Treating pain is a notoriously tricky business. But it’s even harder if the medications on which we rely are inappropriately marketed. Last month, a Los Angeles Times investigation of Purdue Pharma asserted that for years, the company falsely elevated the efficacy of its twice-daily OxyContin, a powerful opioid pain reliever. The Times’ review of evidence -- including three decades of court cases, investigations, patient and sales rep ...

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Recently, the CDC announced that its Advisory Committee on Immunization Practices (ACIP) voted to stop recommending the nasal spray flu vaccine, FluMist, for anyone. Bottom line: it doesn’t work. Though their recommendation against the use of FluMist still has to be approved by the CDC director to make it “official,” it’s pretty much a done deal. The AAP’s president has already endorsed the announcement, too. Bye, Flumist. We’ll ...

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I sometimes worry that my wife Paula won’t be able to see me grow old. Not that I expect to outlive her. She is four years my junior and has the blood pressure of a 17-year-old track star. It’s her eyesight I’m worried about, because she is at risk for a form of blindness called macular degeneration. Paula is the youngest in a long line of redheads, several of whom ...

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We’ve heard it before: Antibiotics just don’t work for viral infections. Docs know this, and I think most patients know this, but it’s an addiction we’ve had a hard time shaking. Docs overprescribe because it’s fast, it’s easy, and it (might) increase patient satisfaction and return visits. That’s led to a cycle of reinforcing expectations from patients -- who, after all, keep feeling better after the antibiotics. Of course, they do. ...

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In his recent article “Feed Me, Pharma,” ProPublica’s Charles Ornstein has been calling attention to studies showing that the prescribing decisions of doctors are linked to the amount of money that drug companies can bestow on them, usually in the form of meals, travel expenses, tuition support to attend courses, and so on. I find nothing surprising about that, and Ornstein need not be so scrupulous when he clarifies that “the ...

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Polypharmacy was once the exception in psychiatry; now it seems to have become the rule. Patients frequently are taking 3, 4, even 5 psych meds at one time. And often it’s primary care doctors, not psychiatrists, who are doing the prescribing -- usually without adequate training in psychiatry. Some polypharmacy is rational -- e.g., a patient with bipolar disorder who receives the combination of antidepressant and mood stabilizer. But most polypharmacy is ...

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I don’t want to need it. That is a thought that has been all too familiar to me when I venture on the patient side of health care, an industry that I study as a scholar as well with the distance of one investigating a foreign land in which they do not intend to become entrenched. It is a thought that has been all too familiar as I see added to my ...

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Prince died of an opioid overdose. A tragic and avoidable fate but, even more tragically, one that is becoming increasingly common in the United States. Some people who overdose live on the edge of society–homeless and with no access to good medical care. Prince, by contrast, had several mansions and a number of physicians actively involved in his care, physicians aware of his problem with opiates. ...

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It’s an unmitigated disaster.  One hundred million pain patients.  Millions addicted to opioids, hundreds of thousands dead.  Pain patients abruptly cut off medication they’ve depended on, sometimes for decades, and offered nothing to replace it.  Doctors, fearful of prosecution for overprescribing, dropping pain patients like hot potatoes.  Pain patients unable to find any doctor that will treat them.  Patients turning to heroin when they can’t get their prescription painkillers.  Articles ...

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Bacteria are rapidly becoming resistant in our antibiotic-loving society. This statement is a fact. We are facing a threat not only to our country, but to the world. I have a proposal to make: over-the-counter antibiotics. (Insert tongue-in-cheek here.) Will this help us deal with the falsely popular notion that antibiotics are a cure-all? I don’t know, but here’s something I do. I've had patients storm out because I've said no, and I ...

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