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.

Why a marketing study for Niaspan was published in a medical journal

Larry Husten, PhD

Medications

September 3, 2010

The authors call it “an in-office linguistic study” and write that it “was conducted to assess physician–patient discussions of mixed dyslipidemia.” But it’s really an Abbott marketing study for Niaspan, the company’s long-acting niacin product, and the question is: why is it published in the American Journal of Cardiology?

The study involves the recorded conversations of 12 cardiologists and 12 PCPs with 45 patients with low levels of HDL. The …

Mail order pharmacies have cheap prices, but also problems

WhiteCoat, MD

Medications

September 2, 2010

After seeing Mrs. WhiteCoat argue on the phone with Medco representatives for 20 minutes about why one of her 80+ year old patients hadn’t received her medicine despite three lost faxes to Medco, I had to write this post to let the public know what is going on with some mail order pharmacies.

If you’re like most Americans, you want to try to save some money. One of the ways that …

Empiric antibiotics in the ICU

Paul Sax, MD

Medications

August 31, 2010

Last year, I commented on the ironic sameness of ICU infectious diseases — that incredibly sick, complex patients entered the ICU with vastly different problems, then over time, seemed to converge, presenting similar kinds of clinical issues and management challenges for the ID doc.

Or, as a visiting medical student said to me, “My ICU attending said that every patient in the ICU should be on vancomycin and Zosyn.”

Which brings up …

Read more…

Empiric antibiotics in the ICU

Effect of the Massachusetts Gift Ban law on area restaurants

Daniel J. Carlat, MD

Medications

August 29, 2010

I recently debated Steve DiFillippo, owner of Davio’s and Avila’s restaurants, on the WGBH program Greater Boston, hosted by Emily Rooney. The topic? The effect of the Massachusetts Gift Ban law on area restaurants.

On one level, it was a friendly debate on the economic impact of the law on those restaurants that depend on drug company sponsored dinners for a chunk of their income.

But on another level, this is a …

Too many young children are medicated with powerful drugs

Claudia M. Gold, MD

Medications

August 28, 2010

Recently while cleaning out my office in anticipation of my new job, I discovered that I had unknowingly been witness to an historic moment in child psychiatry. I found a binder from a course I had taken in June of 2001 sponsored by Harvard Medical School on Major Psychiatric Illnesses in Children and Adolescents.

Though I did not remember until I looked at my scrawled notes in the margins, on Saturday …

Statins for heart disease and stroke, and debunking statin myths

Eric Van De Graaff, MD

Medications

August 27, 2010

There is no class of medications in the history of the world that has been better studied that statins.

This class of drugs is more properly termed HMG CoA reductase (3-hydroxy-3-methyl-glutaryl co-enzyme A reductase) inhibitors, but with a name like that a terser nickname is almost mandatory (the name statin comes from the suffix of the members of this class: lovastatin, pravastatin, etc.).

Simply …

How drug companies sell psychiatrists on their drugs

Daniel J. Carlat, MD

Medications

August 26, 2010

An excerpt from Unhinged: The trouble with psychiatry- a doctor’s revelations about a profession in crisis. Copyright © 2010 Daniel Carlat. Excerpted with permission by Free Press, a Division of Simon & Schuster, Inc.

In 1993, the FDA approved Neurontin for the treatment of epilepsy. This should have been a cause for celebration at Warner-Lambert, the drug company that introduced it, but the celebration was muted. The FDA had …

Doctors are often preferred to market a drug to other physicians

Kevin

Medications

August 25, 2010

An excerpt from White Coat, Black Hat.

by Carl Elliott

A few years ago a small group of first-year medical students at the University of Minnesota spoke to me about a lecture on erectile dysfunction that had just been given by a member of the urology department.

The doctor’s PowerPoint slides had a large, watermarked logo in the corner. At one point during the lecture a …

Gifts and money influence physician prescribing

Marya Zilberberg, MD, MPH

Medications

August 19, 2010

It is not a secret that large sums of money have passed from the pharmaceutical and device manufacturers into physicians’ hands.

This money has been paid not only for such socially beneficial pursuits as research and consulting, but also for lavish gifts and junkets. And interestingly, despite disingenuous assertions to the contrary by many a stake holder, these gifts generated a return on investment — surprise! It turns out that the …

Physicians should not be used for FDA ad enforcement

Michael Kirsch, MD

Medications

August 18, 2010

One of the advantages of marrying an immigrant is having intense exposure to another culture. My wife’s Russian heritage, and her family, have enriched my own life immeasurably. The trip that I took with her and my brother to Russia in 1990, where she served as our personal translator, was unforgettable.

