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.
Research and development is critical to battling disease. Now, more than ever, technology can rapidly impact a patient and their disease process in a very positive way. The process of developing a new drug or device is expensive and can be very time consuming. As government funding for projects continues to decline, more funding is coming from private sponsorship according to a recent New York Times piece.
Another critical source of …
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Negative results from clinical trials need to be reported
As physicians, we often write prescriptions for our patients. Where, when, and how patients fill their prescriptions are usually outside of our realm of expertise. But should we be more involved?
On occasion, the cost of a medication and possible alternatives will be the subject of my conversation with a patient. I was surprised, however, when one of my patients complained about the price of an antidepressant that I had prescribed. …
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Be more involved in how patients fill their prescriptions
Readers have contacted me about a recent study that links acetaminophen use in pregnancy to the later development of ADHD in children. Is Tylenol yet another thing pregnant women need to avoid?
The study, titled “Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders” was published this month in JAMA Pediatrics. Dutch researchers looked at about 60,000 children born from 1996-2002. Their parents have been filling out questionnaires and …
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Is acetaminophen taken during pregnancy associated with ADHD?
When I was in medical school, our nutrition researchers taught us that vitamins didn’t do much good and only made expensive urine (where the water soluble ones end up). We did learn about the classic vitamin deficiencies like scurvy, beriberi, rickets, etc. But the evidence that healthy people should take vitamins was marginal at best.
Is our search for immortality the reason that we turn to the pill or potion? Do …
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Vitamin and mineral supplements for healthy individuals don’t work
Bewildered, panicked, and disheartened. I watched my mother’s eyes dart back and forth as she read the pharmacy’s prescription cash price list, knowing she could not possibly dig deep enough in her faded purse to pay for her monthly medicines. In her early fifties, she did not qualify for Medicare, nor could we afford the COBRA payments that would extend coverage for our family since my father’s recent lay off.
We …
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The costs of care challenge requires a physician’s creative compassion
The discovery of antibiotics is one of the most significant medical achievements of the 20th century. In the 1920s Alexander Fleming pioneered the discovery and use of penicillin, winning the Nobel Prize in Physiology and Medicine for his work. Other pioneers built upon his success and scientific research to pave the way for even more antibiotic development. The ability to fight infections has ultimately resulted in longer life spans and …
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Preserving antibiotics for future generations
It was like watching the news footage of shoppers trampling each other to get through the doors of a Filene’s Basement sale or witnessing people standing outside all night for the new iPhone even though it isn’t a sale and it will be made in mass production for months or years to come. I am talking about seeing people line up in the dark of pre-dawn to get their fingers …
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3 concerns about the legalization of marijuana
The other day at an interdisciplinary rounds meeting at the hospital, one of our nurses who is also an emergency medical technician mentioned that in Britain injured patients receive tranexamic acid before arriving at the hospital because it reduces death from bleeding.
“What’s that?” I said.
I kind of barely remembered hearing this medication’s name associated with the treatment of a rare disease, but not treatment of trauma. So I was guessing …
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Why isn’t tranexamic acid used more often in routine practice?
What an amazing time to be a champion of new health care delivery models. Three megatrends are driving change at a pace that I only wished for 20 years ago. Back then, I first had the insight that care could be improved, in some instances, if we separate doctor and patient in time and space.
The first trend is provider reimbursement reform. For provider organizations going at risk with their payers, these are …
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Can the pharmaceutical industry move beyond the pill?
The evening news is filled with fatal car crashes and shootings. But drug overdoses kill nearly 40,000 people a year, accounting for more deaths than vehicular accidents or homicides.
Drug overdoses are on the rise in America, fueled largely by prescription meds. Reversing the course of this epidemic will require some dramatic changes.
The facts
Drug overdose rates climbed more than 100 percent between 1990 and 2012. But what most people don’t recognize …
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Reversing the epidemic of drug overdoses
Opioids are a family of pain medications chemically related to opium and heroin. They include morphine, fentanyl, codeine, hydromorphone and others. Opioids have unique properties that make them both indispensable for pain management and extremely dangerous.
