Medications

How long should I take antibiotics? Exploring the Goldilocks problem.

Physician
August 5, 2017

Antibiotics save lives, but antibiotics can have negative effects.  When patients have bacterial infections, we want to treat them to prevent complications of the bacterial infection, but not treat them for an excessive duration.  So we have a Goldilocks problem — we want antibiotic duration to be just right — neither too short or too long.

Some clinical conditions have adequate research to define the Goldilocks duration.  Community acquired pneumonia only …

Read more…

Why this physician doesn’t prescribe pain medications

Meds
July 18, 2017

It may seem strange that a gastroenterologist like me does not prescribe pain medicines.

Let me rephrase that. I don’t prescribe opioids or narcotics. I write prescriptions for so few controlled substances that I do not even know my own DEA number. You might think that a gastroenterologist who cares for thousands of patients with abdominal pains would have a heavy foot on the opioid accelerator. But, I don’t. Here’s why.

I …

Read more…

Behind the scenes of a detox scam

Meds
July 7, 2017

It is surprisingly easy to sell snake oil. I know, because I’ve done it. In 2014, I helped create and sell The Right Detox. This was a bogus detoxification program that purported to improve anyone’s well-being and perhaps, cure disease. I was the face of the scam. I launched The Right Detox at a spring-time women’s health expo in Tucson, Arizona.

I kicked off my sales-pitch in front of a small …

Read more…

How a one-time bridging prescription became an every time refill

Meds
June 11, 2017

At what point, we have to ask ourselves, does a medical error that we do over and over again cease to be an error, and simply become business as usual?

At one of the patient safety conferences this week, where we reviewed sentinel events that occurred in the hospital and in the outpatient setting, one of the cases was about a patient who developed an abnormal cardiac rhythm as a result …

Read more…

6 tricks that pharmaceutical marketers use

Meds
May 30, 2017

Long before the Internet and direct-to-consumer advertising, the medical profession tried to reassure people about their health concerns. Remember “take two aspirins and call me in the morning?”

Flash forward to today’s online “symptom checkers.” They are quizzes to see if someone has a certain disease and exhortations to see their doctor even if they feel fine. Once drug makers discovered that health fears and even hypochondria sell drugs, there seems …

Read more…

Do expired EpiPens still work?

Meds
May 24, 2017

A small study published this month showed that most Epipens retain their potency for at least 4 years after their expiration date. That’s no guarantee, of course. I’d still recommend as a “best practice” that families replace them as they expire. But it’s reassuring to know that they’ll usually be effective even when expired. And using an expired EpiPen is almost certainly better than using nothing …

Read more…

It is not a great time to be a pharmaceutical rep

Meds
April 24, 2017

More than a decade ago, the job of the pharmaceutical rep was enviable. Direct-to-consumer advertising pre-sold many drugs so doctors already knew about them. Medical offices welcomed the reps who were usually physically attractive and brought lunch. In fact, reps sometimes had their own reception rooms in medical offices.

By 2011 thanks to drug safety scandals and new methods of marketing, the bloom had fallen off the pharma …

Read more…

Should we treat anti-vaxxers with more respect?

Physician
February 7, 2017

Years ago, when I was less flexible, I took up Pilates. My instructor, Jim, a charming chap with an infectious laughter, was a 9/11 truther. I’d egg him on to hear about his conspiracy theories. Jim believed that 9/11 was concocted by Bush and Halliburton so that the U.S. could invade Iraq to capture their oil. He thought that United Flight 93 never took off. Whatever happened after 9/11 became …

Read more…

Should I take a statin to lower my risk of a heart attack?

Meds
November 6, 2016

Most everyone has had the experience of sitting across from a doctor, being offered a prescription and walking out the door. Most patients will accept the instructions — maybe ask a few questions — and move on. For some of those patients, the medications are more than a one-off; they are intended to be taken indefinitely.

One of the most common of these medications is a statin. Imagine you exercise four …

Read more…

Who’s really prescribing medicine? Hint: It’s not doctors.

