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 trade-offs of statins: How much benefit is needed for you to take a pill?

Richard Young, MD

Medications

April 23, 2015

Do you like to take pills? I don’t. I bet most family physicians would say they have some patients who should be better at taking pills and some who love taking pills too much.

For people who don’t like taking pills, what would a trade-off look like? If you were given the option of living X months fewer, but in return you wouldn’t have you doctor twisting your arm to take pills every …

Don’t use essential oils for asthma. Here’s why.

Chad Hayes, MD

Medications

April 22, 2015

Alright, we need to talk. Those of you who follow my blog know that I don’t shy away from controversial topics and that I don’t have a problem speaking my mind. I try to do it in a respectful, informative, and somewhat humorous way. But I saw something this morning that needs to be addressed, and it’s not funny at all.

As I was eating breakfast before work, I saw a …

How are drug companies making millions from generic drugs?

Peter Ubel, MD

Medications

April 17, 2015

It is well accepted among health economics wonks that the lion’s share of pharmaceutical company profits come when these companies hold exclusive rights to their products. Once their blockbuster pills go “generic,” competitors enter the marketplace and profits plummet. Consider captopril, a groundbreaking heart failure medication introduced in the early 80s by Bristol-Myers Squibb under the trade name Capoten. After making a fortune for the company, captopril went generic in 1996. …

We need to reframe alternative medicine in a new way. Like this.

Chad Hayes, MD

Medications

April 14, 2015

I’ve written before about various forms of complementary and alternative medicine — most recently about the use of essential oils for serious medical conditions. I’m planning to dive deeper into that topic in an upcoming post. But before I do, I want to take some time to reframe how we think about alternative therapies. And I want to make it clear from the beginning that doctors don’t get paid for prescribing medications; we …

Alcohol or marijuana? Rethinking what to take when you unwind.

Jeffrey Parks, MD

Medications

April 14, 2015

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Aaron Carroll, a pediatrician who blogs at the Incidental Economist, had a piece published a few weeks ago in the New York Times concluding that adolescents and college kids would be better off — given a choice of illicit substances — opting for marijuana over alcohol. Of course, he would prefer that his kids chose neither. But he is a …

What does it mean to live in the age of Abilify?

Steven Reidbord, MD

Medications

March 23, 2015

I learned recently that the antipsychotic Abilify is the biggest selling prescription drug in the U.S. To be a top seller, a drug has to be expensive and also widely used. Abilify is both. It’s the 14th most prescribed brand-name medication, and it retails for about $30 a pill. Annual sales are over $7 billion, nearly a billion more than the next runner-up.

Yes, you read that right: $30 a pill. A little more …

Don’t be scared: Let’s see what’s really in vaccines

Katie Noorbakhsh, MD

Medications

March 7, 2015

Let’s talk about vaccine ingredients. I am reading less about vaccines causing autism (we all know that theory is utter nonsense, right?) and more about vague concerns regarding the chemicals in vaccines. To begin with, we are surrounded by chemicals. Water (H2O), caffeine (C8H10N4O2), sugar (C12H22O11) are all chemicals. But perhaps it is the unfamiliar ingredients that people find intimidating.

Let’s tackle the ingredients in the measles, mumps, rubella and varicella (MMRV) vaccine …

Bill Maher criticizes doctors: A physician responds

Steven Naymagon, MD

Physician

March 5, 2015

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A few weeks ago Bill Maher made a number of critical remarks about medicine and physicians. I sent Mr. Maher the following response in an effort to address his comments. I am sharing this with you in hopes that other physicians will also speak out in defense of our profession.

Dear Mr. Maher,

Let me start by saying that I have been a …

A domperidone dilemma: A patient’s perspective on ordering from Canada

Anonymous

Medications

March 5, 2015

Three years ago I received some of the best news of my life — that I have dopa-responsive dystonia. (Yes, a neuromuscular disorder was welcome news.) Painful, life-interrupting muscle contractions had made the dystonia diagnosis likely several years before, despite poor response to standard treatments, and I was fighting through graduate school: trying to compensate for medication-induced memory problems, increasing need to work from bed, and a disappearing social life. …

Herbal supplements: What are you really taking?

Michael Kirsch, MD

Medications

February 28, 2015

Many of my patients are taking herbal supplements, or so they think. This herbal and health supplements industry likely is envied by traditional pharmaceutical companies. The latter has to spend zillions of dollars proving safety and efficacy to the Food and Drug Administration (FDA). Many of these drugs are cast aside during the approval process or afterwards when serious side effects become known, or a new medicine is proved safer …

Which drugs are on formulary? A little help, please.

