prescription drugs

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One usually thinks of a doctor as one who gives out prescription – sometimes much too easily.  I’m often known as the doctor who declines to push drugs.

I take these things seriously.  I’ve studied long and hard and know what drugs can do – both positively and negatively.  If the risks outweigh the benefits, I can be down-right stubborn.  However, I’ll always have an alternative that can help.

I’m reminded of one case where a woman wanted Chantix (varenicline) – a prescription medicine FDA approved to help people stop smoking — and I said “No.”  To my knowledge and experience, the drug has some problems. The last patient I saw who was already taking Chantix asked me for a renewal. I told her that the symptoms of which she was complaining would probably disappear completely if she got off the Chantix.  I never saw her a second time. Read more on Its Not Only The Smoking That Can Kill You…

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Am I a Brit-snob?  Never thought I was, but maybe I am turning into one. Or maybe it is because The Daily Mail has more detail about the trial of Michael Jackson’s doctor — and better pictures. Whatever.  The truth of the matter is that when the story about Michael Jackson’s death first came out, I had to look up the generic name of Propofol, because I have never used it.  I mean, why would I be hanging around with general anesthesia?  For that matter, why would a cardiologist be hanging around with general anesthesia?? Money alone?  Possible, I do not know what this guy’s finances were like. But I have never personally known or heard of a starving cardiologist — although I suspect that those who do insurance only no co-pay may be closer to it than they want to admit.  But I suspect this guy was not one of those. “Rescuer?”  Perhaps.  Although I cannot quite see Michael Jackson as a “victim” needing saving. Someone basking in the glare of celebrity?  More likely.  A rich person’s doctor, maybe — a doctor wanting to work with famous people. I have felt the pull of that one myself.  But I ran like crazy when I figured out these folks are more interested in getting the prescriptions they want – usually recreationally — rather than in getting something that might actually help any actual medical problem they might have. “Celebrity” may be a new kind of pathology, where people imagine themselves as uber-people who have more rights than other people, and who can buy pretty much anything they want.  Some doctors are easier to buy than others –otherwise how could tobacco companies present medical experts who say smoking won’t harm you? Who can put a price on credentials, or even signatures?  I think this man sold it all. Sure, The Mail has verified — other stories, other places, too — that his purchase of large amounts of propofol was legal, and that his credentials were real. This is not substitute for “ethics,” which people often say they will teach in medical school, but which are, basically, impossible to teach. How can you teach something that life-experience will be the only thing to test you on? Ethics are learned young, far before medical school, and internalized. Read more on Celebrity Pathology Requires Ethics To Treat…

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“I wants me some of them-there antidepressant pills.”

He was a 47 year old good old boy of the sort I had treated in Oklahoma and other rural parts west –a real cowboy. He had herded animals and done the rodeo and all of that.

No, he had never seen a psychiatrist before, ever.  He had been out crying on the front porch, and it was a next door neighbor who had somehow convinced him that there were medications and he did not have to tell his whole life story to get pills. Well, maybe that would work with a general practitioner, but he was not only disappointed but also angry that it was plainly NOT going to work with me. Figuring he had been had, he broke down and told me the story.  I could understand at once why he had been reluctant to get into this, for we went through half a box of Kleenex while he gave me a plot that was worthy of a tear-jerky country song. Read more on A Cowboy’s Lesson — Antidepressants Won’t Work Well With Alcohol…

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It does not matter what country they were from. The father got into the system when his 19 year old son went stark raving looney bonkers and started destroying the homestead. Luckily it was an apartment in an urban setting, or I don’t think anyone else would have known about it. There was one older child who had already flown the coop, one wife who had died because the strain of leaving the old country had been too much. I had a feeling she had also gotten raped or something, but that was father’s post-traumatic stress disorder if anything. I told him to come back for himself, but I never saw him again. He swore on a stack of bibles that his son did not use drugs.  He said nobody had ever explained to him what was wrong with his son. At least no way he could understand and explain back to me.

