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.

Tricks for helping patients save money on prescriptions

Leslie Ramirez, MD

Medications

December 8, 2010

As a primary care doctor, I have figured out many tricks for helping patients save money on prescriptions. Some of them I am sure you have never heard of, and others, well — you might have, but they bear repeating.

All of the prices quoted here are from Costco, unless otherwise specified.

1. Price compare between pharmacies. Can’t stress enough the potential differences in medicine prices between pharmacies. Generic medicine prices vary more than branded/trademarked …

How the pharmaceutical industry changed psychiatry

Jan Henderson, PhD

Medications

December 3, 2010

What’s happened to psychiatry over the last 15 to 20 years? That’s a big subject, discussed in many recent and excellent books. One of those books is by Daniel Carlat, author of Unhinged: The Trouble with Psychiatry – A Doctor’s Revelations about a Profession in Crisis.

One of the problems Carlat readily acknowledges is that psychiatry is excessively focused on psychopharmaceuticals at the …

MKSAP: 70-year-old woman with hypothyroidism and a fractured hip

mksap

Conditions and Diseases

December 2, 2010

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

A 70-year-old woman with hypothyroidism fell and fractured her hip. During preoperative evaluation for hip fracture repair, she mentions recent mild fatigue, which has not significantly limited performance of her daily activities, and ongoing right upper-quadrant abdominal pain after eating. She takes levothyroxine, 0.075 …

Conspiracies against vaccines: Blame the media

Jennifer Gunter, MD

Conditions and Diseases

December 1, 2010

How did the idea that vaccines are dangerous, toxin-filled CDC experiments metastasize so quickly from the fringe to the mainstream?

Keep in mind that not only have vaccines been scientifically proven to be safe, but that some of the arguments against vaccines are so scientifically incredulous they are the equivalent of saying there is a UFO sitting in Central Park right now.

So let’s begin at the beginning. In 1998 Andrew Wakefield …

Antibiotics need to become controlled substances and regulated

WhiteCoat, MD

Medications

November 29, 2010

Antibiotics for viral infections are a big pet peeve of mine. No. Make that a huge pet peeve.

Some doctors prescribe antibiotics for coughs and stuffy noses because the patients want them. If you’re one of those patients who think that antibiotics make your coughs go away, or clear up your stuffy noses, or somehow make your sinus headaches vanish, or if you’re a doctor who prescribes antibiotics for these symptoms, …

Electronic health records (EHR) to improve medication compliance

Robert Rowley, MD

Health Technology

November 29, 2010

A recent report in the Annals of Internal Medicine on the characteristics of prescriptions that are abandoned at the pharmacy raise the question of (1) how to ensure that people actually pick up their prescriptions, and (2) how to make sure that people actually take the medications that are prescribed.

What role does modern Electronic Health Record (EHR) technology play in this question?

A study by the non-profit New England Healthcare Institute …

Ethics of placebo in cancer treatment clinical trials

Wendy S. Harpham, MD

Conditions and Diseases

November 27, 2010

The New York Times recently ran an article tackling a complex ethical dilemma in cancer care: the withholding of treatment in clinical trials. Because I was treated in 3 clinical trials in the 1990s, the topic is close to my heart.

Scientists have advanced the treatment of disease using the scientific method. By that, I mean they have tested a theory using rigorous methods that give a reliable and reproducible answer. This …

Concerns about long term acid suppressive therapy

Chris Rangel, MD

Medications

November 26, 2010

Physicians hate acid. But, hey, who doesn’t hate acid? It burns things. It corrodes. It’s that after-pizza punishment.

We prescribe antacid medications by the ton in this country, not because people’s stomachs have developed increased acidity, but because people in our modern society are generally overweight, like to eat large meals, and prefer fatty foods and things like alcohol, chocolate, and tobacco, all of which tend to worsen acid reflux.

Physicians like …

Penicillin and the Cocoanut Grove fire in Boston

MedPage Today

Medications

November 24, 2010

by Nancy Walsh

The recent report of the deliberate infection of Guatemalans with syphilis in the 1940s to see if penicillin could cure and prevent transmission of the disease was a reminder of just how short the time has been since most infectious diseases were untreatable. Penicillin — discovered by Scottish biologist Alexander Fleming in 1928 but not available for clinical use until the 1940s — …

Drug reps know what doctors are prescribing

Kevin

Medications

November 24, 2010

An excerpt from White Coat, Black Hat.

by Carl Elliott

[Michael] Oldani worked as a rep in the late 1980s and the 1990s, a period when the drug industry was undergoing key transformations. Its ethos was changing from that of the country-club establishment to the aggressive, new-money entrepreneur.

