Monday, December 29, 2008

This Started Off As A "Highlights From Friday's Pill Counting Action" Post, But Honestly, This Is A Highlight That Deserves To Stand All On Its Own

It started as a routine reject. A quick phone call should straighten things out. 

Me: Yeah I'm calling about this reject message I'm getting, It says that only Prevacid Solutabs are covered for patients over 1. I think the rest of the message must have got cut off or something. 

Actually what I suspected was that Prevacid itself was non-formulary. Those of you in the profession know it is not unusual for an insurance reject message to bear little resemblance to the actual reason a claim is being rejected. A quick phone call and the nice lady would tell me which meds in the class were covered.  

Medco: No sir, that is correct, only the solutabs are covered for any patient over 1 year old.

Me: Ok, that can't be right. Do you know what a solutab is? It melts in your mouth, which makes them, you know, ideal for children.

Medco: Silence.

Me: Are you telling me if the patient is under 1 year old you would only cover the regular capsules?

Medco: The plan sponsor sets the parameters sir.

Me: That's not what I'm asking. If this customer was under 1 year old, I would have to give them the regular capsules. Is that how it works?

Medco: Yes.

Me: And since this person is over 1 year old, a fully grown adult actually, the only thing I can give them is the melt in your mouth version.

Medco: Silence

Me: I can only give them the solutab?

Medco: Yes.

Me: You realize.....that someone has obviously made a mistake here. A typo that should take like 2 seconds to correct. 

Medco: It's the plan sponsor that sets the parameters sir.

Me: You understand that these parameters involve asking a 1 year old baby to swallow a capsule while making an adult take the formula ideal for children

Medco: Yes.

Me: So you know this is stupid.

Medco: I understand your frustration, but I can't change the plan parameters sir.

Me: Ok, fine, but do you think that maybe you could contribute a little to the solution of this problem, like maybe telling your supervisor about this idiotic situation so they could perhaps open a line of communication to the people who set up the parameters?

Medco: Silence

Me: Can your kid swallow a capsule?

Medco: Is there anything else I can help you with?

Me: What exactly have you helped me with to this point?

Medco: Silence

Me: Is this call being recorded for training purposes? Because I think it really should be. Because this is....fu.....I stopped myself before the whole word came out because I knew that would be an automatic hang up and I wasn't done yet. I mocked the Medco lady. I ridiculed the Medco lady. I asked her if she was proud of the work she was doing. I was pretty Goddamn mean. I had to hand it to the Medco lady though. Cold. As. Ice. I was opening up on her with both barrels and there was no display of emotion, much less any budging. In the end, a 47 year old man got melt in your mouth Prevacid

And somewhere a baby just probably choked to death. It's a good thing we don't let the government run health care though, because if the government ran health care, then stupid bureaucratic shit would happen. 

Don't think the Canadians aren't laughing at us. 

 

Sunday, December 28, 2008

Updated: A Milestone In My Life This Night. I Realize The Influence Of Larry "Bud" Melman Is Smaller Than That Of Even Ohio Northern University.

So the world is a small place my friends, and try try try as I might, the efforts I made to escape the one into which I was born will never be completely successful. This weekend I came across someone from Ada, Ohio. If you have ever heard of Ada, you know what that means. She was a college student. There are people who live in Ada who are not affiliated with Ohio Northern University, like 25 or so I think, and they are truly frightening individuals of such intellectual quality I doubt any of them could get piss out of a boot with instructions written on the heel. They make the footballs that are used by the National Football League. I'm not kidding about that. 

But anyway, this woman did not make footballs, so naturally the small talk centered around Ohio Northern University, which was the institution that was foolish enough to grant me a degree in pharmacy during an era when computers weren't advanced enough to verify a student had actually taken all required prerequisite classes. It went something like this....

Me: "Blah blah blah.....boring ONU small talk.......blah blah blah" Talk about ONU is unavoidably boring. 

