Medications

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.

The complications of firing patients who won’t vaccinate

Christopher Johnson, MD

Medications

September 26, 2016

A manifesto has been making the rounds on Twitter (and other places) over the past year. It has been attributed to Dr. Mike Ginsberg, a California pediatrician. It reportedly was originally a Facebook post that has since been taken down, perhaps because of the controversy it generated. I can understand why; vaccines are a hot button topic, and anyone who writes about them attracts attention, some of it unpleasant. I know …

This doctor is against medical marijuana. Here’s why.

Michael Kirsch, MD

Medications

September 26, 2016

I have already opined on my disapproval of a medical marijuana law recently passed in Ohio. Once of my points in that piece is that I did not want legislators making medical decisions for us. They can’t even do their own jobs.

I am not against medical marijuana; I am for science. The currency of determining the safety and efficacy of a medicine should be medical evidence, not faith, …

Pain patients are being cut off from their drugs. Here’s why.

Cindy Perlin, LCSW

Medications

September 18, 2016

In March, 2016, the CDC released guidelines for prescribing opioids. The guidelines were a response to a serious and growing problem: millions of pain patients became addicted to prescribed opioids, and hundreds of thousands died as a result.

Since the guidelines were released, reports of pain patients being abruptly cut off of their medication or having their medication abruptly reduced have become rampant. These patients report they were using opioids long …

When treating chronic pain, don’t compromise your principles

Michael J. Stephen, MD

Medications

September 17, 2016

One of the most difficult things I deal with as a physician is patients’ demands for pain medications. I treat patients with cystic fibrosis, a genetic disease present at birth with no cure, and its issues are indeed complex. There are legitimate causes for misery from the chronic coughing, abdominal pain, and joint pain recognized as common symptoms of the disease.

But the associated issues of depression, stress with family, and …

How prudent antibiotic prescribing lowers patient satisfaction

Raj Waghmare, MD

Medications

September 13, 2016

I’m seeing a fifty-something with knee pain when I feel the curtain behind me erupt open. It’s Roland, my last patient, and his breath is at my neck: “Why are you being so difficult?” he says. “Why can’t you just give me the prescription?”

I turn, and wave my hand over Roland’s head.

“Call security.”

He’s swearing again, and I can hear security’s racing footsteps as a code white is called.

“I have nothing more to …

We must face some unpleasant truths about opioids

David Juurlink, MD, PhD

Medications

September 11, 2016

Over the past year I’ve lost track of how many times the opioid epidemic has, in one incarnation or another (Prince, naloxone, fentanyl, newborns in agonizing withdrawal and so on) found its way onto the front page news. What distinguishes this epidemic is not only its catastrophic toll — hundreds of thousands dead, uncountable millions harmed — but also the fact that, unlike SARS, Ebola or influenza, this epidemic has …

Your EpiPen is too expensive. These are your 4 options.

Roy Benaroch, MD

Medications

September 5, 2016

EpiPens have gotten crazy expensive, yes: $600 for a two-pack. Here are some alternatives that might help you save a few bucks.

1. Wait a few weeks, and see what Mylan does. Mylan, the company that makes the “EpiPen” brand of epinephrine auto-injector, has been under a lot of pressure lately to back off their unseemly price gouging. They’ve introduced a savings card that claims to lower your …

A medicine for poor people

Kellie Wilding, MD

Medications

September 3, 2016

Last week I had an appointment with one of my well-controlled diabetics. She has been in my care for the last six years. Our usual cheery interaction turned sour when she stated in an accusing tone, “My husband is diabetic, and I talked to his doctor about the medication you have me on. He says it is junk, and he only writes it for poor people, and he doesn’t understand …

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A medicine for poor people

An open letter to Heather Bresch: What is legal is not always ethical

Anonymous

Medications

September 3, 2016

Dear Ms. Bresch,

I couldn’t help but notice the barrage of negative press you’ve received lately regarding the significant price increases in EpiPens. A 461 percent increase since 2007, to be exact. People who require this medication for themselves or their children are up in arms about spending over $600 for a twin pack of autoinjectors. Most of these people have life-threatening anaphylaxis if they are exposed to certain allergens. To …

What physicians can do about EpiPen

Kristen Maguire, MD

Medications

September 2, 2016

When I found out my daughter was allergic to peanuts, she was a year old. She couldn’t have cared less. She was smiling and happy, sitting on my lap in the allergist’s office, blissfully unaware of the big red mark on the side of her face. And I was crying and sad, crushed for that moment that the first challenge had been put in her path. I wasn’t sad that she was different, that …

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What physicians can do about EpiPen

Mylan Pharmaceuticals made these 2 critical mistakes

Justin Reno, MD

Medications

August 31, 2016

Pharmaceutical companies are brilliant. They make profit off of chemicals that can be potentially life-saving. The list is quite impressive: antibiotics for somebody who would otherwise succumb to sepsis, insulin for someone whose pancreas loses the ability to function, antivirals for chronic viral suppression, antineoplastic agents for somebody whose cells have lost their regulatory mechanisms, just to name a few.

