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.

Can we blame Martin Shkreli for succeeding in a system that we created?

Peggy Bui, MD, MBA

Medications

October 14, 2015

Recently, public outrage over Daraprim’s price hike from $13.50 to $750 was loud and clear — so loud that its CEO Martin Shkreli had to rescind it. In the business world, he might be praised as a savvy investor. He saw a product that was drastically undervalued and priced it at a level that the market was willing to bear, reaping huge profits. This type of mentality is a trait many …

Blame the system, not Martin Shkreli

Dr. Saurabh Jha

Medications

October 8, 2015

Toxoplasma gondii is a parasite that causes opportunistic infection in helpless people. It may have met its match. The cost of treating toxoplasmosis, a rare but extant infection, just shot up exponentially. Drug-resistant strain, you ask? Have physicians in infectious disease gone mercenary, you wonder? No. A change in ownership.

Daraprim (pyrimethamine) is a nifty drug that kills parasites. It’s been around for eons. I still recall its name from my …

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Blame the system, not Martin Shkreli

Find a cost-effective way for drug companies to innovate

Kevin R. Campbell, MD

Medications

October 3, 2015

Recently, two significant pharmaceutical breakthroughs have resulted in a renewed debate about the costs of drug therapy. In the last year, a new drug class for the treatment of hepatitis C has been released by two different manufacturers and has been found to cure a once incurable chronic liver disease for nearly 90 percent of patients who are treated with a full course of therapy. The drug appears to be …

Legalize medical marijuana? See how a decision can affect this cancer patient.

James C. Salwitz, MD

Medications

September 28, 2015

What is not to like about medical marijuana? It treats pain, vomiting, fatigue, anxiety, depression, insomnia, seizures, muscle spasms, Crohn’s disease and allows many cancer patients to resume remarkably normal lives. It is not addictive. It does not interact with other medicines. It acts quickly and is easy to adjust. It can be consumed in numerous ways. It is safer than essentially any other drug: 1,500 Tylenol deaths in the …

4 things on the horizon in childhood cancer

Lisa Diller, MD

Medications

September 21, 2015

The 20th century saw striking advances in curing childhood cancer, primarily as a result of the discovery that broadly toxic chemotherapy agents could kill malignant cells. As a result, pediatric cancer, once a virtually incurable disease, now enjoys an overall long-term survival rate that tops 80 percent. In the 21st century, attention is turning to newer agents that promise to open additional, less toxic avenues to cure. As we mark Childhood …

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

Vamsi Aribindi, MD

Medications

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 …

Patients are taking far too many medications. It’s time to fix that.

Val Jones, MD

Medications

September 16, 2015

Medication non-adherence is a hot button topic in health care. Physicians lament patient “non-compliance” with their medical advice, and policy wonks tell us that more than half of patients do not take their medications as directed. Missed opportunities to control chronic illnesses such as diabetes, heart disease, and cancer surely do cost us untold billions of dollars and millions of quality life years lost annually in the U.S. …

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

Brian J. Secemsky, MD

Medications

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 …

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

Jennifer Gunter, MD

Medications

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. …

The FDA approved Addyi. But was there a hidden agenda?

Shirie Leng, MD

Medications

September 1, 2015

Ladies, the moment you have all been waiting for is here! No, not affordable childcare. Not equal pay for equal work. Not gun control. Not abortion rights or paid maternity leave or a female majority in Congress or a constitutional ban on the words “chick lit.” Girls, it is so much better than all that. We got pink Viagra!

Flibanserin. Catchy name. Addyi for short. Approved by the FDA for hypoactive …

Drugs and devices are getting more expensive and less useful. Why?

Janice Boughton, MD

Medications

August 27, 2015

A few weeks ago I was feeling angry and disappointed when I noticed that many of the articles I was reading in my favorite medical journal were funded by companies who made the products those articles evaluated.

This is nothing new, but it looks to me like there are increasingly more of these articles which celebrate products and fewer interesting articles about the science of medicine. The other thing …

Is the crusade against pill mills turning into a witch hunt?

