@zanchey We have a "dispense as written" box. My problem is more on the #EHR side. When I type "Procardia", what comes up on my screen is "nifedipine (Procardia)". Next step is to call the pharmacy and find out how they actually receive the prescription. After that, most likely, is yelling impotently at the programming team.

@Stacky Outpatient.

And I had the same thing happen later today with Spiriva tiotropium. Patient needs brand name to keep her PBM happy. (Yes, her insurance will pay for the brand name and not the generic. )

Today's first #EHR #EMR obstacle: I have a patient who has a bad reaction to generic nifedipine extended release, but does well with name-band Procardia XL. When I enter a prescription for Procardia, the EMR changes it to "nifedipine (Procardia)". So not only do I click "dispense as written", I also put "name brand Procardia XL only" in the field for comments to the pharmacy.

Guess who got the generic?

Again.

@valen1 As I understand it, CHC Restored is deliberately stuck in January 2025, during the Biden administration. That's good as a point of reference.

The AMA website doesn't focus on information for the public. It's targeted towards doctors. You may want to look at CIDRAP, the Center for Infectious Disease Research and Policy, instead: https://www.cidrap.umn.edu/

I missed this article when it appeared on The Guardian last month:

US plan for $1.6m hepatitis B vaccine study in Africa called ‘highly unethical’ https://www.theguardian.com/society
/2025/dec/19/hepatitis-b-vaccine-study-guinea-bissau-rfk?CMP=share_btn_url

In a country where over 10% of toddlers are infected with hep B, some will receive the vaccine at birth, and some will have the vax deliberately withheld until 6 weeks. And researchers will know who's in which group.

H/t Paul Offit's newsletter

Today's press release from the CDC goes out of its way to highlight how many vaccines aren't recommended for every kid -- EVEN THE ONES THAT NEVER WERE. Dengue is only for a very small group. RSV antibodies are only if vaccine wasn't given in pregnancy. Men B vaccine has always been "ask your doctor."

The downgrading of prior recommendations will mean many kids won't get vaccinated, some will get sick, and a few will die.

And the hype on top of the changes shows just how anti-vax HHS now is.

Last in the "squick" group are the meningitis vaccines. In teens, meningococcal meningitis is associated with close contact: college dorms, military barracks, and necking. But here's the thing: in small kids, the ACWY vaccine was already recommended only for those at higher risk. The men B vaccine was never recommended for all teens -- it was for those at high risk, plus "ask your doctor." Policy is changing for ACWY vaccine for teens, but the press release makes it sound like more than that.

Rotavirus causes really really nasty diarrhea -- the kind that can put kids in the hospital to get IV fluids. I'm citing the CDC itself at https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-19-rotavirus.html:

Before rotavirus vaccine, estimated 2.7M infections every year; 410K doc visits, 200K ER visits, 55-70K hospitalizations, and 20-60 deaths every year.

A vaccine that prevents all that, and doesn't even need a shot? For a disease that 95% of kids get by age 5? But it has to do with poop, so off the recommended list.

Hep A is spread by fecal-oral contact. I'm sure that someone is fixated on what that means in terms of sex, but far more often it's when a food handler doesn't wash their hands after using the bathroom -- or when a toddler has a blowout at daycare.

Hep B is blood borne. It can be spread during fetal development, by sharing toothbrushes, by kids biting when they fight, etc.

We tried limiting these to hi-risk groups before. Didn't work.

Hey all! It's been a busy few days. Med-mastodon went down for a while, and there were thoughts it was not going to come back; but with the efforts of a whole lot of people across the Fediverse, it's back.

Extra thanks to the team who runs mstdn.science, which was my social media home for a few days while things got fixed here.

Glad to be back!