Medications and Prescribing

Physicians writing on KevinMD about prescribing: the prior authorization that stands between a prescription and a pharmacy, opioids and the tapers that followed the CDC guideline, GLP-1 drugs and what happens when patients stop them, compounded and direct-to-consumer drugs, shortages, and what a prescription costs the patient. Three maintained records draw on this archive: Prior authorization: what physicians say, in their own words, Opioids: what physicians and pain patients say, in their own words, and GLP-1 drugs: what physicians say about Ozempic and its successors, in their own words.

Are there reasons to doubt remdesivir?

Daniel Hopkins, MD

Medications

May 23, 2020

On April 29th Anthony Fauci announced the National Institute of Allergy and Infectious Diseases, an institute he runs, had completed a study of the antiviral remdesivir for COVID-19. The drug reduced time to recovery from 15 to 11 days, he said, a breakthrough proving “a drug can block this virus.” Now people are clamoring for $1,000-a-pill remdesivir.

While the results were preliminary, unpublished, and unconfirmed by …

Read more…

Are there reasons to doubt remdesivir?

Nurses do not get paid extra for being pharmacists

Anthony Langley, RN

Conditions and Diseases

May 7, 2020

An excerpt from Nurses are Nuts.

The pharmacy department plays a vital role in hospitals. They prepare and dispense medications. Sometimes the pharmacist will receive an order from the doctor on a med whose written dosage he is not sure of. In some cases, the pharmacist will …

Scientists predicted remdesivir’s success with a simulation. Here’s how.

Cesar Padilla, MD

Medications

May 7, 2020

In 2002 pro baseball manager Billy Beane accomplished the impossible. He took the Oakland Athletics, a low-budget team comprised of unknown baseball players to the playoffs. The story’s magic is that he was able to compete with the Goliaths of the baseball world – the New York Yankees – with only a fraction of the budget. The idea is simple – draft players who are statistically successful in their respective …

Prior authorization is another barrier to cost-effective care

Rachel Offenbacher, MD

Physician

February 10, 2020

The Affordable Care Act, aka “Obamacare,” has improved patient’s access to health care since its passing in 2010.

The increase in coverage, however, does not address the restriction of prior authorization (PA), where a physician is required by a patient’s insurance company to obtain special approval from the insurance company for a medication or treatment. PA is not only needed for medication, but also for scans, potential …

You think insurance is confusing? Try being a patient.

Lynne Peterson

Patient

February 4, 2020

My husband is a type 2 diabetic with mild chronic kidney disease, which has been well controlled on 500 mg metformin BID plus saxagliptin (AstraZeneca’s Onglyza).

At the end of last year, he got a letter from his Medicare Advantage PPO, UnitedHealthcare (UHC), advising him that the Onglyza (UHC only uses brand names) would no longer be covered and recommending he have his doctor switch him to another DPP-4 inhibitor, either …

Black boxes: health warning or profit warning?

Martha Rosenberg

Medications

February 1, 2020

“Boxed warnings” or “black boxes” are the strictest FDA label warnings. They appear on cigarettes, fluoroquinolones (for tendon rupture), Lamictal (for SJS and TEN), Accutane (birth defects), and other products with well-known risks.

The industry obviously dislikes black boxes since they reduce sales (though their lobbyists charge the boxes “confuse” and “unnecessarily alarm” patients).

So it was no surprise that when the Read more…

Black boxes: health warning or profit warning?

Stop cutting patients off their prescribed benzodiazepines

Christy Huff, MD

Medications

January 2, 2020

In the wake of the opioid epidemic, benzodiazepines have been called “our other prescription drug problem” and “the next U.S. drug crisis.” Prescriptions are on the rise, with over 30 million Americans reporting benzodiazepine use in the previous year. This is alarming, as benzodiazepines are implicated in at least 30% …

Beyond the EpiPen: Irrational drug prices are now pervasive

Stephen C. Schimpff, MD

Medications

December 19, 2019

There was outrage over the sudden rise in the price of the EpiPen. But the rise in many other pharmaceutical prices gets less attention but is just as concerning. It can be easy to forget issues like this until they affect us personally. My two encounters with irrational drug price increases for dermatologic conditions are a reminder of how pervasive this problem is today.

I have rosacea, a …

Drugmakers discover tardive dyskinesia. And they profit in it.

Martha Rosenberg

Medications

November 30, 2019

Before direct-to-consumer ads, physicians tried to reassure patients they were probably fine. Today, drug ads and online symptom checkers do just the opposite. The most insidious are “unbranded” ads that scare people about a disease without mentioning the drug they are trying to sell. Notable unbranded disease campaigns sell the obscure exocrine pancreatic insufficiency, shift work sleep disorder, and non-24-hour, sleep-wake disorder. Unbranded advertising is designed to appear like a …

Don’t use stimulants to cram for exams. It ruins sleep and doesn’t help test scores.

