Meds

The real reason to be cautious about Z-Paks and azithromycin

Meds
April 10, 2013

The FDA issued a warning about the antibiotic azithromycin (Zithromax). The media stories have some patients terrified and some of them are calling me convinced that azithromycin is poison, a reliable agent for suicide.

What’s the hubbub about?

Azithromycin is in a family of antibiotics called macrolides, which also includes erythromycin and clarithromycin (Biaxin). Erythromycin and clarithromycin have long been known to very rarely cause fatal abnormal heart rhythms. It …

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Toradol in sports: A culture change is needed

Meds
February 23, 2013

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Former Boston Red Sox closing pitcher Jonathan Papelbon may have opened up a can of worms with his remarks about his frequent use of the injectable anti-inflammatory drug Toradol (ketorolac) during his time with the Red Sox.

Papelbon, who now plays for the Philadelphia Phillies, told ESPNBoston.com that several Red Sox players were frequently injected with the drug:

“It was kind of …

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Why I’m not sure that psychiatric medications work

Meds
January 25, 2013

I have a confession to make.  I don’t think what I do each day makes any sense.

Perhaps I should explain myself.  Six months ago, I started my own private psychiatry practice.  I made this decision after working for several years in various community clinics, county mental health systems, and three academic institutions.  I figured that an independent practice would permit me …

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10 advances that have changed medicine forever

Meds
December 4, 2012

I’ve been thinking lately about all the great advances in medicine over the years. There have been lots of them. And despite everything you’ve heard about looming cuts in healthcare, I have no doubt that the hits will keep on coming. Since I seem to be on this Top 5 thing lately, I figured I would continue this ride and rank my top 10 medical advances over the years. There …

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Does Linzess have a role in IBS with constipation?

Meds
October 13, 2012

Linzess is a new drug that received FDA approval by Forest Laboratories for use in irritable bowel syndrome (IBS) with constipation and in chronic idiopathic constipation.  It got my attention because of its biochemistry.

Learning about the mechanism of action of new drugs like Linzess reminds me how much more is understood about the molecular biological level of physiologic function of the human body than when I was in med school.  Linzess …

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Taking medications in the middle of the night can be risky

Meds
September 30, 2012

You may have heard that veteran NBC News correspondent Tom Brokaw was hospitalized recently after he reported feeling lightheaded after making an appearance on MSNBC’s “Morning Joe.”

He’s fine. Brokaw tweeted, “All is well. Early a.m. I mistakenly took a half dose of Ambien and made less sense than usual.”

And that’s what you’ve got to be careful not to do.

Any time you get up in the wee hours of …

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Should doctors stop prescribing inhalers for smokers?

Meds
September 18, 2012

I’ve always had a tough relationship with cigarettes and the people who love them. As a lung doctor I hate cigarettes, and I hate that patients I see everyday continue to use them. But I also understand that vilifying smokers seems to be in vogue right now. I figure that if someone does something that is not considered socially palatable, and that does them harm, even as they strive to …

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Do oncologists have an incentive to prescribe expensive treatments?

Meds
July 4, 2012

A recent economic analysis concluded that patients with metastatic cancer value their treatments significantly more than regulators recognize, with many expensive new therapies looking like veritable bargains to most patients. Yet the study ignored the values really driving oncology spending—the warped incentives oncologists have to promote their own bottom line by prescribing expensive treatments.

Let’s start with the economic analysis, another in a series of studies by a USC team of …

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Don’t accept the face value price of a drug

Meds
June 28, 2012

Everybody knows that some medications can cost a lot of money.  I always try to take the cost to my patients into account when prescribing a medication- after all, if someone can’t afford it, they are not going to take it.  When it’s appropriate (and 9 times out of 10 it is), I try to prescribe a generic medication.  They are much cheaper and work just as well as the …

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Is there a harm to not seeing drug reps?

