Articles Posted in Medications

codeineWhen severe colds, flu, or other infections run down youngsters with bad aches or an unrelenting hack, worried parents and doctors may turn to potent painkillers and cough suppressants. But the federal Food and Drug Administration has issued its strongest warnings about key ingredients in some of these, saying kids should not receive medications containing codeine or tramadol.

Both are powerful opioid painkillers. Prescription cough syrups often contain codeine. Tramadol typically is a drug given only to adults, though the FDA says it is seeing it prescribed more often, off label, to kids. Both tramadol and codeine have been prescribed for post-surgery pain for youngsters who have had their tonsils or adenoids removed.

But children, especially those 12 and younger, can have severe reactions to codeine and tramadol. They can slow or labor their breathing.

D-vitaminsThe health care pendulum appears to have taken a bad swing to the extreme with vitamin D.  Too many Americans may be taking unnecessary tests to see if they’re deficient of this important nutrient. Too many of us are taking unneeded amounts of it.

Federal experts report that blood tests for vitamin D among Medicare beneficiaries, most 65 and older, increased 83-fold from 2000 to 2010. Testing rates rose 2.5-fold from 2009 to 2014 among those with commercial insurance.  Among a recent sample of 800,000 patients in Maine, nearly one in five had at least one test for blood levels of the vitamin over a three-year period. More than a third got two or more tests, often for vague complaints like malaise or fatigue. Labs and doctors are telling patients who have undergone tests and who have readings in the normal range of 20 to 30 nanograms of the vitamin per milliliter of blood that they suffer a deficiency.

This all is leading to what some experts are terming a “pandemic” of over-testing, faulty diagnosis, and excess consumption of a nutrient, based on sparse evidence and misplaced belief that, as the New York Times reports, “vitamin D can help turn back depression, fatigue, and muscle weakness, even heart disease or cancer. In fact, there has never been widely accepted evidence that vitamin D is helpful in preventing or treating any of those conditions.”

IMG_1029-300x201At a time when drug costs are skyrocketing and Americans are demanding relief, President Trump’s nominee to be the chief regulator of Big Pharma and medical device makers says he initially must sidestep a lot of oversight of the industry because his deep ties to it might cause conflicts of interest.

Scott Gottlieb made his ethics disclosure as he gets set for congressional vetting of his appointment as head of the federal Food and Drug Administration.

Critics question if Gottlieb, a physician, is too cozy to crack down on excesses in an industry in which he has worked for most of his career and that has paid him millions of dollars. He has pledged to speed up FDA drug and medical device reviews, and to slash the agency’s bureaucracy and red tape.

Maryland_State_House_from_College_Ave-300x254Big Pharma’s skyrocketing prices are finally in for some real scrutiny by the U.S. Government Accountability Office (GAO), as well as new initiatives in the Maryland and New York statehouses.

The GAO—the independent, nonpartisan agency that works for Congress and often is called the “congressional watchdog”—has announced that it soon will undertake an investigation requested by three members of Congress of abuses of the federal Food and Drug Administration’s Orphan Drug Act.

That act is supposed to spur Big Pharma to develop drugs for “orphan diseases,” illnesses that affect fewer than 200,000 Americans. Drug makers have resisted investing time and money on therapies for these diseases because the medications may offer insufficient financial returns. So, Congress granted tax incentives and limited exclusive rights to makers of drugs targeted at patients with niche diseases.

Donald_Trump-1-225x300A GOP assault on American health care has been turned aside, for now. But major questions have been exposed that will need answering if we as a country are ever to come together over health care. Do we recognize that health care—comprising 17.5 percent of the Gross Domestic Product and trillions of dollars in spending annually— has become so costly, complicated, and critical that each of us, at some point in our lives, must have some assistance from all the rest of the collective us?

In short: Do we believe that health care is a right?

