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.
I have been beating the population health drum for more than 20 years, and I think the rest of the band is finally catching on to the rhythm.
From healthcare reform efforts at the very top of the heap to the healthcare industry to large and small communities, there is a heightened awareness that the physical and mental health of our diverse population is linked to our continued health and success …
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Population health initiatives by the pharmaceutical industry
The current fungal meningitis outbreak has put a spotlight on compounding pharmacies, and regulators and stakeholders say Congress needs to clarify exactly who should regulate these entities.
The practice of compounding, which has been around for decades, was intended to give pharmacies the ability to produce a product under a doctor’s orders when a particular drug wasn’t available. …
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Compounding pharmacies need stricter FDA oversight
There are interesting double standards that we apply to different fields of human endeavor. In sports the use of performance enhancing drugs is forbidden. Whilst that does not necessarily stop athletes using them at least it is not condoned. Efforts are made to try and catch and sanction those who are found to be using such drugs.
The rationale behind this is that sporting contests are meant to be about who …
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ADHD medications: Performance enhancing drugs of the mind
I got an unusual request last week. I written a prescription of a generic medication (which has been generic for a couple of years) and the prescription was denied by the insurance carrier. The reason for denial: I had to try a brand-name medication first.
Stop. Read that again. They wouldn’t allow me to give a prescription for the (cheaper) generic drug because I had to try the brand-name medication first. This …
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Generic drug denied, try a brand name first
I’ve always had a tough relationship with cigarettes and the people who love them. As a lung doctor I hate cigarettes, and I hate that patients I see everyday continue to use them. But I also understand that vilifying smokers seems to be in vogue right now. I figure that if someone does something that is not considered socially palatable, and that does them harm, even as they strive to …
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Should doctors stop prescribing inhalers for smokers?
With regard to antibiotics, physicians and the public have each been enablers of the other. Patients want them and we doctors supply them. There’s nothing evil about this arrangement. Antibiotics are one of medicine’s towering achievements and have saved millions of lives. Shouldn’t we prescribe them to patients who need them? Of course we should. But why do we prescribe them to patients who don’t?
Before you race to the comment …
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Antibiotic overuse: Physicians and patients enable each other
An investigative newspaper article published in the Milwaukee Journal Sentinel, in cooperation with online periodical MedPage Today, chronicles the increased use of narcotics for chronic pain relief in the elderly.
The article highlights how in 2009 the American Geriatrics Society put together a panel of geriatric pain specialists who published geriatric narcotic pain relief guidelines that have led to the dramatic increase in use of narcotics in the elderly. There is apparently …
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Chronic pain in the elderly: The role of opioids
As a geriatrician who believes strongly in prevention, my perspective is that the recent high volume of research on healthy aging, chronic disease and its association with vitamin D and calcium supplementation has done nothing but confuse the picture for us all. I have always been an advocate of healthy eating – a balanced diet that is prepared in a manner that retains and promotes the absorption of the foods …
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Vitamin D and calcium in women: One doctor’s advice
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 53-year-old woman is evaluated in the office for a 4-month history of tremor. The tremor affects both upper extremities and is present “most of the time.” She has a 15-year history of type 2 diabetes mellitus; she also has a history of hypertension, gastroparesis, and chronic kidney disease. Medications are insulin glargine, insulin …
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MKSAP: 53-year-old woman with a 4 month history of tremor
A law is a rule of conduct or action formally recognized as binding and enforced by a controlling authority. Law enforcement broadly refers to any system by which some members of society act in an organized manner to promote adherence to the law by discovering and punishing persons who violate the rules governing that society.
The purposes of punishment for crimes include:
1. Punishment will stop them from committing further crimes.
2. Punishment …
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The largest health care fraud settlement in history: Is it big enough?
Physicians who liberally prescribe empiric antibiotics are often maligned as irresponsible or unthinking by condescending colleagues and policy wonks. But are these doctors actually courageous and prudent, saving countless thousands of lives every year by refusing to bend to misguided pressure from antibiotic-conserving paper-pushers?
As antibiotic resistance has emerged, many hospitals have begun requiring physicians to provide a rationale for every antibiotic dose prescribed. The Centers for Medicare and Medicaid (CMS) …
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Doctors who prescribe too many antibiotics: It’s not that simple
More than 80 percent of the United States supply of heparin, a commonly used blood thinner, originates from pigs reared in farm co-ops in China. Farmers scrape mucus from the intestines and send it to central processing facilities, where heparin is extracted and purified before being sold to U.S. pharmaceutical companies.
But in 2007, blue-ear pig disease, causing a respiratory syndrome, became endemic in Asia—leading to a shortage of pigs …
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Why the drug shortage is leading to desperate measures in hospitals
Narcotic pain medication prescribing is an issue heavily laden with emotion these days. I have observed that most doctors tend to fall on one side of a spectrum bordered by these two extremes:
“Undertreated pain is worse than addiction.”
On one end is the doctor who is deeply, morally troubled by patients in pain. This doctor is not unaware of the risk of addiction but is willing to risk being taken advantage …
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The bias behind narcotic prescribing
The section of the Affordable Care Act, which calls for the creation of the biosimilar pathway, was recently upheld by the Supreme Court. While not as headline-worthy as the news surrounding the individual mandate, the fact that the Biologics Price Competition and Innovation Act (BPCIA) provision survived the process was significant for the biotech world.
Biologics are some of the best treatment options for serious medical conditions such as cancer, autoimmune …
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How are biosimilar drugs affected by health reform?
E-cigarettes seem to be a very popular product these days, so I thought I’d do a bit of research to figure out what the heck an e-cigarette is and to try to answer the question, “Are e-cigarettes safe?”
It appears that the primary reason people use e-cigarettes is to avoid smoking, either as a way to get their nicotine in areas where smoking is prohibited, or as a means to try …
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E-cigarettes: Are there better ways to quit smoking?
Media outlets are reporting the results of a small, but very important study regarding a new treatment for Alzheimer’s Disease. Most Americans are familiar with Alzheimer’s because it is so common (President Reagan had it), so devastating, and without a cure. This new study gives hope to people who have or are at risk for the disease.
Recently at the Alzheimer’s Association International Conference 2012 in Vancouver, researchers presented the …
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IVIG for Alzerheimer’s: Cost is a barrier
One summer in college, when I couldn’t think of what else to do, I lived near campus in a punishingly hot walk up apartment, held down three boring jobs, and took intensive Latin. Every morning we met in a blissfully air-conditioned classroom–that was the upside!– to conjugate and decline: a whole year of Latin in 6 weeks. I remember nothing I learned, of course. I’m reminded of the great Woody …
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Go behind the scenes of naming a drug
Most of the American public doesn’t know that different pharmacies can and do charge drastically different prices for their prescription drugs. Does that surprise you? It sure surprised me when I found this out a few months ago in my medical school class.
I consider myself well educated. I’m a college graduate and in the throes of professional school — in healthcare nonetheless. I have an open mind and I read quite …
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Pharmacies can charge different prices for their prescription drugs
