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.

Options when your drug copays are too expensive

Leslie Ramirez, MD

Medications

July 25, 2011

You have insurance and, supposedly, it covers your medicines. However, you still get stuck with a portion of the bill that the insurance company calls a “copay.” In some cases these copays can run more than $150/ month per medication (e.g. Enbrel). If you are on more than one of these expensive, branded medications the copays can really add up. What are your options?

1. Generic alternative. Always ask your doc if there …

Current psychiatric drugs are only marginally effective

Steve Balt, MD

Medications

July 23, 2011

The scientific journal Nature ran an editorial recently with a rather ominous headline: “Psychopharmacology in Crisis.” What exactly is this “crisis” they speak of? Is it the fact that our current psychiatric drugs are only marginally effective for many patients? Is it the fact that they can often cause side effects that some patients complain are worse than the original disease? No, the “crisis” is that the …

Neurotransmitters and the side effects of antidepressants

Dheeraj Raina, MD

Medications

July 22, 2011

We certainly wish that antidepressants in particular, and all psychiatric medications in particular were free of side-effects. It would be a boon to our patients, and their families. Sadly, there is no such thing as a medication without any risk of side-effects. Even over-the-counter medications such as Tylenol, Benadryl an aspirin can have pretty serious side-effects.

Some side-effects of medications are related to dose — the higher the dose, the …

Vaccines on the horizon and vaccine economics

Stephen C. Schimpff, MD

Medications

July 19, 2011

What else is on the horizon? There is progress to develop vaccines to control addiction to both nicotine and to opioids. Vaccination may be the best route to get control of the bacteria having a major impact on methicillin resistant Staphylococcus aureus (MRSA) and other highly pathogenic antibiotic resistant bacteria that have become endemic in hospital ICUs.

A vaccine for dengue is likely within the next five years. The World Health Organization …

Vaccines in the developing world

Stephen C. Schimpff, MD

Medications

July 15, 2011

When we think of vaccines we need to divide the world into the industrialized countries, those with transitional economies and the developing countries.

In the developing world, the proportion of the population less than 15 is very high, e.g., Mali has about 50% of its population under age fifteen compared to about 15% in the industrialized countries. This suggests that the emphasis in the …

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Vaccines in the developing world

Medical marijuana in psychiatric illness

Christina Girgis, MD

Medications

July 9, 2011

Recently, 16 states and Washington DC have legalized medical cannabis.

An additional 10 states have pending legislation. With all the attention legalized medical marijuana has been receiving, patients have started asking if they are candidates for a prescription. Well, my answer is easy. Right now it is not legal in Illinois, although it is one of the states that is pending. Even if it does become legalized, I …

Using genomic data to understand disease entities

Douglas Elwood, MD, MBA

Medications

July 5, 2011

Three recent studies point to the continued presence and increasing importance of genomic information to improving health care.

We have discussed the power of personalized medicine in multiple posts and highlighted the potential of genomics and though this movement is really still in its infancy it is a burgeoning component of medicine.

The first study, published in the American Journal of Gastroenterology, explores Helicobacter pylori, a common …

What do hospice nurses and teenage heroin addicts have in common?

Richard Barager, MD

Medications

July 1, 2011

What do hospice nurses and teenage heroin addicts have in common? One may be an unintended consequence of the other.

A pair of articles published recently in two prestigious medical journals help make the case.

The Lancet reported that 47 million of the 58 million deaths occurring annually worldwide take place in developing countries, and that of these, fully 27 million die without having received proper palliative care. The article attributes …

Pharmacies selling prescription information to data mining companies

David Harlow

Medications

June 30, 2011

Walgreens is being sued by customers who are not happy that their prescription information – even though it has been de-identified – is being sold by Walgreens to data-mining companies.

The data privacy and security concerns surrounding the transfer of de-identified data are significant. To “de-identify” what is otherwise protected health information under HIPAA, some outfits will simply strip data of 18 types of identifiers listed in federal …

The tragic irony of pharmaceutical coupons

Chris Lillis, MD

Medications

June 24, 2011

As a primary care physician in private practice, I have my own little taste of celebrity.

