Medications and prescribing

What pharmacogenetic testing can and can’t do in depression

October 27, 2026Oct 27, 2026

More of my patients now arrive with a pharmacogenetic report, an ad promising to "end trial and error," or an MTHFR result from an online forum. Others ask for a blood test or brain scan to "prove" their depression. These…

More of my patients now arrive with a pharmacogenetic report, an ad promising to “end trial and error,” or an MTHFR result from an online forum. Others ask for a blood test or brain scan to “prove” their depression. These requests are reasonable. Patients want objective answers to a frustrating process. But the marketing has run ahead of the evidence, and the conversation increasingly falls to us. Here is how …

Opioid settlement funds reward fewer pills, not less pain

Heidi Sykora, DNP

October 26, 2026Oct 26, 2026

Somewhere along the way, the patient stopped being the point. A patient who was stable A year ago this month, 74-year-old Martha was stable. She lives with osteoporosis, osteoarthritis, degenerative disc disease, multiple joint replacements, and chronic anxiety. Even so,…

Somewhere along the way, the patient stopped being the point.

A patient who was stable

A year ago this month, 74-year-old Martha was stable. She lives with osteoporosis, osteoarthritis, degenerative disc disease, multiple joint replacements, and chronic anxiety. Even so, she was functioning. Her pain was controlled on a low, unchanged dose of oxycodone that she had taken responsibly for more than five years.

At her annual visit, everything changed. Her primary care …

How serial patent litigation delays cheaper generic drugs

Reuben Mathew, MD

October 24, 2026Oct 24, 2026

As a physician caring for patients in New Orleans, I see the consequences of America's prescription drug affordability crisis every day. Many of my patients need essential medications like insulin, blood thinners, and inhalers to manage chronic conditions that impact…

As a physician caring for patients in New Orleans, I see the consequences of America’s prescription drug affordability crisis every day. Many of my patients need essential medications like insulin, blood thinners, and inhalers to manage chronic conditions that impact their day-to-day lives. But far too often, these medicines are unaffordable, even for patients with solid health insurance.

One major reason prescription medicines are so expensive is a little-known Big Pharma …

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The exercise pill is back, and history urges caution

Francisco M. Torres, MD

October 22, 2026Oct 22, 2026

I was once the proud owner of a gadget from the early 2000s. A belt you wrapped around your midsection, switched on, and supposedly watched the vibrations melt the fat away. Predictably, it did not work. In fact, it never could have. Still, at the time I wanted it to work so much that, for a moment, I set aside everything I knew as a physician about how muscle and …

Health technology

Alert fatigue is a design problem, not a vigilance problem

Thomas Powell, MD

October 20, 2026Oct 20, 2026

Any safety system that is ignored 96 percent of the time is not an effective safety system. It is only a record that the alert fired, and the clinician did not act. Override rates on drug safety alerts consistently run…

Any safety system that is ignored 96 percent of the time is not an effective safety system. It is only a record that the alert fired, and the clinician did not act.

Override rates on drug safety alerts consistently run between 49 percent and 96 percent, depending on the alert and the setting. This fact has been repeated and has strong data. The usual reading of those numbers is that physicians …

Patients ask for antibiotics because they are afraid

Lin Kai

October 19, 2026Oct 19, 20263

An old man at my pharmacy window digs into his coat and hands me a piece of paper. It is soft at the folds, the way paper gets when it has been carried around for a while. He smooths it…

An old man at my pharmacy window digs into his coat and hands me a piece of paper. It is soft at the folds, the way paper gets when it has been carried around for a while. He smooths it flat on the counter.

“Do you have this?” he asks.

It isn’t a prescription. There is one word written on it. Amoxicillin.

He doesn’t say what for. He doesn’t mention a cold, or …

Esketamine vs. ketamine: what to ask before you refer

October 19, 2026Oct 19, 20263

In my practice, more and more patients arrive with a ketamine clinic advertisement in hand. Many have already asked their primary care physician, "Should I try this?" The honest answer depends on a distinction those advertisements routinely blur: The "ketamine"…

In my practice, more and more patients arrive with a ketamine clinic advertisement in hand. Many have already asked their primary care physician, “Should I try this?” The honest answer depends on a distinction those advertisements routinely blur: The “ketamine” offered for depression is not a single, standardized therapy.

On one side is intranasal esketamine (Spravato), the S-enantiomer of ketamine. The FDA approved it in 2019 for treatment-resistant depression (TRD) in …

Are 12-step programs maligned because they sell nothing?

Martha Rosenberg

October 13, 2026Oct 13, 2026

Twelve Step programs like Alcoholics Anonymous, Narcotics Anonymous, and Cocaine Anonymous are free, self-supporting, and do not advertise. That's why many do not know about them and their success rate. Instituted in the 1930s, such programs promote no drugs and…

Twelve Step programs like Alcoholics Anonymous, Narcotics Anonymous, and Cocaine Anonymous are free, self-supporting, and do not advertise. That’s why many do not know about them and their success rate. Instituted in the 1930s, such programs promote no drugs and use no psychiatric or psychology experts, relying instead on peer-to-peer healing and often meeting in church basements.

In the last decade, drugmakers and insurance companies, distressed by all that non-prescription health …

Does nicotine cause cancer? What clinicians should say

Giorgi Mzhavanadze

October 13, 2026Oct 13, 2026

A patient considering a nicotine patch asks, "Doesn't nicotine cause lung cancer?" A reassuring answer should not minimize nicotine's risks. It should explain why a nicotine patch and a cigarette are not medically equivalent. Our survey in Ukraine suggests that…

A patient considering a nicotine patch asks, “Doesn’t nicotine cause lung cancer?” A reassuring answer should not minimize nicotine’s risks. It should explain why a nicotine patch and a cigarette are not medically equivalent.

