Drugs and prescribing

1,242 articles · Since 2007

Articles, page 48

Fair balance gives natural pills and supplements an advantage

August 26, 2011Aug 26, 201110

The reality is that my job constantly challenges my sanity. Sometimes, I just want to scream. Patient: "Doc, I don’t want to put any poisons in my body! Isn’t there a 'natural' remedy I can take?" Doc: "No, I want…

The reality is that my job constantly challenges my sanity. Sometimes, I just want to scream.

Patient: “Doc, I don’t want to put any poisons in my body! Isn’t there a ‘natural’ remedy I can take?”

Doc: “No, I want you to take my poison! I haven’t poisoned my quota of patients this month and need to reach my goal.”

Poisoning patients really isn’t good for business. Why would a patient believe that …

A cream to fight obesity is being ignored

George Lundberg, MD

August 7, 2011Aug 7, 20112

Do you, or many of your patients, have a little more belly fat around your and their middle than you and they would like? Me, too. Turns out that there are two decent published studies from reputable places that report…

Do you, or many of your patients, have a little more belly fat around your and their middle than you and they would like? Me, too.

Turns out that there are two decent published studies from reputable places that report that a person may rub a cream on their skin over the fat spots and make the fat go away.

Wow, what a deal.

The first study addresses fat thighs, with each …

Should Lipitor go OTC? A cardiologist says yes, an internist says no

Kevin Pho, MD

August 4, 2011Aug 4, 201111

With the patent for Lipitor expiring, Pfizer is considering selling an OTC version of the statin. It's generated a firestorm of debate, with doctors speculating on the impact for patients. According to Pharmalot, "an OTC version would allow Pfizer to…

With the patent for Lipitor expiring, Pfizer is considering selling an OTC version of the statin.

It’s generated a firestorm of debate, with doctors speculating on the impact for patients.

According to Pharmalot, “an OTC version would allow Pfizer to capture some of the sales that will be lost when the Lipitor patent expires in November. In fact, Pfizer execs recently changed …

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Patients lose when insurers cut reimbursement for immunizations

Stewart Segal, MD

August 3, 2011Aug 3, 201110

I recently received a declaration of war from one of the major healthcare insurers. Not happy with its current record profits, this insurer has decided to reduce its reimbursement on immunizations and injectable medications by 40%. I do not have a 40% margin on immunizations and injectable medications. My margin is at most 10%. This means that with a 40% reduction, I will have to pay at least 30% …

Who to blame in fatal medication overdoses

Emily Gibson, MD

July 31, 2011Jul 31, 20113

There was news of yet another high profile death from an uncertain cause in a star with addiction history. Media accounts included reference to the "27 club" -- a lengthy list of famous artists who have perished by their own…

There was news of yet another high profile death from an uncertain cause in a star with addiction history. Media accounts included reference to the “27 club” — a lengthy list of famous artists who have perished by their own hand, often unintentionally, at the age of twenty seven.

The reality is that too many fatal overdoses responsible for the deaths of the famous and not-so-famous are from medications …

Tobacco cigarettes should be sold only in pharmacies to people with a permit

George Lundberg, MD

July 31, 2011Jul 31, 201118

I like Iceland. It is a really neat place; great people; terrific scenery; lively nightlife; surprisingly temperate climate, considering the latitude, thanks to the Gulf Stream. Of course, it is true that some of the Iceland bankers, poorly regulated and…

I like Iceland. It is a really neat place; great people; terrific scenery; lively nightlife; surprisingly temperate climate, considering the latitude, thanks to the Gulf Stream.

Of course, it is true that some of the Iceland bankers, poorly regulated and without scruples, were even more predatory than many of the American Wall Street investment bankers, taking the money and running to lead a pack of nations into international fiscal calamity, a …

How dabigatran is an atrial fibrillation paradigm shift

John Mandrola, MD

July 28, 2011Jul 28, 20113

My iPhone vibrated with an urgent message that read: "Please call … the INR on your atrial fibrillation patient scheduled for cardioversion is too low. He is on that new blood thinner, Pradaxa. What do you want to do?" I…

My iPhone vibrated with an urgent message that read: “Please call … the INR on your atrial fibrillation patient scheduled for cardioversion is too low. He is on that new blood thinner, Pradaxa. What do you want to do?”