All other civilized countries answered that question long ago in the affirmative and have implemented systems that guarantee everyone living within their borders (or even visitors from places like the USA) a basic package of health care.  But we here in the United States still struggle with the world’s most expensive health care system that delivers care to a smaller percentage of its residents than anywhere else and that gets worse outcomes than most other advanced countries.

repatha®-evolocumab-product-shot-5-HR-300x189With all the public attention now focused on soaring drug costs, Big Pharma just can’t seem to stay out of the spotlight. Drug makers are keeping up their eyebrow-raising actions, as are purveyors of so-called “stem cell” treatments, and it’s worth noting some of what’s happening with these:

Will insurers, MDs, patients pay for $14,000-a-year cholesterol fighting drug?

cdc-logo-300x226When it comes to the nation’s health, the Trump Administration and the GOP-dominated Congress seem determined to prove they know how to do penny-wise and pound-foolish. They’re amply demonstrating this with proposed slashes in the nation’s basic budget for public health. They’re calling for a $1 billion cut for the Centers for Disease Control and Prevention, notably in the agency’s funding to combat bioterrorism and outbreaks of disease, as well as to battle smoking and to provide critical medical services like immunizations. Their target is the Prevention and Public Health Fund, set up under the Affordable Care Act, aka Obamacare. With the ACA under fire by partisans who want to repeal and replace it, the fund was already imperiled. GOP lawmakers, determined to cut domestic spending, seem disinclined to come up with substitute sums.

Andy Harris, a Maryland Republican congressman, physician, and House appropriations health subcommittee member, has been quoted as calling the public health money, “a slush fund.” He argued that, “It’s been used by the secretary [of health and human services] for whatever the secretary wants. It’s a misnomer to call it the Prevention and Public Health Fund, because it’s been used for other things, and it’s about time we eliminated it.”

The Obama Administration did embarrass Congress by tapping the fund to provide emergency aid last summer to Florida, Puerto Rico, Hawaii, and other states battling tropical infections, including Zika and dengue fever. Congress took a long recess vacation, as states clamored for help for mosquito eradication and vaccine development to deal with Zika, a virus that can cause severe birth defects and other harms.

PrecisionHealth-300x108It’s a $50-million business with a roster of blue-chip consultants who would be an envied faculty at most any major university. But look closely at the activities of Precision Health Economics because this firm’s esteemed academic economists, for big bucks, are boosting Big Pharma’s efforts to justify some of its sky-high prices for its products to policy-makers, regulators, and lawmakers.

Pro Publica, the Pulitzer Prize-winning online investigative site, deserves credit for raising questions about yet another area in which ordinary Americans may be outgunned by special-interest money. Big Pharma already has earned notoriety for seeking to advance its causes by paying physicians, underwriting patient advocacy groups—and now retaining high-powered economists.

Economists play a key role in providing expert views on drugs, their prices, and markets, all of which are increasingly controversial issues as Americans struggle to afford medications that can cost $1,000 a day or tens of thousands of dollars for treatment regimens lasting for a few months.

Back-Pain-300x188Back pain is one of Americans’ leading debilitating complaints, prompting us to spend billions of dollars annually for relief and costing more than $100 billion, especially in lost work and wages. But an influential physicians’ group, joining a growing number of other experts, now recommends that we buck up, exercise, keep moving—and stay away from a reflexive reach for drugs, especially powerful painkillers, to deal with aching backs.

The American College of Physicians, with guidelines published in the Annals of Internal Medicine, concedes it is breaking with longstanding medical views on treating low back pain. But the group’s experts said they conducted a “systematic review of randomized, controlled trials and systematic reviews published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain.”

They found that many patients with low back pain recovered over time “regardless of treatment,” and these individuals might benefit most from heat, rest, exercise, and over the counter, non-steroidal medications. Another group of back pain sufferers might need physical therapy, stress reduction, acupuncture, yoga, or ta-chi. Only after patients have not found relief with “non-pharmacological therapy,” should doctors consider giving non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. If these don’t work, tramadol (Cymbalta) or duloxetine (Ultram) might be considered.

prescription-bottles-1-300x170Some diligent, grown-up sons and daughters may want to check in on mom, dad, and grandma, grandpa, all the aunties and uncles, too. That’s because there’s yet another warning that too many doctors are whipping out their prescription pads all too readily and writing scripts for retirement-age Americans, who now take on average three psychiatric drugs without any mental health history.

Research published in the JAMA Internal Medicine shows that over-prescribing of powerful psychotropic drugs, including sleeping pills, painkillers, and anti-depressants may be more common than believed. The study was based on an analysis of data from a big number of doctors’ office visits, with researchers finding the number of “polypharmacy” incidents (cases in which seniors received scripts for multiple drugs) increased between 2004 and 2013 from 1.5 million to 3.68 million.

This doubling resulted from seniors’ greater openness in talking with their doctors about mental health issues, and, in instances where visits were related to “anxiety, insomnia, or depression,” the researchers write. But, in disturbing fashion, a high number of women and rural patients were involved in cases where multiple psychotropics were prescribed, and many of the prescriptions were for painkillers.

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