Steven Reznick, MD

Medications

August 16, 2015

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I care for a 65-year-old woman suffering from sarcoidosis affecting her lungs, her skin, her bones, her nerves, her blood chemistries, her kidneys, her colon and her mind. She has gone from an active spouse, mother, grandmother, tearing up the dance floors with her husband, to a home recluse calling friends to drive her to medical and care appointments while ambulating with …

OTC Lipitor? Why Pfizer made the right decision for the wrong reason.

Ira Nash, MD

Medications

August 15, 2015

There were several news stories recently that reported that Pfizer had abandoned its efforts to have its Lipitor brand of atorvastatin made available over the counter (OTC), without a prescription. I was never a big fan of OTC statins, but I was struck by the reason that Pfizer put out:

The study did not meet its primary objectives of demonstrating patient compliance with the direction to check their low-density lipoprotein cholesterol …

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OTC Lipitor? Why Pfizer made the right decision for the wrong reason.

Is there a place for alternative therapy in cancer treatment?

Don S. Dizon, MD

Medications

August 9, 2015

I vividly remember meeting her, despite all the years that had passed. At 6 feet tall she towered over me (granted, anyone who has met me will know that’s not hard to imagine) and yes, I’ll admit it — she had physically intimidated me. But about 10 minutes into the initial consultation, I realized she was soft-spoken, kind, and, …

Do proton pump inhibitors cause heart attacks?

Frederick Gandolfo, MD

Medications

July 18, 2015

There has been concern for several years about commonly prescribed antacid drugs called proton pump inhibitors (PPIs) and the heart. PPIs are used to treat gastroesophageal reflux disease (GERD), peptic ulcer disease, and other acid-related diseases. Common drugs in the PPI class are omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), lansoprazole (Prevacid), and dexlansoprazole (Dexilant), among others.

Specifically, there is a potential interaction …

The loud chorus against conflict of interest

Dr. Saurabh Jha

Medications

July 14, 2015

I recall a talk on imaging biomarkers for Alzheimer’s disease (AD). “Take this with a pinch of salt. I have a financial conflict of interest (COI) in the success of these markers,” the speaker warned. I glanced at the audience — MDs and PhDs with a cumulative IQ higher than the French intake of wine. I looked for pinches. I searched …

It’s time for pain doctors to step it up

Shirie Leng, MD

Medications

July 13, 2015

Fifteen months ago, the Federal Drug Enforcement Agency, or DEA for short, began an investigation in four states: Alabama, Arkansas, Louisiana, and Mississippi. The DEA was looking for illegal drug trafficking, as they do. But they were looking for prescription drug dealers, not Columbian drug cartels. And they found them. They are doctors.

Forty-eight people were arrested, seven of them doctors. DEA …

Do heartburn drugs cause osteoporosis? A gastroenterologist answers.

Michael Kirsch, MD

Medications

July 7, 2015

Every week, I am asked by patients if their heartburn medicine causes osteoporosis. The most effective heartburn medicines are called proton pump inhibitors, or PPIs. If you watch more than an hour of TV per week, then you have seen ads for some of them. Nexium, Prilosec, and Protonix are three examples of these medicines.

Many of them are now available over-the-counter at reduced dosages.

Patients today are incredibly informed, and sometimes …

Dose recommendations for extended half-life hemophilia factor products fall short

Ellis Neufeld, MD, PhD and Stacy Croteau, MD

Medications

July 2, 2015

We, like many in the hemophilia community, were excited to see extended half-life (EHL) factor VIII and IX products start coming to market over the last few months. These products — and expected future products — promise equivalent or greater prophylactic bleeding control with fewer infusions, and so could greatly enhance patients’ quality of life.

Yet, as we noted in our recent editorial in Haemophilia, we are greatly concerned that patients …

Conflicts of interest aren’t only about financial incentives

Rocky Bilhartz, MD

Medications

June 30, 2015

Everyone has an angle. Everyone.

Your doctor? Sure. But, he or she isn’t the only one. The pharmaceutical company? Of course. The medical device company? The hospital? The insurance company? You get the point. Everyone has an angle. Everyone has a conflict of interest. Know it. Get over it. It’s time to focus on something else.

Like filling up your car with gas. In …

Medications

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