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.

FDA regulation, and off label use of atypical antipsychotic drugs

Jan Henderson, PhD

Medications

April 7, 2011

Abilify, Seroquel, Zyprexa, Risperal – these are among the atypical antipsychotics for which Americans paid $10 billion in 2008. $6 billion of that was for off-label use.

The FDA only approves drugs when their safety and efficacy have been tested for specific conditions. For example, an antipsychotic might be approved for the treatment of schizophrenia. When it’s prescribed for anxiety or depression, that’s …

How the reformulation of Oxycontin has affected patients

Christian Sinclair, MD

Medications

April 7, 2011

Having a healthy level of respect for opioids is critical for any physician. For those of us who prescribe or recommend this class of medicines on a daily basis, this statement rings all the more true. Recent events and research reinforce this reality.

“Oxycontin, Other Opioid Painkillers Tied to Higher Health Risks” was the title of a recent BusinessWeek …

Should doctors give more Oxycontin to chronic pain patients?

Kevin

Medications

April 6, 2011

by Christopher, BA

We all know of the folly “Just Say No” as it just does not work. I disagree that a physician should ignore the requests of her or his patients, based solely on the perceivable abuse of the drug Oxycontin.

This is an opiate that works wonders for patients in chronic pain situations, …

Potassium iodide won’t protect you from nuclear reactor radioactive isotopes

Derek Lowe, PhD

Medications

April 6, 2011

Well, the nuclear crisis in Japan seems to be causing a run on potassium iodide (KI), and not just in Japan.

If news reports are to be believed, people in many other regions (such as the west coast of the US and Canada) are stocking up, and some of these people may have already started dosing themselves.

Don’t do that. Don’t …

Overuse of heart stents and the response of Abbott Labs

Joe Flower

Health Policy

April 5, 2011

“Someone needs to take this writer out and kick his ass.”

The quote leaped out at me from a New York Times article.

Now, maybe I’m a little sensitive about using physical threats to try to silence writers, since I am a writer. Maybe I am especially sensitive about threatening to kick someone’s ass for writing about healthcare. To my eyes, the quote stood out as emblematic of the tumor …

Treatment of chronic pain puts doctors in a no win situation

Edward Pullen, MD

Physician

April 4, 2011

First do no harm.

Treat every patient with respect and dignity.

These are values I try to live by and incorporate into my daily work. Treatment of chronic pain is the scenario that puts me and every practicing primary care physician in a no-win situation regularly in the office. To try to make physicians feel more comfortable treating pain most states have tried …

How academic physicians are being used as live bait for journalists

Larry Husten, PhD

Physician

April 3, 2011

Here’s something little known outside of the small circle of industry marketers, academic docs, PR flacks, and medical journalists: pharmaceutical and device companies (or their PR agencies) regularly offer to arrange interviews with well-known academic physicians to talk about new trials, drug approvals, and other items of obvious interest to the companies involved.

I receive these sort of invitations all …

Cannabis use and medicine, the debate over benefits and harms

Kevin

Medications

March 22, 2011

An excerpt from Uses and Abuses of Plant-Derived Smoke: Its Ethnobotany as Hallucinogen, Perfume, Incense, and Medicine.

by Marcello Pennacchio, PhD

Few plants have generated as much debate and controversy as cannabis (Cannabis sativa).

Throughout the ages, it has been labelled both a dangerous drug and potent medicine. Where the former is concerned, law-enforcement agents and governments spend millions …

What to do with a prescription bottle with the wrong pills inside

Stephen Meyers, MD

Medications

March 22, 2011

Have you ever opened a prescription bottle to find the wrong pills inside? If so, you may have found it to be an expensive mistake.

Whatever the reason for the error (and there are numerous possible causes), here is how to best handle the situation.

Of course, it is always smart to confirm the medications, quantities and dosages at the pharmacy checkout. A mistake recognized at the time of purchase can be easily …

Alternative medicine problems patients need to know about

Alex Lickerman, MD

Medications

March 14, 2011

Americans spend an astounding 34 billion dollars on alternative medicine annually. Given that so many of us put our faith in alternative care, I wanted to clear up some common misconceptions about it to help people make wiser choices when and if they turn to it.

What is alternative medicine?