I responded, sounding like an expert: “It’s ok. Pradaxa thins the blood adequately, it just doesn’t change the INR.”

She astutely responded, “How do know the blood is thin? What if …

Celebrity endorsements of prescription drugs

Richard Meyer

July 27, 2011Jul 27, 2011

Boniva continues to use Sally Field as a celebrity spokesperson for their product but as John Mack pointed out, should any prescription drugs be paying celebrities to endorse their products? Well, according to an Ace Metrix study the answer to…

The Ace Metrix study found of more than 2,600 ads that celebrity ads do not perform any better than non-celebrity ads and in some case …

Options when your drug copays are too expensive

Leslie Ramirez, MD

July 25, 2011Jul 25, 20114

You have insurance and, supposedly, it covers your medicines. However, you still get stuck with a portion of the bill that the insurance company calls a "copay." In some cases these copays can run more than $150/ month per medication…

You have insurance and, supposedly, it covers your medicines. However, you still get stuck with a portion of the bill that the insurance company calls a “copay.” In some cases these copays can run more than $150/ month per medication (e.g. Enbrel). If you are on more than one of these expensive, branded medications the copays can really add up. What are your options?

1. Generic alternative. Always ask your doc if there

…

Current psychiatric drugs are only marginally effective

Steve Balt, MD

July 23, 2011Jul 23, 20118

The scientific journal Nature ran an editorial recently with a rather ominous headline: "Psychopharmacology in Crisis." What exactly is this "crisis" they speak of? Is it the fact that our current psychiatric drugs are only marginally effective for many patients?…

The scientific journal Nature ran an editorial recently with a rather ominous headline: “Psychopharmacology in Crisis.” What exactly is this “crisis” they speak of? Is it the fact that our current psychiatric drugs are only marginally effective for many patients? Is it the fact that they can often cause side effects that some patients complain are worse than the original disease? No, the “crisis” is that the …

Neurotransmitters and the side effects of antidepressants

Dheeraj Raina, MD

July 22, 2011Jul 22, 2011

We certainly wish that antidepressants in particular, and all psychiatric medications in particular were free of side-effects. It would be a boon to our patients, and their families. Sadly, there is no such thing as a medication without any risk of side-effects. Even over-the-counter medications such as Tylenol, Benadryl an aspirin can have pretty serious side-effects.

Some side-effects of medications are related to dose — the higher the dose, the …

Vaccines on the horizon and vaccine economics

Stephen C. Schimpff, MD

July 19, 2011Jul 19, 2011

What else is on the horizon? There is progress to develop vaccines to control addiction to both nicotine and to opioids. Vaccination may be the best route to get control of the bacteria having a major impact on methicillin resistant Staphylococcus aureus (MRSA) and other highly pathogenic antibiotic resistant bacteria that have become endemic in hospital ICUs.

A vaccine for dengue is likely within the next five years. The World Health Organization …

Vaccines in the developing world

Stephen C. Schimpff, MD

July 15, 2011Jul 15, 2011

When we think of vaccines we need to divide the world into the industrialized countries, those with transitional economies and the developing countries. In the developing world, the proportion of the population less than 15 is very high, e.g., Mali…

When we think of vaccines we need to divide the world into the industrialized countries, those with transitional economies and the developing countries.

In the developing world, the proportion of the population less than 15 is very high, e.g., Mali has about 50% of its population under age fifteen compared to about 15% in the industrialized countries. This suggests that the emphasis in the …

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Vaccines in the developing world

Medical marijuana in psychiatric illness

Christina Girgis, MD

July 9, 2011Jul 9, 201110

Recently, 16 states and Washington DC have legalized medical cannabis. An additional 10 states have pending legislation. With all the attention legalized medical marijuana has been receiving, patients have started asking if they are candidates for a prescription. Well, my…

Recently, 16 states and Washington DC have legalized medical cannabis.