During the early years of our relationship, I heard stories about her family that seemed incredible to an American like …

Incentives for switching patients from branded drugs to generic

Matthew Mintz, MD

Medications

August 18, 2010

There’s an interesting video from WCVB in Boston about doctors getting kick backs from the insurance company to switch patients from branded medications to generic medications: New Rules To Protect Prescription Drug Customers.

If people were concerned about undue influence when drug companies used to give physicians pens and other novelties (now currently banned by most companies), they should really be concerned about actual monetary payments.

The patient interviewed in the Boston …

Creatine causing muscle cramps and how supplements may be dangerous

Orly Avitzur, MD

Medications

August 18, 2010

About a month ago, a 44-year-old insurance executive came to see me with complaints of headaches and muscle cramps. His pain was caused by the typical cluster headache located behind one eye, accompanied by one-sided tearing and nasal congestion, and often triggered by occasional wine or chocolate. The muscle cramps mainly affected the legs and seemed to worsen after exercise.

When I got the results of his lab work, I was …

Why DTC drug marketing still clings to TV

Richard Meyer

Medications

August 13, 2010

Top of mind positioning has been replaced with top of page positioning. The old ad model of informing, persuading and reminding are being replaced by involvement, community and empowerment. So why are the nightly network newscasts still being subsidized by drug direct to consumer (DTC) ads?

From all the latest research that I have done, coupled with the research from other sources like Manhattan Research, Pew and Rodale, it’s quite clear …

Pharmaceutical sponsored dinners have educational value

Randall S. Bock, MD

Medications

August 5, 2010

It is insulting to think that doctors who are ostensibly smart enough to save one’s life are in fact so stupid, or merely gullible enough, to be swept away by what is in actuality only a very weak potion of sales-presentation intermixed with and embedded within generally informative and pharmaceutical-balanced subject-focused medical lectures.

Such lectures occur usually at a private function room at a restaurant or, in conjunction with a served …

Was JUPITER trial data influenced by AstraZeneca to favor Crestor?

Charles Bankhead

Medications

August 3, 2010

by Charles Bankhead

Reanalysis of a landmark cholesterol-lowering trial of people typically considered at low risk for heart attacks indicated that the results are flawed — and do not support the primary-prevention benefits that made headlines, authors of the review asserted.

The reanalysis of the massive JUPITER trial involving almost 18,000 people with low or normal cholesterol but elevated levels of the inflammatory biomarker C-reactive protein (CRP) — turned up no evidence …

Medications that increase the risk of photosensitivity

Kevin

Medications

August 3, 2010

by Marianna Rakovitsky, RPh

Oh, Summer! The weather is warm, the sun is shining and it is the time when we try to get outside as much as possible. Summer is my favorite time of the year. I love the beach, days that are filled with light and sunshine, trips to the orchards and hanging out in the backyard. The sunshine that makes the summer such a …

Homocysteine lowering does not reduce heart attack risk

Crystal Phend

Medications

July 29, 2010

by Crystal Phend

Homocysteine-lowering supplements do not help prevent further cardiovascular events in heart attack survivors, a large randomized trial affirmed.

The trial, which followed more than 12,000 heart attack survivors over nearly seven years, found that folic acid plus vitamin B12 effectively reduced homocysteine levels, but did not reduce major vascular events overall nor any other individual endpoint compared with placebo, reported Jane M. Armitage, BM BChBSc, MBBS, of the University …

ADHD and how drugs impede meaningful help for children

Claudia M. Gold, MD

Medications

July 28, 2010

I recently received a call from a mother that made me both want to cry and scream out in frustration.

Several months ago I wrote a post entitled Drugs for Children May Silence Stories, in which I described a young boy who had suffered severe neglect as an infant. His adoptive parents had sought help from me when he was four, but when I recommended intervention for the whole family …

What doctors think about drug and device marketing

Charles Bankhead

Medications

July 26, 2010

by Charles Bankhead

Increased emphasis on conflicts of interest has yet to sway physicians’ generally positive attitudes toward drug and device manufacturers’ marketing activities, a survey of almost 600 attending physicians and trainees showed.

More than 70% of respondents saw nothing inappropriate about attending sponsored lunches, and 25% had no problems with accepting large gifts from industry representatives, according to an article in the June issue of Archives of Surgery.

Surgeons, trainees, and …

The Massachusetts gift ban benefits health insurance companies

Kevin

Medications

July 23, 2010

by Edison Wong, MD

With the recent proposal to repeal the so-called Massachusetts “gift ban” (more appropriately referred to as the “interaction ban”), I asked myself who stands to gain the most from such bans?

Is it the consumers or patients? Is it the physicians or their practices? Is it the federal or state governments? Nope. Sadly, it is the insurers who gain the most, at the expense of patients.

The …

Medications

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