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.

The nightmare of medicine is the absurd price we have to pay

Manoj Jain, MD, MPH

Medications

January 27, 2016

A grandmother develops a boil that turns out to be a difficult-to-treat staph infection (MRSA). She needs high-powered antibiotics. A middle-aged man who received a blood transfusion decades ago now has hepatitis C and needs anti-viral medicine. A young woman with HIV develops golf-ball-size lesions in her brain, has toxoplasmosis and needs anti-parasite medicine.

The marvel of medicine today is that we can treat all three infections, and save the lives …

This doctor won’t prescribe Addyi, the “female Viagra.” Here’s why.

Jennifer Gunter, MD

Medications

January 9, 2016

Addyi (flibanserin), the drug to increase female libido had a timid entry into the market with very few prescriptions considering the “hype.” Bloomberg Business reported 227 prescriptions in the first month. That’s a pittance considering Valeant paid $1 billion for the drug.

I am unlikely to help Valeant recoup their investment, because the more I read about this drug, the worse it looks. Here’s why:

It barely works

One of the study endpoints (meaning …

Martin Shkreli speaks an inconvenient truth

Dr. Saurabh Jha

Medications

January 6, 2016

I don’t subscribe to conspiracy theories. I never believed a second shot was fired. Nor do I believe that Bill Clinton was stalked on the grassy knoll. So I won’t speculate that Martin Shkreli’s arrest for alleged securities fraud that happened years ago is related to his raising Daraprim’s price by 5,500 percent.

Just because something isn’t suspicious doesn’t mean that it isn’t odd.

Shkreli is a perfect poster child for rapacious …

Pharmaceutical free speech is anything but free

Kenneth Lin, MD

Medications

December 30, 2015

The American Medical Association (AMA) recently called for a ban on direct-to-consumer (DTC) advertising of prescription drugs and medical devices, arguing that this type of advertising drives the nation’s escalating drug bill by creating demand for new, expensive medications that are often no more effective than older ones. Since the first televised prescription drug ad aired in the U.S. in 1983, pharmaceutical companies have spent billions of dollars …

Hospitalization for patients with alcohol use disorder: A teachable moment

Jeffrey Hom, MD, MPH, MSHP & Shilpa Shah, MD

Medications

December 18, 2015

“Help me stop doing this.”

Mr. G was a 55-year-old homeless man who uttered these words to us during his fifth hospitalization for problems related to his alcohol use: intoxication, falls, and alcohol withdrawal. He was on a downward spiral through the hospital’s revolving door and felt helpless. As a medical team, we felt helpless too. We did not know how to address his real problem—his cycle of addiction.

Hospitalized patients like …

This is why a computer algorithm cannot ever fully replace a doctor’s judgment

Nathan A. Pennell, MD, PhD

Physician

December 15, 2015

The past year had been a tremendously exciting time to be an oncologist, and to be a lung cancer oncologist in particular. It seems we hardly have time to get used to one newly approved agent before another one becomes available. In 2015, we have seen gefitinib (don’t I know you from somewhere?), afatinib, nivolumab (twice), pembrolizumab, necitumumab, and osimertinib all …

Would heroin addiction be the price of legalizing marijuana?

Raymond Abbott

Medications

December 11, 2015

I am a bit of a coin collector, and recently I visited my favorite coin shop in downtown Louisville. I was met with this news: A coin dealer I know in Austin, Indiana had been killed recently, murdered in his own coin shop, shot in the head by robbers. Four persons were later arrested when coins belonging to this elderly man were found in their possession. Austin, Indiana is, by …

Bringing sky-high prescription drug prices down to Earth

Erin A. Taylor

Medications

December 9, 2015

After a New York pharmaceutical company recently raised the price of a drug that’s been around for more than 60 years from $13 to $750 a pill, the nation appeared to collectively gasp over a seemingly capricious, “anything goes” approach to drug pricing. The move also revived a recurring debate over whether pharmaceuticals should have free rein to charge outrageously high prices for important medications.

Madness? Perhaps. But pharmaceutical companies are simply responding …

There is no oversight for prior authorizations. There should be.

Dinah Miller, MD

Medications

December 6, 2015

The letter from the insurance company was addressed to my patient. The two pages of information boiled down to one simple sentence: “After a thorough review, our decision to not cover the medication Provigil (modafinil) is unchanged.”

The letter went on to explain that there was no further recourse, and that the medication would not be approved because it was not Food and Drug Administration–approved for the condition my patient had: …

Reducing antibiotic use requires a commitment from both patients and doctors

Aunna Pourang, MD

Conditions and Diseases

December 5, 2015

It was recently World Antibiotic Awareness Week and Get Smart About Antibiotics Week. According to the CDC, 2 million people in the United States become infected with antibiotic-resistant bacteria and 23,000 people die from such infections each year. What’s worse is that antibiotic resistance continues to increase.

