Drugs and Medical Devices

Contents

A. This Page Is Not About Substance Use Disorders, But Here Are 2 Resources

B. General Sites On Drugs And Medical Devices:

C. Specialized

D. Erroneous Prescriptions

E. Drug Interactions

F. Cost & Number Of Prescriptions

G. Medical Companies Influence Doctors

Direct URL: drugs.globe1234.com

Patients can get independent information on drugs and medical devices from sites listed farther down on this page (many track your IP address; you can check their privacy statements).

 

A. This page is not about substance use disorders, but here are 2 resources

  1. 800-662-4357 (HELP) is a government referral number in English and Spanish, 24/7/365. They have other languages at 877-696-6775. They say, "The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs." For zip code (and phone number if it appears in their system), "We will retain the information only for as long as necessary to respond to your question."
  2. Thousands of counseling and treatment programs are listed on a map by the government. They use Google maps and Google Analytics, so Google will know that you're looking for help on that website. A private company lists its own and some other rehab centers, not clear what the criteria are. The company makes you waive class actions, but they don't require indemnification or arbitration. It has ad tracking from Google and Microsoft, so those companies will know you're looking for rehab. If that concerns you, the phone number above may be better, but if you do any web searches, major web companies and advertisers know it.

The sources in italics below cover medical devices, like pacemakers, artificial joints, lenses, etc. as well as drugs. FDA has a search box for US recalls of medical devices, and the press has an international list. Many devices have serious problems, and experts advise finding how many patients a device was tested on, how many times your doctor has installed it, and how it can be removed if necessary, before getting it implanted.

 

B. GENERAL SITES ON DRUGS AND MEDICAL DEVICES:

Advice from WorstPills.org, the first site below:

  1. WorstPills.org ($15/year, cites many studies), side effects, advice and comparisons among drugs, run by Public Citizen.
  2. Multiple prescriptions have gotten more common since the 1990s, so people need to be more careful with each and with interactions. 4 of 5 people over 65 use 5+ drugs per month, as do 2 of 5 people 45-64.
  3. Drugs.com (free, paid by selling your searches) shows side effects. The professional tab shows their frequency. Less information is at RxList.com, pdr.net and MedLinePlus.gov. A source without tracking is a site at the University of Modena and Reggio, Italy, but sometimes it fails to open. You can name your collection of items and come back to it later without giving your own name.� The free Italian tool shows side effects, but not interactions, which you can see for 88 euros per year.
  4. Interactions among� drugs and vitamins are available free at some websites listed on another page.
  5. Medical Letter (many citations, free trial with online access for 6 weeks, $10/article, $159/year or $98 for cumulative file from 1988 to previous December or June) Reviews new drugs and compares drugs and recommendations for common diseases. Some major diseases are listed as most read. Others are searchable as "drugs for". Comparable to UpToDate from Wolters Kluwer, which has cheap access but not free trials. More comparisons than GuideToPharmacology. French version for Canadian drugs comes out a few weeks after English version.
  6. UpToDate.com from Wolters Kluwer ($20/week, $45/month, covers medical and surgical treatments as well as drugs, detailed, many citations), recommendations for most conditions, interactions, side effects. Many doctors go here to get complete info and training.� Or if your doctor depends on drug company presentations (see article), you can get more information here than s/he has. Comparable to Medical Letter on drugs, which has free trial, but UpToDate from Wolters Kluwer also covers all medical approaches, not just drugs. More comparisons than Guide to Pharmacology. For major life decisions, people can check all three.
  7. ​When those sources give citations, you may find free copies of academic articles through Google Scholar. Even if an article is not free the abstract usually is, which summarizes findings (hyping with more positive words than 50 years ago). You can find which libraries get each journal at worldcat. Google Scholar will link to pubmed.gov which lists later articles and systematic reviews on the same subject, such as the ones which cite the first article. A similar search site for free pre-prints is prepubmed, and thousands of preprints are at the Social Science Research Network (SSRN). Presentations by AAAS on many topics are at SciLine.org. A more controversial source is Sci-Hub, which stores millions of papers and accesses others as needed. It uses login codes from anonymous academics who have free access.
  8. TRIPdatabase.com (free version or $40/year pro version) lets you search for primary research, or systematic reviews, or TRIP's own summaries, called "answers". Not just drugs, it covers all medical interventions, like UpToDate from Wolters Kluwer, which is more thorough, but not free. TRIP says drug companies "do not have any editorial say in Trip".
  9. AskaPatient.com (free, cites FDA), patient reviews, and FDA reports of adverse events, for over 4,000 drugs. Much easier than FDA. Ad-supported, not sponsored by drug companies. Adverse events are rarely reported, in part because doctors who report them get scant response from FDA, and disapproval or threats from drug companies.
  10. GuideToPharmacology.org (free, technical, many citations). Search "Ligands", which are bio-active drugs. For example if you type "statin" in the ligand search box and just wait without clicking anything, it will suggest Atorvorstatin, Lovastatin, and many more. Click on one to see chemical and clinical research about it. You can type brand names in the same search box.
  11. MedShadow.org (free, some citations), many articles on side effects and advice, and links to patient forums

