Medications

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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Neurotransmitters and the side effects of antidepressants

Meds
July 22, 2011

We  certainly wish that antidepressants in particular, and all psychiatric medications in particular were free of side-effects. It would be a boon to our patients, and their families. Sadly, there is no such thing as a medication without any risk of side-effects. Even over-the-counter medications such as Tylenol, Benadryl an aspirin can have pretty serious side-effects.

Some side-effects of medications are related to dose — the higher the dose, the …

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Pharmacies selling prescription information to data mining companies

Meds
June 30, 2011

Walgreens is being sued by customers who are not happy that their prescription information – even though it has been de-identified – is being sold by Walgreens to data-mining companies.

The data privacy and security concerns surrounding the transfer of de-identified data are significant.  To “de-identify” what is otherwise protected health information under HIPAA, some outfits will simply strip data of 18 types of identifiers listed in federal …

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What to do with a prescription bottle with the wrong pills inside

Meds
March 22, 2011

Have you ever opened a prescription bottle to find the wrong pills inside? If so, you may have found it to be an expensive mistake.

Whatever the reason for the error (and there are numerous possible causes), here is how to best handle the situation.

Of course, it is always smart to confirm the medications, quantities and dosages at the pharmacy checkout.  A mistake recognized at the time of purchase can be easily …

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Successfully appeal an insurance company reviewer decision

Physician
March 7, 2011

Coverage requests get rejected when the requested service does not fit within an insurance company’s initial guidelines for approval.

This happens for a number of reasons, but usually it comes down to poor documentation or inappropriate care, or in some cases care that is appropriate but can’t be supported in the literature.  When a denial occurs, the physician or patient has several opportunities to appeal this decision.  The first appeal is …

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Alternatives to NSAIDs, pros and cons

Meds
February 3, 2011

by Marianna Rakovitsky, RPh

Recently, I have talked about the concerns with the use of NSAIDs and their effects on the heart.  All medications carry a risk of adverse effects. NSAIDs are usually very effective in controlling pain especially muscle and bone pain, but they also carry a potential risk of side effects such as stomach and kidney problems, increased risk of bleeding and adverse effects …

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FDA regulation and non-approved use of drugs

Meds
January 26, 2011

The other day, I happened to be talking to Mark, a sales representative from one of the pharmaceutical companies.  He’s the type of rep that many doctors don’t mind seeing – someone who is careful of your time, is happy to hunt down the answers to questions that come up on the medications his company makes, and brings by useful information about new drugs that seem to be practice-appropriate.  He …

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Create a disease to market a new drug

Meds
January 24, 2011

An excerpt from White Coat, Black Hat.

by Carl Elliott

Many of us have a relatively simple, commonsense view of the way that drug development and marketing work.

People get diseases; scientists develop drugs to treat those diseases; and marketers sell the drugs by showing that the drugs work better than their competitors. Sometimes, however, this pattern works in reverse. Drug company scientists develop a drug …

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How cocaine can be used in sinus surgery

Meds
January 16, 2011

Many people are already aware that marijuana is now legal in some states in the US with a medical prescription.

What many people may not realize is that cocaine is also used in medical care, especially in the ENT world.

Cocaine is one of the most potent anesthetic and vasoconstrictor. These two characteristics make it an ideal medication for use during sinus surgery as well as any nasal procedure where bleeding and …

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Why doctors should profit from dispensing medications

Meds
January 15, 2011

Hold onto your hats. I am about to enter dangerous territory. I am about to suggest maybe doctors should profit from dispensing medications from their office to offset declining reimbursements and rising expenses by using prescriptions as a source of ancillary revenues.

Why dangerous?  For a number of reasons.

One, physicians still grapple with the perception that it is improper for a physician to make money from …

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Adding tiotropium (Spiriva) to an inhaled steroid a mistake?

Meds
December 30, 2010

There is a lot of press about a study recently published in the New England Journal of Medicine that shows that adding tiotropium (Spiriva) to an inhaled steroid might have benefit in asthmatic patients. This study is creating a lot of buzz due to recent concerns of ICS/LABA safety and might prompt doctors and patients to start switching (some already have before this study came out). However, this …

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The cost of keeping the terminally ill alive

Physician
December 16, 2010

Last year, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients’ lives.

And it has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked. This statistic is from a 60 Minutes story on “The Cost of Dying” and …

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Medical errors that involve handwritten prescriptions

Physician
December 14, 2010

by Daphne Swancutt

Two people in the United States just died in the last hour. Seventeen more will die in the next 7 to 8 hours. Over a year, that number will accumulate to about 7,000.

The reason? Medical errors that include misread or otherwise misinterpreted handwritten prescriptions. Believe it. This means that doctors are being sloppy, pharmacies are making mistakes and people are getting dead.

Even more …

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MKSAP: 70-year-old woman with hypothyroidism and a fractured hip

Conditions
December 2, 2010

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 70-year-old woman with hypothyroidism fell and fractured her hip. During preoperative evaluation for hip fracture repair, she mentions recent mild fatigue, which has not significantly limited performance of her daily activities, and ongoing right upper-quadrant abdominal pain after eating. She takes levothyroxine, 0.075 …

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Antibiotics need to become controlled substances and regulated

Meds
November 29, 2010

Antibiotics for viral infections are a big pet peeve of mine. No. Make that a huge pet peeve.

Some doctors prescribe antibiotics for coughs and stuffy noses because the patients want them. If you’re one of those patients who think that antibiotics make your coughs go away, or clear up your stuffy noses, or somehow make your sinus headaches vanish, or if you’re a doctor who prescribes antibiotics for these symptoms, …

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Help patients synchronize their prescription drugs

Meds
November 12, 2010

Here’s the scenario: on the 2nd of the month, a patient with diabetes on metformin and high blood pressure on benazepril sees her family physician for a routine follow up.

The patient’s blood pressure is elevated and the decision is made to add carvedilol to help get the blood pressure to goal. The patient’s metformin and benazepril “drop” (are renewed) at the pharmacy on the 18th of every month, a date …

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