Medications

How drug prices are manipulated

Meds
September 30, 2022

I wondered whether to recommend Nuedexta for my elderly relative with worsening Alzheimer’s disease and daily spontaneous crying. Often she would deny feeling sad and couldn’t account for her sobbing.   Avanir Pharmaceuticals released Nuedexta in 2010 to treat pseudobulbar affect: involuntary emotional outbursts due to certain neurologic conditions or brain injury. I wasn’t sure if these crying bouts qualified as pseudobulbar affect. But my biggest hesitation was the breathtaking …

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A friendly battle with a patient’s potassium

Conditions
September 14, 2022

“By God’s grace, Dr. Sal!”

“Yes, T.J.! What’s the good news?”

“Guess what Mr. Thompson’s potassium is now?”

“3.1 …”

“Wrong! 4.1!”

We high-fived each other immediately and breathed a huge sigh of relief. For six days straight, we’ve been giving Mr. T potassium through an IV and by mouth with little to no change in his potassium level.

He came to the hospital after being found passed out in his home. Very low initial blood …

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Management of acute postoperative pain reveals systemic flaws in health care policy

Physician
August 23, 2022

Medical care in the United States is broken. The pandemic contributed, but we were well along this misdirected journey. There is a pathological push/pull between financial pressures applied by payors and health care systems to decrease costs, thereby generating profits versus the desire of providers to deliver outstanding care to patients. This is ingrained into our system as it is designed. The dynamic is further muddled by our unique medicolegal …

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Cancer of the future: diagnosis, treatment, and impact on the health care system and patients

Meds
August 3, 2022

While cancer has been around for decades, the fight for survival and treatment options are still very top of mind. Treatment is simply playing catch up. We continue to try and get rid of the disease that has already infiltrated one’s body rather than catching it before it develops. We need to shift the focus from therapeutics that fight the disease to ways we can catch it before the deterioration …

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The promise of in silico drug development to improve patient outcomes

Meds
July 2, 2022

In the last two years, pharmaceutical companies have become increasingly interested in the possibilities in silico technologies bring to the world’s multi-billion-dollar drug development market. Among the factors that have been reported as drivers of recent interest in what is also known as virtual clinical trials are the COVID-19-related restrictions that began impacting traditional human-based clinical trials in 2020.

In silico drug development utilizes real-world data (RWD), artificial intelligence (AI), computational …

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Automatic refill and 90-day fill programs don’t improve medication adherence

Meds
May 20, 2022

Health care has fooled us into believing a number of myths that—taken at face value—sound logical and true. Here’s one of the most pervasive and dangerous myths: Pharmacy’s value comes from convenience and access. And here’s another one: 90-day fills, and automatic refills on prescriptions improve medication adherence and patient health.

It’s not surprising that people might champion the efficacy of these tactics. It feels easier to get 90 days of …

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A path toward clinical trial diversity

Conditions
May 8, 2022

Minority and marginalized communities have historically been underrepresented in local and federal governments and in dozens of private sectors globally. Pharma is no different; there exists a steep chasm that drugmakers have yet to bridge concerning research and trials. The longer this gulf exists, the harder it becomes to address – the feelings of mistrust, resentment, and disenfranchisement only get harder to overcome with time.

Over the last decade, the pharmaceutical …

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Before taking Paxlovid, consider these drug interactions

Meds
April 7, 2022

FDA and Health Canada recently approved Paxlovid as an oral treatment option for mild-to-moderate COVID-19 who are at high risk of progression to severe COVID-19. It is a combination drug containing nirmatrelvir/ritonavir. Nirmatrelvir works by binding to SARS-CoV-2 3CL protease to ultimately stop viral replication. Ritonavir does not have any antiviral activity against COVID-19 but increases concentrations of nirmatrelvir by decreasing its metabolism by CYP3A4 enzyme. Ritonavir is …

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Will Biden’s State of the Union remarks revive prescription drug reform?

Policy
April 7, 2022

My credit card hovered over the card reader at the pharmacy as I contemplated whether I should pay. Two hundred and eighty dollars and some change. For two EpiPens, each with 0.3 mg of epinephrine that could potentially save my life if I accidentally ate something with sesame seeds. At that moment, I realized that even I, as someone with good employer-based family health insurance, was being forced to make …

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Concerns about the generic formulations of ADHD medications

Meds
March 25, 2022

I love generic brand products. I will fight to the last breath for my Shoppers’ Choice Adhesive Bandages rather than pay an extra $0.49 for Band-Aids. So why, then, have I been paying up to $395 every month for brand-name medication for the last two years instead of getting the generic version for $7.56? After all, aren’t generic drugs the same as their brand-name counterparts?

