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.

5 ways to reduce antibiotic use in children

Wendy Sue Swanson, MD

Medications

December 18, 2013

Research shows that about 1 in every 5 pediatric visits for “sick visits” results in an antibiotic prescription. Now not all of those antibiotics are taken; many pediatricians now use the rx pad for “wait and see” or “delayed prescribing” antibiotics. They give a prescription and allow the family to watch and wait — if a child is not getting better, they advise parents to start taking them.

However, in total …

Cough medicines shouldn’t be used in small children

Christopher Johnson, MD

Medications

December 17, 2013

It’s once more cold season, bringing up the question parents commonly face. Should they buy one of those rows and rows of cough, sneeze, and runny nose medicines one finds in every drug store and supermarket?

In a nutshell, no — none of the preparations sold over-the-counter to treat upper respiratory infections in children work, and all could be dangerous. That’s the conclusion of a report some years ago by the Food and Drug Administration, …

Cholesterol management with patients requires shared decisions

Michael J. Barry, MD and John B. Wong, MD

Medications

December 14, 2013

New guidelines from the American College of Cardiology and the American Heart Association on the assessment of cardiovascular risk and the manipulation of cholesterol levels to mitigate that risk have certainly been in the news. The guidelines appropriately use high quality evidence to abandon old untested or unproven paradigms such as treatment to LDL targets and manipulation of non-HDL cholesterol as a secondary goal. In many ways, the new guidelines …

Katie Couric brings attention to the HPV vaccine

Natasha Burgert, MD

Medications

December 11, 2013

The HPV vaccine is in the news again. This time it is Katie Couric’s daytime talk show that is shining the spotlight. And, I am thankful.

A medicine that prevents cancer is worth giving airtime.

In the segment, Couric chose to highlight the experience of 3 mother-daughter duos and their experience with the HPV vaccine. One story ended in loss, one in pain, and one in quiet confidence. Couric also highlighted advice from …

Speakers need to explicitly state financial relationships

James Colbert, MD

Medications

December 8, 2013

I just returned from the annual American Heart Association meeting where I heard distinguished cardiologists and researchers from around the world present the latest in cardiovascular disease.

Yet, amidst all the late-breaking clinical trial presentations and ask-the-expert sessions, what I didn’t hear were the speakers’ financial conflicts of interest.

Don’t get me wrong — the AHA mandates that all speakers present a disclosure slide at the beginning of every talk, and this rule was …

Standardize drug names and reduce the risk of medication errors

John Schumann, MD

Medications

December 5, 2013

Ever get confused over the names of medicines?

I do.

There’s Zantac and Xanax. Zanaflex and Zaleplon.

But Zanaflex is also known as tizanidine. Tizanidine functions very differently than Zantac and its other name, ranitidine, even though they sound alike.

Every drug has (at least) two names — one proprietary, and one generic. Proprietary names are created to sound catchy by the original manufacturer, almost always under a patent. The generic names are more like chemical …

What a doctor learned from a visit to an e-cigarette store

Natasha Burgert, MD

Medications

December 2, 2013

From gas stations to grocery stores, slender cylinders of nicotine “e-juice” seem to be available everywhere. On my drive to work, in fact, 2 new e-cigarette shops have opened their doors in just the last 3 months. So I was not surprised to read a recent report suggesting a rise in the number of teens trying e-cigs.

E-cigarettes deliver nicotine by heating nicotine-containing fluid into a vapor that is …

Digging deeper into the new cholesterol guidelines

Janice Boughton, MD

Medications

November 26, 2013

The American Heart Association, in collaboration with the American College of Cardiology, recently released recommendations that should change the way we prescribe medications called statins, including drugs like Lipitor and Crestor and their generics, atorvastatin and rosuvastatin.

The headlines say stuff like, “More Americans may be Eligible to Receive Cholesterol Lowering Drugs!”

I am a bit skeptical of news about statin therapy because Lipitor, before it went generic, was responsible for over …

Generic drugs play a central role in reining in health care spending

Naomi Freundlich

Medications

November 20, 2013

It was a huge relief to Carol Thompson in 2011 when her breast cancer drug Femara (letrozole) went off patent and became available in a generic version. With a high deductible in her private insurance plan, Thompson was forking over $450 for a month’s supply of the life-saving drug. After the generic hit the market she was thrilled to find letrozole available for just $11 a month at Costco. But …

Stopping the threat of drug resistant bacteria

Roy Benaroch, MD

Medications

November 20, 2013

Well, this isn’t good news.