Unlike virtually any other family of medications, opioids have no maximum effective dose. If any dose, no matter how high, is ineffective at controlling pain, a higher dose can give more pain relief. Most other …
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The societal problem of opioid addiction
“Hey doc, I saw on an ad on the TV last night about this new asthma inhaler. Shouldn’t I give it a try?”
This type of question would occur several times a week. When I started practicing medicine it was considered unethical to advertise medical treatments. Now, we’re bombarded with enticements for tests and treatments. The inhaler the patient requested cost $264 a month — more than double what he was …
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The medical industrial complex and the surge of health costs
On February 18, 2014 the Food and Drug Administration indicated their consideration to allow pharmaceutical companies to shorten the list of possible side effects seen by millions everyday and night in pharmaceutical ads and commercials.
In recent years, citizens — patients and consumers — have been bombarded with numerous and lengthy televised commercials in which pharmaceutical companies push their medicinal wares. It’s called “direct-to-consumer” advertising (DTC).
Such DTC efforts work for detergents, …
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Rid the airwaves of pharmaceutical advertising
I was up helping my son for the majority of the night. He’s got a stomach bug (which he got from his brother) therefore I was up dealing with the enormous mess that comes with vomiting in the middle of the night. I know you know my woe. This is the second round of this bug at our house so I was clearly exhausted when 6am rolled around.
First thing I …
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What to remember about children and caffeine
Despite representing only 4% of the world’s population, the United States accounted for almost 35% ($326 billion) of the global market for pharmaceutical drugs in 2012. Not surprisingly, the pharmaceutical industry’s business practices, considerable marketing budgets, and substantial profits are hotly debated as part of virtually every health policy discussion. But before addressing the possibility of transcendent evil in that industry, we should pose a more mundane yet critical question: …
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Is Big Pharma evil? Doctors should share the blame
Now that medical marijuana is legal in Massachusetts and licenses have been awarded for the first twenty dispensaries across the state, you’d guess that my practice is busily preparing to meet the demands of patients seeking marijuana prescriptions for several debilitating conditions including chemotherapy-related nausea and AIDS-related weight loss.
You’d guess wrong.
Since Massachusetts voters approved legalization of marijuana in 2012 I’ve received no special training (required for physicians to certify patients as eligible …
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Why your doctor isn’t prescribing medical marijuana yet
The death penalty has been in the news lately, what with a “botched” execution in Ohio, using a 2 drug method that Louisiana has also recently adopted for it’s administration of the death penalty.
These changes come on the heels of a new tactic by death penalty opponents: getting European countries to ban their pharmaceutical manufacturers from exporting drugs that may be used to execute people. These bans were partially responsible for nationwide …
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Using drugs for executions: What really happened in Ohio?
At least 12 college students have been diagnosed with Meningitis type B (MenB) this year, and cases like this may spread to other campuses unless the Food and Drug Administration intervenes. While people of any age can contract the infection that affects the brain and spinal cord, children and people over 60 are more likely to contract the infection. So, too, are college students because of their close contacts in dormitories and …
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Why the FDA should approve the MenB vaccine
Cardiovascular disease — including coronary atherosclerosis and cerebrovascular disease — remains the number one cause of mortality in the United States. One out of three people in this country will die of cardiovascular causes. Although I can’t say that the other top causes of mortality are particularly attractive — cancer, chronic lung disease, accidents and dementia — premature cardiovascular death can certainly be very devastating and it makes sense to do …
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Applying the new cholesterol guidelines to real life patients
Kayla wrote in:
Hello! I am curious what you think about essential oils. They have recently become incredibly popular in my community, but I am pretty skeptical because so much of the enthusiasm is coming from those who have signed up as ‘distributors’ with doTerra or Young Living (2 essential oil multi-level marketing companies.). The biggest concern I have is that these companies (and all these new distributors) recommend taking many …
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Be suspicious of the marketing for essential oils
