Traditionally the patient is supposed to come to the doctor to get some sort of help with a problem. That’s what people pay us for, I guess. Patients bring us their various miseries, we help them figure out what they mean and what causes them and prescribe potions or recommend they do something that will help make them better, if there is such a thing. But in the normal give …
It’s amazing what I’ve learned from patients
Linzess is a new drug that received FDA approval by Forest Laboratories for use in irritable bowel syndrome (IBS) with constipation and in chronic idiopathic constipation. It got my attention because of its biochemistry.
Learning about the mechanism of action of new drugs like Linzess reminds me how much more is understood about the molecular biological level of physiologic function of the human body than when I was in med school. Linzess …
Does Linzess have a role in IBS with constipation?
Who is your favorite addict? I guess we have to talk about addiction as a preface to that question.
Everybody I know takes psychoactive drugs, except maybe some Mormons, Seventh Day Adventists, and the like.
All drugs are habit-forming, but only a subset of psychoactive drugs can produce psychological and physical dependence, tolerance, and withdrawal symptoms when taken away, the usual definition of addiction.
Most people who become addicted to one drug often …
Do drugs aid and abet genius or does genius lead to drugs?
You may have heard that veteran NBC News correspondent Tom Brokaw was hospitalized recently after he reported feeling lightheaded after making an appearance on MSNBC’s “Morning Joe.”
He’s fine. Brokaw tweeted, “All is well. Early a.m. I mistakenly took a half dose of Ambien and made less sense than usual.”
And that’s what you’ve got to be careful not to do.
Any time you get up in the wee hours of …
Taking medications in the middle of the night can be risky
A recent economic analysis concluded that patients with metastatic cancer value their treatments significantly more than regulators recognize, with many expensive new therapies looking like veritable bargains to most patients. Yet the study ignored the values really driving oncology spending—the warped incentives oncologists have to promote their own bottom line by prescribing expensive treatments.
Let’s start with the economic analysis, another in a series of studies by a USC team of …
Do oncologists have an incentive to prescribe expensive treatments?
Everybody knows that some medications can cost a lot of money. I always try to take the cost to my patients into account when prescribing a medication- after all, if someone can’t afford it, they are not going to take it. When it’s appropriate (and 9 times out of 10 it is), I try to prescribe a generic medication. They are much cheaper and work just as well as the …
Don’t accept the face value price of a drug
Now more than ever, the growing consensus among many is that doctors should avoid seeing pharmaceutical sales representatives, otherwise known as drug reps. A position statement from the AAMC, the head organization of all US medical schools and residency programs, recommends that all academic health centers avoid having drug reps on their campuses, hospital and clinics. Many medical institutions including the VA and Kaiser have also enacted similar policies banning …
Is there a harm to not seeing drug reps?
I am not a huge baseball fan to begin with, and when I am, I root for the Nationals. Thus, I pay little attention to the New York Yankees, and was not aware that Yankee player Mark Teixeira had been suffering from a cough for the past month until it the story from the New York Times came through one of my Twitter feeds. According to the story: “Mark Teixeira had …
Using Advair to treat postinfectious cough
The FDA is deciding whether to allow patients to purchase prescription medications over the counter for many common ailments.
This idea is controversial.
On one hand, deregulation would remove one of the largest barriers to receiving treatment for some conditions – the doctor’s visit. If no doctor’s visit is necessary to receive necessary blood pressure medications or diabetes medications, then patients don’t have to wait for an appointment and the patient/government …
Go ahead, let patients buy prescription drugs over the counter
An excerpt from The Truth About Statins.
Like all physicians, I’ve had interactions with pharmaceutical companies. Shortly after I went into private practice in Rhode Island in 1977, I received a telephone call from a drug company representative. He offered me an all-expense-paid weeklong trip to Germany to attend a medical conference. I was taken aback, knowing that the cost of such a trip would run to thousands of dollars. I …
The unholy alliance between Big Pharma and the medical profession
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old man is brought to the emergency department after becoming disoriented, combative, and agitated earlier that day. He is accompanied by a friend, who states that the patient has a history of alcohol and drug abuse, including inhalants.
On physical examination, the patient is uncooperative and …
MKSAP: 32-year-old man is disoriented, combative, and agitated
I’m reluctant to write a post about ADHD. It just seems like treacherous ground. Judging by comments I’ve read online and in magazines, and my own personal experience, expressing an opinion about this diagnosis—or just about anything in child psychiatry—will be met with criticism from one side or another. But after reading L. Alan Sroufe’s article (“Ritalin Gone Wild”) in the New York Times, I feel compelled to write.
If …
Why we should eliminate the diagnosis of ADHD
Today, I want to review another article I wrote in last year. That article started with a confession: “I confessed that I ate lunch with a representative of a pharmaceutical company.”
I must now confess that I often eat lunch with representatives of pharmaceutical companies and I’m proud of it. At this stage of my career, I can well afford my own lunch. I could sit quietly and relax over a cup …
I eat lunch with drug company representatives and I’m proud of it
When they first discovered the tumor in his pancreas in October 2003, his doctors told him an immediate operation was necessary, and could lead to a cure.
As first reported by Peter Elkind in 2008, Jobs decided to think different, declined surgery, and explored alternative medicine treatments for his disease.
Nine months later, in July 2004, the tumor had grown. Only then would he allow his doctors to operate.
Would Steve Jobs be alive today had he consented to surgery when they first discovered …
How alternative medicine may have killed Steve Jobs
Under current guidelines from the American Stroke Association, tissue plasminogen activator (tPA, commonly known as a “clot buster” drug) should be administered within 3-4.5 hours of “last seen normal” – and 1 hour of patient arrival – to potentially ameliorate a new onset stroke. (“Last seen normal” means exactly what it says. A patient who went to bet at 10 PM and awoke with slurred speech at 6 AM was …
tPA is the standard of care for stroke but with significant risks
Being a physician certainly biases how I view the world around me. I can’t help but think in terms of problem-solving and healing. But have you noticed how medicalized our society has become? The other night watching television, we watched at least four drug commercials and one health insurance commercial — during a half-hour show! I believe we are in the middle of the medicalization of America, and I don’t …
A young man on my sobriety-based detox program (only after showing positive for opiates) admitted to heroin-usage, but hedged the matter saying it was “5 days ago.” His implicit presumption was that an isolated episode, days ago — compared to continuous, more recent, heroin-usage — would lessen the likelihood of his getting kicked off the program.
Is his story of “no heroin [ingestion] in the last five days,” likely, the whole …
Consider half life during drug detoxification
We have to crush pills sometimes. Either the patient (through aversion or physical limitation from stroke) can’t swallow whole pills so we crush them and put them in applesauce, or the patient gets their pills through a tube, so we crush them and dissolve them in water.
When I started nursing, we had a mortar and pestle.
Anyway, this is what we used …
The expensive progression of pill crushing technology
While diligently perusing a stack of unread journals, a piece in the July 25, 2011 issue of Modern Healthcare caught my attention.
Titled “What’s the Agenda?” this special report deftly navigated the murky waters of “physician participation on advisory boards” and managed to present an accurate appraisal of the issues.
Here is a brief recap.
Back in the days before “medical ethics” issues were commonplace, pharmaceutical and medical device manufacturers were accustomed …
The ethics of being on a pharmaceutical advisory board
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 …
A cream to fight obesity is being ignored
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