For an American the solution would have been a support group, like the Alliance for the Mentally Ill. They lived in a rural area, though, and I did not know if the local chapter had anybody who spoke his language.  There is no way the patient could have handled that – and probably not the father, either. Read more on You Can’t Pick And Choose Which Medicines You Want…

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Eli Lilly gets credit for being economically savvy and the first out of the chute.

Cymbalta (duloxetine) is a much awaited antidepressant that is supposed to be effective especially on the bodily aspects of depression.  Those pesky aches and pains that are associated with depression in one form or another.

They seem to have secured “back pain” as an indication for Cymbalta. Read more on Cymbalta For Back Pain…

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97 million Americans with chronic pain and I got a 57 year old screamer in a wheelchair. Back pain, leg pain, pain in places she was not sure of. No, psychiatrists are not supposed to give out morphine.  Yes, I know I have a prescription pad.  But I keep it close to my heart, locked in my file cabinet, or in my purse, because I actually enjoy practicing medicine and do not enjoy the vision of my license certificate on wings on its way out the window. Even if I could have done it fearlessly, I would not have increased her pain medicine.  The more you give, the more they hurt, the more they need.  This is written in a lot of places but you only have to look at the patients who have been created into addicts, and there are plenty of them.

Alternative recommended approach nobody will listen to: A Bryn Mawr college student, apparently not loaded down with clinical cynicism or even clinical experience, came up with this one.

The way it is said is brilliant.  We all act as if we had a pool of attention, and the more of it we place on something that is not pain, the less pain we feel. Experiments cited go from virtual reality to guided imagery to music. Read more on Down With Pain…

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I thought this person should be fired from the county clinic, but most counties don’t let me do that sort of thing.  The state of California has a nice service, where I ask to see who else is prescribing this person the same abusable drugs that I am.  I try to work with people who abuse drugs, I really do.  In one sense, it is the purest of pharmacologies, in that things I usually think are parts of a physician-patient encounter, like conversation and logic, play little or no role. House said that patients lie.  House is a Vicodin (opiate) addict.  Some of my more intelligent substance abusers are House fans. The same way that “Cops” was the most watched TV show in prison, when I was a jailhouse doc.

This person, was getting weaned off amphetamines.  After a lot of  years, I am not very sure I believe in ADHD, or “Attention deficit disorder.”  We all have problems of differential maturity.  These are just people who learn to concentrate later.  They may have other skills like class clowning that are way ahead.  My book learning was ahead of my social skills for a lot of my life. Besides, most anybody brightens up when you give them amphetamines.  Not that the effect lasts very long, mind you.  Even kids who take Ritalin in a quest to do better on the Scholastic Aptitude Test seem to revert pretty quickly to their previous state of dullness. Read more on Getting Amphetamines In Other Places…

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Well, I did not expect to have anything good to say about the FDA this soon.
We have written on QNEXA, one of those drugs compounded from previously known compounds that are devised, as far as I can tell, to make money fast by combining previously approved drugs.  And putting them towards a popular indication, like weight loss. Read more on More On Qnexa Rejection By FDA…

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He was a pale faced, somewhat overweight 50 year old with a tired demeanor.  He had a treatment resistant depression and I had asked his primary care physician to run some tests.  He complained of not just lower back pain, but pain in all his joints, and I wanted to rule out autoimmune illness; things like rheumatoid arthritis, or even lupus. I also told him to review his pain meds with the doctor.

He claimed 8 months of sobriety from what had once been a pretty heavy alcohol habit.  Who knows what is real or true?  He had told me he had a couple “little relapses,” not unexpected in that sort of problem.

“The doctor says I am an addict and I am going to die from my pain meds, because I take too much of them.  I told him if he would give me better ones or stronger ones, I would not have to take so much.  It is his fault.  I really hurt.” Read more on Death By Pain Pills…

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The FDA has declined to approve the weight-loss drug Qnexa, which I wrote about a couple of months ago.

Generally, diet drugs are more danger than help.  But my opinion on that matter is already on the record.

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