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.

How women can benefit from oral contraceptive pills

Kevin

Medications

December 31, 2009

Originally posted in MedPage Today

by Nancy Walsh, MedPage Today Contributing Writer

Hormonal contraceptives have a variety of noncontraceptive uses, ranging from common problems such as dysmenorrhea to severe conditions such as premenstrual dysphoric disorder, according to a new practice bulletin from the American College of Obstetricians and Gynecologists (ACOG).

“Combined hormonal contraceptives can correct menstrual irregularities resulting from oligo-ovulation or anovulation and …

How constant H1N1 breaking news updates may be going too far

Jeffrey Hall Dobken, MD, MPH

Conditions and Diseases

December 23, 2009

Originally posted in MedPage Today

She is 11, a fifth grader, as prepubescent as nature allows, and utterly terrified.

She hasn’t eaten normally for nearly a month, her mother reports. She sleeps poorly, reports nightmares, and cleans her hands so obsessively that she is literally bleeding raw.

Her fifth grade peer group typically does not guard its language nor govern its remarks, …

How medication mistakes happen in the hospital

Kevin

Medications

December 22, 2009

Originally published in MedPage Today

by Katrina Woznicki, MedPage Today Contributing Writer

Hospitalized patients were often clueless when asked about their medications, with almost all of them unable to name all their medications and many leaving out as many as a half-dozen drugs they have been prescribed, according to a small survey of patients in a Colorado hospital.

Ninety-six percent of the …

What the H1N1 vaccine recall means for kids

Kevin

Medications

December 15, 2009

Originally posted in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Sanofi Pasteur has recalled about 800,000 pediatric doses of its vaccine against pandemic H1N1 influenza because of low potency, the CDC announced, but the agency is not calling for revaccinations.

The recalled doses come from four lots of 0.25-mL prefilled syringes for pediatric use in both 10-packs (lot numbers UT023DA, …

Previous influenza exposure can protect against the H1N1 flu

Kevin

Conditions and Diseases

December 4, 2009

by Bruce Goldman

People of a certain age have been known to complain that, while they lucidly recall the details of childhood events, they can’t remember what they ate for breakfast.

As it is with brains, so it may be with immune systems. Older people’s immune responses, while generally somewhat sluggish in revving up after, say, a vaccine against seasonal influenza, seem to retain a knack for fending off the current H1N1 …

Tamiflu kills babies, and other H1N1 flu pandemic misconceptions

Kevin

Medications

December 3, 2009

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

As one of the two MedPage Today writers on full-time H1N1 duty since the beginning of the outbreak in April, I feel like I know the issues well enough to help clear up misconceptions when they come up in conversation.

The other day, just such a situation presented itself. An …

Pharma, evidence, and trust

Kevin

Medications

December 2, 2009

by David Rind, MD

A number of the other blogs that have noted the existence of this blog seem to have “Pharma” in their titles in one way or another, and the implication is not that the blogger likes much about Big Pharma.

In the late 1990s, when I was spending much of my clinical time providing HIV care, I was a defender of Pharma on Usenet, at least as it related …

Read more…

Pharma, evidence, and trust

How does Zetia and niacin affect the carotid intima-media thickness (CIMT)?

Kevin

Medications

November 22, 2009

Originally published in MedPage Today

by Peggy Peck, MedPage Today Executive Editor

By a margin of 0.014 mm in carotid intima-media thickness (CIMT), extended-release niacin (Niaspan) demonstrated superiority over ezetimibe (Zetia) as an add-on for high risk patients on long term statin therapy.

But is a difference of 0.014 mm clinically significant?

The niacin versus ezetimibe findings come from the ARBITER 6-HALTS trial, …

Discharged from the hospital without answers; the death of Jane Q. Patient

Dan Walter

Patient

November 20, 2009

We found out that her real name was Cindy Chapman, and that she died alone and afraid.

Cindy was a paralegal, an activist and a fighter of lost causes who lived in Worcester, Massachusetts. She was part of an online community called RATEMDs, where she had many soul mates. Her posts on health care were funny and cynical and wise. Her screen name was Jane Q. Patient.

My wife, Pam, was especially …

How should the FDA regulate the social media advertising of drugs?

Kevin

Medications

November 20, 2009

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

Drug and device makers are urging the FDA to establish clear guidelines that will allow the industry to discuss and promote products in the unsettled world of online social media.