Meds
November 4, 2016

In our current health care system, doctors should get to decide what medication is prescribed. Typically, the patient and doctor decide what is the best, then the prescription gets sent off to the pharmacy. When the patient goes to pick up the prescription, often they find a different one instead or are told that their health insurance coverage is not covering that prescription. Instead of receiving the best medication for …

Read more…

This doctor is against medical marijuana. Here’s why.

Meds
September 26, 2016

I have already opined on my disapproval of a medical marijuana law recently passed in Ohio.  Once of my points in that piece is that I did not want legislators making medical decisions for us.  They can’t even do their own jobs.

I am not against medical marijuana; I am for science.  The currency of determining the safety and efficacy of a medicine should be medical evidence, not faith, …

Read more…

I question the ethics of any doctor who sells supplements to patients

Physician
September 20, 2016

I was seeing a patient who brought me a bag of supplements she bought from another specialist. I looked skeptical and then she pulled out the list of lab results the other doctor ordered on her. I reviewed the results with her and asked why all these tests were ordered in the first place, some of which I had never ordered in my life. She said she told the specialist …

Read more…

When treating chronic pain, don’t compromise your principles

Meds
September 17, 2016

One of the most difficult things I deal with as a physician is patients’ demands for pain medications. I treat patients with cystic fibrosis, a genetic disease present at birth with no cure, and its issues are indeed complex. There are legitimate causes for misery from the chronic coughing, abdominal pain, and joint pain recognized as common symptoms of the disease.

But the associated issues of depression, stress with family, and …

Read more…

Benzodiazepine addiction is real. This physician shares his story.

Meds
July 24, 2016

Say the words, “drug addiction,” and most of us think of heroin, alcohol, cocaine, or opiates. However, lurking in the shadows is a less talked about epidemic: addiction to benzodiazepines, commonly known as “benzos.” I should know because after taking a nighttime dose of lorazepam (Ativan) for about ten years; I finally weaned myself off this and all other prescription sleep medications.

About twelve years ago, my father died and then …

Read more…

Saving billions of dollars in health care: The story of Avastin and Lucentis

Meds
July 17, 2016

I sometimes worry that my wife Paula won’t be able to see me grow old. Not that I expect to outlive her. She is four years my junior and has the blood pressure of a 17-year-old track star. It’s her eyesight I’m worried about, because she is at risk for a form of blindness called macular degeneration. Paula is the youngest in a long line of redheads, several of whom …

Read more…

We want access to safe and effective Avastin. Here’s a solution.

Conditions
February 15, 2016

Recently, two states in India halted all use of Avastin for the treatment of eye disease following the report of 15 patients who underwent emergency surgery for potentially blinding infections at the C.H. Nagri Municipal Eye Hospital in Ahmedabad.  Though further investigations are ongoing, there is worry that the cluster of infections centered around a tainted lot of compounded Avastin. This most recent event serves as a reminder of …

Read more…

The games drug companies play can dramatically raise costs for patients

Physician
February 14, 2016

I had a patient last week who was a real pain in the ass.  Wait.  No.  He was actually a really nice guy.  He wasn’t a pain in the ass; he had a real pain in the ass.  Literally.

I was initially concerned about a pilonidal cyst, given the unfortunate fact that he was previously afflicted with this condition (which I consider to be incontrovertible proof of Satan).  But, fortunately to …

Read more…

This doctor won’t prescribe Addyi, the “female Viagra.” Here’s why.

Meds
January 9, 2016

Addyi (flibanserin), the drug to increase female libido had a timid entry into the market with very few prescriptions considering the “hype.” Bloomberg Business reported 227 prescriptions in the first month. That’s a pittance considering Valeant paid $1 billion for the drug.

I am unlikely to help Valeant recoup their investment, because the more I read about this drug, the worse it looks. Here’s why:

It barely works

One of the study endpoints (meaning …

Read more…

11
pages

CME Spotlights