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.

Which is the right flu vaccine for you?

Albert Fuchs, MD

Medications

October 23, 2014

The best way to avoid the flu is spending the months from fall until spring in a solitary bunker, communicating with other people only electronically. The second best way is getting the flu vaccine. The Centers for Disease Control and Prevention (CDC) recommends the flu vaccine for everyone over 6 months who doesn’t have a specific contraindication to it.

Because of the increasing number of different flu vaccines that are now …

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Which is the right flu vaccine for you?

The Sunshine Act escalates the war on physicians

Arvind Cavale, MD

Health Policy

October 23, 2014

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The media has feasted on the recent release of data by the Center for Medicare and Medicaid Services (CMS) that details payments made by the pharmaceutical and device companies to hospitals and physicians in 2013. This was part of the Physician Payments Sunshine Act (PPSA) — also known as section 6002 of the Affordable Care Act (ACA) of 2010.

What the …

Treating hepatitis C with Sovaldi: Is it worth it?

Michael Kirsch, MD

Medications

October 22, 2014

One catch phrase in health care reform is cost-effectiveness. To paraphrase, this label means that a medical treatment is worth the price. For example, influenza vaccine, or flu shot, is effective in reducing the risk of influenza infection. If the price of each vaccine were $1,000, it would still be medically effective, but it would no longer be cost-effective considering that over 100 million Americans need the vaccine.

Society could not …

Open Payments: Detailing the media’s witch hunt

Margalit Gur-Arie

Health Policy

October 14, 2014

Physicians, whether practicing medicine or not, should not be involved in clinical research. They should never be consulted on development of new drugs and medical devices. Doctors should not invent new treatments, and should never supervise clinical trials. They should not travel to or speak at conferences either, and they should banish all entrepreneurial notions out of their heads. If they insist on engaging in these activities, they should do …

Why your doctor won’t refill prescriptions over the phone

Michael Kirsch, MD

Medications

October 13, 2014

Giving prescription refills is not quite as fun as it used to be. Years ago, we doctors would whip out our prescription pads — often sooner than we should have — and we’d scribble some coded language that pharmacists were trained to decipher. I’m surprised there were not more errors owing to doctors’ horrendous penmanship. On occasion, the Food and Drug Administration (FDA) would require a pharmaceutical company to change …

MKSAP: 48-year-old man with urinary frequency

mksap

Conditions and Diseases

October 11, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 48-year-old man is evaluated during a follow-up visit for urinary frequency. He reports no hesitancy, urgency, dysuria, or change in urine color. He has not experienced fevers, chills, sweats, nausea, vomiting, diarrhea, or other gastrointestinal symptoms. He feels thirsty very often; drinking water and using lemon drops seem to help. He …

Two-tiered generic drugs will lower quality of care

Trudy Lieberman

Medications

October 9, 2014

As we head into health insurance enrollment season, which opens in November, consumers/patients will face yet another challenge in selecting the best health plan. Sorting through policies was tough already, but now insurers are making it even harder by changing the way they will cover generic drugs.

It used to be that opting for generics was a snap. Health plans usually offered three or four tiers of drugs — one for …

Prevent the overdose of OTC pain medications

Byron Cryer, MD

Medications

October 6, 2014

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Recently in the emergency room, I saw a 35-year-old patient — we’ll call her Jane — who was vomiting blood. The source of the vomiting turned out to be a bleeding ulcer caused by unintentionally overdosing on ibuprofen. Jane was in pain — she was taking prescription ibuprofen for her chronic knee pain — but she was also taking over-the-counter (OTC) …

What the iPhone 6 bendgate can teach us about vaccines

Davis Liu, MD

Physician

October 5, 2014

I received my new thinner bigger iPhone. Within a few days, news reports highlighted how new iPhone 6 owners accidentally bent the latest Apple iteration of the modern smartphone. A blogger bent an iPhone 6 Plus with his bare hands. This story, the subsequent fallout, and response has learnings for doctors and health care on the challenges facing the vaccination “debate.”

The best launch in iPhone history with roughly 10 million smartphones shipped …

How the costs of care impacted H. pylori treatment

Neel Butala, MD

Physician

October 4, 2014

There he sat, hunched over with rugged, muscular arms stretched across his abdomen, his weary eyes stealing hopeful glances from behind an otherwise steely facade. Mr. J was a 53-year-old Latino agricultural laborer with a history of H. pylori who presented at our student-run free clinic with persistent abdominal pain, unchanged from his multiple previous visits. As I learned more about Mr. J and his story, I realized that treating …

Marijuana and motor vehicle safety: An impending public health dilemma

Abraar Karan, MD

Medications

October 4, 2014

Since 1996, 21 states have approved the legalization of marijuana for medical use. More recently, Washington and Colorado have legalized the use of recreational marijuana, with California and Oregon not far behind. The health risks associated with marijuana have been well documented in a number of studies, but these are secondary to the much greater mortality risk associated with an increased prevalence of the drug: driving under the influence.