“To give you an idea of how high the pressure is to prescribe antibiotics, I didn’t get a job once because during …

Natural drugs aren’t necessary safe. Don’t make that mistake.

Stephen Kamelgarn, MD

Medications

November 17, 2015

According to a study published in the New England Journal of Medicine, the use of dietary supplements sends an estimated 23,000 Americans to the emergency department each year. Approximately 25 percent of the ER visits that were supplement related were by adults who were using herbal weight loss products. Another 10 percent were caused by adults consuming “energy products” (although people using energy drinks were excluded from the …

The FDA’s epic regulatory failure

Brian Klepper, PhD

Medications

November 9, 2015

A new study in JAMA Internal Medicine finds that two-thirds of cancer drugs considered by the U.S. Food and Drug Administration (FDA) over the past five years were approved without evidence that they improve health outcomes or length of life. (This study closely corroborates and acknowledges the findings published last year by John Fauber of the Milwaukee Journal Sentinel and Elbert Chu of MedPage Today.)

Follow-up …

Read more…

The FDA’s epic regulatory failure

Pain management is personal

Val Jones, MD

Medications

November 4, 2015

Most of my patients think about pain medicines in terms of the symptoms they treat. “This is my headache medicine, and this is my arthritis medicine,” they often say. Health care providers are more likely to categorize pain medicines by the way they work: some are anti-inflammatory, some affect nerve endings, and others influence how the brain perceives pain. But the truth is that no matter how you classify pain …

Read more…

Pain management is personal

Welcome to our glorious world of regulated health economics

Michel Accad, MD

Medications

October 20, 2015

The shaming campaign that followed the news of two generic drug prices somersaulting into the stratosphere after being acquired by private companies is not too surprising. The idea that a drug that cost $13.50 one day can cost $750 the next, seemingly on the whim of greedy Wall Street investors and pharma start-ups, is fodder for the outrage machine.

But what the outrage machine does not realize is the …

Are new cancer drugs really worth their price?

Peter Ubel, MD

Medications

October 19, 2015

Cancer drugs have become increasingly expensive in recent years. No one blinks anymore when a new lung cancer or colon cancer treatment comes to market priced at more than $100,000 per patient. In part, we don’t blink because we have simply gotten used to such prices — the shock has worn off.

Moreover, many of these new treatments are targeted therapies that only work for patients whose cancers express specific mutations, …

Who’s to blame for the price Daraprim? It’s not who you think.

Brian C. Joondeph, MD

Medications

October 14, 2015

Daraprim is a drug that no one ever heard of unless they are taking it. It is used to treat toxoplasmosis, a parasitic infection, has been around for decades, and is prescribed typically in patients with weakened immune systems, such as those with AIDS. Daraprim has been newsworthy because a small company, Turing Pharmaceuticals, recently purchased the drug from Impax Laboratories for $55 million, and promptly raised the price of …

Can we blame Martin Shkreli for succeeding in a system that we created?

Peggy Bui, MD, MBA

Medications

October 14, 2015

Recently, public outrage over Daraprim’s price hike from $13.50 to $750 was loud and clear — so loud that its CEO Martin Shkreli had to rescind it. In the business world, he might be praised as a savvy investor. He saw a product that was drastically undervalued and priced it at a level that the market was willing to bear, reaping huge profits. This type of mentality is a trait many …

Legalize medical marijuana? See how a decision can affect this cancer patient.

James C. Salwitz, MD

Medications

September 28, 2015

What is not to like about medical marijuana? It treats pain, vomiting, fatigue, anxiety, depression, insomnia, seizures, muscle spasms, Crohn’s disease and allows many cancer patients to resume remarkably normal lives. It is not addictive. It does not interact with other medicines. It acts quickly and is easy to adjust. It can be consumed in numerous ways. It is safer than essentially any other drug: 1,500 Tylenol deaths in the …

The story of the pot-smoking neurosurgeon is more complicated than you think

Vamsi Aribindi, MD

Medications

September 20, 2015

A brief article recently posted the name and picture of a neurosurgery resident accused of smoking marijuana on the job. Dr. Gunjan Goel, MD is a neurosurgery resident at University of California, San Diego, and the list of her awards and publications alone is almost as long as my entire CV. The article is brief, and rather uninformative. The only facts that are known are this: The …

Patients are taking far too many medications. It’s time to fix that.

Val Jones, MD

Medications

September 16, 2015

Medication non-adherence is a hot button topic in health care. Physicians lament patient “non-compliance” with their medical advice, and policy wonks tell us that more than half of patients do not take their medications as directed. Missed opportunities to control chronic illnesses such as diabetes, heart disease, and cancer surely do cost us untold billions of dollars and millions of quality life years lost annually in the U.S. …

Medications and Prescribing

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