by Leigh Ann Otte, managing editor

My Family Doctor has learned that Boniva and Tamiflu are no longer covered by the recently announced Medicare-discount agreement.  Whether their manufacturer Roche Pharmaceuticals will instate its own discount is unclear.

On June 20, the powerful trade group Pharmaceutical Researchers and Manufacturers of America made big news, announcing their members would offer a 50-percent discount to most people in the dreaded Medicare Part D doughnut hole. But today, the Center for Medicine in the Public Interest reported Roche is leaving PhRMA.

My Family Doctor asked Roche whether they would still offer the discount. (more…)

by James Hubbard, M.D., M.P.H.

It may be a pharmacy urban legend but there is this ageless story of a doctor prescribing rectal suppositories to a patient.  On the follow-up visit the doctor asked if the suppositories helped and the patient replied, “No doc. It just falls right back out still wrapped in that aluminum foil.” It may or may not be true but I always write directions to unwrap suppository, then insert rectally.

In our March/April issue of James Hubbard’s My Family Doctor we asked physicians what were common mistakes they see patients make when it comes to taking medicines.  We now have the article, “Top 10 Medication Mistakes: Doctors’ tips on taking your medicine,” up on our web home page.  If you have time, take a read.  You might learn something new.

If you do, I would love to know your comments including any additional tips you might add.

by James Hubbard, M.D., M.P.H.

Acupuncture got an official seal of approval from a respected medical organization this year. It effectively treats tension-type headaches and helps keep away migraines—even better than other preventive treatments—they said.

The Cochrane Collaboration is in independent, well-respected, nonprofit organization that analyzes evidence-based medicine (available studies) to to come up with recommendations of whether interventions work.  They are strict, conservative and not easy to please, and it’s hard to get their approval.  So if they think some treatment works, the evidence bears them out.

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by James Hubbard, M.D., M.P.H.

I recently wrote about why drug ads are the way they are. Lo and behold, a study comes out that suggests perhaps a change is in order.

The FDA recognizes we need better quality drug direct-to-consumer ads.  Several groups, including the Institute of Medicine, have called for better information conveying benefits versus adverse effects in these ads.

From a sponsor’s standpoint, ads are for one reason: to sell products.  Regulators are there to make sure these ads aren’t misleading, but don’t want to place undue restrictions that cause ads (and their money) to disappear.  So where is the middle ground?

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by James Hubbard, M.D., M.P.H.

Have you ever been watching one of those ads for prescription drugs touting how wonderful the drug is … then they go into detail about side effects like may it may cause blurred vision, anal leakage, heart palpitations, blindness, maybe death?  Why do they do that?  You don’t see it on all drug ads, just some.  Are these drug companies just more open and truthful than others?

Stay tuned for “the rest of the story.”
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by James Hubbard, M.D., M.P.H.

Unless you have asthma, you probably don’t know the cost of inhalers doubled starting the first of the year. This wasn’t due to market factors or greedy pharmaceuticals, nor did it improve quality of or access to health care.  It was due to a government regulation, just like the regulations on the mortgage, auto and airline industries that have contributed to their bankruptcy.

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by James Hubbard, M.D., M.P.H.

A while back, I blogged about a study that suggested over-the-counter lidocaine gel decreases the discomfort of a mammogram. (The gel numbs the skin after you rub it on.)

Recently, the FDA issued an alert reminding us that, although there were no serious side effects in the study, this same lidocaine gel and similar numbing agents can cause life-threatening side effects if you absorb too much through the skin.  Rarely, it has caused heart irregularities, seizures, breathing problems, coma and death.

A lot to risk for the minimal benefit found in the study, don’t you think?  In small amounts it appears to be safe, but the FDA recommends:

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by James Hubbard, M.D., M.P.H.

I’m starting to wonder if we’re on the right path with fibromyalgia. Is it truly the type of disorder we think it is? Here are some clues I’ve come up with. What do you think, Sherlocks?

I recently wrote about a JAMA study that showed how well the antidepressant amitriptyline worked for fibromyalgia symptoms, though we don’t know why. That got me to thinking. We also don’t know why another drug, Lyrica, helps.

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by James Hubbard, M.D., M.P.H.

Like a lot of doctors, I have mixed feelings about narcotics.  They are great for severe, short-term pain and a must for some terminal cancer pain.   Some people abuse them for nothing more than the high they get.  And then there are all of the in-betweens.  We doctors are kind of caught in the middle, also.  We can lose our license if we prescribe too much or inappropriately.  We are told, by some groups, we prescribe too little to the patients that really need it.  But how do we know who really needs them?  If we are too gullible, we will be prescribing to a bunch of abusers, too strict and we are doing a disservice to those in need.

It is the long-term, chronic use that concerns us the most.  Narcotics are habit forming. They alter your mental state. If you take them long enough, you will have a physical withdrawal trying to get off of them.  Most people will become tolerant needing more and more to get the same effect.

So what to do?

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by James Hubbard, M.D., M.P.H.

Some drugs have a narrow therapeutic index.  You need just the right amount in your system.  Too little and it doesn’t work; too much and you can have toxic effects.  Doctors worry about these and many hedge on the side of caution by using the more expensive but trustworthy brand-name medicine.  But are they really more reliable than the cheaper generic alternative?

The latest JAMA takes on this question by trying to make sense of all past studies that have looked at cardiovascular brand and generic therapeutic levels in patients.

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