accounts for the patients’ self-assessment but, for the first …
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A paradigm shift in acute pain assessment and management
The FDA has given official approval to market eskatamine as a treatment for depression. As expected, there has been great fanfare (press releases, morning TV talk show guests, NPR segments and so on). The news leaves me salty. The esketamine story reveals so much of what is wrong about how we get useful medical science findings into clinical practice.
Esketamine is not a new drug
Esketamine is being promoted as a new …
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Esketamine is not a breakthrough new drug: Why the nasal spray for depression is old news
In my clinical practice, I have encountered patient aggression typically with narcotic medications, in particular with the refusal of a refill due to evidence of concerning behavior, like a positive drug screen for drugs not prescribed. Aggressive behavior can include yelling, threatening physical violence or intimidation. I have had less trouble with narcotic-related aggression nowadays especially with media coverage of the dangers of narcotic abuse and especially since a lot …
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Inappropriate antibiotics are the new drugs of abuse
Life experience gives one an intimate appreciation for the meaning behind the saying “just the tip of the iceberg.” Everyone’s encountered something that turned out to be much larger and more complex than was initially understood. In my experience, medicine has yet to submerge its head underwater to discover the true depths of the sordid underside of what I’m calling the “iatrogenic benzodiazepine iceberg.” My own boat capsized on that …
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The tip of the iatrogenic benzodiazepine iceberg
In hindsight, I should have never accepted a Xanax prescription from my doctor. What followed was catastrophic — rapidly developing tolerance and physical dependence on the drug and a prolonged illness. Three-and-a-half years later, I am still slowly tapering off Valium (having transitioned to a longer-acting benzodiazepine to aid in tapering) and experiencing debilitating symptoms daily.
I was unprepared for what happened to me by my medical …
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A Xanax prescription that should have been rejected
“I feel like a caged animal” — My patient offered me this lens through which to view his life seeped in chronic pain. For him, pain dictated his entire sense of being — it was something that simply could not be distilled down to a single value on a 10-point scale. The cage represented the restriction of life and the boundaries within which he was allowed to experience, let alone …
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How opioids can destroy the most beloved of personalities
Last week I had a patient with mild kidney disease and a high potassium. I thought that it would be easy to take care of. We called around to all the pharmacies from Bangor to Ellsworth to Belfast, and nobody had Kayexalate, the time-tested antidote, in stock.
It happened to be on a Tuesday night with my Suboxone group starting at 5 o’clock. The patient had been there since 4; his …
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A shortage of Kayexalate leads to an ER visit
Advocates for the legalization of medical and retail marijuana are quick to point out all the possible benefits that a community might see from such a venture. These include increased jobs, increased tax revenue, possible medical benefits and they advertise it as “safe” and “healthy” and “organic.” Many people who have voted for legalization thought they were talking about the marijuana of the 1960s to 1980s when the THC content …
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The problem with high-potency marijuana
Chemotherapy drugs have become ridiculously expensive. Many new drugs come to market costing more than $100,000 per patient for a full course of treatment. Often, patients have to pay a significant portion of these costs. For example, a 20% co-insurance rate, typical for basic Medicare coverage, leaves patients responsible for more than $20,000 of chemotherapy costs, an often crippling burden.
Fortunately, many expensive cancer drugs are going …
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Generics aren’t going to help the cost of chemotherapy drugs
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
I recently attended a state medical society’s annual meeting where the agenda consisted of an awards program, several speakers and a keynote address. The highlight of the evening, however, was listening to patients share their stories with the local medical community. We’ve all heard …
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Your patients are counting on you
Many people think eradicating cancer is unattainable. But for cervical cancer, we are well on our way to doing just that.
Cervical cancer was once the leading cause of death in women in the U.S. But we are on the cusp of vanquishing this disease thanks to regular pap screening and a vaccine that protects women and men from developing the human papilloma virus (HPV), the cause of nearly all cervical …
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We have a shot at preventing cervical cancer
Pharmacists play an essential role in today’s ever-expanding health care system today. They check for drug interactions, watch for signs of opioid overprescribing and try to determine whether a drug for one condition prescribed by one doctor will negatively impact the patient because of another diagnosis the patient has. In hospital units, their roles have become yet more complex — often serving on various quality committees, managing daily dosages of …
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The conflict between pharmacists and their corporate superiors
Sometimes it is hard for hospitals to provide expensive care to poor patients. When a low-income patient needs $20,000 of chemotherapy, a hospital loses money if that patient cannot pay for the medicine, or pays through Medicaid, with its relatively stingy reimbursement. Fortunately, the federal government created a program for hospitals that care for a disproportionate share of low-income patients, whereby they can purchase those medicines at a discount. The program …
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How hospitals are taking advantage of the 340B Drug Pricing Program
Marijuana has been used for reported medical purposes for thousands of years when the plant had THC content of 0.5 to 3%. The most common reported medical use is for pain. Several states and the District of Columbia have some form of legalized marijuana, with many states having legalized for recreational use.
There has been discussion about how cannabis will help curb the opioid epidemic. It’s been reported that medical cannabis …
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Marijuana will not fix the opioid epidemic
We are writing as a parent and a dentist to spread a message to parents and dental health care providers across Canada: there are alternatives to prescribing opioids after wisdom tooth removal.
Removing wisdom teeth is considered by many as a rite of passage for teenagers. It is one of the most common surgical procedures done in young people aged 16 to 24.
Amy’s 16-year-old son, Felix recently had his wisdom teeth …
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A call for the end of routine opioid use after wisdom tooth removal
The over-the-counter sale of probiotics is a huge industry. They are heavily promoted on social media as a cure-all for a wide variety of ills. Probiotics are live cultures of what are often called “good bacteria,” and there are solid physiological reasons for recommending them. But, and this is a huge but, actual clinical data demonstrating their usefulness behind some well-defined disorders is pretty scant. Their potential usefulness in many …
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Using probiotics in children: a pediatrician’s take
Many Americans hold beliefs about the flu vaccine that are at odds with the best available scientific evidence. For example, a recent study found that more than two-fifths, or 43 percent, of Americans believe that the seasonal flu vaccine can give us the flu. Scientific research strongly suggests that this is not true. Because most modern flu shots do not contain a live virus, the shot itself simply cannot get …
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Countering misinformation about flu vaccine: Why it’s so hard
I prescribe heartburn medicines every day. There’s a gaggle of them now — Prilosec, Nexium, Prevacid, Protonix — to name a few. As far as experts know, their primary effect is to reduce the production of stomach acid. This is why they are so effective at putting out your heartburn fire. In simple terms: no acid, no heartburn.
I am quite sure that well-meaning physicians like myself do not understand or …
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Seasoned medical professionals prescribe new medicines sparingly