Sara C. Mednick, PhD

Medications

October 26, 2019

Along with a steeper financial burden and an increasingly competitive academic environment, this year’s incoming freshman university class will likely be confronted with the pressure to take a little pill that some popular culture references say will make you “awesome at everything.” Or they may eschew the temptation and rely on the standard practice of study, sleep, repeat.

Welcome to #GenerationAdderall, the …

Drug ads are a campaign against physician trust

Judy Salz, MD

Medications

October 15, 2019

There was a time when drug reps fed us lunch and gave us an endless supply of pens, pads, and even umbrellas all emblazoned with their newest drugs. They explained why their drug was better than their competitors’ and what it would offer to our patients. I still have my Zantac umbrella in the trunk of my car for rain emergencies.

Although it was somewhat annoying, it did keep us somewhat …

A skin-lightening cream put a woman into a coma. How can that happen?

Anna Almendrala

Medications

October 8, 2019

She had been buying face cream through a friend of a friend for 12 years. This time, it was Pond’s “Rejuveness,” a version of the company’s anti-wrinkle cream that is made and sold in Mexico.

But someone in the Mexican state of Jalisco laced the cream with a toxic skin-lightening compound, and it had a devastating effect on the 47-year-old Sacramento resident.

She showed up at the emergency room Read more…

A skin-lightening cream put a woman into a coma. How can that happen?

Enter a clinical trial because it helps others, not necessarily yourself

Michael Kirsch, MD

Physician

October 2, 2019

From time to time, I am asked by someone about participating in a medical research study. These situations are usually when an individual, or someone close to them, has unmet medical needs. Understandably, a patient with a condition who is not improving on standard treatment, would be amenable to participating in a clinical trial to receive experimental treatment.

I find that most folks misunderstand and exaggerate the benefits they may receive …

Using low-dose naltrexone to treat pain

Alex Smith

Medications

October 2, 2019

Lori Pinkley, a 50-year-old from Kansas City, Mo., has struggled with puzzling chronic pain since she was 15.

She has had countless disappointing visits with doctors. Some said they couldn’t help her. Others diagnosed her with everything from fibromyalgia to lipedema to the rare Ehlers-Danlos syndrome.

Pinkley has taken opioids a few times after surgeries, but they never helped her underlying pain, she said.

“I hate …

Read more…

Using low-dose naltrexone to treat pain

How do we manage pain in the era of the opioid crisis?

Rita Agarwal, MD

Medications

October 2, 2019

“6 in 10 Kids Got Opioids After Tonsil Surgery, Study Says.”

So screams the headline from The Daily Beast.

“In the midst of the opioid crisis, doctors sent many kids home with oxycodone and hydrocodone,” it goes on to say. Another example of scaremongering and sensational headlines, or is this something we should still be concerned about?

Well, according to the actual article, there was no greater risks of complications …

How we got from 18th-century tinctures to the opioid crisis

Mike Magee, MD

Medications

October 2, 2019

Americans have always loved their medicines and sought them out actively to cure whatever ailed them. Their interest ranged all the way from “staying well” to “feeling better.” Productivity in this hard-charging, pull yourself up by the bootstraps society required activity, and it’s hard to be active when you’re sick.

In the 18th-century in Germany, England, France, and Switzerland, men practicing pharmacy saw their retail operations as the …

An expensive treatment may be a victim of its own widening use

Julie Appleby

Medications

October 1, 2019

Medical treatment has knocked down tumors in 6-year-old Easton Daniels’ brain, but the drug used also wiped out his immune system.

To bolster his immune function and help keep him healthy, he has visited a hospital for intravenous infusions of immune globulin about every month for the past year and a half.

But in early July, his family was stunned by a letter from Cincinnati Children’s Hospital: “All of Easton’s appointments canceled …

Black market pharmaceuticals target immigrants

John M. Glionna

Health Policy

September 25, 2019

The bootleg medications were smuggled across the border and sold to mostly Latino immigrants in public spaces throughout Los Angeles — at swap meets, parks, beauty salons and makeshift stands outside mom-and-pop grocery stores.

The drugs were cheap, and the customers — mostly from Mexico and Central America — did not need prescriptions to buy them. Some of the products featured brand names and colorful packaging that immigrants knew well from …

Here’s why your patients disregard prescriptions

Kevin R.R. Williams

Patient

August 26, 2019

Take one-half tablet three times per day with meals, increasing by half each week until reaching a maximum of three tablets three times per day.

Did you get a new prescription from your doctor? If so, there is a 50 percent chance you will not adhere to label directions. Either the instructions are too complicated, the drugs are too expensive, you do not like the way the medicine makes you feel …

How drugmakers became masters at producing authorized generics

Jay Hancock and Sydney Lupkin

Medications

August 14, 2019

When PDL BioPharma’s $40 million blood-pressure medicine faced the threat of a generic rival this year, the company pulled out a little-known strategy that critics say helps keep drugs expensive and competition weak.

It launched its own generic version of Tekturna, a pill taken daily by thousands. PDL’s “authorized” copycat hit the market in March, stealing momentum from the new rival and protecting sales even though Tekturna’s patent ran out last year.

PDL’s …