The recipe seems to be quite simple: Charge as much money …

The maker of EpiPen sticks it to patients

Monique Tello, MD

Medications

August 31, 2016

Recently, friends of ours had a frightening experience: They were on vacation, and ordered takeout from an unfamiliar restaurant. They specifically asked about peanuts: “Are the egg rolls fried in peanut oil? Our daughter has an allergy.”

The server replied: “No, no peanut oil.”

And so they ordered the egg rolls.

Awhile after eating an egg roll, their school-aged child Anna (not her real name) complained of a tummy ache. Then, nausea. They …

The vaccine crisis we’re facing isn’t the one that you think

Peter Ubel, MD

Medications

August 16, 2016

We have a vaccine crisis in the this country. Not just the one caused by anti-vaxxers like Jenny McCarthy, scaring Americans away from life-saving childhood vaccines with pseudo-scientific claims about autism. Instead, I’m talking about a bigger crisis, one caused by a dangerously thin supply of vaccines. Wise parents who ignore the blatherings of people like McCarthy may soon arrive at their pediatricians’ offices prepared to vaccinate their children, only …

Benzodiazepine addiction is real. This physician shares his story.

David Mokotoff, MD

Medications

July 24, 2016

Say the words, “drug addiction,” and most of us think of heroin, alcohol, cocaine, or opiates. However, lurking in the shadows is a less talked about epidemic: addiction to benzodiazepines, commonly known as “benzos.” I should know because after taking a nighttime dose of lorazepam (Ativan) for about ten years; I finally weaned myself off this and all other prescription sleep medications.

About twelve years ago, my father died and then …

How OxyContin taught doctors to trust pills over patients

Anna Reisman, MD

Medications

July 24, 2016

Treating pain is a notoriously tricky business. But it’s even harder if the medications on which we rely are inappropriately marketed. Last month, a Los Angeles Times investigation of Purdue Pharma asserted that for years, the company falsely elevated the efficacy of its twice-daily OxyContin, a powerful opioid pain reliever. The Times’ review of evidence — including three decades of court cases, investigations, patient and …

The demise of FluMist is a victory for science

Roy Benaroch, MD

Medications

July 21, 2016

Recently, the CDC announced that its Advisory Committee on Immunization Practices (ACIP) voted to stop recommending the nasal spray flu vaccine, FluMist, for anyone. Bottom line: it doesn’t work. Though their recommendation against the use of FluMist still has to be approved by the CDC director to make it “official,” it’s pretty much a done deal. The AAP’s president has already endorsed the announcement, too.

Bye, Flumist. We’ll …

Saving billions of dollars in health care: The story of Avastin and Lucentis

Peter Ubel, MD

Medications

July 17, 2016

I sometimes worry that my wife Paula won’t be able to see me grow old. Not that I expect to outlive her. She is four years my junior and has the blood pressure of a 17-year-old track star. It’s her eyesight I’m worried about, because she is at risk for a form of blindness called macular degeneration. Paula is the youngest in a long line of redheads, several of whom …

Antibiotics: Maybe it’s time to just say no

Roy Benaroch, MD

Medications

July 17, 2016

We’ve heard it before: Antibiotics just don’t work for viral infections. Docs know this, and I think most patients know this, but it’s an addiction we’ve had a hard time shaking.

Docs overprescribe because it’s fast, it’s easy, and it (might) increase patient satisfaction and return visits. That’s led to a cycle of reinforcing expectations from patients — who, after all, keep feeling better after the antibiotics. Of course, they do. …

The pharma-fed doctor and the foundation-fed journalist

Michel Accad, MD

Medications

July 16, 2016

In his recent article “Feed Me, Pharma,” ProPublica’s Charles Ornstein has been calling attention to studies showing that the prescribing decisions of doctors are linked to the amount of money that drug companies can bestow on them, usually in the form of meals, travel expenses, tuition support to attend courses, and so on.

I find nothing surprising about that, and Ornstein need not be so scrupulous when he clarifies that “the …

The problem of polypharmacy in psychiatry

Allen Frances, MD

Medications

July 14, 2016

Polypharmacy was once the exception in psychiatry; now it seems to have become the rule. Patients frequently are taking 3, 4, even 5 psych meds at one time. And often it’s primary care doctors, not psychiatrists, who are doing the prescribing — usually without adequate training in psychiatry.

Some polypharmacy is rational — e.g., a patient with bipolar disorder who receives the combination of antidepressant and mood stabilizer.

But most polypharmacy is …