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.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 61-year-old woman is evaluated for hot flushes, which have been persistent for the last 10 years. They occur at least 7 times per day, last for approximately 60 seconds, and are associated with severe sweating, palpitations, and occasional nausea. She is awakened several times per night. She has tried herbal medications, …
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MKSAP: 61-year-old woman with hot flushes
The cold ultrasound probe pressed uncomfortably onto my abdomen. “It looks like an ovarian cyst,” the pleasant technician told me, “But of course we’ll run it by the radiologist.”
For the past few months, I had felt a dull, heavy pain in my right lower quadrant that sharpened when I coughed. I’d put off having it checked during my busy schedule as a third year medical student. However, the nagging knowledge …
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I felt abandoned by the system to which I had committed my career
To understand the Vicodin story we first have to understand how habit-forming medicines are currently prescribed in the U.S. The Drug Enforcement Agency divides potentially addictive substances into different schedules. Schedule II controlled substances are prescription medicines that have a high potential for abuse and severe dependence. They include all the opiate (narcotic) pain medicines, like morphine, oxycodone, and fentanyl. These medications must be prescribed on a paper …
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Does restricting Vicodin make sense?
When I was in middle school, I went to Lake Tahoe with my best friend on a ski trip. I had only been skiing a few times before, and even though my friend was only twelve, she was already a talented and experienced skier.
She was patient with me, but I became increasingly frustrated as I had trouble going down even the most basic runs without falling. At one point, after falling …
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Antidepressants and the placebo effect
I have represented a number of physicians who have been accused of “overprescribing.” Some of these were criminal investigations by local law enforcement authorities, such as a county sheriff’s office. Some were investigations by the Drug Enforcement Administration (DEA). Some were investigations by the state licensing agency (in this case, the Florida Department of Health).
In almost every one of these cases, either the DEA, the Department of Health or the …
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A lawyer provides pain management tips for doctors
To almost every claim that the American healthcare system is overpriced, defenders of the United States can point to the comparison problem — it is not fair to compare American surgeons, or hospitals, to our peers in Europe when American surgeons and hospitals are not the same as in those other countries. Our surgeons are better trained, the defenders retort, and our hospitals offer higher quality care. When quality measures …
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The balance between cost control and drug innovation
The state of diabetes drugs has gotten to the point where it is good news that a drug does not produce worse outcomes than a placebo.
I am not kidding.
The New England Journal of Medicine published two trials, each testing whether a diabetes drug increased the risk of heart attacks and death from heart disease. The trials are a result of FDA guidance for companies to assess the cardiovascular safety of new …
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Stop mandating narrow studies of cardiovascular and diabetes drugs
Flu season has begun, which means that it’s flu shot time.
I see lots of different responses when I talk to families at our clinic about the flu shot. Some are happy to get it. Others are unsure, worried about side effects. Others plain old refuse.
Plain old refusal isn’t an option for me — as a doctor and an employee of Boston Children’s. I need to get it — and I …
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Getting the flu shot isn’t about you
Mail order pharmacies like Express Scripts and Medco have become increasingly prominent players in health care. But these companies are a lot more than simply mail order pharmacies, they are in fact a new generation of pharmacy benefit managers (PBMs). PBMs are essentially middle-men between insurance and pharmacy, with companies like Express Scripts merging the dual functions of a PBM and pharmacist into one. PBMs manage and administer medication benefits …
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Why I stopped working with mail order pharmacies
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 47-year-old woman is evaluated for a 6-month history of severe fatigue in the afternoon that is often disabling. The patient has a 15-year history of multiple sclerosis. She states that her mood is good and that she is not feeling depressed or sad. She describes no problems with her sleep, and her partner …
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MKSAP: 47-year-old woman with severe fatigue
Testosterone is one of the most over-prescribed and poorly understood medications. It is prescribed to millions of men for myriad indications, many of them unproven. Athletes believe it will improve their muscle mass and strength. Older men look to it as an anti-aging remedy. Men with flagging libido hope it will restore their sex drive. Testosterone has developed a mythology of masculinity. This is very similar to the notions we …
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Estrogen in men: Masculinity isn’t a molecule
Did your team win this weekend?
I hope so. It is so exciting when your team gets to throw up a “W” after their first contest. It gives all the fans hope for a successful and exciting season.
Fall also is a time to cheer for our annual opportunity to protect our families against a predictably unpredictable opponent: influenza.
That’s right. It’s time to defend against the flu by getting an annual flu vaccine.
This …
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A gameplan against this year’s flu
Everywhere I look today, I see ads claiming huge savings from drug discount cards. These cards promise huge savings to consumers, yet they are unable to deliver on these outrageous statements. Now, when I see these ads, I’m skeptical — and you should be too because not all the claims are real.
The old saying, “If it seems too good to be true then it probably is” also applies to drug …
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Drug discount cards: Tips and tricks to watch out for
You’re at the doctor’s office, and you see strolling up to the window a good-looking, well-dressed professional. They’re usually pulling a little discreet cart, and after a few words with the receptionist they’re rushed right back. Sometimes they’ll bring a tray of cookies, or they’ll be followed by a caterer with a cartful of food.
You think they had an appointment? No, but you can be they’re here to see the …
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Is your physician immune to drug marketing?
When you reach for ibuprofen for your sore back or a pill to help you sleep, are you sending a bad message to your kid?
Yes, says Bryant Gumbel in his video commentary about the drug charges against ball player Alex Rodriguez. While he thinks that Rodriguez should be punished for being a liar and a cheat, he doesn’t think that people should be shocked by the fact that Rodriguez was …
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Are parents active parts of a national drug epidemic?
Annoying mall vendors have been pushing what may be one of public health’s greatest accomplishments—and few have taken notice. Behind pillow pet stations and the candle stand, mall shoppers can find electronic cigarettes, or “vapes.” Often targeted at smokers wanting to quit, e-cigarettes offer many of the joys of smoking without one of its major components: smoke.
Smokeless cigarettes have become a hot product, with an estimated $1.7 billion in sales …
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Can e-cigarettes be a public health victory?