She: "Well we have a McDonald's now, after David Letterman mentioned on his show that we were the college campus furthest from one"

Me: "Really? We had Larry Bud Melman on campus once when I was there"

I was starting to perk up now. It had been a long time since I had thought of Larry Bud Melman and God I missed him. 

Blank stare. Total blank stare. A blank stare that was the beginning of a shock I have yet to recover from. 

"He was a regular on Letterman's show back when he was on at 12:30"

Incomprehension. I might as well have been speaking in tongues. 

I walked back into the happy pill room slightly stunned. My keystone tech would help me out. My keystone tech always bails me out. 

"Do you remember Larry Bud Melman?"

"Who?"

"You know who David Letterman is...."

"I think so.....the one who's not Jay Leno"

"You know he used to be on at 12:30"

"What?"

"You remember Johnny Carson....."

"Not really"

I looked around the store. Desperately. I mean, I know I'm getting old, but a lot of the stuff I liked when I wasn't old is still generally recognizable by the public. I just heard someone talking about fucking Fonzie the other day and Larry Bud Melman was better on his worst day than Fonzie ever was in his wet dreams. There was a time, my friends, when I would have been constantly surrounded by people hip to Larry Bud Melman, and now, as I looked around, I didn't see a soul I had any confidence would know the name. Larry has slipped off the earth and I failed to notice. 

Or else Larry hasn't. I know I could put Larry Bud Melman into the Google, but if I do, and Larry isn't there, that means I'm not just old, but that I've gone insane. Toast on a stick. Melman Bus Lines. It might all be just in my head, and if it is, I can't take the risk of finding that out. This night I find myself quite possibly clinging to what could be the final facade of my sanity. 

By the way, that wasn't a random expletive thrown in there in front of Fonzie. The person was actually talking about having sex with the former sitcom icon. 

At least in my head they were. I think.

Update 12/29: Thank you dear readers, for assuring me that I am not insane. Maybe I should rephrase that.  For assuring me Larry Bud Melman existed somewhere outside my head. You gave me the courage to venture onto the YouTube and dig this up. You are missed Larry. 

As are you Mr. Letterman. All the more so because you're still around. 



Wednesday, December 24, 2008

Apparently Pharmacy Has A Code Of Ethics. Who Knew?

Not me. But there it was in black and white in the latest issue of the trade magazine Drug Topics. The code of ethics by the way, was by far the most interesting thing in that rag, Jim Plagakis being the exception that proves the rule. Why Jim continues to do the clowns that think we'd be interested to read about drugstores in the suburbs on Atlanta putting in generators and publishes statements like "Tylenol was one of the top acetaminophen products suggested" the favor of writing for them baffles me. 

Name another acetaminophen product. 

Quick. C'mon. No Googling. 

See my point? Drug Topics hurts my eyes, and if it weren't for Jim Plagakis and the curiosity aroused by seeing an alleged code of ethics that governs my profession, I might have had to try to gouge them out this Christmas Eve to stop the pain. 

Evidently The Code of Ethics for Pharmacists was adopted by the American Pharmaceutical Association in 1994. The involvement of APhA in the code of ethics goes a long way towards explaining why no one has ever heard of it. 

Name an accomplishment of APhA

This time you don't have to be quick, and you can use the Google all you want. See my point? But, since some geeks most likely spent the better part of a week debating what should go into this code of ethics, then another day or two deciding if the bullet points should be marked with little dots or a dash-like symbol, I figured I might as well see how I stacked up. It was Christmas Eve remember, which means there wasn't much else to do in the happy pill room. 

- A pharmacist respects the covenantal relationship between the patient and pharmacist. 

What? Covenantal? That's Jesus talk. Forget that. Unless APhA is trying to say something like my customers should worship me. I could totally respect that, and it would be the most sensible thing to come out of APhA's mouth in years. 

- A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner. 

Confidential? Check. Caring and compassionate? Mmmmm....not so much. I'll make sure your prescription gets filled correctly, and if you have questions I'll do my best to get the answers through your pointy little head, but most of the time, if you decide to walk out the front door of my store and take a flying leap off a cliff, I wouldn't give it a second thought.  Yeah, I think caring's definitely off the list. 

