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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by  James Hubbard, M.D., M.P.H.

The FDA wants you to know that drugs not only interact with other drugs; they also interact with dietary supplements, food and beverages.  Always talk to your doctor and read any information available before starting new medicines.

To prove the point, the FDA has listed examples.

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

The older we get, the more we start to worry about dementia. … What was I saying?  Oh, yeah, dementia, a decline in our memory, thinking, figuring things out.  Declining cognition.  Alzheimer’s is a type of dementia.

Actually, it is nothing to laugh about. The increasing elderly population makes certain it will become a big and bigger public health hazard.  Our ignorance of how to prevent or treat it, or even knowing the causes for certain, makes it fair game for people to want to try anything they’ve heard might help.

Ginkgo biloba falls into that category of hope.

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

I have been treating irritable bowel syndrome, sometimes called spastic colon, since I began practice in the 1980s.  I saw a lot of it when I had a full-time family practice.

Several new treatment drugs have been developed and removed from the market within the past few years, due to bad side effects.  An article in the British Medical Journal shows that really, much has not changed since the 1980s.

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

Do you understand Medicare Part D? Do you even know what it is? How about your elderly loved ones?

Medicare open enrollment starts November 15 and ends December 31. During this time every year, Medicare participants can change or tweak their Medicare Part D (prescription drug) plan.  Start early so everything is in place by the time the new coverage kicks in on January 1.

If you’re under Medicare age, consider helping loved ones with their decision.  There are several options and it can get complicated.

Here’s some help to get you started.

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

Waiting for health-care reform?  Guess what.  It’s going to be a while, and no matter what the changes are, it will stay relatively expensive.  In the end, it’s still our responsibility to take care of ourselves, and to find ways to limit costs.  We can do that now.

Here are a few suggestions.

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

I don’t know about you, but when I go to the cough-and-cold section of the pharmacy, I feel a little overwhelmed.  I think I know what I want but then see the same brand with just a little different type or amount of ingredients.  Which is better for your symptoms? (Make no mistake, the over-the-counter meds treat symptoms, not the underlying problem.  Many times that’s all you need, just to feel a little better until your body agrees.)

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

A new study concludes that many physicians prescribe placebos to their patients.  The news, which made headlines all over the place late last week, was surprising to me.  But I think the study is a tad weak and misleading.

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

The FDA met to look at evidence, take comments and decide whether there should be a ban on children’s cough and cold medicine under the age of 6.  They acknowledged the evidence from pediatricians that it was not effective at that age and sent thousands of kids to the ER each year.  Then they punted.  No ban or recall.

A spokesperson for the FDA acknowledged there was no evidence that the meds worked under 6  (apparently the meds were “grandfathered” by the FDA many years ago with no tests on children), but was afraid that parents would use stronger adult meds on children if there was a ban.  The American Academy of Pediatrics does not recommend the meds under 6 and an independent group advised the FDA to ban them last year.

Now in steps the Consumer Healthcare Products Association (CHPA) to save the day (sort of).

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