Dopesick (2018) Beth Macy

Dopesick(2018) Beth Macy

Dealers, Doctors, and the Drug Company that Addicted America


Wow.  I thought I knew something about the opioid crisis but it turns out I had no idea. For instance, I had no notion that a drug company (Perdue Labs) had the ability to reformulate oxycontin into a form that would be more difficult to abuse but waited to do this until their patent expired on the original.

The big misconception is that you cannot get addicted if you just use narcotics for “true” pain.  That is completely wrong.  Macy makes that clear in case after case of people who are put on oxycontin after injury or surgery and cannot get off and eventually resort to heroine. Macy also spends a good deal of time dispelling the myth that abstinence is the only solution. Not a very cheerful book but if you want to learn what is happening around us –  this is it.

Why We Should Care About Compounding Pharmacies

Almost everyone in healthcare is aware of the debacle of New England Compounding Center beginning in 2012 causing over 800 cases of meningitis and 76 deaths.   That case and others like it brought a magnifying glass onto the role of compounding pharmacies that have been creating medications on an ad hoc basis that many times are not available in anyway.  Due to the small batches created (often a single unit) quality and cost is highly variable.  Surely, it is just that irresponsible pharmacists operating these be shut down and in some cases prosecuted.  However, in my experience there are many more really terrific people operating these establishments with the goal of helping doctors and their patients with remedies that are unavailable otherwise.


In my specialty, ophthalmology, the use of compounded medication is standard of care.  From avastin for retinal disease to fortified antibiotics to treat severe corneal ulcers we use compounding pharmacies all of the time.  Unfortunately, do to the costs of complying with increased enforcement many have had to close their compounding operations.  Oversight of these operations is obviously necessary and important but so is our ability to obtain sight saving medications in a timely fashion. I have recently moved from a large metro area with 3 compounding pharmacies to a more rural area (West Virginia) which is now down to a single establishment, as far as I am aware.


It seems to me that one solution is to encourage hospitals to fill the gap.  They have the resources and experience to easily meet the necessary standards.  Their inflated cost structure would need to be reckoned with and somehow still motivate them to add this service or support those in the private sector who are still hanging in there.

New Treatment for Malaria – Genetically modified mosquitos

Read this article in STAT.  It details the efforts of researchers to get acceptance for the release of genetically engineered mosquitos in parts of Africa.  Ultimately, the idea is to release a strain that will decrease the numbers of mosquitos there which are the vector for malaria which kills 3000 children every day and a million people every year.

Restasis Update: Generic (Teva) available in Canada – When in the US?

Restasis what approved by the FDA and introduced in the US in 2003.  Patent laws would have made a generic possible in 2015 (12 years).  Allergan has taken the unusual step of considering selling their patent to a Native American tribe to obtain sovereign immunity.  It did not work.  Allergan CEO Brent Saunders is trying to delay a generic as long as possible as they the generate greater than $1B per year from this drug.   Now Canada has a generic made by Teva.  Teva and Mylan are fighting to make a generate in the US.

Allergan took an expensive risk to develop topical cyclosporin into a useable drug for severe dry eye.  By all measures it has been a huge success and helped huge numbers of patients.  They deserve to generate a profit for their innovation.  However, enough is enough.  It is time to lower the costs on this mature drug.  Allergan should develop a new, better drug to start the whole process again and capture the rewards.

US Cataract Surgery is a Bargain

US Cataract Surgery is a Bargain

 Cost of cataract surgery

The US takes a rap for having the most expensive healthcare in the world. Sometimes countries spend far less and get equal, if not better, outcomes. One area that does NOT seem to follow this pattern is cataract surgery. The US has costs near the bottom of most countries with outstanding results. Thanks mainly to the huge cuts that Medicare and Medicaid have enacted on cataract surgery as well as the competition that surgery centers have dealt to hospitals. Surgeon have aggressively adopted innovation to improve outcomes and efficiency. It is a model for other areas of medicine.

Surgery – The Ultimate Placebo – Ian Harris

Surgery Placebo

Surgery – The Ultimate Placebo

Ian Harris

As it turns our sham surgery is often as successful as real surgery.

Arthroscopic knee surgery was no better than the sham surgery for the treatment of degenerative changes involving the meniscus of the knee.

Vertebroplasty may also not be any better than the sham for treating low back problems.

The placebo effect of invasive procedures is so strong that sham injections were used in the evaluation of VEGF inhibitors in the treatment of wet macular degeneration. In this case the treatment performed better than the sham.

The question we must ask ourselves is why are surgeons still preforming surgeries that have proven to be no better than the sham? Perhaps they do not trust published research. If so, they may have good reason. A high proportion of research papers have been shown to have critical data and statistical errors in addition to outright fraud.