Our survey in Ukraine suggests that this distinction warrants attention. Healthy Initiatives collected 1,538 responses to a questionnaire targeting health care professionals between October 2025 and September 2026. Asked to identify the most harmful components of smoking, …

Sleep apnea and depression: Screen before a third drug

October 12, 2026Oct 12, 2026

In a community study of 700 men, 43 percent of those who had both obstructive sleep apnea and insomnia met criteria for depression. That compared with 22 percent of those with insomnia alone and just 8 percent of those with…

That gradient captures something most of us see every week but rarely name. The patient who comes to me on referral has usually cycled through two or three …

Robert Pretzlaff, MD, MBA

The scarlet letter O: a physician on Ozempic stigma

October 11, 2026Oct 11, 2026

Stop your moralizing. I grow weary of your superior airs. I am a 60-plus-year-old physician who has led a disciplined life. Despite going to the gym two to three times a week and with an acute awareness of my caloric…

Stop your moralizing. I grow weary of your superior airs.

I am a 60-plus-year-old physician who has led a disciplined life. Despite going to the gym two to three times a week and with an acute awareness of my caloric intake, I had been overweight for many years. I, along with nearly three-quarters of Americans, have committed the sin of being heavy. Today I have a BMI slightly above 25 and …

Patient voices

Done ADHD telehealth case: the mother’s warning no one heard

Nicole Drapeau Gillen

October 10, 2026Oct 10, 2026

On Oct. 2, a federal jury in Michigan convicted Dr. Jonathan Decker of distributing more than 2 million stimulant pills through Done, a subscription ADHD telehealth platform. Prosecutors said he prescribed without examining patients and was paid more than $1 million. He is the 11th person convicted in what prosecutors describe as a $100 million drug distribution and health care fraud scheme tied to the company.

Most of the …

Pharmacy benefit managers and the price no one can see

Matt Hasan, PhD

October 7, 2026Oct 7, 2026

A physician writes a prescription believing the clinical decision has been made. In reality, another decision-making process is just beginning. Between the prescription and the patient sits an increasingly powerful infrastructure of pharmacy benefit managers, insurers, formularies, rebate agreements, pharmacy…

A physician writes a prescription believing the clinical decision has been made. In reality, another decision-making process is just beginning.

Between the prescription and the patient sits an increasingly powerful infrastructure of pharmacy benefit managers, insurers, formularies, rebate agreements, pharmacy networks, prior authorization rules, and specialty pharmacies. Most physicians see only fragments of this system. Patients usually understand even less.

The result is a peculiar form of American medicine: The person making …

A letter to Congress: Repeal the Controlled Substances Act

Richard A. Lawhern, PhD

October 7, 2026Oct 7, 2026

I write as a health care educator and author with thirty years of research experience and over three hundred papers published as author or co-author, several of them widely cited. In that role, I see thousands of emails and social media postings every month from people whose lives are being destroyed by misdirected and frequently outright fraudulent U.S. public health policy on treatment of pain and addiction. The …

How to choose a GLP-1 weight loss program

Neil Panchal, DO

October 7, 2026Oct 7, 2026

Glucagon-like peptide-1 (GLP-1) medications work. Semaglutide and tirzepatide help people lose more weight than any pill or shot we've had before. The harder problem is everything that happens around the drug. In real-world studies, about a third of patients stop…

Glucagon-like peptide-1 (GLP-1) medications work. Semaglutide and tirzepatide help people lose more weight than any pill or shot we’ve had before. The harder problem is everything that happens around the drug.

In real-world studies, about a third of patients stop treatment within the first month. In one large insurance claims analysis, only about one in twelve adults who started a GLP-1 for weight loss were still taking it three years later. …

5 OCD screening questions every clinician should ask

October 6, 2026Oct 6, 2026

Obsessive-compulsive disorder (OCD) is one of the most delayed diagnoses in psychiatry, and much of that delay happens in offices like ours. Patients typically notice their first symptoms in adolescence or early adulthood but are not correctly diagnosed until roughly a decade later. One outpatient study found an average of about 12.8 years between symptom onset and diagnosis, and a meta-analysis of 31 studies put the pooled duration of untreated …

Who monitors patients after telehealth ADHD prescribing?

Timothy Lesaca, MD

October 5, 2026Oct 5, 2026

Last month, I took on five new patients who were already prescribed stimulants. I had not met any of them in person before. Each came to me with a diagnosis, an active Schedule II prescription, and a chart note from a telehealth visit that I cannot fully piece together. My role now seems to be continuing these prescriptions. I am concerned about the handoff, and I doubt anyone decided who …

Access to interventional psychiatry should not end downtown

October 5, 2026Oct 5, 2026

A standard course of repetitive transcranial magnetic stimulation (TMS) for depression means coming to the clinic five days a week for four to six weeks, roughly 20 to 36 sessions. That is because response depends mainly on the number of…

Esketamine (Spravato) carries a different but equally demanding logistical load. Under its FDA safety program, known as a Risk Evaluation and Mitigation Strategy (REMS), each …

Does CVS controlled substance policy put patients at risk?

Arthur Lazarus, MD, MBA

October 2, 2026Oct 2, 20263

Recently, a close friend called me in a panic. He was running dangerously low on lorazepam and asked if I could prescribe a small, bridging quantity over the weekend until his regular refill was due in a few days. As a physician, I wanted to help, but I first advised him to do what any reasonable patient would: call his pharmacy, CVS, explain the situation, and ask for a sliver …