- A pharmacist respects the autonomy and dignity of each patient. 

Autonomy = Your right to decide to have your prescription filled somewhere else. Yeah, I totally respect that. 

Dignity? Yet to be tested on that one. As soon as I get a customer with some dignity I'll let you know how it turns out. 

- A pharmacist acts with honesty and integrity in professional relationships. 

Check. There's no need for me to rip you off or lie to you any more than Big Pharma already does. 

- A pharmacist maintains professional competence. 

Why exactly did this one make the list? We have to be told we should make an effort to know what we're doing? Sigh. Moving on....

- A pharmacist respects the values and abilities of colleagues and other health professionals. 

Nope. Because the values of Lloyd Duplantis, of Gray, Louisiana do not belong in our profession, and deserve no respect. 

As far as other health professionals,  I will respect the ability of a Physician's Assistant to be able to write a prescription that makes sense just as soon as I see a prescription from a Physician's Assistant that does. 

- A pharmacist serves individual, community, and societal needs. 

I need to get laid right now. That's my individual need. So according to APhA, there's another pharmacist out there that will serve that. Sweet. 

- A pharmacist seeks justice in the distribution of health resources. 

OK, now I feel bad. I've been mocking the APhA throughout this whole post and then they have to go and spring this one on me at the end. If only there were any justice in the distribution of health resources. If APhA magically became able to be effective at something, this is what I would pick for APhA to actually be able to do. 

Unfortunately it took them 14 years to make me aware they consider me to be a woefully ethically challenged pharmacist.  I expect they'll write in sometime in 2022 and tell me I should have used little dots to mark their bullet points. 

APhA sucks. 

Tuesday, December 23, 2008

Dear Employer, I Wonder If You've Noticed Something......

With all your charts and graphs, your computerized doo-dads that measure how long it takes us to get a prescription out the door (not that you're putting any pressure on us to work more quickly at the expense of patient safety you say) or how long a caller is left on hold, I wonder if you've picked up on a very simple statistic:

The more you cut our tech hours, the more often we are out of stock on something. Have you noticed that? And if you have, which I doubt, have you ever wondered why? The answer's simple really. When you cut our tech hours there are fewer people around to do the same amount of work. That part I bet you know. Which means there are times during the day when it is impossible to meet both your workload expectations and my professional responsibilities to the people who have entrusted me with their health. Guess who wins when you set up that conflict employer? Hint. Not you. Here's how it works:

All hell is breaking loose at the pharmacy counter. People as far as the eye can see, the fax machine a whirring, the five phone lines for three pharmacy employees ringing off the hook. Your wet dream. I start working the in window. The next customer in line is a mall rat with a prescription for the acne med Duac. 

"I need this as soon as possible" 

"I'm so sorry, I don't seem to have this on the shelf, the best I can do would be to order it for you tomorrow"

You just lost $200 employer. The next man in line just got out of the hospital. He's hobbling around on some sort of wacky-looking crutches. His painkiller will cost around $15 and will be out in about 20 minutes. 

He'll also leave knowing to watch out for drowsiness and to stay away from the over the counter Tylenol while he's taking that painkiller. Things I am obligated to tell him but never would have been able to had I tried to squeeze in the mall rat with the zits.

Do you get it now employer? Cut my tech hours and I start playing triage, and when I start playing triage, you won't like the results, because medical needs of humans trump financial needs of corporations.

You may say you're doing what you have to do to remain financially viable. I say that's not my problem. My suggestion to you would be to grow a pair of testicles and take it up with the insurance companies that put so little value on my professional obligations. 

Oh, and one more thing. It seems that without me saying a word to her, my keystone tech has picked up on what I'm doing. She's developed a habit, when all hell is breaking loose the way you know all hell will break loose when you cut our help, of coming over and asking me if we have something in stock when she takes a new prescription. She's a smart one that keystone tech. 

