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.

Should doctors talk about the cost of drugs with their patients?

Peter Ubel, MD

Medications

February 23, 2012

I first realized something was amiss when I picked up my prescriptions and the pharmacist explained that she could not fill the anti-malarial medications as prescribed: “Your medication plan only pays for 30 days of pills, and your prescription was for five pills.” The pharmacist continued: “Your PBM [that’s an acronym for pharmacy benefits management company, the type of company that coordinates many peoples’ medication coverage] only fills this medication …

Doctors cannot be expected to be financial engineers

Andrew Schutzbank, MD, MPH

Physician

February 20, 2012

Peggy was in her early 70s and suffered from a terrible lung disease known as pulmonary hypertension. So bad in fact, that she had a pump infusing a medicine under her skin 24 hours a day to keep the blood supply to her lungs open. Once started, this medicine, treprostinil, was known to improve life in those with pulmonary hypertension. Unfortunately, like all continuous infusion medicines of this type, it …

We need an app for credible information on vaccines

Wendy Sue Swanson, MD

Health Technology

February 14, 2012

Stop what you’re doing to read this The New England Journal of Medicine perspective by Dr. Doug Diekema. It’s about vaccines, opportunities for health, and physician obligation. Written for physicians, it also speaks loudly to parents and includes a few very essential points. The whole time I read the article, my thoughts kept leaping to our imminent opportunities. Today, in 2012, we can harness the tools of social media …

Why we should eliminate the diagnosis of ADHD

Steve Balt, MD

Conditions and Diseases

February 8, 2012

I’m reluctant to write a post about ADHD. It just seems like treacherous ground. Judging by comments I’ve read online and in magazines, and my own personal experience, expressing an opinion about this diagnosis—or just about anything in child psychiatry—will be met with criticism from one side or another. But after reading L. Alan Sroufe’s article (“Ritalin Gone Wild”) in the New York Times, I feel compelled to write.

If …

A look behind the growing cost of cancer drugs

Merrill Goozner

Medications

February 7, 2012

Julie Gralow, an oncologist at the Fred Hutchinson Cancer Center in Seattle, recently prescribed an exciting new therapy for a 60-year-old woman with metastatic breast cancer. Three-and-a-half years into her battle against the disease, the patient had already exhausted three different anti-estrogen therapies, each of which only put a temporary check on the spreading tumors.

The newly prescribed drug, Novartis’ Afinitor, is one of the recently approved targeted therapies that have …

MKSAP: 60-year-old woman with pruritic hives

mksap

Conditions and Diseases

February 5, 2012

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

A 60-year-old woman is evaluated for pruritic hives that have persisted for 12 weeks. The lesions appear, resolve within hours, and leave no residual mark but reappear at a later time. She does not associate the hives with any particular foods or exposures. Her medical history …

Innovative technologies can markedly enhance safety

Stephen C. Schimpff, MD

Health Technology

January 23, 2012

“To Err Is Human” is the title of the now famous book from the Institute of Medicine on patient safety published about a decade ago. From it we learned that anywhere from 44,000 to 98,000 individuals die each year of preventable medical errors (and other sources suggest the number might even be much higher). In this continuing series of posts on disruptive and transformational technologies, there are some that can …

An American ER doctor in Tasmania

Rick Abbott, MD

Medications

January 23, 2012

Beginning work at Launceston General Hospital in Tasmania, orientation really, I noticed a lot of things missing: places to sign my name.

For any given patient I’d sign: the completed chart note, perhaps a lab (sorry, pathology) and imaging slip, a prescription form (in triplicate – ok, so that was weird), and a GP letter.

I didn’t have to sign (physically or electronically) multiple different “attestations,” I didn’t have to generate multiple …

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An American ER doctor in Tasmania

Meaningful treatments in the battle against coronary disease

Eric Van De Graaff, MD

Conditions and Diseases

January 16, 2012

I saw a patient in my office this week who had received a stent from one of my partners last month. The man was highly satisfied with his experience—the procedure was tolerable, the recovery short, and the nurses were pretty (he specifically made a point of this, presumably because the post-hospitalization customer surveys don’t include what seemed to him to be the most important feedback metric)—but his wife had a …

Robotics can revolutionize the delivery of medical care

Stephen C. Schimpff, MD

Health Technology

January 16, 2012

Robotics has the potential to revolutionize the delivery of healthcare. It can help extend the delivery of information, expertise and clinical care across time and geographical space barriers. Robotics offers the opportunity to enhance quality of care through extension of clinical expertise and leveraging of integrated datasets and best practices. It can be used across the continuum–from the hospital setting (e.g. OR, ER, etc.) into primary care offices and even …

Is it ethical to prescribe a placebo for a patient?