As is …

Medical reversals: When wonder drugs become harmful

John Schumann, MD

Medications

October 3, 2014

Twenty-five years ago, the New England Journal of Medicine issued a report on a stunning new medical discovery: Aspirin helps prevent heart attacks.

Yes, good ol’ aspirin. Known since the time of Hippocrates for its magical abilities to quell fever and pain, it took only 2,000 years for us to understand the science of it well enough to design a ‘sufficiently powered’ double-blind, placebo-controlled randomized trial on aspirin’s efficacy in preventing heart attacks. The Physicians’ …

A new drug to treat RSV bronchiolitis

Christopher Johnson, MD

Medications

October 1, 2014

Respiratory syncytial virus infection, aka RSV, is a common infection in children. A key aspect of RSV is how poor a job our immune systems do in fighting it off. Virtually all children are infected with RSV during the first few years of life. Not only that, all of us are reinfected multiple times during our lives. Attempts at devising a vaccine for RSV have all been unsuccessful. In fact, …

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A new drug to treat RSV bronchiolitis

Curb the soaring costs of vaccines

Ruth Macklin, PhD

Medications

September 30, 2014

Few medical interventions have been as successful as vaccines in improving public health.

Whether they are childhood vaccinations, vaccines to prevent healthy adults from contracting influenza or the more recent HPV vaccine for adolescents, these preventive methods have resulted in dramatic benefits for individuals and the public. We have only to think of the eradication of smallpox and the virtual eradication of poliomyelitis to see the enormous benefits vaccines can bring. …

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Curb the soaring costs of vaccines

A surprising cause for acute hepatitis in the rehab unit

Val Jones, MD

Conditions and Diseases

September 30, 2014

I recently treated a patient who was hospitalized with paraplegia. During some routine lab testing I noticed that his liver function tests were elevated, and so I began looking for a cause. I discussed the patient’s drinking habits (he rarely drank alcohol), risks for viral hepatitis (no IV drug use or exposure to those with known hepatitis), and general medical history (nothing relevant to liver disease). I reviewed his current …

What is going on with generic drug prices?

Hans Duvefelt, MD

Medications

September 29, 2014

Fran Barker called today. She was in a panic because the cost of her monthly prescription of 150 mg amitriptyline tablets had gone up to $130 from $13 the month before.

Amitriptyline has been available in this country since 1961, and the 100 mg strength was on Walmart’s list of $4/month drugs the last time I looked at it a few months …

The long road to a blockbuster drug

Vern L. Schramm, PhD

Medications

September 24, 2014

One thousand dollars per pill?

A single treatment course for hepatitis C virus to cost $83,000?

How can those prices be justified?

The drug-discovery process is a long one, fraught with disappointments and massive investment, no matter what the outcome. Some pharmaceutical companies argue that the high prices charged for their rare “blockbuster” drugs help them recover research and development costs.

While drug pricing and drug access are contentious and controversial issues — ones …

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The long road to a blockbuster drug

A pediatrician answers your HPV vaccine questions

Jean Moorjani, MD

Conditions and Diseases

September 18, 2014

What is HPV?

HPV stands for human papillomavirus, and these viruses are the most common sexually transmitted viruses in the United States. Most of the people who are diagnosed with HPV are young and sexually active. The rates of HPV infection are high because most people who have HPV do not know they are infected because sometimes the virus shows no symptoms. Most HPV infections show no symptoms, and resolve within …

Alternative medicine: There should only be one standard

Hans Duvefelt, MD

Medications

September 16, 2014

“Doctor, what do you think of alternative medicine?” a patient with chronic fatigue syndrome asked me the other day. She was interested in doing something more for her severe fatigue. “Would acupuncture help me?”

I paused and, as I have done many times before, answered that my training and most of my clinical experience has been in Western, allopathic medicine. (Ironically, the word “allopathic” was first used as a derogatory term …

Don’t become your kids’ drug dealers

Roy Benaroch, MD

Medications

September 11, 2014

Doing drugs no longer requires a dealer on the street corner.

Between the late 1990′s and 2010 sales of narcotic pain medicines quadrupled in the United States. Hydrocodone use increased by 280%, methadone by 1300%, and oxycodone by 900%. As the consumption of these medicines increased, so did ER visits and deaths from overdose — up by about 500%.

A whole lot of these medicines are not going to medical use. And …

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Don’t become your kids’ drug dealers