Meds

Why is the government so scared of directly negotiating drug prices?

Meds
August 29, 2020

President Trump recently signed two executive orders directly related to prescription drug prices in the U.S.

One order would allow the “reimportation” of prescription drugs from Canada. This longstanding idea would allow U.S. pharmacies and drug wholesalers the ability to pay generally much lower prices for their prescription drugs by getting them from Canadian suppliers who benefit from government management of the system. Many consumers have been buying direct from Canadian …

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Goodbye, Benadryl: It is time for you to retire

Meds
February 7, 2020

Sometimes, old ideas and time-tested treatments remain the best. Newer doesn’t always mean better. Except in the case of one of our oldest antihistamines, tried-and-true Benadryl. It is time for that old drug to be retired, sent off to pasture, and never used again. Goodbye, Benadryl. Fare thee well, adieu, and don’t let the door hit you on the way out.

Benadryl (diphenhydramine) was introduced in 1946. The top single that …

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Black boxes: health warning or profit warning?

Meds
February 1, 2020

“Boxed warnings” or “black boxes” are the strictest FDA label warnings. They appear on cigarettes, fluoroquinolones (for tendon rupture), Lamictal (for SJS and TEN), Accutane (birth defects), and other products with well-known risks.

The industry obviously dislikes black boxes since they reduce sales (though their lobbyists charge the boxes “confuse” and “unnecessarily alarm” patients).

So it was no surprise that when the Read more…

How to help your patients understand antibiotic stewardship

Meds
January 27, 2020

Antibiotics are ubiquitous in today’s society. Prescriptions for these bacterial killers have become so prevalent that a wonder drug cure phenomenon for any illness has become the cultural norm. The evidence is overwhelming that antibiotics are far too overprescribed for viral illnesses. They are 100 percent ineffective against viruses. And the number of inappropriate antibiotics prescribed has been increasing for decades, as high as 30 percent in one study.

For years, …

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Beyond the EpiPen: Irrational drug prices are now pervasive

Meds
December 19, 2019

There was outrage over the sudden rise in the price of the EpiPen. But the rise in many other pharmaceutical prices gets less attention but is just as concerning. It can be easy to forget issues like this until they affect us personally. My two encounters with irrational drug price increases for dermatologic conditions are a reminder of how pervasive this problem is today.

I have rosacea, a …

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Drugmakers discover tardive dyskinesia. And they profit in it.

Meds
November 30, 2019

Before direct-to-consumer ads, physicians tried to reassure patients they were probably fine. Today, drug ads and online symptom checkers do just the opposite. The most insidious are “unbranded” ads that scare people about a disease without mentioning the drug they are trying to sell. Notable unbranded disease campaigns sell the obscure exocrine pancreatic insufficiency, shift work sleep disorder, and non-24-hour, sleep-wake disorder. Unbranded advertising is designed to appear like a …

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Why your doctor may be concerned about prescribing benzodiazepines

Meds
October 29, 2019

As an academic psychiatrist who treats people with anxiety and trauma, I often hear questions about a specific class of medications called benzodiazepines. I also often receive referrals for patients who are on these medications and reluctant to discontinue them.

There has been increasing attention into long-term risks of benzodiazepines, including potential for addiction, overdose, and cognitive impairment. The overdose death rate among patients receiving …

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Don’t use stimulants to cram for exams. It ruins sleep and doesn’t help test scores.

Meds
October 26, 2019

Along with a steeper financial burden and an increasingly competitive academic environment, this year’s incoming freshman university class will likely be confronted with the pressure to take a little pill that some popular culture references say will make you “awesome at everything.” Or they may eschew the temptation and rely on the standard practice of study, sleep, repeat.

Welcome to #GenerationAdderall, the …

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Second-tier, off-label treatments for anxiety

Meds
October 10, 2019

In previous posts, we have reviewed the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), as well as the off-label prescribing of gabapentinoids, for treating anxiety disorders. Anxiety is such a ubiquitous problem that it is not surprising that many other compounds have been used off-label as well.  In this posting, we will review some of the common ones: propranolol, mirtazapine, and quetiapine.  …

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Using low-dose naltrexone to treat pain

Meds
October 2, 2019

Lori Pinkley, a 50-year-old from Kansas City, Mo., has struggled with puzzling chronic pain since she was 15.

She has had countless disappointing visits with doctors. Some said they couldn’t help her. Others diagnosed her with everything from fibromyalgia to lipedema to the rare Ehlers-Danlos syndrome.

Pinkley has taken opioids a few times after surgeries, but they never helped her underlying pain, she said.

“I hate …

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How we got from 18th-century tinctures to the opioid crisis

Meds
October 2, 2019

Americans have always loved their medicines and sought them out actively to cure whatever ailed them. Their interest ranged all the way from “staying well” to “feeling better.” Productivity in this hard-charging, pull yourself up by the bootstraps society required activity, and it’s hard to be active when you’re sick.

In the 18th-century in Germany, England, France, and Switzerland, men practicing pharmacy saw their retail operations as the …

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An expensive treatment may be a victim of its own widening use

Meds
October 1, 2019

Medical treatment has knocked down tumors in 6-year-old Easton Daniels’ brain, but the drug used also wiped out his immune system.

To bolster his immune function and help keep him healthy, he has visited a hospital for intravenous infusions of immune globulin about every month for the past year and a half.

But in early July, his family was stunned by a letter from Cincinnati Children’s Hospital: “All of Easton’s appointments canceled …

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Does marijuana really relieve pain? Here’s what anesthesiologists say.

Meds
September 13, 2019

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

Marijuana is made from the dried flowers of the cannabis plant. Made of more than 500 chemicals, including over 100 compounds called cannabinoids, the primary active compounds in the plant are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC acts on specific brain cell receptors that …

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Considering CBD oil? This psychiatrist suggests these questions to ask first.

Meds
August 26, 2019

One question I get asked a lot lately is this: “Is it OK  for me to use CBD oil?”

First of all, CBD oil and associated preparations are types of alternative medications, medicines that might not be mainstream or readily prescribed by doctors, but are nevertheless used by many people on their own. Alcohol and marijuana are two substances that are often used as “medicines” by those that think they function …

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Are benzodiazepines “the worst thing that’s ever happened to people”?

Meds
July 17, 2019

Although Arnold Knutsen and I “met” virtually five years ago, we only first spoke on the phone recently when he called to share his story. He’s the eldest member of the online benzodiazepine support group we cohabitate. His posts in the group always reeked of desperation, and there was a palpable sense of urgency to his pursuit of a cure for his situation. It was clear …

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The art of off-label prescribing

Meds
July 10, 2019

Some drugs are used for indications beyond their original FDA approved ones that make complete sense. I mean, if old seizure medications help nerve pain, it might be reasonable to try new ones for the same purpose if everything else fails.

Sometimes the broader use of a medication leads to additional FDA approved indications. One good example is bupropion, Wellbutrin, for smoking cessation. It even got a new name for that indication, Zyban, …

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The ethics behind the world’s most expensive medication

Meds
June 14, 2019

With the recent FDA approval, Zolgensma became the world’s most expensive medication. Priced at $2.125 million per patient, the one-dose gene therapy is a potential life-saver for children with spinal muscular atrophy (SMA). Now, the treatment is at the center of an intensifying debate over the rising price of medications.

Industry watchdogs are outraged. They say Zolgensma is merely the …

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