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.

Psychiatry benefits when psychologists prescribe drugs

Daniel J. Carlat, MD

Medications

April 7, 2010

I want to touch on what is probably the hottest topic in psychiatry: whether psychologists should obtain prescription privileges. This is topical because Oregon just overwhelmingly passed a law authorizing prescriptive privileges for psychologists, although it is unclear whether the governor will sign the bill.

I endorse psychologists prescribing, and here’s why: it would be the single best thing that could happen to psychiatry.

Yes, I know it sounds ridiculous, but …

Chronic pain patients may have been disobedient children

MedPage Today

Medications

April 7, 2010

by Nancy Walsh

Children who are irritable or disobedient, or who steal or bully others, are at risk for chronic pain in middle age, a large prospective study found.

Youngsters who had persistent behavior problems at ages seven, 11, and 16 years had more than twice the risk of widespread chronic pain at age 45 as other children (RR 2.14, 95% CI 1.43 to 3.21), according to Dong Pang, PhD, of the …

Pain management depends too heavily on narcotics

Michael Kirsch, MD

Medications

April 4, 2010

by Michael Kirsch, MD

First, let me state unequivocally that I am against all varieties of pain, foreign and domestic. Indeed, I wish that we could snuff the varmint out every time and place it surfaces. Pain is a wily opponent that can be difficult to vanquish. In recent years, physicians have been resorting to a ‘shock and awe’ strategy of using excessive force against it.

While this may be sound military …

Drug companies are using community doctors for dinner talks

Kevin

Medications

March 30, 2010

Originally published in MedPage Today

by John Fauber, Milwaukee Journal Sentinel/MedPage Today Reporter

When looking for a doctor to travel the country to promote its prescription fish oil product, a leading pharmaceutical company looked to a small-town community doctor rather than an academic heavyweight.

Its choice was a Delafield, Wis., primary care physician and clinical lipidologist who entered private practice in 2001.

For speaking …

Oxycontin should be prescribed less often by doctors

Edward Pullen, MD

Medications

March 29, 2010

Oxycontin is an oral pain medication that contains the single active ingredient oxycodone. Oxycodone is one of the most potent of the oral opiates, and has more euphoric effect than many other opiate analgesics.

Oxycontin is the most notorious prescription drug of abuse in the US, and for good reason. Though marketed as a sustained release medication, as much as 30% of the medication is absorbed immediately and the rest absorbed …

Industry relationships with physicians are coming under fire

Kevin

Medications

March 21, 2010

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Earlier this year, Harvard’s Partners Healthcare put a cap on payments its physicians can receive for serving on corporate boards at $5,000 a day.

Although the cap primarily affects top researchers and executives, it is by far the stiffest limit imposed by any academic medical center, and drives deeper the …

Vaccine safety still concerns parents

Kevin

Medications

March 9, 2010

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Even though 90% of parents believe vaccines protect their children against disease, many are also concerned about potential adverse effects, a new survey found.

More than half of survey respondents said they were concerned about vaccine safety profiles, particularly for newer immunizations, Gary L. Freed, MD, MPH, of the University …

Read more…

Vaccine safety still concerns parents

Why rosiglitazone would not have been approved today

Larry Husten, PhD

Medications

March 7, 2010

Avandia continues to dominate cardiovascular-related news this week. Recently, the AHA and the ACC issued a highly detailed, thoughtful, though perhaps slightly over-diplomatic science advisory on TZDs and CV risk. Taking a completely opposite tack, GSK, in no mood to take prisoners, and apparently about to nominate itself for a Nobel Prize, issued a 30 page White Paper in response to the Senate report published on Saturday.

At the core …

C Diff and antibiotic resistance in kids

Marya Zilberberg, MD, MPH

Medications

March 4, 2010

A recent story from the UK reported a school child who developed diarrhea and tested positive for C difficile.

The alarming thing is that there did not seem to be any explicit risk factors for this. The appalling thing is the mis-information by the story that, “children rarely become ill with C diff, which normally strikes elderly people in hospital.”

This is how things used to be, before the BI/NAP1/027 bug evolved …

Bipolar disorder and how Rebecca Riley could have been saved

Claudia M. Gold, MD

Medications

March 1, 2010

Carolyn Riley’s act of giving her daughter Rebecca an overdose of prescribed medication may have been the immediate cause of Rebecca’s death, the conclusion reached by the jury that convicted her of murder.

