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.
I am a medical doctor. I am also called an allopath, someone who practices “Western medicine.”
We allopaths like data, proof, science, randomized, double-blind, placebo-controlled trials. We want to know the “mechanism of action.” We want someone to prove that yoga or medication or some procedure actually helps your depression or blood pressure or back pain and that these treatments are safe before we prescribe them. We feel more confident about …
Read more…
Most doctors don’t like prescribing pills
After seeing Mrs. WhiteCoat argue on the phone with Medco representatives for 20 minutes about why one of her 80+ year old patients hadn’t received her medicine despite three lost faxes to Medco, I had to write this post to let the public know what is going on with some mail order pharmacies.
If you’re like most Americans, you want to try to save some money. One of the ways that …
Read more…
Mail order pharmacies have cheap prices, but also problems
Last year, I commented on the ironic sameness of ICU infectious diseases — that incredibly sick, complex patients entered the ICU with vastly different problems, then over time, seemed to converge, presenting similar kinds of clinical issues and management challenges for the ID doc.
Or, as a visiting medical student said to me, “My ICU attending said that every patient in the ICU should be on vancomycin and Zosyn.”
Which brings up …
Read more…
Empiric antibiotics in the ICU
I recently debated Steve DiFillippo, owner of Davio’s and Avila’s restaurants, on the WGBH program Greater Boston, hosted by Emily Rooney. The topic? The effect of the Massachusetts Gift Ban law on area restaurants.
On one level, it was a friendly debate on the economic impact of the law on those restaurants that depend on drug company sponsored dinners for a chunk of their income.
But on another level, this is a …
Read more…
Effect of the Massachusetts Gift Ban law on area restaurants
Recently while cleaning out my office in anticipation of my new job, I discovered that I had unknowingly been witness to an historic moment in child psychiatry. I found a binder from a course I had taken in June of 2001 sponsored by Harvard Medical School on Major Psychiatric Illnesses in Children and Adolescents.
Though I did not remember until I looked at my scrawled notes in the margins, on Saturday …
Read more…
Too many young children are medicated with powerful drugs
Vitamin D seems to be all the rage in medicine these days. A family physician colleague commented to me recently that the laboratory test for vitamin D deficiency is becoming the most frequently ordered test in his practice.
This clinical bandwagon is likely a response to data from multiple recent studies that found low vitamin D levels in the majority of children and adults of all ages. While vitamin D has …
Read more…
Treating vitamin D deficiency requires caution
There is no class of medications in the history of the world that has been better studied that statins.
This class of drugs is more properly termed HMG CoA reductase (3-hydroxy-3-methyl-glutaryl co-enzyme A reductase) inhibitors, but with a name like that a terser nickname is almost mandatory (the name statin comes from the suffix of the members of this class: lovastatin, pravastatin, etc.).
Simply …
Read more…
Statins for heart disease and stroke, and debunking statin myths
Cancer prevention is built around screening. In screening, the hope is to catch cancer at an earlier stage than it would be found otherwise and increase options for treatment and chances of cure. In some cases, screening prevents cancer — for example, when a precancerous polyp is removed from the colon during colonoscopy — but generally it is aimed at early detection.
What if instead we could prevent cancer from developing …
Read more…
Tamoxifen for breast cancer prevention is not routinely used
It is not a secret that large sums of money have passed from the pharmaceutical and device manufacturers into physicians’ hands.
This money has been paid not only for such socially beneficial pursuits as research and consulting, but also for lavish gifts and junkets. And interestingly, despite disingenuous assertions to the contrary by many a stake holder, these gifts generated a return on investment — surprise! It turns out that the …
Read more…
Gifts and money influence physician prescribing
One of the advantages of marrying an immigrant is having intense exposure to another culture. My wife’s Russian heritage, and her family, have enriched my own life immeasurably. The trip that I took with her and my brother to Russia in 1990, where she served as our personal translator, was unforgettable.
During the early years of our relationship, I heard stories about her family that seemed incredible to an American like …
Read more…
Physicians should not be used for FDA ad enforcement
There’s an interesting video from WCVB in Boston about doctors getting kick backs from the insurance company to switch patients from branded medications to generic medications: New Rules To Protect Prescription Drug Customers.
If people were concerned about undue influence when drug companies used to give physicians pens and other novelties (now currently banned by most companies), they should really be concerned about actual monetary payments.
The patient interviewed in the Boston …
Read more…
Incentives for switching patients from branded drugs to generic
About a month ago, a 44-year-old insurance executive came to see me with complaints of headaches and muscle cramps. His pain was caused by the typical cluster headache located behind one eye, accompanied by one-sided tearing and nasal congestion, and often triggered by occasional wine or chocolate. The muscle cramps mainly affected the legs and seemed to worsen after exercise.
When I got the results of his lab work, I was …
Read more…
Creatine causing muscle cramps and how supplements may be dangerous
Top of mind positioning has been replaced with top of page positioning. The old ad model of informing, persuading and reminding are being replaced by involvement, community and empowerment. So why are the nightly network newscasts still being subsidized by drug direct to consumer (DTC) ads?
From all the latest research that I have done, coupled with the research from other sources like Manhattan Research, Pew and Rodale, it’s quite clear …
Read more…
Why DTC drug marketing still clings to TV
One of my medical school professors was an internationally renowned subspecialist, whose ward occupied the entire top floor of the medical tower at Academy Hospital in Uppsala.
He had cadres of residents working for him, and for two glorious months I rotated through his ward as part of my internal medicine training in medical school.
One thing that stands out in my memory, to this day, from those two months is how …
Read more…
Male hormone treatment and testosterone replacement concerns
I’ve been interested in the role of testosterone in physical performance, depression and aging for many years. While at the University of Iowa, I was involved in research to detect testosterone doping, the psychological effects of testosterone and the potential for testosterone to alleviate depression in older men.
One of the difficult questions facing clinicians is when is testosterone too low in older men.
One problem with answering this question is the …
Read more…
Testosterone and when should low levels be treated in older men
It is insulting to think that doctors who are ostensibly smart enough to save one’s life are in fact so stupid, or merely gullible enough, to be swept away by what is in actuality only a very weak potion of sales-presentation intermixed with and embedded within generally informative and pharmaceutical-balanced subject-focused medical lectures.
Such lectures occur usually at a private function room at a restaurant or, in conjunction with a served …
Read more…
Pharmaceutical sponsored dinners have educational value
Unlike climate change, where there’s a large contingent of denialists who spread doubt about the scientific evidence, no one denies that antibiotic resistance is a problem. There is controversy, however, on the question of just how much the widespread use of antibiotics contributes to the problem.
The mechanism is not in dispute: If you expose bacteria to antibiotics, they will mutate to become resistant. But “overuse” of antibiotics is not the …
Read more…
Bacterial resistance to chronic antibiotics, and why it’s a problem
by Charles Bankhead
Reanalysis of a landmark cholesterol-lowering trial of people typically considered at low risk for heart attacks indicated that the results are flawed — and do not support the primary-prevention benefits that made headlines, authors of the review asserted.
The reanalysis of the massive JUPITER trial involving almost 18,000 people with low or normal cholesterol but elevated levels of the inflammatory biomarker C-reactive protein (CRP) — turned up no evidence …
Read more…
Was JUPITER trial data influenced by AstraZeneca to favor Crestor?