The FDA is hearing testimony from drug and device companies, online marketing experts, and consumer groups about what steps the …

Why you should stop taking Vytorin for high cholesterol

Matthew Mintz, MD

Medications

November 16, 2009

At the American Heart Association meeting in Orlando, the results of the ARBITER 6-HALTS study were released. No Vytorin was used in the study, but I am sure that all the headlines will mention Vytorin.

The actual study published ahead of press online in the New England Journal of Medicine. Essentially, they enrolled over 200 patients from Walter Reed and Washington Adventist who had known heart disease or were at …

Niacin beats Zetia in the ARBITER 6-HALTS trial, and what this means for ezetimibe

Kevin

Medications

November 16, 2009

Originally published in MedPage Today

by Peggy Peck, MedPage Today Executive Editor

Boosting HDL cholesterol with extended-release niacin (Niaspan) is a more effective way of slowing atherosclerosis in high-risk patients on long-term statin therapy than seeking additional LDL cholesterol reductions by adding ezetimibe (Zetia), researchers here reported.

Compared with ezetimibe, 2 grams of niacin led to significant reductions in both the mean …

Saying no to a re-tweet request, and whether Twitter as a legitimate news source

Marya Zilberberg, MD, MPH

Social Media in Medicine

November 15, 2009

The other day I re-tweeted a tweet from someone whose Twitter activity I enjoy very much. I like where his links take me, and I appreciate the intellectual and emotional honesty of his own writing. The message I re-tweeted was about Gardasil, Merck’s HPV vaccine marketed in the US.

Diane Harper of the University of Missouri is a prominent researcher who was heavily involved in the Gardasil development program. Over the …

Patients who want the H1N1 vaccine need to be triaged

Kevin

Medications

November 11, 2009

by Kairol Rosenthal

I am a young adult cancer patient who waited five and a half hours for the H1N1 vaccination along with 1200 other Chicagoans in a city college hallway. I do not have the trained eye of a public health analyst, yet it was easy to spy the glaring flaws that occurred in the whimsical distribution of this short supply vaccine. One of these oversights was the absence …

Doctors and patients need to learn to live with health insurance companies

Kevin

Health Policy

November 10, 2009

by Marie Cooper

Consider two patients with the same managed care plan.

One has multiple sclerosis and receives an infusion of Tysabri every month. It needs pre-certification. The requirements are black and white. The patient qualifies if they have relapsing/remitting MS and have failed other therapies. The drug costs $2,000, the infusion center is another $1,000. The infusion center is a contracted provider that has …

Vaccines do not cause autism in children, whether or not they have inborn errors of metabolism

Kevin

Conditions and Diseases

November 6, 2009

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

Vaccination does not appear to cause autism or other health problems in children with inborn errors of metabolism, a researcher said here.

In a retrospective analysis, children with such conditions were not more likely than normal children to visit emergency rooms or need hospital care after vaccination, according to …

Clostridium difficile infection is spreading from the hospital to the community

Kevin

Conditions and Diseases

November 5, 2009

Originally published in MedPage Today

by Charles Bankhead, MedPage Today Staff Writer

Clostridium difficile infection has spread from the hospital to the community but has proved manageable thus far.

From 1991 to 2005, the incidence of community-acquired C. difficile in Olmsted County, Minn., quadrupled but still remained less common than the hospital-acquired gastrointestinal infection, Sahil Khanna, MD, of the Mayo Clinic in …

H1N1 vaccine adverse events, and how to reassure patients

Kevin

Medications

November 3, 2009

Originally published in MedPage Today

by Crystal Phend, MedPage Today Senior Staff Writer

Failure to account for background rates when considering adverse events from pandemic H1N1 flu vaccination could spark public panic, researchers cautioned.

Coincidental cases of dramatic events including sudden death, Guillain-Barré syndrome, and spontaneous abortion can be expected to boost the true incidence of adverse events after immunization, said Steven …

Rheumatologists debate whether fibromyalgia is really a disease

Kevin

Conditions and Diseases

November 2, 2009

Originally published in HCPLive.com

What defines a “disease?” At what point does a collection of symptoms and causes make the transition from “condition” to disease? Is it when a consensus forms around a concrete, observable, and repeatable set of biochemical and/or physiological processes and outcomes? Surely there is little doubt that diabetes or hypertension qualify as a disease under the standard paradigm. …