You cannot cut your way to prosperity employer. That's been an eternal truism that unsuccessful businesses have failed to learn over and over again through the decades, but you cut my tech hours again...... and I'll make damn sure that point gets driven home to you. You hired a professional when you hired me employer, not a salesman. I know you don't want it that way, but the sooner you learn that's the way it has to be, the sooner you can both make money and contribute to the health of our community. 

I'm not hopeful.

Monday, December 22, 2008

Personally, I Don't Think Jesus Is The Type Of Guy Who'd Want You Making A Big Deal About His Birthday.

Most of those hippie, live in the woods, take no shower types really aren't into birthdays and such. 

Especially since his time on Earth really didn't go all that well. It might be better not to remind Jesus of what happened to him here. I think if you really care about Jesus, you'd try to distract him on Thursday, maybe take him to a movie. Or camping. That's it. Those hippie types are totally into the camping. 

Of course, I would offer Jesus some scotch. Scotch is really good at helping you forget traumatic experiences for awhile. Those hippie types are usually more into weed though. I don't have any weed to give Jesus, and I'm not really sure where to get any. 

I do have some wine, but there's no way offering Jesus his own blood on his birthday would be cool. 

Crap. I don't know what to do for Jesus if he comes over for his birthday. I guess I'll just buy a cake. 


Please Help Me Identify My Christmas Present.

It happens every year. Some mystery customer comes in when I'm not working and drops off little presents for the pharmacy staff. I don't mean that the customer is trying to be mysterious, I mean that even after seeing the name on the tag, I wouldn't know who this customer is if they came up and bit me on the nads. I mean, I guess it's a nice gesture and all, but honestly, I've said for years the best way to show your gratitude for me doing  my job is by shutting up, taking your stuff, and getting away from the counter as soon as possible. Seriously. I will appreciate your quick exit more than anything you can do or say. 

Anyway, this year's present from the mystery customer was a manicure set. Wait. Maybe this wasn't a nice gesture at all. Maybe my hands so disgust this person that they have been moved to try to relieve themselves of beholding their grotesqueness ever again. Could it be that part of me is.......unattractive? Suddenly I am intrigued by the manicure set and the possibility of becoming even hotter. 

Except that I don't know what half the things in the manicure set are. There's like three sets of nail clippers, which is seven short of one for each of my nails, a set of tweezers, a utensil I have never owned until today, a little pair of scissors, a nail file that totally doesn't look like a nail file, and then this group of unidentifiables:



I am honest to God stumped my friends. The thing on the left has an angled edge like some sort of knife. Cuticle pusher backer? Could the fact I'm not pushing back my cuticles be the reason I'm not getting laid at the moment? 

If the thing second from the left were a little bigger, it might be the type of object you use to dig out some caviar to spread on your Ritz cracker or whatever it is you eat caviar on. Maybe with the economy being the way it is, the average caviar portion size has gone way down. Wait. This is part of a manicure set, so caviar server doesn't make any sense. I bet you might be able to use it to actually pry one of your fingernails off though. Is that some sort of new fad among the kids nowdays maybe?

My best guess for the third thing is an earwax digger. Except it kinda tickles when I gently probe my ear canal with it. Maybe it's some sort of ear dildo. 

Shit. I can't hear anything all the sudden. I should probably go to the ER when I'm done writing this. 

I'm thinking the last thing is a nose picker. See how the end of it is like a two-pronged fork? Bet you could totally spear a booger with this. Perhaps that is the civilized way to clear your nasal passageways in high society. A finger does seem sort of barbaric. 

So anyway, any help you guys could give me here would be appreciated. With your assistance, I may end this year hotter than I began it.  Or at least avoid large hospital bills.

Thanks in advance. 

Sunday, December 21, 2008

I Fought The Mall And The Mall Won. She Fought The Mall And Kicked Its Ass.

So, yeah, I work at the mall. I am not proud of this. As a matter of fact, it grates my ass from the moment I pull into the mall and see that goddamn water fountain of theirs next to the street. I live in an area of chronic water shortage where an average person can fight for years to put in a second bathroom and the mall thinks it's a great thing to shoot water around for the hell of it all day long. Someday I'm gonna put so much dish soap in that water fountain it will be both ruined and squeaky clean for at least 20 years.