Hans Duvefelt, MD

Medications

February 23, 2015

The letters are usually four pages long and begin by saying that my patient has received a temporary supply of the medication I prescribed.

Next, there are general paragraphs about how the drug either isn’t on their formulary or the quantity exceeds the plan limits. None of these letters contains a reference to an online formulary physicians can access to compare covered alternatives.

Then there are several cumbersome explanations about the appeal …

Should we give more Tamiflu for influenza? A look at the evidence.

Kenneth Lin, MD

Medications

February 18, 2015

As the Centers for Disease Control and Prevention (CDC) reported that people who received this season’s influenza vaccine were only 23 percent less likely to be diagnosed with influenza than unvaccinated persons, CDC director Tom Frieden was publicly urging high-risk patients and their physicians to use antiviral medications to prevent complications and disease transmission:

People who are sick with flu, if they’re very sick in the hospital or if they have …

Read more…

Should we give more Tamiflu for influenza? A look at the evidence.

The truth about Miralax in children

Natasha Burgert, MD

Medications

February 12, 2015

Parents are appropriately expressing concern about the safety of Miralax®, a commonly used stool softener in kids, after a recent New York Times article exposed a potential association with long-term use of the drug and undesired behavioral side effects. As the article explains, the FDA has awarded a research grant to a team at the Children’s Hospital of Philadelphia (CHOP) to directly address these concerns.

Miralax® has been used …

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The truth about Miralax in children

Be aware of cost savings available to every patient

Diane Scheb, RN

Medications

February 11, 2015

Spend less. Live better. Except, she didn’t have that long to live. Maybe ten days … probably not.

Thirty-three years old, an illegal Mexican migrant worker, she was diagnosed in an emergency room with an aggressive stomach cancer two years ago, and she had been fighting for her life ever since. Multiple rounds of chemo administered through our community medical clinic had not worked.

And now, here she was in my ICU, …

Advances in hepatitis C treatment. Why aren’t they being used?

Nezam H. Afdhal, MD

Conditions and Diseases

February 7, 2015

The really incredible advances in the treatment of hepatitis C bring to life several relevant questions as we move forward into 2015. First, who should be treating hepatitis C patients (primary care providers, gastroenterologists, infectious disease specialists)? Second, can we really afford to use these new treatments? I recently discussed this topic with my GI and hepatology colleagues in AGA Perspectives, the bi-monthly opinion magazine of the American …

Is health insurance the new paternalism in health care?

Martine Ehrenclou, MA

Patient

February 6, 2015

If I could drop our health insurance altogether, I would. With a high deductible of $4,000 for in-network providers, my family of three has yet to reach our collective deductible over the last three years. This means we have to pay out of pocket for medical care until we reach that amount. To make matters worse, our health insurance premiums increased by 10 percent, forcing us to find a less …

Prescribing off-label: It’s gotten out of control

Allen Frances, MD

Medications

February 5, 2015

Doctors prescribe way too many medicines for patients who don’t really need them. A lot of the pressure comes from intense drug company marketing. Some comes from patients who aren’t happy leaving the office without a pill. And doctors have too little time with each patient to explain non-pill solutions to problems. Wild prescribing is not new. For thousands of years, doctors have given patients useless (and often quite harmful) …

How to talk to your patients about alternative medicine

Mel Borins, MD

Medications

February 1, 2015

A woman told me she saw her physician recently and, when she told him all the things she was doing to help herself, naturally he told her he practices Western medicine and that he does not believe in that stuff.

Not a good conversation.

A number of research studies have found that one in three patients routinely use alternative treatments, but …

The time to regulate e-cigarettes is now

Ruth Macklin, PhD

Medications

January 25, 2015

A new revelation has added to the ongoing controversy over the health risks of e-cigarettes. Some commentators have viewed the use of this electronic delivery system for nicotine as a way for smokers to cut down on tobacco cigarettes or quit the habit altogether. Others have contended that e-cigarettes can be a “gateway” to smoking and may actually increase …

3 amazing medical advances that haven’t caught on

Ilana Yurkiewicz

Conditions and Diseases

January 23, 2015

The life cycle of a medical advance usually goes something like this: from discovery at the research bench and replication of findings to translational research and clinical trials, to implementation. The bottleneck can be at any one of these stages, and often it is in the discovery one; we just haven’t yet found the thing that works.

But other times, we have — the intervention works, we have shown and confirmed …