Let’s go back to November 2019, …

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Medication management and how consultant pharmacists can help

Meds
February 22, 2022

Management of medications is sometimes handled sub-optimally, at least in the United States. At the extreme, physicians who prescribe multiple medications prescribe some medications that treat the side effects of other medications. This could be considered physician negligence in extreme cases.

An example was given in a class I took at UCSF (the University of California at San Francisco). UCSF physicians jointly provided remote advice for a physician treating a developmentally …

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Patients are captive pharmacy benefits manager consumers

Meds
February 16, 2022

I still recall the ICU physician holding my hand and preparing me for the possibility I might not survive the blood clots in my lungs, pulmonary embolism. It was eighteen years ago when out of the blue, I found myself unexpectedly holding the hand of that gentle, concerned doctor, whose name I do not even know. My son was three years old at the time, and all I could think …

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Do prescription drug monitoring programs hurt more than they help?

Physician
February 3, 2022

It was a warm summer in Maine but felt like a cold winter in the confines of the hospital building. I was seated next to a physician who was quietly working on a big screen monitor. It was a slow workday as I pondered tips and tricks to make the physician workflow efficient while training providers on implementing electronic health records. I stared at the computer screen and the physician …

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The status quo is failing people with opioid use disorder

Conditions
January 23, 2022

As we anticipated the release of new CDC data on overdose deaths, those of us who specialize in substance use disorders braced for grim statistics, but this milestone was still shocking: over 100,000 lives lost to overdoses in one year, the great majority from opioids. Overdose deaths began outpacing traffic fatalities in the United States in 2013, but 2.5 times as many people died from …

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How drug distributors contributed to the opioid crisis

Meds
December 28, 2021

A recent headline in my neighborhood newspaper read, “A Dentist Became a Top Opioid Buyer in W. Va. Now a Drug Firm Faces Penalty for Ignoring Red Flags.” The drug firm sent 25,400 hydrocodone pills and 3,600 Xanax to one Huntington, WV area dentist. The DEA raided the dentist’s office and shut it down. The dentist admitted to ordering the pills for personal use.

This summer, also right …

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Is Descovy really the better option?

Meds
December 12, 2021

When the FDA approved Gilead’s Truvada (emtricitabine/tenofovir disoproxil) for HIV PrEP in 2012, it was a revolutionary step forward. The drug was safe and up to 99 percent effective in preventing HIV infection in at-risk individuals.

Then in 2019, Gilead received FDA approval for a second drug for PrEP called Descovy (emtricitabine/tenofovir alafenamide), with equivalent efficacy to Truvada. Recent research has shown that by the end of 2020, …

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How did we let insurers run health care?

Meds
November 15, 2021

How did we Americans allow health insurers to dictate how physicians practice good medicine? The hypocritic oath says, “Do no harm.” We should not allow insurance company profits to prevent proper care for patients.

Our insurer is now telling our young adult son, a Crohn’s patient (Crohn’s is not yet a curable disease), who has been in remission since he began taking Remicade over 11 years ago to switch to a …

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Are collagen supplements good for you? A physician’s deep dive answer.

Physician
November 2, 2021

I was asked this question at least three times this week, so I think there must be something going around.  It doesn’t help that a Kardashian with 140 million Instagram followers recently signed a deal to become an equity partner and global spokeswoman for a company selling collagen supplements.  The global market for collagen-containing products was estimated at $300 million last year, and is projected …

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The abundant and colorful world of pharmaceuticals

Meds
August 25, 2021

Creative photography

Year after year, new medications find their way into the market, adding to the abundant and colorful world of pharmaceuticals.

Medications play a dual role in our lives, as they represent wellness and illness concomitantly. I am primarily fascinated by the human love-hate relationship with medicine in the form of dependency and liberation, desire and distaste, and hope and despair. On one …

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The ritual of taking medications: the pill wheel

Meds
August 21, 2021

Woodworking / Illustration

The problem with the act of taking medications is that it’s so mundane that we don’t see any problem with it.

This machine-cut, flat, unemotional, same-size-fits-all object that we defencelessly welcome in our very private body has a role. Medications occupy our existence by interlocking with our cells and taking control of our body, fighting, provoking, sedating, and changing the music …

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