In general, alternative medicine is used to describe practices outside the bounds of conventional medicine. …

ASA addresses drug shortages to ensure patient safety

Kevin

Medications

March 14, 2011

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

by Arnold J. Berry, MD, MPH

Drug shortages continue to impact patients across the nation. Over the past year, anesthesiologists have been faced with the challenge of finding alternatives for several unique drugs needed to safely provide anesthesia for patients having surgical, diagnostic or therapeutic procedures.

Anesthesiologists have …

Taking Chantix to help smokers quit may be worth the risk

Michael Aaronson, MD

Medications

March 10, 2011

I decided to dedicate a medical blog on smoking cessation after realizing that too many people in Douglas County (Omaha, Nebraska) smoke. Did you know that despite a smoking ban in restaurants and bars, 18.3% of people in Nebraska are smokers? That’s one in five people. And this number contributes to Omaha’s health ranking of 142 out of 182 cities in …

Successfully appeal an insurance company reviewer decision

Nicholas Fogelson, MD

Physician

March 7, 2011

Coverage requests get rejected when the requested service does not fit within an insurance company’s initial guidelines for approval.

This happens for a number of reasons, but usually it comes down to poor documentation or inappropriate care, or in some cases care that is appropriate but can’t be supported in the literature. When a denial occurs, the physician or patient has several opportunities to appeal this decision. The first appeal is …

A primer on brand name drugs and generics

Aaron E. Carroll, MD

Medications

March 7, 2011

That there are some serious misunderstandings out there about the difference between name-brand drugs and generics, as well as some bizarre assumptions about the merits of newer drugs. So here’s a quick primer on how you (and everyone else) are sometimes not getting accurate information about your pharmaceuticals.

As a society, we’re addicted to drugs. Almost all of them are legal, and we’re not abusing them per se, but we want …

Strategy and support is needed to quit smoking

Erin Marcus, MD

Conditions and Diseases

February 11, 2011

Tobacco is the single biggest cause of preventable death and disability in the United States. But nicotine is highly addictive, and quitting the cigarette habit can be extremely tough.

L.J., a 55 year old man who gave up smoking after 35 years, proves that it can be done. In L.J.’s words, he was “sick and tired of being sick and tired.” But he didn’t do it alone; his success depended on …

Medication lists need to be shared in a meaningful way

John Halamka, MD

Medications

February 11, 2011

Recently, I spent a few days in California when both my parents ended up in the hospital with different issues. They’re home, settled and doing well at this point.

Just as when I first wrote about experiencing healthcare with my family, there are important lessons to learn about this trip.

As we strive to achieve meaningful use and create health information exchange in the US, the …

Does screening and treating high cholesterol save money?

Richard Young, MD

Conditions and Diseases

February 10, 2011

A commenter (I believe a physician) on one of my posts wrote the following: “I can prevent heart attacks and strokes (caused by atherosclerosis – “blockage”) in people (minimal cost) who have no symptoms. If I wait for their heart attack or stroke – it costs a whole lot more.”

The implication is that screening and treating high cholesterol saves money in the long run. Unfortunately, the truth is the opposite. …

Tips to help patients save money on prescriptions

Leslie Ramirez, MD

Medications

February 9, 2011

As a primary care doc, I have compiled several tips to help patients save money on prescriptions.

All the prices quoted in the following examples are from Costco.

1. Patient assistance programs (PAP). Try to get free meds from the pharmaceutical company that manufactures your medication. Most of the time this service is only offered if there is not a generic available for your medicine. I heartily recommend you check out NeedyMeds.org and …

ProPublica’s Dollars for Docs: Strengths and weaknesses

Daniel J. Carlat, MD

Medications

February 6, 2011

The non-profit media organization ProPublica last year announced a new website/database called Dollars for Docs. It lists cash payments made to 17,000 U.S. doctors by seven large drug companies.

I’ve been browsing through the database and I have some thoughts about its strengths and weaknesses—and how it might be useful for patients.

First, here’s what these journalists did. Rather than waiting for the provisions of the Physician’s Payments Sunshine Act …

A stent anecdote from a former FDA Associate Commissioner

Kevin

Physician

February 4, 2011

by Peter J. Pitts

As the saying goes, the plural of anecdote isn’t data. That is unless the anecdote supports your theory. Here’s a personal anecdote — a story of how the system works.

Being adopted, I have no family history, so when I suffered through some late night chest pains I figured I’d better act on the warning signals. I called my GP and got a same-day consultation, resulting in a next-day referral …

Medications and Prescribing

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