Jim deMaine, MD

Medications

January 11, 2012

Betty was complaining at an escalating rate. She’d been in her nursing home for four years and wasn’t happy. She kept coming up with new symptoms like aching, fatigue, nervous stomach, tingling, dizziness, etc. Her daughter Nancy was getting daily calls from Betty and the staff at the nursing home. Multiple trips to the doctor for diagnostic tests had ensued: blood counts, liver functions, x-rays, thyroid function, plus many others. …

Birth control and cancer: What you should know

Helen Rhodes, MD

Conditions and Diseases

January 10, 2012

Does your birth control pill put you at risk for cancer? Or, does it actually protect you from the disease? Recent headlines might have you wondering.

Here’s what we do know: oral contraceptives — better known as the pill — may impact a woman’s chances of developing breast and gynecologic cancers. In some cases, that means a bigger chance of cancer. In others, it means protection against cancer.

The reason? Most oral …

MKSAP: 67-year-old man with confusion, agitation, and malignant hypertension

mksap

Conditions and Diseases

December 31, 2011

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

A 67-year-old man is evaluated in the emergency department for confusion and agitation secondary to malignant hypertension. Initial blood pressure is 230/130 mm Hg, and funduscopic examination reveals papilledema.

He is admitted to the intensive care unit, and therapy with nitroprusside by continuous infusion is begun; the …

Human papillomavirus and the risk of oropharyngeal cancer

Dr. Frederick

Conditions and Diseases

December 29, 2011

Cancers of the tongue and throat, all categorized as oropharyngeal cancers, are appearing at an epidemic rate.

The old paradigm is that such cancers most often occur in older men who drink and smoke. But this is no longer true. Now the most common cause of cancer of the tonsil and tongue is human papillomavirus (HPV). That’s right, the sexually transmitted disease. And it is occurring in ever younger people …

Abbreviate your med list with caution

WarmSocks

Medications

December 23, 2011

People who regularly take medicine should know what we’re taking. To me, this seems obvious, but there are always those who need everything stated explicitly. People taking prescriptions, vitamins, herbs, and any other treatments should know what’s being taken and why.

It’s pretty easy to make yourself a list and stick it in your wallet so that it’s always available. If you need medical assistance (for instance, if you’re in a …

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Abbreviate your med list with caution

Why I vaccinated my sons against HPV

Orly Avitzur, MD

Medications

December 21, 2011

I knew it was more than a tragic coincidence when two of my friends, middle-aged men without the usual risk factors of tobacco and alcohol use, developed late stage (IV) tongue cancer, reportedly the identical condition with which actor Michael Douglas was diagnosed last year. Cancers of the mouth and throat are growing so quickly that experts in the medical and scientific community are calling this an “epidemic,” for which …

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Why I vaccinated my sons against HPV

Vaccines, preventable disease, and the nature of risk

Danielle Rosenman, MD

Medications

December 20, 2011

Two nights ago, I was watching, with my family, an old episode of Dr. Quinn, Medicine Woman, in which a young woman is bitten by a rabid wolf, develops rabies, and dies. That same night, I read a post on Facebook decrying the dangers of immunizations, with a link to an online “news” article blaming immunizations for everything from spreading cancer to HIV.

My mother, as a girl, was bitten by …

How medications are like vehicles

Stewart Segal, MD

Medications

December 15, 2011

I usually cringe when I see a pharmaceutical company ad on TV. I think most pharma commercials do more harm than good. The ads scare patients out of taking medications they need.

Actor: Do you have uncontrollable diarrhea? I did, and then my doctor prescribed “No-More-Poop!” Now I feel great and don’t have to worry about embarrassing accidents.

Commentator: Clinical studies done at a leading university prove that “No-More-Poop” cures 99% of …

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How medications are like vehicles

Taking the knife to doctor-drug company relationships

Nagarathna Manjappa, MD

Medications

December 15, 2011

With health care industry reaching unsustainable lows, media attention is on physician’s relationship with the pharmaceutical industry. A Google search will give results that paints doctors as culprits, leading to a prejudiced opinion where doctors are thought of as co-conspirators with drug companies. This article teases this tainted relationship, from a typical doctor’s perspective.

Pharmaceutical companies have strategies not only to survive, but also to grow with general public investing in …

The erosion of psychiatric training has consequences

Steve Balt, MD

Physician

December 11, 2011

One of my most vivid memories of medical school was during my internal medicine rotation, when it had become apparent to me that, despite spending my pre-clinical years studying complex pathophysiology and pharmacology, and the fine art of history-taking and the physical exam, the actual clinical work seemed to be more like a numbers game. I felt like I was always responding to a data point: a blood pressure reading, …

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