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.

Why do patients accept chemotherapy, but not flu shots?

James C. Salwitz, MD

Physician

November 1, 2016

Fall brings school buses, a freshening breeze and an avalanche of meetings. There are seasonal sales, myriad projects and the splendor of colored leaves. The season is also announced, again and again, by a particular peculiar and perilous decision, which, no matter how much I try, I do not fully understand. Frankly, I just don’t get it.

“Jane, it is time to start chemotherapy.”

“What are the side effects?”

“Well, this is powerful …

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Why do patients accept chemotherapy, but not flu shots?

Money and virtue: An odd tension in health care

Dr. Saurabh Jha

Health Policy

October 8, 2016

Publishing in the BMJ, Vinay Prasad, an oncologist and health care’s leading evidence-based iconoclast, found that over half of medical reviewers who leave the FDA work for device and pharmaceutical industries. Prasad’s findings created disquiet amongst purists of various stripes. The media was shocked and tried shocking people by showing how shocked it was. The …

What’s the best way to get rid of unused medications?

Roy Benaroch, MD

Medications

October 2, 2016

A patient wrote in, asking what she ought to do with unused medications, including some psychiatric drugs and controlled substances. It’s good to get those out of the house, safely — but how?

Parents should make sure to keep their homes free of unused medications. The misuse of prescription medications (usually narcotic painkillers) has surpassed motor vehicle accidents as the leading accidental cause of death in the U.S. A lot …

The statin wars expose 2 factions in medicine

Dr. Saurabh Jha

Medications

September 30, 2016

It is the beauty of evidence-based medicine (EBM) that a scientist can at once be a Pope and a Galileo. His transmutation is as effortless as it is discretionary. If you think you’ve met Galileo — a rebel, a free thinker, a rocker of the establishment — the following week he is a Pope, castigating detractors, censoring critics, and celebrating uniformity. He changes by a roll of the dice. His …

The medical histories of Hillary Clinton and Donald Trump shouldn’t be a big deal

Manoj Jain, MD, MPH

Physician

September 28, 2016

When you are 70 years old, you are bound to have some medical problems, so I am not sure why the media and the public are making a hoopla about the medical histories of Hillary Clinton and Donald Trump.

For an elderly patient, my usual medical dictation reads “Mr. A is a 70-year-old former truck driver who has hypertension, diabetes, bypass surgery, and who now comes in with a cough and …

Sharing medications happens more often than we think

Anne Katz, RN, PhD

Medications

September 28, 2016

Many men experience significant erectile problems after having a radical prostatectomy, and many of the men treated by the urologists I work with eventually land in my office. We talk frankly about the quality of their erections before the surgery, what they are like now, and what they have tried to do to resolve the problems they are having. After this, …

This doctor is against medical marijuana. Here’s why.

Michael Kirsch, MD

Medications

September 26, 2016

I have already opined on my disapproval of a medical marijuana law recently passed in Ohio. Once of my points in that piece is that I did not want legislators making medical decisions for us. They can’t even do their own jobs.

I am not against medical marijuana; I am for science. The currency of determining the safety and efficacy of a medicine should be medical evidence, not faith, …

I question the ethics of any doctor who sells supplements to patients

Linda Girgis, MD

Physician

September 20, 2016

I was seeing a patient who brought me a bag of supplements she bought from another specialist. I looked skeptical and then she pulled out the list of lab results the other doctor ordered on her. I reviewed the results with her and asked why all these tests were ordered in the first place, some of which I had never ordered in my life. She said she told the specialist …

When treating chronic pain, don’t compromise your principles

Michael J. Stephen, MD

Medications

September 17, 2016

One of the most difficult things I deal with as a physician is patients’ demands for pain medications. I treat patients with cystic fibrosis, a genetic disease present at birth with no cure, and its issues are indeed complex. There are legitimate causes for misery from the chronic coughing, abdominal pain, and joint pain recognized as common symptoms of the disease.

But the associated issues of depression, stress with family, and …

How prudent antibiotic prescribing lowers patient satisfaction

Raj Waghmare, MD

Medications

September 13, 2016

I’m seeing a fifty-something with knee pain when I feel the curtain behind me erupt open. It’s Roland, my last patient, and his breath is at my neck: “Why are you being so difficult?” he says. “Why can’t you just give me the prescription?”

I turn, and wave my hand over Roland’s head.

“Call security.”

He’s swearing again, and I can hear security’s racing footsteps as a code white is called.

