prescription drugs

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One of my Frequently Asked Questions is “why do you hate prescription drugs so much?”

And the answer is, I DON’T.  Not at all.  I have used, and will continue to use, prescription drugs whenever they are the best treatment for an individual.

What I DO hate is the way they are mis-used, and the way some companies push their drugs for inappropriate purposes, or in dosages that are harmful when they could be helpful in (usually lower) doses. Read more on A Remarkable Medicine And Its Champion…

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My psychopharmacology preceptor told me a long time ago that the best and most efficient way to know what is happening in pharmacology is to check out the business news.  He was right.

I want to applaud the FDA for doing something perhaps a bit audacious, surely without precedent, but something I consider correct and appropriate.

They declined acceptance of Contrave, a pill for obesity, and requested a longer term and larger study.Bravo.  It’s rare that I give the FDA a “standing O.” The folks at Orexigen pharmaceuticals concocted Contrave — an amalgam of 400mg. of Wellbutrin sustained release and a couple of different doses of naltrexone, 48 and 16 mg. Here is the clinical trials record if you are interested. Read more on Prescription Diet Drug Makes Food Taste Horrible…

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Here are some phrases that you might not expect to hear sweet, friendly Dr. G use very often:

“No, there is no way in hell I am going to renew that prescription as written.”

“Read my lips.  No more oxycodone.  We gotta get you into a rehab, sweetie.”

“Sure, you can see another doctor.  I don’t know how long it will take to get an appointment.  If I am your doctor, you go on a tapering schedule.  Today.”

“If I did what you want, I could kiss my license goodbye.  I am not prescribing outside my specialty and certainly not this crap.  Yes it is crap.  I am sorry you don’t like how I talk, but it is crap.  I can start getting you off it.”

These are all things I have actually said.  Usually loud, yelling over the patient. Read more on Pill Mills Are Death Traps — Marginally Legal…

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I was making one of my rare but periodic attempts to watch commercial television.  Sometimes I amaze myself that I have not given up, especially when I saw a few minutes of “the View.”  I mean, someone has to get in there and promote stereotypes about women, and they are doing an incredible job, what with asking women involved in politics about bathing their babies or something.

Claire Danes in "Romeo + Juliet"

Claire Danes in "Romeo + Juliet"

I admittedly learn a great deal from the commercials.

Like Claire Danes — whom I used to consider a Shakespearean-quality actress — does not seem to be getting any good roles, because she did this incredible commercial, where her eyelashes and face were photographed every couple of weeks.  Admittedly, after four to six weeks, she had pretty lush looking eyelashes compared to week 1.

Here is the prescription drug— yes prescription drug — she was advertising. On the website they have Brooke Shields, too.

Read more on … By An Eyelash…

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He was in his mid-fifties and seemed pretty clueless.  What’s more, he had more abnormal movements than any 20 people and looked like he was dancing with an invisible partner.

Prescription Drugs Should Not Be Shared

It's Dangerous To Take Drugs Prescribed For Someone Else

He sat at home all day trying to get himself involved in things like doing laundry and watching television so that he could get himself tired enough to sleep, focused enough to avoid the voices. He was safe — no forced hospitalization was necessary or even possible here. He promised that he would not harm himself no matter what the voices said, but it became clear that he lived in a world where devils and demons gave him a continuous commentary on everything from why Obamacare would never help him to — the size of his wife’s behind. There may have been some exhortations to harm self or others in the distant past, but they were indeed distant.

He said he had no medicine for the past ten years.  I asked how he lived and he said his family was no help, but his woman was. He was married to someone else but this woman was the only person who knew his day-to-day life and she had brought him to the clinic, so I got a release signed and got her in there. I told her he said he had no medicines in say, the past ten years or so.  She started laughing.

“He ought to be telling you the truth.  He gets his Mama’s old Seroquel whenever he can. Makes the voices shut up so he can sleep a little. ” Read more on Taking Mama’s Pills…

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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…