Meds
June 10, 2012

Now more than ever, the growing consensus among many is that doctors should avoid seeing pharmaceutical sales representatives, otherwise known as drug reps. A position statement from the AAMC, the head organization of all US medical schools and residency programs, recommends that all academic health centers avoid having drug reps on their campuses, hospital and clinics. Many medical institutions including the VA and Kaiser have also enacted similar policies banning …

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Using Advair to treat postinfectious cough

Meds
June 3, 2012

I am not a huge baseball fan to begin with, and when I am, I root for the Nationals.  Thus, I pay little attention to the New York Yankees, and was not aware that Yankee player Mark Teixeira had been suffering from a cough for the past month until it the story from the New York Times came through one of my Twitter feeds. According to the story: “Mark Teixeira had …

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Go ahead, let patients buy prescription drugs over the counter

Meds
May 14, 2012

The FDA is deciding whether to allow patients to purchase prescription medications over the counter for many common ailments.

This idea is controversial.

On one hand, deregulation would remove one of the largest barriers to receiving treatment for some conditions – the doctor’s visit. If no doctor’s visit is necessary to receive necessary blood pressure medications or diabetes medications, then patients don’t have to wait for an appointment and the patient/government …

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The unholy alliance between Big Pharma and the medical profession

Meds
May 12, 2012

An excerpt from The Truth About Statins.

Like all physicians, I’ve had interactions with pharmaceutical companies. Shortly after I went into private practice in Rhode Island in 1977, I received a telephone call from a drug company representative. He offered me an all-expense-paid weeklong trip to Germany to attend a medical conference. I was taken aback, knowing that the cost of such a trip would run to thousands of dollars. I …

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I eat lunch with drug company representatives and I’m proud of it

Meds
December 1, 2011

Today, I want to review another article I wrote in last year.  That article started with a confession: “I confessed that I ate lunch with a representative of a pharmaceutical company.”

I must now confess that I often eat lunch with representatives of pharmaceutical companies and I’m proud of it.  At this stage of my career, I can well afford my own lunch.  I could sit quietly and relax over a cup …

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Why medicine is not health

Meds
September 26, 2011

Being a physician certainly biases how I view the world around me. I can’t help but think in terms of problem-solving and healing. But have you noticed how medicalized our society has become? The other night watching television, we watched at least four drug commercials and one health insurance commercial — during a half-hour show! I believe we are in the middle of the medicalization of America, and I don’t …

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Consider half life during drug detoxification

Meds
August 30, 2011

A young man on my sobriety-based detox program (only after showing positive for opiates) admitted to heroin-usage, but hedged the matter saying it was “5 days ago.” His implicit presumption was that an isolated episode, days ago — compared to continuous, more recent, heroin-usage — would lessen the likelihood of his getting kicked off the program.

Is his story of “no heroin [ingestion] in the last five days,” likely, the whole …

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The expensive progression of pill crushing technology

Meds
August 29, 2011

We have to crush pills sometimes.  Either the patient (through aversion or physical limitation from stroke) can’t swallow whole pills so we crush them and put them in applesauce, or the patient gets their pills through a tube, so we crush them and dissolve them in water.

When I started nursing, we had a mortar and pestle.

 

Anyway, this is what we used …

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The ethics of being on a pharmaceutical advisory board

Meds
August 27, 2011

While diligently perusing a stack of unread journals, a piece in the July 25, 2011 issue of Modern Healthcare caught my attention.

Titled “What’s the Agenda?” this special report deftly navigated the murky waters of “physician participation on advisory boards” and managed to present an accurate appraisal of the issues.

Here is a brief recap.

Back in the days before “medical ethics” issues were commonplace, pharmaceutical and medical device manufacturers were accustomed …

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A cream to fight obesity is being ignored

Meds
August 7, 2011

Do you, or many of your patients, have a little more belly fat around your and their middle than you and they would like? Me, too.

Turns out that there are two decent published studies from reputable places that report that a person may rub a cream on their skin over the fat spots and make the fat go away.

Wow, what a deal.

The first study addresses fat thighs, with each …

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