The CDC has compiled an extensive report of the top US health risks from infections. Called “Threat Report 2013,” their evaluation shows that the three most worrisome risks have all been created by our own indiscriminate overuse of antibiotics. The biggest baddies:

Carbapenem-resistant Enterobacteriaceae. The carbenapenem antibiotics were first developed in the 1970s and grew into wide use in the late 1980s. They had been the biggest, baddest …

How to know whether antidepressants will help

Elana Miller, MD

Medications

November 18, 2013

It seems to be trendy these days to say we’re all overmedicated. People say we swallow a pill to try to escape any fleeting negative feeling, or that we throw them at our kids for any bad behavior. To be honest, there are times I agree.

However, sometimes people take the anti-medication thing way, way too far. They say antidepressants are a conspiracy of the drug companies to make us all …

Hormone replacement and the profound importance of maybe

David L. Katz, MD

Medications

November 5, 2013

Recently, colleagues and I published what I consider a very important paper in the American Journal of Public Health, indicating that tens of thousands of relatively young women who have undergone hysterectomy are dying needlessly because of an over-generalized fear of hormone replacement. Publication in the Journal of the American Medical Association of a rich compilation of findings from the Women’s Health Initiative (WHI) trial does nothing to change …

Does restricting Vicodin make sense?

Albert Fuchs, MD

Medications

November 1, 2013

To understand the Vicodin story we first have to understand how habit-forming medicines are currently prescribed in the U.S. The Drug Enforcement Agency divides potentially addictive substances into different schedules. Schedule II controlled substances are prescription medicines that have a high potential for abuse and severe dependence. They include all the opiate (narcotic) pain medicines, like morphine, oxycodone, and fentanyl. These medications must be prescribed on a paper …

Read more…

Does restricting Vicodin make sense?

Antidepressants and the placebo effect

Elana Miller, MD

Medications

October 31, 2013

When I was in middle school, I went to Lake Tahoe with my best friend on a ski trip. I had only been skiing a few times before, and even though my friend was only twelve, she was already a talented and experienced skier.

She was patient with me, but I became increasingly frustrated as I had trouble going down even the most basic runs without falling. At one point, after falling …

Read more…

Antidepressants and the placebo effect

The balance between cost control and drug innovation

Peter Ubel, MD

Medications

October 24, 2013

To almost every claim that the American healthcare system is overpriced, defenders of the United States can point to the comparison problem — it is not fair to compare American surgeons, or hospitals, to our peers in Europe when American surgeons and hospitals are not the same as in those other countries. Our surgeons are better trained, the defenders retort, and our hospitals offer higher quality care. When quality measures …

Stop mandating narrow studies of cardiovascular and diabetes drugs

Harlan M. Krumholz, MD

Medications

October 18, 2013

The state of diabetes drugs has gotten to the point where it is good news that a drug does not produce worse outcomes than a placebo.

I am not kidding.

The New England Journal of Medicine published two trials, each testing whether a diabetes drug increased the risk of heart attacks and death from heart disease. The trials are a result of FDA guidance for companies to assess the cardiovascular safety of new …

Getting the flu shot isn’t about you

Claire McCarthy, MD

Medications

October 17, 2013

Flu season has begun, which means that it’s flu shot time.

I see lots of different responses when I talk to families at our clinic about the flu shot. Some are happy to get it. Others are unsure, worried about side effects. Others plain old refuse.

Plain old refusal isn’t an option for me — as a doctor and an employee of Boston Children’s. I need to get it — and I …

Read more…

Getting the flu shot isn’t about you

Physicians are fearful of fulfilling their duty to treat pain

James Patrick Murphy, MD

Medications

October 6, 2013

I recently testified before the Medical Licensing Board of Indiana regarding the pending emergency rules for physicians prescribing opioids for chronic pain. The session went on for four intense hours — ten minutes of which had been promised to me.

At my turn, I stated my name, told the Board I hailed from Indiana’s prescription ground zero, gave a brief summary of my credentials, thanked the Board, the American Academy …

Why I stopped working with mail order pharmacies

Deep Ramachandran, MD

Medications

October 2, 2013

Mail order pharmacies like Express Scripts and Medco have become increasingly prominent players in health care. But these companies are a lot more than simply mail order pharmacies, they are in fact a new generation of pharmacy benefit managers (PBMs). PBMs are essentially middle-men between insurance and pharmacy, with companies like Express Scripts merging the dual functions of a PBM and pharmacist into one. PBMs manage and administer medication benefits …

A gameplan against this year’s flu

Natasha Burgert, MD

Medications

September 17, 2013

Did your team win this weekend?

I hope so. It is so exciting when your team gets to throw up a “W” after their first contest. It gives all the fans hope for a successful and exciting season.

Fall also is a time to cheer for our annual opportunity to protect our families against a predictably unpredictable opponent: influenza.

That’s right. It’s time to defend against the flu by getting an annual flu vaccine.

This …

Read more…

A gameplan against this year’s flu