Have you noticed that medication costs are skyrocketing? Even if you donâ€™t take medication these higher costs are passed along to you in your health insurance premiums. The recently enacted Sunshine Act will combat these economic forces but in ways you may not realize. The legislation requires pharmaceutical companies to report all payments made to doctors. Physicians receiving substantial amounts of money from these companies include “thought leaders” who are sponsored by the drug companies to lecture the nationâ€™s doctors on newly approved medications. (more…)
Early in May 2014 a patient being treated with Armour Thyroid (desiccated thyroid) for hypothyroidism reported that her pharmacy service would not refill her prescription for Armour Thyroid because it was an “illegal” drug. We were both very distressed to learn of this, but for different reasons. My patient was rightfully concerned that she might be receiving a wildly inappropriate medication, while I was concerned that I might not be able to prescribe a medication I knew to be extremely helpful and safe. (more…)
A sensational action by the FDA to cripple development of new weight loss drugs came about two weeks ago. The FDA denied approval to the weight loss drug candidate Contrave, a combination of two medications. Both of the drugs in the combination pill are presently in use and were FDA approved decades ago for indications other then weight loss. One of the drugs Naltrexone, is used to treat opiate drug overdoses and the other bupropion HCL is used to treat depression. Given the long history of safety of both drugs it would seem surprising the FDA would reject the combination of these drugs on grounds of safety concerns, which was what happened. Making the FDA rejection even more astounding is that just a month before, a majority of members of the FDAâ€™s own Endocrinologic and Metabolic Drugs Advisory Committee, gave a thumbs-up to Contrave. In almost all previous instances where the Advisory Committee gives their green light to a new drug candidate, the FDA has followed through with an approval. I can hardly imagine a clearer way for the FDA to say â€œDrop Dead!!â€ to all those seeking to get approval for a new weight loss medication.
Michael Narachi, CEO of Orexigen the maker of Contrave, is quoted as saying he â€œwas surprised and extremely disappointed with the agency’s (FDAâ€™s) request”, a request which essentially ended any chance of getting approval for his companyâ€™s weight loss drug. My advice Michael, is to move on with your company and find another drug class to work on. Maybe something to smooth away skin wrinkles or relieve constipation. Iâ€™m sure you will have a lot more success. In the meanwhile, the epidemic of diabetes type 2, cardiovascular disease, and disabilities due to degenerative joint disease, all related to obesity, marches on.
A final note of advice to investors in the medical field. I would spend my money on a psychiatrist before investing money in companies conducting research on weight loss medication, since you wonâ€™t see a penny from your investment for ten plus years.
A few days ago I was concluding a visit with a patient with thyroid disease, while her diabetic husband, also my patient, looked on. They are a pleasant older couple I have known for years, who are devotedly helping each other stay healthy. As they were leaving the exam room the wife apologetically turned the subject to her husband mentioning he was having almost daily â€œepisodesâ€ of weakness and confusion. “I hadnâ€™t changed his diabetic medication recently so why should his blood sugar be an problem now”, I thought. A number of other unpleasant possibilities immediately occurred to me. I inquired about signs of a possible stroke or heart condition. If these other angles were unproductive I faced the choice of sending him to the hospital for an evaluation. We quickly ran through a routine systems review. He had lost 10 lbs in the past month, the wife mentioned. â€œOh, no, cancerâ€ , was my first thought. His wife explained that as a New Yearâ€™s resolution he enrolled in a commercial weight loss program for diabetics. With relief, I knew we had the explanation of his disturbing new symptoms.
Most of my diabetic patients are on medication since they are unable to maintain good glucose control with diet and exercise only. If they succeed however, in achieving weight loss then the diabetes medication must be reduced to prevent undesirable hypoglycemia (low blood sugar). Hypoglycemia is potentially dangerous because the brain cannot function properly resulting in abnormal behavior, loss of muscle control and even unconsciousness. Imagine this occurring while behind the wheel? Down here in Florida this is all too common.
Many commercial weight loss programs have started targeting Type 2 diabetics (adult onset) with their TV ads. These programs are generally administered by people without any medical background. They cannot advise medication changes (not that you would want them to) without breaking the law by practicing medicine without a license. The result, as with my patient, is the development of potentially serious complications of hypoglycemia.
In a previous blog https://metabolism.com/2010/10/17/injured-diabetic-diet , I worried that this type of problem could develop with commercial weight loss programs. I didnâ€™t expect to see evidence of it so soon and in my own exam room. If my patientâ€™s wife didnâ€™t stop and mention his new symptoms at the last moment that day, I imagine a far worse outcome for her husband was possible.
The mission of the The Thyroid Project is to encourage sharing of information and experience between the public and the medical community about the treatment of hypothyroidism (low thyroid function). For at least the past few decades there is a growing awareness of â€œsomething missingâ€ in the way suffers of hypothyroidism are treated for their disease.
Too many patients, as documented in an on-line study of 12,000 individuals conducted by the American Thyroid Association published in June 2018, (https://doi.org/10.1089/thy.2017.0681) , complain of persistent symptoms of hypothyroidism despite what their doctors believe is successful treatment with levothyroxine (brands include Synthroid, Unithroid, Tirosent, Levoxl). We believe something needs to be done to resolve this conflict between patients and their doctors.
Discover the impact of AI on the spread of medical information! Dr. Gary M. Pepper examines the risks of relying on AI summaries from potentially tainted sources, highlighting a controversial NEJM study on testosterone treatment. Learn why it’s crucial to keep public medical data clean and what this means for the future of health information.
Metformin has been the mainstay of diabetes treatment for 50 years with an impressive array of success stories in terms of effectiveness and affordability. On top of this, recent research points to the unexpected potential of metformin for the ability to reduce the risk of dementia and cancer and may even slow the aging process. So why is this drug so under-rated? Our review at metabolism.com digs into these intriguing questions.
Without effective intervention the early stage of type 2 diabetes known as prediabetes carries a high risk of progressing to outright diabetes. Metabolism.com provides an up-to-date summary of recommendations from national authorities, for preventing and possibly reversing this life long affliction