It is well accepted among health economics wonks that the lion’s share of pharmaceutical company profits come when these companies hold exclusive rights to their products. Once their blockbuster pills go “generic,” competitors enter the marketplace and profits plummet. Consider captopril, a groundbreaking heart failure medication introduced in the early 80s by Bristol-Myers Squibb under the trade name Capoten. After making a fortune for the company, captopril went generic in 1996. ...

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I’ve written before about various forms of complementary and alternative medicine -- most recently about the use of essential oils for serious medical conditions. I’m planning to dive deeper into that topic in an upcoming post. But before I do, I want to take some time to reframe how we think about alternative therapies. And I want to make it clear from the beginning that doctors don’t get paid for prescribing ...

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shutterstock_226013521 Aaron Carroll, a pediatrician who blogs at the Incidental Economist, had a piece published a few weeks ago in the New York Times concluding that adolescents and college kids would be better off -- given a choice of illicit substances -- opting for marijuana over alcohol.  Of course, he would prefer that his kids chose neither.  But he is a ...

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I learned recently that the antipsychotic Abilify is the biggest selling prescription drug in the U.S.  To be a top seller, a drug has to be expensive and also widely used.  Abilify is both.  It’s the 14th most prescribed brand-name medication, and it retails for about $30 a pill.  Annual sales are over $7 billion, nearly a billion more than the next runner-up. Yes, you read that right: $30 a pill.  A little more ...

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Let’s talk about vaccine ingredients. I am reading less about vaccines causing autism (we all know that theory is utter nonsense, right?) and more about vague concerns regarding the chemicals in vaccines. To begin with, we are surrounded by chemicals. Water (H2O), caffeine (C8H10N4O2), sugar (C12H22O11) are all chemicals.  But perhaps it is the unfamiliar ingredients that people find intimidating. Let’s tackle the ingredients in the measles, mumps, rubella and varicella (MMRV) vaccine ...

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shutterstock_83139061 A few weeks ago Bill Maher made a number of critical remarks about medicine and physicians. I sent Mr. Maher the following response in an effort to address his comments. I am sharing this with you in hopes that other physicians will also speak out in defense of our profession. Dear Mr. Maher, Let me start by saying that I have been a ...

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Three years ago I received some of the best news of my life -- that I have dopa-responsive dystonia. (Yes, a neuromuscular disorder was welcome news.) Painful, life-interrupting muscle contractions had made the dystonia diagnosis likely several years before, despite poor response to standard treatments, and I was fighting through graduate school: trying to compensate for medication-induced memory problems, increasing need to work from bed, and a disappearing social life. ...

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Cholesterol pills are one of the great medical advances I’ve witnessed during my professional career. I am talking specifically about a category of medications called statins, drugs like Lipitor and Pravachol. These drugs have prevented probably hundreds of thousands of heart attacks and strokes. Only one problem with these drugs, however: statins won’t help people who don’t take them. And according to a study in the Annals of Internal Medicine, when ...

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Many of my patients are taking herbal supplements, or so they think.  This herbal and health supplements industry likely is envied by traditional pharmaceutical companies.  The latter has to spend zillions of dollars proving safety and efficacy to the Food and Drug Administration (FDA).  Many of these drugs are cast aside during the approval process or afterwards when serious side effects become known, or a new medicine is proved safer ...

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The letters are usually four pages long and begin by saying that my patient has received a temporary supply of the medication I prescribed. Next, there are general paragraphs about how the drug either isn’t on their formulary or the quantity exceeds the plan limits. None of these letters contains a reference to an online formulary physicians can access to compare covered alternatives. Then there are several cumbersome explanations about the appeal ...

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