Even if, as the prosecutor argued, Carolyn and her husband concocted symptoms of mental illness and the psychiatrist, who diagnosed bipolar disorder, was a gullible enabler, the real guilty party in this story is, in my opinion, …

Your metformin may smell like dead fish

Kevin

Medications

March 1, 2010

Originally published in MedPage Today

An immediate-release form of the antidiabetic agent metformin has a dead fish odor that may cause patients to stop taking the drug, clinicians warned.

Metformin is known to cause adverse gastrointestinal effects such as diarrhea, nausea, vomiting, flatulence, distention, and abdominal pain. Those side effects “often necessitate discontinuing the drug,” a group of physicians and pharmacists …

Read more…

Your metformin may smell like dead fish

Medical marijuana has doctors asking questions

Kevin

Medications

February 19, 2010

Originally published in HCPLive.com

In January, New Jersey became the 14th state in the nation to legalize marijuana use for certain chronic illnesses. Other states where the use of medical marijuana is permitted include Alaska, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont, and Washington; around a dozen more states are weighing pending bills.

The New Jersey …

How alternative and herbal medications can have dangerous side effects

Kevin

Medications

February 13, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Herbal medicines are not always the harmless nostrums that many patients and even some physicians think, but may actually contribute to cardiovascular morbidity and mortality, researchers warned in a review covering 44 years of research into the subject.

Many such products, including aloe vera, ginkgo biloba, ginseng, and green tea, can …

Not enough patients receive vaccines and what doctors can do about it

Shantanu Nundy, MD

Medications

February 9, 2010

Imagine a world where consumers all knew about the latest developments in preventive health.

Earlier this month the Advisory Committee on Immunization Practices (ACIP) released the 2010 immunization schedules. Revised annually, the immunization schedules are what doctors in the U.S. use to decide who should be immunized against what diseases. Far from esoteric, the schedules pertain to every single person living in the United States. If the H1N1 pandemic and subsequent …

An anesthesiologist accused of making up trial data pleads guilty to federal charges

Kevin

Medications

February 8, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

A Massachusetts anesthesiologist accused of fabricating data in studies of pain drugs will plead guilty to federal criminal charges under an agreement with prosecutors.

Scott Reuben, MD, a well-known pain researcher at Baystate Medical Center in Springfield, Mass., was charged with one count of healthcare fraud.

Early last year, the hospital …

How should pharmacy benefit managers (PBMs) and pharmacies communicate with physicians?

Kevin

Medications

February 2, 2010

by George Van Antwerp

In the pharmacy and pharmacy benefit manager (PBM) business, there are lots of reasons to reach out to a physician:

* Drug-drug interactions
* A chemically equivalent version of the drug prescribed is available
* A therapeutically equivalent version of the drug prescribed is available
* The prescribed drug is not covered
* A prior authorization is required
* The patient is required to try an alternative drug first (step therapy)
* The prescribed …

Why doctors are too quick to prescribe drugs for ADHD

Kevin

Medications

February 1, 2010

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Physicians may be too quick to medicate children suspected of having attention deficit hyperactivity disorder (ADHD).

The etiology of the disease is not well understood, and while some cases may have neurological causes, children may respond to psychotherapy instead, Esther Fine, PhD, a psychoanalyst in private practice in Los Angeles, told …

How can doctors stop drugs prescribed by other physicians that are no longer effective?

John Mandrola, MD

Medications

January 30, 2010

Here are two vignettes illustrating the failure of doctors to master the obvious and maybe a window onto the future struggles to control medical costs.

A 90-year old is referred for care due to “end stage dementia.” End-stage dementia is medical speak and as such does not really convey the appropriate imagery. It means a skeletal man, in a wheelchair or mostly in bed, with diapers, who has does not know …

Can morphine help prevent post-traumatic stress disorder (PTSD)?

Kevin

Medications

January 25, 2010

Originally posted in MedPage Today

by Todd Neale, MedPage Today Staff Writer

The use of morphine may prevent the development of post-traumatic stress disorder (PTSD) in military personnel injured in combat, an observational study showed.

Those who received the drug during resuscitation or trauma care were about half as likely to later develop PTSD (OR 0.47, P<0.001), according to Troy Lisa Holbrook, PhD, …

When are stroke patients more likely to receive clot busting drugs?

Kevin

Medications

January 23, 2010

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Patients suffering an acute ischemic stroke are about 20% more likely to receive clot-busting therapy with tissue plasminogen activator (tPA) if they arrive at the hospital on the weekend, a retrospective study showed.

However, there was no difference in rates of inhospital mortality based on the time of admission, Abby …