Medications

Why energy drinks should be considered stimulant drugs

Kevin Pho, MD

KevinMD

March 2, 2013

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A version of this column was published on February 3, 2013 in USA Today.

I’m seeing more patients than ever consume so-called “energy drinks,” a rapidly emerging class of beverage which promise to increase energy, improve alertness, and boost attention span. The energy drink business is booming, with more than $12 billion sold last year, eclipsing established beverage categories like iced tea …

Toradol in sports: A culture change is needed

Michele R. Berman, MD

Meds

February 23, 2013

Former Boston Red Sox closing pitcher Jonathan Papelbon may have opened up a can of worms with his remarks about his frequent use of the injectable anti-inflammatory drug Toradol (ketorolac) during his time with the Red Sox.

Papelbon, who now plays for the Philadelphia Phillies, told ESPNBoston.com that several Red Sox players were frequently injected with the drug:

“It was kind of …

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Toradol in sports: A culture change is needed

Make patients more accountable for their own health

Shirie Leng, MD

Physician

February 20, 2013

Let’s talk a little about health accountability. Two news items have provoked the following rant: why is it always someone else’s responsibility?

The first item was on NPR. The FDA, reacting to the epidemic of prescription drug abuse in this country, is offering incentives to the pharmaceutical company that can come up with a less addictive painkiller. Such a drug would be a gold-mine for that pharma company because it could …

Behind the fetish of vitamin B12 shots

Roy Benaroch, MD

Conditions

February 3, 2013

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Medicines and other treatments need to be tested. We want reliable proof that something works and is safe before we recommend it. We don’t like the false dichotomy of “alternative medicine”. If there is good evidence that it works, it’s medicine. If it doesn’t work, it’s quackery.

It doesn’t matter who’s doing the quacking. A quack is a quack, even if …

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Behind the fetish of vitamin B12 shots

Why I’m not sure that psychiatric medications work

Steve Balt, MD

Meds

January 25, 2013

I have a confession to make. I don’t think what I do each day makes any sense.

Perhaps I should explain myself. Six months ago, I started my own private psychiatry practice. I made this decision after working for several years in various community clinics, county mental health systems, and three academic institutions. I figured that an independent practice would permit me …

It’s amazing what I’ve learned from patients

Janice Boughton, MD

Physician

November 29, 2012

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 …

Does Linzess have a role in IBS with constipation?

Edward Pullen, MD

Meds

October 13, 2012

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 …

Do drugs aid and abet genius or does genius lead to drugs?

George Lundberg, MD

Physician

October 13, 2012

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 …

Taking medications in the middle of the night can be risky

Barbara Bronson Gray, RN

Meds

September 30, 2012

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 …

Do oncologists have an incentive to prescribe expensive treatments?

Peter Ubel, MD

Meds

July 4, 2012

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 …

Don’t accept the face value price of a drug

Marni Nicholas, MD

Meds

June 28, 2012

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 …

Is there a harm to not seeing drug reps?

Matthew Mintz, MD

Meds

June 10, 2012

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 …

Using Advair to treat postinfectious cough

Matthew Mintz, MD

Meds

June 3, 2012

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 …

Go ahead, let patients buy prescription drugs over the counter

WhiteCoat, MD

Meds

May 14, 2012

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 …

The unholy alliance between Big Pharma and the medical profession

Barbara H. Roberts, MD

Meds

May 12, 2012

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 …

MKSAP: 32-year-old man is disoriented, combative, and agitated

mksap

Conditions

March 25, 2012

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 …

Why we should eliminate the diagnosis of ADHD

Steve Balt, MD

Conditions

February 8, 2012

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 …

I eat lunch with drug company representatives and I’m proud of it

Stewart Segal, MD

Meds

December 1, 2011

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 …

How alternative medicine may have killed Steve Jobs

Michele R. Berman, MD

Conditions

October 30, 2011

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 …

tPA is the standard of care for stroke but with significant risks

Charles A. Pilcher, MD

Conditions

October 17, 2011

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 …

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