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.
Foria wants you to know they are selling vaginal suppositories of THC (tetrahydrocannabinol) and CBD (cannabidiol) called Fiora Relief for menstrual cramps. Each suppository contains 60 mg of THC and 10 mg of CBD.
Foria claims they can treat the pain of menstrual cramps and endometriosis. Is this possible?
THC and cannabidiol (CBD) are compounds found in marijuana. The psychoactive (i.e., high) from marijuana is believed to be due to …
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Vaginal marijuana for menstrual cramps. Does it really work?
A grandmother develops a boil that turns out to be a difficult-to-treat staph infection (MRSA). She needs high-powered antibiotics. A middle-aged man who received a blood transfusion decades ago now has hepatitis C and needs anti-viral medicine. A young woman with HIV develops golf-ball-size lesions in her brain, has toxoplasmosis and needs anti-parasite medicine.
The marvel of medicine today is that we can treat all three infections, and save the lives …
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The nightmare of medicine is the absurd price we have to pay
Addyi (flibanserin), the drug to increase female libido had a timid entry into the market with very few prescriptions considering the “hype.” Bloomberg Business reported 227 prescriptions in the first month. That’s a pittance considering Valeant paid $1 billion for the drug.
I am unlikely to help Valeant recoup their investment, because the more I read about this drug, the worse it looks. Here’s why:
It barely works
One of the study endpoints (meaning …
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This doctor won’t prescribe Addyi, the “female Viagra.” Here’s why.
I don’t subscribe to conspiracy theories. I never believed a second shot was fired. Nor do I believe that Bill Clinton was stalked on the grassy knoll. So I won’t speculate that Martin Shkreli’s arrest for alleged securities fraud that happened years ago is related to his raising Daraprim’s price by 5,500 percent.
Just because something isn’t suspicious doesn’t mean that it isn’t odd.
Shkreli is a perfect poster child for rapacious …
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Martin Shkreli speaks an inconvenient truth
The American Medical Association (AMA) recently called for a ban on direct-to-consumer (DTC) advertising of prescription drugs and medical devices, arguing that this type of advertising drives the nation’s escalating drug bill by creating demand for new, expensive medications that are often no more effective than older ones. Since the first televised prescription drug ad aired in the U.S. in 1983, pharmaceutical companies have spent billions of dollars …
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Pharmaceutical free speech is anything but free
“Help me stop doing this.”
Mr. G was a 55-year-old homeless man who uttered these words to us during his fifth hospitalization for problems related to his alcohol use: intoxication, falls, and alcohol withdrawal. He was on a downward spiral through the hospital’s revolving door and felt helpless. As a medical team, we felt helpless too. We did not know how to address his real problem—his cycle of addiction.
Hospitalized patients like …
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Hospitalization for patients with alcohol use disorder: A teachable moment
I am a bit of a coin collector, and recently I visited my favorite coin shop in downtown Louisville. I was met with this news: A coin dealer I know in Austin, Indiana had been killed recently, murdered in his own coin shop, shot in the head by robbers. Four persons were later arrested when coins belonging to this elderly man were found in their possession. Austin, Indiana is, by …
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Would heroin addiction be the price of legalizing marijuana?
After a New York pharmaceutical company recently raised the price of a drug that’s been around for more than 60 years from $13 to $750 a pill, the nation appeared to collectively gasp over a seemingly capricious, “anything goes” approach to drug pricing. The move also revived a recurring debate over whether pharmaceuticals should have free rein to charge outrageously high prices for important medications.
Madness? Perhaps. But pharmaceutical companies are simply responding …
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Bringing sky-high prescription drug prices down to Earth
The other day, the mother of a nine-week-old baby girl called my office in a panic. Her daughter was having terrible breathing trouble, with coughing and wheezing. She asked to been seen that day, and of course I said yes. I asked mom how the baby had been doing overall, and she said that she’d had some noisy breathing as a newborn, but all was well until the past few …
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Others can be harmed when patients lie
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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There is no oversight for prior authorizations. There should be.
According to a study published in the New England Journal of Medicine, the use of dietary supplements sends an estimated 23,000 Americans to the emergency department each year. Approximately 25 percent of the ER visits that were supplement related were by adults who were using herbal weight loss products. Another 10 percent were caused by adults consuming “energy products” (although people using energy drinks were excluded from the …
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Natural drugs aren’t necessary safe. Don’t make that mistake.
An August, 2015 study in Multidisciplinary Respiratory Medicine is being touted as evidence that homeopathy is as effective as antibiotics for respiratory infections in children. It doesn’t show that at all — in fact, it doesn’t show anything, except that crappy studies in crappy journals can nonetheless be used to manipulate opinion. Beware.
First, the study itself. Researchers in Italy looked at about 90 children with ordinary …
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Beware of predatory journals when it comes to homeopathy studies
A new study in JAMA Internal Medicine finds that two-thirds of cancer drugs considered by the U.S. Food and Drug Administration (FDA) over the past five years were approved without evidence that they improve health outcomes or length of life. (This study closely corroborates and acknowledges the findings published last year by John Fauber of the Milwaukee Journal Sentinel and Elbert Chu of MedPage Today.)
Follow-up …
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The FDA’s epic regulatory failure
Most of my patients think about pain medicines in terms of the symptoms they treat. “This is my headache medicine, and this is my arthritis medicine,” they often say. Health care providers are more likely to categorize pain medicines by the way they work: some are anti-inflammatory, some affect nerve endings, and others influence how the brain perceives pain. But the truth is that no matter how you classify pain …
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Pain management is personal
The shaming campaign that followed the news of two generic drug prices somersaulting into the stratosphere after being acquired by private companies is not too surprising. The idea that a drug that cost $13.50 one day can cost $750 the next, seemingly on the whim of greedy Wall Street investors and pharma start-ups, is fodder for the outrage machine.
But what the outrage machine does not realize is the …
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Welcome to our glorious world of regulated health economics
Cancer drugs have become increasingly expensive in recent years. No one blinks anymore when a new lung cancer or colon cancer treatment comes to market priced at more than $100,000 per patient. In part, we don’t blink because we have simply gotten used to such prices — the shock has worn off.
Moreover, many of these new treatments are targeted therapies that only work for patients whose cancers express specific mutations, …
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Are new cancer drugs really worth their price?
Daraprim is a drug that no one ever heard of unless they are taking it. It is used to treat toxoplasmosis, a parasitic infection, has been around for decades, and is prescribed typically in patients with weakened immune systems, such as those with AIDS. Daraprim has been newsworthy because a small company, Turing Pharmaceuticals, recently purchased the drug from Impax Laboratories for $55 million, and promptly raised the price of …
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Who’s to blame for the price Daraprim? It’s not who you think.
A guest column by the 