Every day attractive people come to my office seeking time to speak with me and collect my autograph. They fawn over my partners and I, and bring us food for lunch, and will invite us to the nicest restaurants in town for dinner. These people also used to bring gifts, until they were barred from …

Bias in top tier academic journals

Derek Lowe, PhD

Medications

June 23, 2011

Venture-capital guy Bruce Booth has a provocative post, based on experience, about how reproducible those papers are that make you say, “Someone should try to start a company around that stuff”:

The unspoken rule is that at least 50% of the studies published even in top tier academic journals – Science, Nature, Cell, PNAS, etc… – can’t be repeated with the same conclusions by an industrial lab. In …

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Bias in top tier academic journals

The future of vaccines for infectious diseases

Stephen C. Schimpff, MD

Medications

June 23, 2011

In concert with sanitation and clean water supplies, vaccination has been the most cost effective means of preventing infectious diseases.

Most vaccines have been inexpensive, easy to administer (albeit objected to by the recipient’s arm!), safe and effective. From when I was a child until today the number of new vaccines has multiplied dramatically. This will only continue at an accelerated pace in the coming years. In the future many …

How switching from brand name drugs to generics is sometimes absurd

Paul Sax, MD

Medications

June 16, 2011

I had an interesting exchange with one of our nurses recently about a long-term patient of ours.

The e-mails went something like this:

Got a fax from —-’s insurance that his Lipitor won’t be covered anymore. They will cover simvastatin, lovastatin, and pravastatin. Let me know what you want to do.
Charlie

He’s on darunavir, and all three of those statins are contraindicated because of drug-drug interactions. Rosuvastatin?
Paul

Checked with them — rosuvastatin needs …

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How switching from brand name drugs to generics is sometimes absurd

The accidental genius of homeopathy thrives

George Lundberg, MD

Medications

June 16, 2011

All thoughtful physicians I know consider the historical theory and philosophy of homeopathy to be rubbish, balderdash, preposterous, BS, or, politely, NOT PLAUSIBLE; thus, not even worth testing for safety and efficacy.

Then, why, when one asks Mr. Google by entering … Homeopathy … and clicking, does one receive 9.9 million results?

And, why does the National Health Service of the U.K. continue to fund homeopathic hospitals, clinics, and treatments?

And why are …

Medication reconciliation brings the ER back to 1960

Chris Rangel, MD

Medications

June 14, 2011

What a blessing and a curse it must have been to practice medicine fifty years ago.

Most internists had only about twenty or so medications that they used regularly. It was a curse not to have effective medications to treat many common ailments but somewhat of a blessing not to have the modern medical nightmare of having patients on 15-20 chronic medications with all the logistical problems of keeping track of …

Why the word “drug” promotes a public bias in chronic pain treatment

Kevin

Medications

June 14, 2011

by Jack Cain

In the United States, there is a heated debate at all levels over the increased use of narcotic pain relievers, especially as part of a long-term treatment regimen for chronic pain. Part of that debate is fueled by the pejorative use of the term “drug” instead of “medication” in conjunction with the legal prescribing, dispensing and consumption of these substances.

Bias is …

The unintended consequences of medical marijuana

Emily Gibson, MD

Medications

June 10, 2011

It was 1978 and I was a third year medical student when my friend was slowly dying of metastatic breast cancer.

Her deteriorating cervical spine, riddled with tumor, was stabilized by a metal halo drilled into her skull and attached to a scaffolding-like contraption resting on her shoulders. Vomiting while immobilized in a halo became a form of medieval torture. During her third round of chemotherapy, her nausea was so …

Adult ADHD and academic performance in college

Emily Gibson, MD

Conditions and Diseases

June 8, 2011

‘Twas the week before finals and all through the dorm, few students were sleeping, since Adderall is the norm …

What is the state of academic performance and achievement in the age of adult ADHD?

Recent media publications feature “neuro-enhancement” sought by college students and stressed professionals through the use of prescribed and non-prescribed medications, particularly stimulants, to guarantee focus, concentration …

Cultural attitudes influence the benefit from stem cell therapy

Stephen C. Schimpff, MD

Medications

June 8, 2011

Embryonic stem cells are present after a fertilized egg divides for two or three days. They have the seemingly miraculous ability to turn into any of the tissue types in the body—whether brain neurons, beating heart cells, bone, or pancreatic islet cells. It is important to understand just where these cells come from.

Those used in science are …