 

C. SPECIALIZED

  1. ​DrugDangers.com (free) broad list of US lawsuits against makers of drugs and devices. It summarizes suits by the law firm which maintains it and other firms, though not giving other firms' names.
  2. Compare-Trials.org (free, full citations) Read some of their letters to see the poor quality of random trials in top medical journals.� Letters cover articles published October 2015 to January 2016 in NEJM, JAMA, Lancet, Annals of Internal Medicine, BMJ. (Also: 538, RetractionWatch, Guardian, Ioannidis, Gizmodo, Chocolate hoax)
  3. HealthNewsReview.org (free) comments on accuracy of articles and press releases about health care.
  4. Open Science Framework (free) stores articles and their original research designs, so you can tell if they changed their approach. You can enter a drug, like "statin" and find articles on it.
  5. PubPeer.com (free, comments on citations), not specifically on drugs. It compiles comments on each published article, so if you find a significant article, you can check what others said about it.
  6. Drugs.com (free), factual, no comparisons, run by 2 pharmacists, supported by ads from drug companies and drug stores
  7. Consumer Reports Drugs (free, no citations), little information
  8. MedWhys.com (free, no citations), factual, lets you ask a pharmacist questions, which you can also do at most drug stores and hospital pharmacies
  9. ClinicalTrials.gov (free, technical, original data), shows random trials started, and results for a few (story on lack of results, and number of missing results by company and university)
  10. Mayo Clinic Shared Decision Making National Resource Center, (free, no citations). Graphs compare risk and benefit of drugs and other treatments for a few conditions (angina, heart attack, osteoporosis). Descriptions but no risk comparison for arthritis, depression, diabetes, and quitting smoking.
  11. Addressing antibiotic-resistant infections with bacteriphages: Tailor at Baylor
  12. Varied articles on Canadian drug issues

 

D. ERRONEOUS PRESCRIPTIONS

The NY Times has a good 2020 article about errors when drug stores give the wrong pills to patients, and ways to protect yourself.

 

There are even big problems when doctors send prescriptions to pharmacies electronically. This is more reliable than hand-written faxes, but:

Cancellation orders are crucial to correct mistakes and cancel refills. Patients can overdose when they keep getting the old medicine after the doctor orders a new one. Only a third of prescribers and 40% of pharmacies use software certified to handle cancellations, so less than a third of cancellations can go through. "Electronic health records allow prescribers to stop a prescription, but what many physicians may not realize is that in most cases that directive is not sent to any pharmacy," even though original prescriptions are reliably sent. Some doctors put cancellation orders in the notes of a new prescription, where many pharmacists will not see it.

Health systems like the Veterans Health Administration and Kaiser Permanente can cancel electronically, where prescriber and pharmacy are in the same organization. Otherwise only 5 pharmacy chains accept e-cancellations (CancelRx):

Many non-chain pharmacies accept e-cancellation. You can ask the pharmacy if their software accepts e-cancellation (CancelRx) .

 

No other chain is certified for e-cancellation, such as Walgreens ($57 billion of US prescriptions) and Walmart ($19 billion). Consumer Reports unfortunately recommends Costco and Sam's Club for price (uncertified), Walgreens for its apps (uncertified), and supermarket chains for convenience (only Kroger's is certified). CR should know better.

 

Doctors can cancel electronically only if their software is certified under "CancelRx". Out of 954 systems, only 156 are marked as certified, and usually only the latest updates. If your doctor is part of a large group, you can ask the group to ensure its software gets certified and updated. Individual doctors have little control. CancelRx is getting more widespread, but the sponsor, Surescripts, is not willing to say how many doctors or pharmacies use it.