It's more than water waste that puts the burr up my butt though. The mall as an institution is a monument to the cheap crap made in China sell your soul to corporate control complex that rules us. Your definition of what is beautiful comes from Victoria's Secret. Your good taste from the Pottery Barn. Your culture from the cineplex down at the south end. And if your money comes from the mall, God have mercy on your soul, because you will be broken before a check is ever issued. Take a good look at the people behind the counter at your favorite store at the mall my friends. They're either high school kids or they are broken.

And if any of this starts to bother you, that's when you come down to the north end of the mall and see me.  To get the chemicals that will make you forget all about it. Unless you're me. They don't sell my brand of scotch at the mall. 

The lady at the pizza place seemed to be an exception though. I could never put my finger on it, but she definitely wasn't broken. Her smile always seemed so........real. It was evident that she lived within the mall culture but was not of it. I sensed something. I totally sensed something, but could never quite tell what it was. 

Until last week. When I read in the local alterna-weekly about the lady who used to work at the pizza place's CD release party. I went. I have no friends mind you, and I hate going to places by myself. But I went because I desperately wanted her to be good. I wanted so much for the mall to finally lose a round. 

The mall lost a round tonight my friends. I am a music snob, and as such I would be unable to tell you she was good  if she was not. She made my ears happy for a little over an hour this night, and a little bit of my soul happy for a good deal longer than that. Because the mall lost one. And I didn't have to break out the dish soap. It's not making contact with the lady who sweeps up the cigarette butts, but It'll make for an OK Christmas this year.  

In your face mall.
  

Saturday, December 20, 2008

I Hate It When Other People Do Pharmacy Humor Almost As Good As I Do.

Because let's be honest, no one comes close to me when I'm on my game. Except every once in awhile. So it is with a sense of seething jealousy and the vague hope of a job offer if qfever.com ever decides to mount a comeback that I pass along a clip an alert reader forwarded my way the other day: 



Nexium® Offers Unique Advantage Over Generic Omeprazole
Only proton-pump inhibitor proven to enrich AstraZeneca

WILMINGTON, DE - Nexium® (esomeprazole), the newest proton-pump inhibitor approved by the FDA for peptic ulcer disease, offers a unique advantage over the generic form of Prilosec (omeprazole), said a panel of industry experts this Wednesday.

Namely, Nexium®, which is simply the L-isomer of omeprazole, is now the only proton-pump inhibitor definitively shown to enrich AstraZeneca, the pharmaceutical corporation that lost its U.S. patent for omeprazole in April 2001.

Nexium® is substantially better for AstraZeneca than omeprazole Experts in the healthcare community attribute the unmatched ability of Nexium® to benefit AstraZeneca to a remarkable series of scientific discoveries made at the company's research centers during the mid-to-late 1990's.

"First, they discovered that when they lost the patent for omeprazole, they wouldn't be making any money from it anymore, " says Dr. George Papadopolous, a pharmacist in Wilmington.

"Then, they realized that omeprazole, like many chemical substances, has both an L- and an R- isomer, each of which is technically [winks] a different compound, according to FDA guidelines."

"Finally, they tested and proved the hypothesis that the American public could be duped into paying far more for things available in less costly, but basically identical, formulations simply by employing colorful ad campaigns and effective direct-to-consumer marketing techniques," he concluded.

Indeed, study after study since Nexium's release has indicated that Nexium® benefits the executives and shareholders of AstraZeneca signficantly more than do generic omeprazole or, for that matter, any of the other FDA-approved proton-pump inhibitors, with a p-value of <.005.

"It's truly a miracle drug," said Patsy Goldberg, a long-time esophagitis sufferer. "Imagine that - a medication that helps my acid reflux about the same as as a cheaper generic would, and allows AstraZeneca to keep making money off me at the same time!"

