by Marianna Rakovitsky, RPh
Recently, I have talked about the concerns with the use of NSAIDs and their effects on the heart. All medications carry a risk of adverse effects. NSAIDs are usually very effective in controlling pain especially muscle and bone pain, but they also carry a potential risk of side effects such as stomach and kidney problems, increased risk of bleeding and adverse effects …
Alternatives to NSAIDs, pros and cons
The approval of dabigatran (Pradaxa) has been long awaited in the cardiology community. Although just about everyone agrees that a good alternative to warfarin is highly desirable, there are many remaining questions about the drug as it prepares to enter the marketplace.
Here are a few questions raised by electrophysiologist John Mandrola on his blog:
Dabigatran (Pradaxa) questions in atrial fibrillation
The other day, I happened to be talking to Mark, a sales representative from one of the pharmaceutical companies. He’s the type of rep that many doctors don’t mind seeing – someone who is careful of your time, is happy to hunt down the answers to questions that come up on the medications his company makes, and brings by useful information about new drugs that seem to be practice-appropriate. He …
FDA regulation and non-approved use of drugs
Antibodies are complex proteins created by immune cells that are targeted to very specific parts of other large and complex molecules called antigens.
Much smaller molecules like nicotine, called haptens, do not normally induce any significant immunologic response so researchers chemically bound several nicotine molecules to a large protein to form an adduct. This combined molecule does induce an immune response, i.e, causes immune cells to produce antibodies targeted to the …
Nicotine vaccine to treat tobacco abuse and nicotine addiction
An excerpt from White Coat, Black Hat.
by Carl Elliott
Many of us have a relatively simple, commonsense view of the way that drug development and marketing work.
People get diseases; scientists develop drugs to treat those diseases; and marketers sell the drugs by showing that the drugs work better than their competitors. Sometimes, however, this pattern works in reverse. Drug company scientists develop a drug …
Create a disease to market a new drug
An excerpt from Tabloid Medicine: How the Internet is Being Used to Hijack Medical Science for Fear and Profit.
by Robert Goldberg, PhD
From the beginning, there were two problems with the connection between thimerosal and autism. The first problem with was that thimerosal, while about half mercury, contains ethyl mercury, for which there were no exposure guidelines. So the scientists used the ones for methyl mercury. However, the ethyl mercury …
Problems with the connection between thimerosal and autism
Many people are already aware that marijuana is now legal in some states in the US with a medical prescription.
What many people may not realize is that cocaine is also used in medical care, especially in the ENT world.
Cocaine is one of the most potent anesthetic and vasoconstrictor. These two characteristics make it an ideal medication for use during sinus surgery as well as any nasal procedure where bleeding and …
How cocaine can be used in sinus surgery
Hold onto your hats. I am about to enter dangerous territory. I am about to suggest maybe doctors should profit from dispensing medications from their office to offset declining reimbursements and rising expenses by using prescriptions as a source of ancillary revenues.
Why dangerous? For a number of reasons.
One, physicians still grapple with the perception that it is improper for a physician to make money from …
Why doctors should profit from dispensing medications
Most parents and all pediatricians are aware of the 1998 study published in The Lancet by Dr. Andrew Wakefield that mentioned a causal link between measles, mumps, rubella (MMR) vaccine and the increased incidence of childhood autism. It shook the medical community and created an international movement of parents questioning the extensive combination of immunizations that are given to children. Could these immunizations be the cause of the increase in …
How the vaccine and autism scare was a fraud to make money
“What do you think of medical marijuana?” my mother, who has never smoked a thing in her life, of the tobacco or cannabis variety, asked me one day as we drove through beautiful upstate New York woods. We had just passed a sign saying “We will destroy your crops,” with a marijuana leaf beneath. “It has its place,” I said. “No reason to be against it.” “But isn’t marijuana a …
Legal tobacco and illegal marijuana are historical accidents costing billions
by John Horton
When the FDA was created in 1906, not even Nostradamus could have predicted the medical advances that would come to extend and improve our lives: childhood vaccines, insulin, and the use of lasers in surgery were all unimaginable a century ago.
While many future advances are beyond our imaginations’ reach, it seems certain that the advances in biologics — medicines made from living organisms — will stand out as …
The safety of biosimilars and FDA regulation
I have a patient who I will call Antonia.
Antonia is in her early 70’s. She came to the United States from Guatemala many years ago, but never learned to speak much English. This doesn’t cause her much of a problem; her community is small and tightly-knit, so she doesn’t have much need to speak English in her home or her neighborhood. And she has a large family—children and grandchildren and …
Start thinking about health literacy in a broader framework
Doctors today are wary about treating chronic pain.
One of the main worries is precipitating fatal opioid overdoses. Indeed, according to the CDC, and reported by American Medical News, “fatal opioid overdoses tripled to nearly 14,000 from 1999 to 2006 … [and] emergency department visits involving opioids more than doubled to nearly 306,000 between 2004 and 2008.”
Requiring chronic pain patients to sign pain contracts is a way to mitigate this risk.
But …
Pain contracts threaten the doctor-patient relationship
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As a kid I had allergies and asthma.
Because of this, for several years, my mother wrote a note excusing me from the 600 meter run in elementary school. My father took me to weekly allergy shots. At times I had eczema on my forearms and eyes, and according to my allergist, whose notes I later read, I had moderate allergic shiners (also known as dark circles under my eyes). My …
Lessons learned from asthma therapy
There is a lot of press about a study recently published in the New England Journal of Medicine that shows that adding tiotropium (Spiriva) to an inhaled steroid might have benefit in asthmatic patients. This study is creating a lot of buzz due to recent concerns of ICS/LABA safety and might prompt doctors and patients to start switching (some already have before this study came out). However, this …
Adding tiotropium (Spiriva) to an inhaled steroid a mistake?
Part 3 of a series. Please read part 1, DTC advertising, and its history with the FDA, and part 2, Economic and commercial impact of DTC advertising.
In the first two parts of this article, we explored the historical and legal contexts of direct-to-consumer (DTC) advertising, the effects of these ads on prescribing behavior, and the economic incentives to advertise.
In this final installment, we will …
Minimize the potentially harmful effects of DTC advertising
Last year, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients’ lives.
And it has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked. This statistic is from a 60 Minutes story on “The Cost of Dying” and …
The cost of keeping the terminally ill alive
by Daphne Swancutt
Two people in the United States just died in the last hour. Seventeen more will die in the next 7 to 8 hours. Over a year, that number will accumulate to about 7,000.
The reason? Medical errors that include misread or otherwise misinterpreted handwritten prescriptions. Believe it. This means that doctors are being sloppy, pharmacies are making mistakes and people are getting dead.
Even more …
Medical errors that involve handwritten prescriptions
About 60% of patients suffering from depression do not find any benefit from their first antidepressant. Up to 20% of patients find depression impossible to overcome even after 1 year. Assertive treatment of depression from the get go is essential to helping recover from depression.
Psychiatrists don’t have a shared definition of treatment resistant depression. However, most would agree that your depression may be treatment resistant if it has not resolved …
Solving treatment resistant depression
New medicines are like new fashions in clothing. They are introduced with great fanfare. Most turn out to seem fairly ordinary after a few years. Some are quickly forgotten or discarded and make us say: “What was I thinking?”
Evaluating a new drug is difficult, for the pharmaceutical and scientific communities as well as for us clinicians. It often takes years of general use before a drug can really prove its …
Evaluating a new drug is difficult for the pharmaceutical community
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