An additional 10 states have pending legislation. With all the attention legalized medical marijuana has been receiving, patients have started asking if they are candidates for a prescription. Well, my answer is easy. Right now it is not legal in Illinois, although it is one of the states that is pending. Even if it does become legalized, I …

Using genomic data to understand disease entities

Douglas Elwood, MD, MBA

July 5, 2011Jul 5, 2011

Three recent studies point to the continued presence and increasing importance of genomic information to improving health care. We have discussed the power of personalized medicine in multiple posts and highlighted the potential of genomics and though this movement is…

Three recent studies point to the continued presence and increasing importance of genomic information to improving health care.

We have discussed the power of personalized medicine in multiple posts and highlighted the potential of genomics and though this movement is really still in its infancy it is a burgeoning component of medicine.

The first study, published in the American Journal of Gastroenterology, explores Helicobacter pylori, a common …

Vaccines to prevent or treat non-infectious chronic illnesses

Stephen C. Schimpff, MD

July 5, 2011Jul 5, 2011

A major megatrend in medicine will be the use of vaccines to prevent or treat (non infectious) chronic illnesses. Although we tend to think of vaccines for preventing infections there are now two vaccines that prevent cancer (via preventing the…

A major megatrend in medicine will be the use of vaccines to prevent or treat (non infectious) chronic illnesses.

Although we tend to think of vaccines for preventing infections there are now two vaccines that prevent cancer (via preventing the infections that are in part causative), one vaccine on the market to treat residual cancer and many vaccines in development to prevent or treat other cancers …

What do hospice nurses and teenage heroin addicts have in common?

Richard Barager, MD

July 1, 2011Jul 1, 201127

What do hospice nurses and teenage heroin addicts have in common? One may be an unintended consequence of the other. A pair of articles published recently in two prestigious medical journals help make the case. The Lancet reported that 47…

What do hospice nurses and teenage heroin addicts have in common? One may be an unintended consequence of the other.

A pair of articles published recently in two prestigious medical journals help make the case.

The Lancet reported that 47 million of the 58 million deaths occurring annually worldwide take place in developing countries, and that of these, fully 27 million die without having received proper palliative care. The article attributes …

Pharmacies selling prescription information to data mining companies

David Harlow

June 30, 2011Jun 30, 20114

Walgreens is being sued by customers who are not happy that their prescription information – even though it has been de-identified – is being sold by Walgreens to data-mining companies. The data privacy and security concerns surrounding the transfer of…

Walgreens is being sued by customers who are not happy that their prescription information – even though it has been de-identified – is being sold by Walgreens to data-mining companies.

The data privacy and security concerns surrounding the transfer of de-identified data are significant. To “de-identify” what is otherwise protected health information under HIPAA, some outfits will simply strip data of 18 types of identifiers listed in …

The tragic irony of pharmaceutical coupons

Chris Lillis, MD

June 24, 2011Jun 24, 201132

As a primary care physician in private practice, I have my own little taste of celebrity. Every day attractive people come to my office seeking time to speak with me and collect my autograph. They fawn over my partners and…

As a primary care physician in private practice, I have my own little taste of celebrity.

Every day attractive people come to my office seeking time to speak with me and collect my autograph. They fawn over my partners and I, and bring us food for lunch, and will invite us to the nicest restaurants in town for dinner. These people also used to bring gifts, until they were barred from …

Bias in top tier academic journals

Derek Lowe, PhD

June 23, 2011Jun 23, 20116

Venture-capital guy Bruce Booth has a provocative post, based on experience, about how reproducible those papers are that make you say, "Someone should try to start a company around that stuff": The unspoken rule is that at least 50% of…

Venture-capital guy Bruce Booth has a provocative post, based on experience, about how reproducible those papers are that make you say, “Someone should try to start a company around that stuff”:

The unspoken rule is that at least 50% of the studies published even in top tier academic journals – Science, Nature, Cell, PNAS, etc… – can’t be repeated with the same conclusions by an industrial lab. In

…

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Bias in top tier academic journals

Drugs and prescribing

Articles, page 48

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