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.

Let’s close the chapter on statin safety

John Mandrola, MD

Medications

December 6, 2011

There was important news recently on statin drugs. As one of the world’s most effective and commonly used medications, statins provide great writing topics. Lots of people have high cholesterol–including cyclists. Lots of people are interested in avoiding our mostly deadly disease.

I’d like to tell you about a recently-published landmark study in the Lancet that should quell safety concerns over statin drugs.

The punch line after I tell you the study’s …

Explaining Propofol to patients after Michael Jackson and Conrad Murray

John E. Vazquez, MD

Medications

December 1, 2011

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

Since the passing of Michael Jackson and the recent trial of his physician, Dr. Conrad Murray, I have been frequently asked by patients whether they will receive the drug that killed the singer. As have many of my anesthesiologist colleagues, I have taken this opportunity …

I eat lunch with drug company representatives and I’m proud of it

Stewart Segal, MD

Medications

December 1, 2011

Today, I want to review another article I wrote in last year. That article started with a confession: “I confessed that I ate lunch with a representative of a pharmaceutical company.”

I must now confess that I often eat lunch with representatives of pharmaceutical companies and I’m proud of it. At this stage of my career, I can well afford my own lunch. I could sit quietly and relax over a cup …

Delta Air Lines goes anti-vaccine

Natasha Burgert, MD

Medications

November 26, 2011

I have many, many patients and their families who are very active travelers. Business flights, vacation trips … some of you really rack up the miles.

It is with shock and disappointment that I must report; Delta Air Lines has made a very poor choice.

An ad, produced by the National Vaccine Information Center (NVIC), is currently being shown to passengers on Delta flights through the month of November. The ad encourages …

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Delta Air Lines goes anti-vaccine

How to talk with your teen about marijuana

Nelson Branco, MD

Patient

November 16, 2011

Adolescence is filled with challenges – at school, at home, with friends, on stage and in sports. Even their own body betrays them from time to time. Acne, hair, changing bodies and voices, parents, siblings and friends are all possible sources of gut-wrenching shame for a normal teen. Parents of teens have challenges too – and high on the list is the challenge of talking about important topics like sex, …

Can vaccine recommendations be based solely on individual and public health?

William Schaffner, MD

Medications

November 14, 2011

Have you heard the parable about the blind men and the elephant? Each is holding a different part of the animal and comes to a different conclusion about what he’s dealing with. The man holding the tail is sure it’s a rope; the one with the trunk fears a snake; the one holding the tusk is certain he has a spear. It’s all in their perspective. They’ll need to share …

How pain as a vital sign contributed to prescription pill mills

Alan Cato, MD

Medications

November 12, 2011

At this point, few would argue against the need for increased oversight of the legions of so-called pain management clinics that have sprung up in the past decade.

After all, an annually increasing majority of them are nothing more than lucrative cash and carries for the legal sale of prescription narcotics to anyone with a need or want — and the cash in hand. They have become a public mental health …

When FDA fines become the cost of doing business

Brian R. Jackson, MD

Medications

November 11, 2011

A recent $3 billion settlement between drug giant GlaxoSmithKline and the FDA really got me thinking. On one hand, it’s a breathtakingly huge number, breaking the old record of $2.3 billion set by Pfizer a couple of years back. And there are some initial indications that the pharmaceuticals may be cleaning up their act a bit, expanding their compliance departments, and reining in their sales forces in order to …

Quality of life issues in caring for cancer patients

Stephen C. Schimpff, MD

Physician

November 2, 2011

Not many years ago it was assumed that most cancers were not caused by viruses. Today it is clear that many are and the list is growing. Head and neck cancers are either caused by the environment (especially tobacco) or by the human papilloma virus, the same virus that causes cervical cancer and some genital warts.

The incidence of HPV-related head and neck cancer has been rising rapidly in the past …

How alternative medicine may have killed Steve Jobs

Michele R. Berman, MD

Conditions and Diseases

October 30, 2011

When they first discovered the tumor in his pancreas in October 2003, his doctors told him an immediate operation was necessary, and could lead to a cure.

As first reported by Peter Elkind in 2008, Jobs decided to think different, declined surgery, and explored alternative medicine treatments for his disease.

Nine months later, in July 2004, the tumor had grown. Only then would he allow his doctors to operate.

