Katie had always come to clinic in an anxious and frazzled state. Hair blond hair disheveled, large handbag open, items at the verge of spilling out. Yet she came, dutifully, to meet her counselor, to attend group therapy, to get vitals checked by her nurse, then to drop off a urine sample. But not today. Nor did she return to clinic over the next three weeks. Katie was found by …
The tragedy of opioid addiction in the young and homeless
While studying for a certification exam, I came across a question that stayed with me well after taking the practice test. The case discussed a patient who was prescribed antibiotics by his physician for a presumed bacterial illness and then returned the following week with an antibiotic-associated diarrheal infection. The test question then asked what could be concluded from this case. The answer: informed consent (i.e., patient permission for a …
Discussing the side effects of medications: How can doctors do better?
A Finnish group randomized patients with acute appendicitis to surgery and antibiotics and found that antibiotics were successful in 73 percent of patients. Depending on how this is framed, you can celebrate a 70 percent success or lament a 30 percent failure. Much of the debate in health care is a battle of framing. The study has limitations. Finland is not just a land of the Read more…
Antibiotics for appendicitis: 3 unintended consequences
It was only a matter of time before Kim Kardashian posted a picture on her Instagram account with a bottle of Diclegis, basically announcing her brand partnership with Duchesnay, the manufacturer of the prescription medication for nausea and vomiting in pregnancy. Duchesnay had been tweeting for ages that they were so relieved Kim had found help with Diclegis — so much so that I was wondering if Ms. …
Kim Kardashian’s first trimester nausea: The truth behind Diclegis
Ladies, the moment you have all been waiting for is here! No, not affordable childcare. Not equal pay for equal work. Not gun control. Not abortion rights or paid maternity leave or a female majority in Congress or a constitutional ban on the words “chick lit.” Girls, it is so much better than all that. We got pink Viagra!
Flibanserin. Catchy name. Addyi for short. Approved by the FDA for hypoactive …
The FDA approved Addyi. But was there a hidden agenda?
I read a fascinating article from ProPublica about a nurse practitioner (NP), Heather Alfonso, who pleaded guilty in June to accepting $83,000 in payments from a drug company in exchange for prescribing a high priced drug used to treat cancer pain. However disturbing this is, notably in the data released by the federal government on payments by drug and device companies to doctors and teaching hospitals, …
Hold nurse practitioners accountable by including them in the conversation
A few weeks ago I was feeling angry and disappointed when I noticed that many of the articles I was reading in my favorite medical journal were funded by companies who made the products those articles evaluated.
This is nothing new, but it looks to me like there are increasingly more of these articles which celebrate products and fewer interesting articles about the science of medicine. The other thing …
Drugs and devices are getting more expensive and less useful. Why?
There were several news stories recently that reported that Pfizer had abandoned its efforts to have its Lipitor brand of atorvastatin made available over the counter (OTC), without a prescription. I was never a big fan of OTC statins, but I was struck by the reason that Pfizer put out:
The study did not meet its primary objectives of demonstrating patient compliance with the direction to check their low-density lipoprotein cholesterol …
OTC Lipitor? Why Pfizer made the right decision for the wrong reason.
I recall a talk on imaging biomarkers for Alzheimer’s disease (AD). “Take this with a pinch of salt. I have a financial conflict of interest (COI) in the success of these markers,” the speaker warned. I glanced at the audience — MDs and PhDs with a cumulative IQ higher than the French intake of wine. I looked for pinches. I searched …
The loud chorus against conflict of interest
I’m a physician, and I’m adrift. I am pretty much lost at sea. I’ve often thought of writing this column, but afraid I’d be recognized, I’ve hesitated for years. Even now, I’ll most likely remain anonymous, because I’m in a vulnerable position. Let me preface my remarks with the reassurance that I’m not a bad person.
I developed dependence on opioids several …
A physician enters rehab. What happens next should disturb you.
