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Managing Labor Pain Without The Use Of Drugs

No one likes pain, least of all pregnant women. Although obstetricians do a great job providing prenatal care and childbirth deliveries, there is always room for improvement regarding patient education.

The management of labor pain is usually delegated to the Anesthesia Department within a hospital or an ambulatory center. The goal of anesthesia is to eliminate physical pain and any suffering that might be a result of pain. However pain and suffering may not always be about cause and effect. To quote the literature, “Although pain and suffering often occur together, one may suffer without pain or have pain without suffering.” Some women want to eliminate pain and others view it as a normal process. However, to the well initiated, it is well known that women who are in pain and “suffering” do not progress as quickly in labor as those who are pain free. For those pregnant moms who would prefer not to have “drugs” here are some options however, please keep in mind that information regarding the safety and effectiveness of these methods is “scientifically” limited, meaning the subjects involved in medical studies to prove whether these methods work or not are small. Having said that, listed below are some of the most popular ways to reduce pain without drugs, however, please consult your physician or healthcare provider prior to using them. Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

Drugs, Drug Reps, And Dealing With Pharmacies

As a gastroenterologist, I treat hundreds of patients with heartburn. You already know the names of the medicines I prescribe, since they are advertised day and night on television and appear regularly in print newspapers. Pharmaceutical representatives for each one of these drugs come to our office each claiming some unique clinical advantage of their products over the competitors. They have a tough job since the medicines are all excellent, are priced similarly and are safe. On some days we will have 2 or 3 reps visiting us, each one proffering a medical study or two that supports their product. They show us graphs where their drug is superior to the others regarding an event of questionable clinical import. Their goal is to show that the graph line of their drug is going up, while those of their competitors are going down.

Physicians, like me, who do give these folks some time, have mastered the art of the slow head nod as the drug’s virtues are being related. In the past, the relationships they cultivated with us translated directly into prescriptions being written. Not so today, when our prescribing pens are controlled by insurance company formulary requirements. Those drugs that are not on the coveted list not just swimming upstream, they’re trying to scale a waterfall.

Drug companies know a lot more about us than we know about them. They have Read more »

*This blog post was originally published at MD Whistleblower*

Are The Low Prices Of Generic Drugs Enough To Make You Switch?

Generic medications appear to be far more cost-effective than previously reported, concluded a team of Harvard professors. But, physicians and patients aren’t adopting them wholeheartedly.

Patents of 20 drugs with annual sales of more than $1 billion expired or will do so between 2010 and 2013, including Lipitor and Plavix, the highest- and second-highest revenue producing drugs in the U.S. While highly effective generics provide low-cost options for chronic disease management, they are not always factored into cost analyses, and are sometimes viewed with concerns about their safety and efficacy.

The Harvard team revisited a 2008 study that used brand-name medication costs in an analysis of the cost-effectiveness of strategies to prevent adverse outcomes associated with cardiovascular disease and diabetes. The study found that up to 244 million quality-adjusted life-years could be gained over 30 years with appropriate preventive care. But, the study authors wrote, that “most prevention activities are expensive when considering direct medical costs.”

The Harvard team recalculated figures from the 2008 research, Read more »

*This blog post was originally published at ACP Internist*

CYA TMI? Drug Label Warnings List Dizzying Number Of Adverse Events

Drug labels warn about a mean of 70 adverse events per medication, leading researchers to conclude that the glut of information is confusing patients.

Jon Duke, MD, an ACP Member, and other researchers extracted 534,125 adverse drug events from 5,602 product labels. There was a mean of nearly 70 events per label. They found 588 with more than 150 adverse drug events and 84 with more than 300, with the top offender having 525 events listed. This top group included selective serotonin reuptake inhibitors, anti-virals, and restless leg syndrome drugs.

Labels for the 200 most commonly dispensed medications contained significantly more adverse drug events than others (median, 79 vs. 47; P<.001). By specialty, there were more adverse drug events listed in the fields of neurology (n=168), psychiatry (n=116), and rheumatology (n=111).

Drugs approved during the 1980s and 1990s had the highest overall number of adverse drug events, while newer medications had significantly more labeled adverse drug events than older medications.

“The findings aren’t unexpected,” wrote Dr. Duke and colleagues in the Archives of Internal Medicine. Newer drugs face more rigorous clinical trials and postmarketing surveillance than older medications. More commonly prescribed drugs are more likely to generate more reports of adverse events. The high volume of events in neuropsychiatric medications “may relate as much to patient population as to the effects of the drugs themselves.”

But, Dr. Duke and colleagues concluded, “The presence of such excess data still may induce information overload and reduce physician comprehension of important safety warnings.”

While the Food and Drug Administration tried to revamp warning labels in 2006, labels have grown more complex since then. “This finding underscores the tremendous challenge faced by the FDA in reversing the long-standing trend toward overwarning.”

*This blog post was originally published at ACP Internist*

What’s Inside Osama Bin Laden’s Medicine Cabinet?

NBC News obtained from sources in Pakistan a list of drugs found in Osama bin Laden’s medicine cabinet, after Navy SEALs left the scene of the raid and Pakistan officials took over the compound.

My Medicine Cabinet by Steve Isaacs via Flickr and a Creative Commons licenseThe list shows that bin Laden was a fairly typical–almost American–consumer of over-the-counter medications. There was nothing to indicate he needed dialysis or had diabetes or Marfan syndrome. He did have secondary osetoporosis, according to physicians who examined photos of him over time. (That’s an actual job, by the way, for physicians who’d want a career drawing up profiles about the health of world leaders or terrorists and feeding that information to intelligence analysts.)

Bin Laden stocked pain relievers for kids living at the compound, some home remedies for nerves and gastrointestinal upset, and Avena syrup, which is an extract of wild oats that’s been associated with enhancing sexual desire. Much hay has been made from those wild oats, such as who might have been taking them.

*This blog post was originally published at ACP Internist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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