 

Automatic refills are even more dangerous. When pharmacies call patients to say, "Your prescription is ready," patients and callers do not know whether the doctor recently ordered it or it is a zombie renewal. Costco, CVS, RiteAid and Walgreens encourage patients to sign up for automatic refills, so patients at Costco and Walgreens (two which lack e-cancellations) can get undesired medicine for long periods, thinking their doctor ordered it.

 

Prior authorization for prescriptions is a system where an insurer tells a pharmacy that a doctor needs to send the insurer detailed information and get the insurer's approval for the prescription. Insurers tell pharmacies, not doctors or patients, when prior authorization is needed, and pharmacies say they have no obligation to tell doctors, though they have the forms and information which the doctor needs, and no one else does. A Massachusetts court says pharmacies must tell doctors, and a doctor says the entire circuitous system of prior authorization for drugs kills patients.

 

E. DRUG INTERACTIONS

Several sites show interactions among all drugs and vitamins you type in, while they track you.

 

I tested them with 6 medicines which do interact: aspirin, atorvastatin, epinephrine, erythromycin, vitamin K, warfarin. ​

 

SITES

Drugs.com gives 5 concise warnings for these 6 drugs, in order of seriousness and 3 food interactions. If you click the professional tab, each warning is very detailed, and cites studies. It did not let me save the list, though it has a save button. (​supported by ads and trading your data with 9 trackers)

EXAMPLE TEXT

Using warfarin together with erythromycin may cause you to bleed more easily. You may need a dose adjustment based on your prothrombin time or International Normalized Ratio (INR)

The Professional tab gives 15 citations and 380 words of explanation, including:

Coadministration with clarithromycin or erythromycin may infrequently but substantially enhance the hypoprothrombinemic effect of warfarin and other coumarin anticoagulants. The exact mechanism of interaction is unknown... In 12 normal subjects, the clearance of warfarin (1 mg/kg single dose) decreased by an average of 14% following pretreatment with erythromycin 250 mg four times a day for 8 days. In a study of eight patients...

WebMD gives 11 concise warnings in order of seriousness, and I found no way to save the list. It owns Medscape and RxList. (supported by ads and trading your data with 17 trackers)

erythromycin oral increases effects of warfarin oral by slowing drug metabolism

RxList gives 12 warnings from WebMD, not in order of seriousness, and cannot save the list. (supported by ads and trading your data with 11 trackers)

erythromycin oral increases effects of warfarin oral by slowing drug metabolism. ​

Medscape gives 11 concise warnings in order of seriousness, with more medical language than WebMD, but not as much as Drugs.com. (supported by ads and trading your data with 17 trackers)

erythromycin base will increase the level or effect of warfarin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug

CVS lets you sign in and load prescriptions or type them in. Adding prescriptions is slow, since they offer every dosage. I also worry that if you sign in to download prescriptions, and add any to evaluate, they could add these to their records and cause confusion later, even if they don't have prescriptions on file for them. (supported by sales and trading your data with 16 trackers)

These drugs may be taken together only under close supervision from your prescriber. Taking these drugs together may increase your risk to bruise or bleed. Call your doctor or health care professional if you notice any unusual bleeding. Signs of bleeding may include bloody or black, tarry stools; red or dark-brown urine; spitting up blood or brown material that looks like coffee grounds; red spots on the skin; unusual bruising or bleeding from the eye, gums, or nose. (The button to get a report did not work for me in any browser, so I got this from someone else.)

​Drug-interactions.eu charges 88 euros per year to show drug interactions. It shows side effects for free. It is managed by a professor at the University of Modena and Reggio, Italy, who seems not to track you. (supported by subscriptions with 0 trackers)

text, blood levels, side effects and 39 cites for erythromycin, 133 for warfarin

...in 12 normal subjects who took a single 1 mg/kg dose of warfarin with and without erythromycin. Erythromycin (250 mg p.o.) every 6 h for 8 days decreased warfarin clearance by 14% (p less than 0.001). Warfarin's apparent volume of distribution was not affected. Further, the effect of erythromycin was greatest among subjects whose control phase warfarin clearance was relatively slow... consistent with the interpretation that erythromycin can potentiate warfarin-induced hypoprothrombinemia by slowing warfarin clearance. Another work studied eight noninfected patients ... The plasma concentrations of warfarin and its anticoagulant effect were increased when it was co-administered with erythromycin...