Would Steve Jobs be alive today had he consented to surgery when they first discovered …

Targeted therapies improve cancer treatment

Stephen C. Schimpff, MD

Medications

October 26, 2011

The revolution in medicine brought about by greater understanding of genomics has led to a number of targeted therapies in cancer care.

The basic concept is to first find the genomic change or mutation that leads to a disease, then learn its gene product and then develop a drug that inhibits the action of the aberrant gene product. The first was imatinib (Gleevec) for chromic myelocytic leukemia (CML.) When a …

Direct to consumer advertising works in correction facilities

Jeffrey Knuppel, MD

Medications

October 25, 2011

One might assume that inmates in correctional facilities would not be influenced by big pharma’s direct-to-consumer advertising (DTCA) strategies. After all, their communication channels with the outside world have largely been silenced.

However, many do have access to television. And despite an increase in online pharmaceutical marketing, TV remains a common medium for trying to persuade patients to “ask your doctor” about drug X. Inmates also read magazines, another common …

The safety of approved drugs needs to be closely watched

Naomi Freundlich

Medications

October 21, 2011

Over the past decade or so, there have been at least 20 prescription drugs removed from the market, including several cases of high-profile blockbuster drugs that were found to be harmful only after millions of patients had taken them. Vioxx, the pain reliever sold by Merck is one example; taken by an estimated 20 million Americans, it increased the risk of heart attack and stroke in some patients. The company …

How can pharma earn the trust of patients?

Richard Meyer

Medications

October 20, 2011

Never in recorded history have Americans been more distrustful of how the U.S. government spends its money. According to Gallup poll, Americans on average say that the federal government wastes 51 cents of every tax dollar, the highest level ever recorded since the poll was first taken in 1979. DTC marketers should understand that this mistrust is also leading to mistrust of marketing and advertising as well as big …

tPA is the standard of care for stroke but with significant risks

Charles A. Pilcher, MD

Conditions and Diseases

October 17, 2011

Under current guidelines from the American Stroke Association, tissue plasminogen activator (tPA, commonly known as a “clot buster” drug) should be administered within 3-4.5 hours of “last seen normal” – and 1 hour of patient arrival – to potentially ameliorate a new onset stroke. (“Last seen normal” means exactly what it says. A patient who went to bet at 10 PM and awoke with slurred speech at 6 AM was …

MKSAP: 60-year-old man with type 2 diabetes mellitus and hypertension

mksap

Medications

October 16, 2011

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

A 60-year-old man with type 2 diabetes mellitus and hypertension visits the office to establish medical care. He reports monitoring his blood pressure and blood glucose measurements at home with good results. He had a cholesterol panel checked approximately 5 years ago, at which time he …

Observing the Primatene Mist controversy as an asthma specialist

Paul M. Ehrlich, MD

Medications

October 8, 2011

As the clock ticks away on Primatene Mist, the only over-the-counter asthma inhaler left on the market, it is being ginned up as an argument against regulatory overreach by the Obama administration. I have been observing the Primatene controversy for decades as an asthma specialist. I have to say that there’s blame enough on many sides of this discussion, not just pro and con government regulation, but both the pharmaceutical …

Disease treatment progress will continue to be slow and painful

James Haddad

Conditions and Diseases

October 4, 2011

Recently, a friend sent me a text message with a rather conservative back-of-the-envelope calculation putting the number of lecture slides we’ve seen since October 2009 at roughly 41,000. That got me thinking: how many questions have I answered in that same time period?

Here’s the conservative estimate, not including quizzes, workshops, and miscellaneous other goodies: with roughly 100 questions per exam, an average of an exam every 3 weeks, and accounting for a few weeks …

MKSAP: 75-year-old woman with a sudden loss of vision

mksap

Conditions and Diseases

October 1, 2011

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

A 75-year-old woman is evaluated for a sudden loss of vision in the left eye that began 30 minutes ago. She has a 2-week history of fatigue; malaise; and pain in the shoulders, neck, hips, and lower back. She also has a 5-day history of mild …

Why medicine is not health

Anonymous

Medications

September 26, 2011

Being a physician certainly biases how I view the world around me. I can’t help but think in terms of problem-solving and healing. But have you noticed how medicalized our society has become? The other night watching television, we watched at least four drug commercials and one health insurance commercial — during a half-hour show! I believe we are in the middle of the medicalization of America, and I don’t …

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Why medicine is not health