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

The FDA released a public statement that pill splitting may be hazardous to your health.  They advise against the growing practice of asking your doctor for a tablet twice the strength you need, then halving it to make two doses. My Family Doctor has advocated this in the past as a way to save money.

They cite four reasons “why splitting is risky.”

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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.

The FDA has become concerned about an increase in deaths from “accidental” narcotics overdoses.  Apparently, the powers that be have come to recognize what we docs have known all along: Not all who ask for prescription narcotics use them in the manner prescribed, and some will do anything for their “fix.” (more…)

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.

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.

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.

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.

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 while back there was news on a couple of pharmaceutical companies working on a new drug type that decreased appetite by blocking the same receptors in the brain that stimulate hunger after smoking marijuana.  Early trials showed promise, but later studies proved that, to take an dose of taranabant strong enough to decrease appetite effectively, the side-effects increased also.  The risk of increased anxiety, depression and suicidal thoughts was too much so Merck has cancelled further testing and pulled the drug from FDA consideration.

I am disappointed in the failure, but commend Merck for doing the right thing.  It is an example of the time, expense and risk involved in trying to bring a new drug to market.  It is also a good example of a medical news story, highly touted and broadcast initially, with little follow-up.  Get the headlines from big media. Get the real scoop from JHMFD.

Can you think of other examples?