UpToDate.com from Wolters Kluwer ($20/week, $45/month) covers medical and surgical treatments as well as drugs, detailed, many citations, recommendations for most conditions, drug interactions, side effects. Regular articles in UpToDate are updated every few months. The example at right of a drug interaction article is not dated, and its latest reference is from 2009. (supported by subscriptions, with 1 tracker)

19 citations and 410 words, including:

Warfarin clearance was decreased approximately 14% in healthy subjects when administered following an 8-day course of erythromycin (1 g/day).1 Other studies confirm this relatively modest impact of erythromycin on warfarin pharmacokinetics.2,3,4 Case reports, however, describe significant episodes of bleeding (hematuria, bruising) and increased prothrombin times in association with erythromycin therapy.5,6,7,8,9...

 

 

F. COST & NUMBER OF PRESCRIPTIONS

Drug stores in half the states are not allowed to volunteer to you that the cash price is less than your co-pay, but the other half of states have laws letting them tell you. You can always ask about the cash price and ask if they have coupons or discount cards for the drugs you're buying.

 

Through 2022, Dr. David Belk had clear data on wholesale (NADAC) and retail costs of generic and branded drugs (from GoodRx) and what drives the costs.

 

CMS has National Average Drug Acquisition Cost (NADAC) database at data.medicaid.gov/nadac. An explanation from West Virginia dhhr.wv.gov/bms/BMS%20Pharmacy/Documents/NADAC%20Survey.pdf and number of Medicaid prescriptions by drug at https://data.cms.gov/summary-statistics-on-use-and-payments/medicare-medicaid-spending-by-drug/medicaid-spending-by-drug

 

Commercial services (cost) wolterskluwer.com/en/solutions/medi-span/price-rx and www.fdbhealth.com/

 

IQVIA reports on wholesale and retail costs and number of prescriptions.

 

Express Scripts has numerous articles on drug pricing and 11 billion prescription records (paid access).

 

Drugs are distributed to retail pharmacies primarily by three companies: AmerisourceBergen, Cardinal, and McKesson, which have paid small fines, relative to their revenue, for not reporting excessive deliveries of opioids.

 

Hospitals which serve many poor people get discounted drugs for some patients from the 340B program.

 

You can find the number of drug prescriptions from each doctor and costs for Medicare patients in at least 2 places, described below. For non-Medicare prices see above.

 

ProPublica has Medicare Part D cost for each drug: number of prescriptions and total spending, ending in 2019. You can get separate totals for US and each state, so you can get average cost per prescription, and for each doctor who prescribed a drug 50 or more times.

 

Medicare itself has more complete Part D data, 2013-2021. The US and state summary files (bottom of the link) show for each drug: the number of beneficiaries as well as prescriptions and spending, so you can get average per beneficiary (total during a year), as well as per prescription for each drug.

 

Medicare's detailed files show number of days prescribed, so you can get average cost of a daily dose, as well as each doctor who prescribed a drug 11 or more time. The geography file has US & state summaries. (Tips for working with large spreadsheets)

 

Some doctors and drugs typically have 30-day or 90-day prescriptions, which may be renewed all year. Their averages include the cost for each whole long prescription (30 or 90 days). Docs & drugs with shorter prescriptions only include that lower cost. Medicare's focus seems to be on cutting total costs, not cost per dose.

 

ProPublica's methodology says it has "retail cost" for these prescriptions.

 

Medicare's fact sheet gives more detail, saying it includes,

It does not directly include patients' monthly premiums, though on average those premiums may cover all drugs, administration, and profits.

 

After seeing which drugs a doctor prescribes, you can find drug safety and effectiveness from sections B, C and E of this page, above.

 

G. MEDICAL COMPANIES INFLUENCE DOCTORS

Direct Payments which doctors get from major medical companies (Medicare's site) and drug companies (ProPublica's site) show which doctors have strong bonds with the companies. Patients need to decide if these affect their care. The sites do not reveal profits from doctors' own businesses. Consumer Reports says that when a doctor orders X-rays or other scans, "ask whether he is financially affiliated with" the radiology clinic, since "studies have found that physicians who own scanners or are part owners of radiology clinics use imaging substantially more than others."

 

The Journal of the American Medical Association (JAMA) May 2 2017 summarizes a lot of research on how payments from drug and equipment companies affect doctors' decisions, usually sub-consciously.� Where policies change or payments stop or start, average prescribing practices then change. Public Citizen has a less detailed November 2017 update.

 

A 2021 study found that dental research supported by companies found larger effects of treatment than independent research.

 

Nurses also get payments and meals from drug companies, but only Massachusetts tracks these payments.

 

Drug companies also have constant access to doctors and give them biased information. A 2012 summary found (emphasis in the original):