“I have nothing more to …

We must face some unpleasant truths about opioids

David Juurlink, MD, PhD

Medications

September 11, 2016

Over the past year I’ve lost track of how many times the opioid epidemic has, in one incarnation or another (Prince, naloxone, fentanyl, newborns in agonizing withdrawal and so on) found its way onto the front page news. What distinguishes this epidemic is not only its catastrophic toll — hundreds of thousands dead, uncountable millions harmed — but also the fact that, unlike SARS, Ebola or influenza, this epidemic has …

An open letter to Heather Bresch: What is legal is not always ethical

Anonymous

Medications

September 3, 2016

Dear Ms. Bresch,

I couldn’t help but notice the barrage of negative press you’ve received lately regarding the significant price increases in EpiPens. A 461 percent increase since 2007, to be exact. People who require this medication for themselves or their children are up in arms about spending over $600 for a twin pack of autoinjectors. Most of these people have life-threatening anaphylaxis if they are exposed to certain allergens. To …

What physicians can do about EpiPen

Kristen Maguire, MD

Medications

September 2, 2016

When I found out my daughter was allergic to peanuts, she was a year old. She couldn’t have cared less. She was smiling and happy, sitting on my lap in the allergist’s office, blissfully unaware of the big red mark on the side of her face. And I was crying and sad, crushed for that moment that the first challenge had been put in her path. I wasn’t sad that she was different, that …

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What physicians can do about EpiPen

Mylan Pharmaceuticals made these 2 critical mistakes

Justin Reno, MD

Medications

August 31, 2016

Pharmaceutical companies are brilliant. They make profit off of chemicals that can be potentially life-saving. The list is quite impressive: antibiotics for somebody who would otherwise succumb to sepsis, insulin for someone whose pancreas loses the ability to function, antivirals for chronic viral suppression, antineoplastic agents for somebody whose cells have lost their regulatory mechanisms, just to name a few.

The recipe seems to be quite simple: Charge as much money …

The story behind removing the satisfaction score barrier from safe prescribing

Roneet Lev, MD

Physician

July 27, 2016

CMS announced that they will remove questions related to pain from the hospital consumer assessment of health care providers and systems (HCAHPS), commonly known as patient satisfaction survey. This means that hospitals would continue to use the questions to survey patients about their inpatient pain management experience, but these questions would not affect the level of payment hospitals receive. This is a big victory for patients and the house of medicine.

Here …

Benzodiazepine addiction is real. This physician shares his story.

David Mokotoff, MD

Medications

July 24, 2016

Say the words, “drug addiction,” and most of us think of heroin, alcohol, cocaine, or opiates. However, lurking in the shadows is a less talked about epidemic: addiction to benzodiazepines, commonly known as “benzos.” I should know because after taking a nighttime dose of lorazepam (Ativan) for about ten years; I finally weaned myself off this and all other prescription sleep medications.

About twelve years ago, my father died and then …

How OxyContin taught doctors to trust pills over patients

Anna Reisman, MD

Medications

July 24, 2016

Treating pain is a notoriously tricky business. But it’s even harder if the medications on which we rely are inappropriately marketed. Last month, a Los Angeles Times investigation of Purdue Pharma asserted that for years, the company falsely elevated the efficacy of its twice-daily OxyContin, a powerful opioid pain reliever. The Times’ review of evidence — including three decades of court cases, investigations, patient and sales rep …

Saving billions of dollars in health care: The story of Avastin and Lucentis

Peter Ubel, MD

Medications

July 17, 2016

I sometimes worry that my wife Paula won’t be able to see me grow old. Not that I expect to outlive her. She is four years my junior and has the blood pressure of a 17-year-old track star. It’s her eyesight I’m worried about, because she is at risk for a form of blindness called macular degeneration. Paula is the youngest in a long line of redheads, several of whom …

The pharma-fed doctor and the foundation-fed journalist

Michel Accad, MD

Medications

July 16, 2016

In his recent article “Feed Me, Pharma,” ProPublica’s Charles Ornstein has been calling attention to studies showing that the prescribing decisions of doctors are linked to the amount of money that drug companies can bestow on them, usually in the form of meals, travel expenses, tuition support to attend courses, and so on.

I find nothing surprising about that, and Ornstein need not be so scrupulous when he clarifies that “the …

Patients are deceived by the slick presentation of statistics

Michael Kirsch, MD

Physician

July 15, 2016

“There are three kinds of lies: lies, damned lies, and statistics.”

There is much truth in this quotation of uncertain provenance. We see this phenomenon regularly in the medical profession. We see it in medical journals when statistics are presented in a manner that exaggerates the benefit of a treatment or a diagnostic test. Massaging numbers is raised to an art form by the pharmaceutical companies who will engage in numerical …

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