Impressed by the success of AIDS activists in pushing for faster drug approvals, the drug industry increased pressure …

Routine use of sleep medication for children

Claudia M. Gold, MD

Medications

November 21, 2010

A recent study published in the journal Sleep Medicine revealed that most child psychiatrists prescribe medication for sleep at least once a month, despite the fact that no sleep medications are approved for use in children. The study was funded by Sanofi-Aventis, makers of Ambien.

Managing sleep is one of the greatest challenges of being a parent. It represents the first major separation and can be fraught with complex ambivalent feelings. …

Quinine, artemisinin and our debt to traditional medical healers

Kevin

Medications

November 20, 2010

An excerpt from Sustaining Life: How Human Health Depends on Biodiversity.

by Eric Chivian, MD and Aaron Bernstein, MD

Ethnobotany, that is, the scientific study of the use of plants by native cultures, including their use as medicines, can be said to have begun with Carl Linnaeus, who in the 1730s published Flora Lapponica, his detailed account of plant use by the Lappish, or Sami, people, …

Side effects of medication sometimes confuse patients

WarmSocks

Medications

November 14, 2010

Side effects. Every medication has them. Some are mild, some are annoying, and some are downright dangerous.

When doctors write a prescription, they mention that some people experience side effects, and if certain bizarre things happen, the patient should phone the doctor.

How do we keep track?

If you get one antibiotic to take for two weeks, it isn’t so hard. First, because it’s for a short time period, and also because it’s …

Help patients synchronize their prescription drugs

Michael Aaronson, MD

Medications

November 12, 2010

Here’s the scenario: on the 2nd of the month, a patient with diabetes on metformin and high blood pressure on benazepril sees her family physician for a routine follow up.

The patient’s blood pressure is elevated and the decision is made to add carvedilol to help get the blood pressure to goal. The patient’s metformin and benazepril “drop” (are renewed) at the pharmacy on the 18th of every month, a date …

Uninsured Americans cannot afford many medications

Brad Wright, PhD

Health Policy

November 9, 2010

I went to the doctor recently and got a new prescription.

The doctor was kind enough to give me some free samples, and a voucher that I could redeem to fill the prescription once at no cost. In the future, it will cost me $50 if I decide to refill it. If I didn’t have pharmaceutical benefits through my insurance coverage, the medication would set me back about $500 for a …

Avandia, Actos and behind the scenes of study 175

Matthew Mintz, MD

Medications

November 7, 2010

Though I am not going to say that the New York Times lied, they either purposely and grossly misrepresented the truth or did a horrible job of reporting.

In their article, “Diabetes Drug Maker Hid Test Data, Files Indicate” the Times states that Avandia maker GSK “secretly began” a study which “provided clear signs that it (Avandia) was riskier to the heart.”

In fact, the study in question, called study …

Economic and commercial impact of DTC advertising

Ishmael Bradley, MD

Medications

November 5, 2010

Part 2 of a series. Please read part 1, DTC advertising, and its history with the FDA.

In the first installment, we looked at the history behind consumer advertising of prescription drugs. We also explored the concept of commercial free speech and why this form of advertising is legal. To fully appreciate the controversy about direct-to-consumer (DTC) advertising, we must now examine the commercial effects of these ad campaigns. …

Blockbuster drugs are an addiction for Big Pharma

Richard Meyer

Medications

October 30, 2010

Blockbuster drugs. They are, to this day, an addiction for big pharma. A blockbuster can produce a huge ROI and fund the development of new drugs and new marketing programs but today the deck is stacked against blockbuster drugs.

The healthcare environment today is one in which cost containment is a key element. In the next few years a lot of blockbuster drugs are going to come off patent including Lipitor, …

How an antidepressant can hurt your patient

Dheeraj Raina, MD

Medications

October 27, 2010

Patients want a quick fix. Society wants patients to have a quick fix, so that they can quickly return to their usual performance at work and home.

Patients still have shame about seeking help from a psychiatrist or other mental health professional. So they ask help for their depression from their primary care physician. The PCP feels an emotional pressure to provide the quick fix in that 15-minute appointment – the …

Arimidex price markup at major pharmacy chains

Leslie Ramirez, MD

Medications

October 22, 2010

The commonly prescribed breast cancer drug, Arimidex, was released as a generic in June 2010. The generic name is anastrozole. I called several local pharmacies last week to find out how much this medicine would cost for a one-month supply. I found some very surprising results:

Costco: $27

Walgreens (with Saver Card): $325 (without Card): $380

CVS: $361

Walmart: $347

Target: $340

These are not typos. Costco is selling a one-month supply of generic Arimidex for $27, …