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.
What is it like living in pain? Those of us who have ever experienced unremitting pain for months or years know that it is enveloping and all consuming. I struggled with intractable pain for several difficult years, and I am fortunate because my pain finally got better — what if your pain never did?
That is a horrible reality millions of people are living in right now. The chronic pain population …
Read more…
Want to stop the opioid epidemic? Stop prescribing opioids.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old man is evaluated for a 4-month history of intermittent, nonprogressive solid-food dysphagia. He has a long-standing history of heartburn that has been well controlled with once-daily proton-pump inhibitor (PPI) therapy for the past 5 years. Results of a screening colonoscopy 4 years ago were normal. There is no family history …
Read more…
MKSAP: 54-year-old man with dysphagia
The WHO’s recent announcement of multi-drug resistant strains of gonorrhea raises the specter of a worldwide SuperClap Attack that even the Avengers couldn’t foil. It also comes as yet another ominous reminder of the perils of rampant and indiscriminate antibiotic use.
There’s plenty of blame to spread around. True, here in the U.S., consumers can’t buy antibiotics over the counter, but that hasn’t kept physicians and other providers from over-prescribing them …
Read more…
Should only infectious disease specialists be allowed to prescribe antibiotics?
Antibiotics save lives, but antibiotics can have negative effects. When patients have bacterial infections, we want to treat them to prevent complications of the bacterial infection, but not treat them for an excessive duration. So we have a Goldilocks problem — we want antibiotic duration to be just right — neither too short or too long.
Some clinical conditions have adequate research to define the Goldilocks duration. Community acquired pneumonia only …
Read more…
How long should I take antibiotics? Exploring the Goldilocks problem.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 67-year-old woman is evaluated during a routine examination. She has a history of hip and knee pain related to degenerative joint disease. The joint pain is now well controlled with diclofenac, which was started 3 months ago. A previous trial of high-dose acetaminophen was not effective. She does not have any …
Read more…
MKSAP: 67-year-old woman who takes diclofenac
None of us wants to live in a world without access to lifesaving antibiotics. No patient should be subject to an allergic reaction or organ dysfunction from these drugs. No one wants to contract a potentially deadly form of diarrhea, claiming roughly 30,000 lives a year in the U.S., that can take hold after antibiotics wipe out healthy gut bacteria.
Yet, every day, patients are prescribed antibiotics that they did …
Read more…
Explore the behavioral factors behind antibiotic misuse
Physicians are influenced by marketing. That’s no surprise. So are most consumers, as evidenced by television and radio commercials, billboards, pop up ads and targeted ads for drugs on your computer screen. Big Pharma markets not only to physicians, but also directly to consumers.
In a recent Washington Post op-ed, Dr. Nicole Van Gronigen made the case that Big Pharma successfully influences physician prescribing behavior via marketing. Specifically, drug …
Read more…
Are pharma gifts to doctors a red herring?
Substance abuse and overdose deaths are nothing new. People who use opioids are dying and will keep dying until we learn how to fix our bigger problem: the “stupidity epidemic.” We see and hear about the opioid epidemic every single day in the media, but no one is talking about the epidemic of stupidity, both in the medical and non-medical communities. We have thrown time, money and even tears at …
Read more…
The stupidity epidemic is far more lethal than the opioid epidemic
Tom’s feet are shackled so he can’t bolt from the hospital bed when the prison guard isn’t looking. The guard places handcuffs on him when he walks to the bathroom and stands just outside the door as Tom relieves himself. Despite being treated for a deep tissue infection in one finger, Tom is in generally good shape — lean but muscular with the strong hands of a workman. Back in …
Read more…
Here’s why opioid addicts are victims
I am a practicing hospitalist physician in Dayton, Ohio. Dayton has emerged in the last year as the city with the highest per capita death rate from opioid overdoses. When we measure the number of deaths here we talk about how many there are per day, not per week or month. We have been inundated with heroin and other products laced with fentanyl or carfentanil. Every other drug, including marijuana, …
Read more…
What it’s like to be a doctor in the heroin capitol of the U.S.
It may seem strange that a gastroenterologist like me does not prescribe pain medicines.
Let me rephrase that. I don’t prescribe opioids or narcotics. I write prescriptions for so few controlled substances that I do not even know my own DEA number. You might think that a gastroenterologist who cares for thousands of patients with abdominal pains would have a heavy foot on the opioid accelerator. But, I don’t. Here’s why.
I …
Read more…
Why this physician doesn’t prescribe pain medications
The New York Times says nonadherence to prescribed medications is “an out-of-control epidemic” in the U.S. and quotes a review in Annals of Internal Medicine, which found “20-30% of medication prescriptions are never filled, and approximately 50% of medications for chronic illness are not taken as prescribed.”
For example, “a third of kidney transplant patients don’t take their anti-rejection medications, 41% of heart attack patients don’t take …
Read more…
Don’t blame doctors for medication nonadherence
You’ve been swindled.
At least that’s the conclusion I’ve come to. It wasn’t the hucksters or the snake oil salesman. It wasn’t big business, big medicine, or some greedy hospital administrator. It was most likely pharma with a large dose of helping from your doctor. Plain and simple.
I’ve learned quite a bit being a hospice medical director. Covering dozens of new admissions a week has given me much insight into doctor …
Read more…
We are not shielding our patients from harm
It is surprisingly easy to sell snake oil. I know, because I’ve done it. In 2014, I helped create and sell The Right Detox. This was a bogus detoxification program that purported to improve anyone’s well-being and perhaps, cure disease. I was the face of the scam. I launched The Right Detox at a spring-time women’s health expo in Tucson, Arizona.
I kicked off my sales-pitch in front of a small …
Read more…
Behind the scenes of a detox scam
This April, my turn to take the medical board exam rolled back around, necessary every ten years for maintenance of certification. I studied diligently for the better part of three months preceding the test (and I think I did well). It was actually pleasurable to go back over details that I had forgotten and to catch up on newer developments in the field. I realized that I don’t do nearly …
Read more…
Pre-authorization is hell. Here’s why.
A 10-year analysis of medical malpractice cases indicates that medication errors continue to represent a significant risk to patients and health care providers, despite myriad efforts to eliminate that risk. For events that occurred beginning in 2003 (12 percent) to those from 2012 (12 percent) the proportion of cases alleging a medication error was, essentially, unchanged. Raised awareness, advances in technology, and millions of dollars directed at improving the medication …
Read more…
Medication errors haven’t gone away
At what point, we have to ask ourselves, does a medical error that we do over and over again cease to be an error, and simply become business as usual?
At one of the patient safety conferences this week, where we reviewed sentinel events that occurred in the hospital and in the outpatient setting, one of the cases was about a patient who developed an abnormal cardiac rhythm as a result …
Read more…
How a one-time bridging prescription became an every time refill
Long before the Internet and direct-to-consumer advertising, the medical profession tried to reassure people about their health concerns. Remember “take two aspirins and call me in the morning?”
Flash forward to today’s online “symptom checkers.” They are quizzes to see if someone has a certain disease and exhortations to see their doctor even if they feel fine. Once drug makers discovered that health fears and even hypochondria sell drugs, there seems …
Read more…
6 tricks that pharmaceutical marketers use