We, like many in the hemophilia community, were excited to see extended half-life (EHL) factor VIII and IX products start coming to market over the last few months. These products — and expected future products — promise equivalent or greater prophylactic bleeding control with fewer infusions, and so could greatly enhance patients’ quality of life.
Yet, as we noted in our recent editorial in Haemophilia, we are greatly concerned that patients …
Dose recommendations for extended half-life hemophilia factor products fall short
Everyone has an angle. Everyone.
Your doctor? Sure. But, he or she isn’t the only one. The pharmaceutical company? Of course. The medical device company? The hospital? The insurance company? You get the point. Everyone has an angle. Everyone has a conflict of interest. Know it. Get over it. It’s time to focus on something else.
Like filling up your car with gas. In …
Conflicts of interest aren’t only about financial incentives
As first-year family medicine residents, our patient care experiences really run the gamut, since our training truly encompasses “cradle to grave” care. With the exception of most pediatric care, the issue of narcotic prescribing and addiction is seen in all specialties, as well as frequently in continuity clinic where we care for our own primary care patients. As dangerous as opiate …
Prescribing pain medicine: Most new physicians aren’t ready
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The New England Journal of Medicine (NEJM) called the question: Has criticism of the pharmaceutical industry, and of physician relationships with that industry, gone too far? Are self-righteous “pharmascolds” blocking the kind of essential collaboration that brought streptomycin and other lifesaving treatments to market? The editorial by Dr. Jeffrey Drazen and the lengthy three–part Read more…
Has criticism of the pharmaceutical industry gone too far?
Hepatitis C is one of the most common chronic infectious illnesses in the U.S. today and affects nearly 3.2 million Americans. Complications of hepatitis C infection include liver cancer as well as cirrhosis. Many patients with chronic hepatitis ultimately develop liver failure and will die without liver transplantation. In the last year, a new drug class has entered the market and can produce cure rates in excess of 90 percent.
These …
How hepatitis C treatment is a glimpse of health care’s future
I recently was invited to participate in a research study, looking at the economic impact of a new drug for the treatment of Clostridium difficile infection. The new drug, called fidaxomicin, has been available for a few years and has proven efficacy in thousands of patients but is generally very expensive. The study will follow patients after their hospitalization and delve into analyzing the monetary costs associated with the medicine, …
It’s time to study the economic impact of new drugs
I suffered from extreme nausea during my pregnancy; I had triplets, and I’m pretty sure I had a triple dose. I never threw up, but you know how your mouth salivates the moment right before you vomit, that sensation that sends you running to the bathroom? I had that. All. Day. Long. For four weeks.
By day four or five I was …
She took Zofran and her son had a heart defect. Here’s why she’s not suing.
I recently completed the buprenorphine waiver training. Buprenorphine, itself a partial opiate, is a medication that can be prescribed to patients who have opiate use disorders (e.g., taking Oxycontins or injecting heroin to get high). A physician must complete an eight-hour training and take an exam to become eligible to prescribe this medication. The physician must then apply for a specific “X license” through the DEA to prescribe it.
In some …
Why must doctors complete extra training to prescribe buprenorphine?
In the old days, blockbuster drugs were moderately expensive pills taken by hundreds of thousands of patients. Think blood pressure, cholesterol and diabetes pills. But today, many blockbusters are designed to target much less common diseases, illnesses like multiple sclerosis and rheumatoid arthritis or even specific subcategories of cancer. These medications have become blockbusters not through the sheer volume of their sales, but as a result of their staggeringly high …
Why are affordable drugs so expensive?
I argue that pharmacist should fill prescriptions even if their own morals do not agree. Pharmacists should not be limiting someone from getting something they may need because they do not agree with it. Pharmacists have no right putting their business (ideology) where it doesn’t belong.
Women struggle enough when going to the pharmacy to fill a prescription for birth control or emergency contraceptive, now with the added possibility of not …
Can pharmacists refuse to fill prescriptions?
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