Researchers at AstraZeneca are currently hard at work "discovering" the R-isomer of omeprazole, with which they plan to overcharge the general public as soon as the patent for Nexium® runs out in 2014.

Thursday, December 18, 2008

It's A Short Night For Me And I Got Nothing For You Except This Picture. I Hope You Enjoy This Picture As Much As I Do

Because I really, really, enjoy this picture. I enjoy this picture more than certain types of porn.





I'll be back with more for you over the weekend. Goodnight.

God that picture never gets old.

Wednesday, December 17, 2008

Tonight I Answer A Question Every Pharmacist Has Probably Heard At Least Once In Their Career.

It showed up tonight in my e-mail box, which marks at least the third time since a Degree in Pharmacy touched my grubby little hands that someone has turned to me for guidance about this evidently burning issue:

Dear Drugmonkey

My roommate and I have read your blog regularly for almost 4 months now and we love it. Since you are The Master of Pharmacy, we want you to settle a bet we have. What is the origin of the famous "Rx" symbol that is associated with our profession? 

Thanks, 

Nikki.

Dear Nikki, 

I bet you dot the "i"s in your name with little hearts don't you? But that's getting off track....

Which one of you bet that I don't give a rat's ass where that symbol came from?  Because that's the answer. I've heard several stories purporting to explain the origin of the Rx, probably all equally full of shit. I guess I could go ahead and add one more to the pile:

The origin of the Rx symbol actually dates to ancient Egypt and the original apothecaries that served the people in the time of the Pharaohs. (Learn to use the fucking google) The business climate during the time of the Middle Kingdom was very competitive, and pharmacist Cutamohnken Venzevian Surmanses found that if he could eliminate the need to urinate during the workday, he would be able to fill an average of 2% more prescriptions each week than his competition, giving him a leg up on other drugstores and ensuring he would not go bankrupt and be drafted into pyramid construction duty. CVS, as he was known to his colleagues, then developed the ultimate penis knot to ensure that all urine would stay in his body for at least 18 hours, and posted a picture of his innovation outside his store to demonstrate his commitment to sacrificing his urea elimination and osmotic balancing needs in order to earn the AWP-40%+25 cents that most Egyptian insurers paid per prescription at the time. 

While we can only dream of reimbursement rates as high as those of ancient Egypt, the business CVS built has never forgotten the financial advantage of the penis knot, administering it to every male pharmacist in a secret ceremony on their first day of employment. How CVS has eliminated urination from its female pharmacists remains a mystery. Many suspect they are actually robots. 

I'm sorry Nikki. I made light of your serious question didn't I? I'll make it up to you. Somewhere in the story I have just written, I have embedded a clue that will guide you to the answer you seek. Good luck in your quest. 

Tuesday, December 16, 2008

A Tribute To Frosty, The Most Selfless Of Water-Based Life Forms.

He kept up appearances for the children. That is the epitaph to remember Frosty The Snowman by always. Frosty loved the children. 

Frosty knew the sun was hot that day. He knew his fate. But Frosty chose to spend what remained of his time living, not dying. He took his broomstick and he ran here and there, around the square, leading the nation's children into a rebellion not of street gangs, violent crime, teenage pregnancy or any of the other social ills that plague our youth, but a rebellion of joy. 

He even paused for a moment when the town square's traffic cop called for him to stop, for Frosty was at his core a good and decent soul.

Frosty is gone now, a victim of seasonal change and global warming. Most of his corpse is scattered in the vast nothingness of this planet's oceans, some of it refroze and may be trapped glacially for millennia, some is locked underground, and some may be carrying away the sewage of the fetid masses of humanity, but the magical moment he gave our children will never die. Which is why I hope.... no, which is why I know, that someday Frosty will know the magic that is a trip over Yosemite falls. 

I think I may have just peed out a piece of Frosty.  

Monday, December 15, 2008

Highlights From Friday's Pill Counting Action.

The day always starts with the checking of voice mails left from the previous night. There were six on the machine. Five of them were from my neighbor. I can look out of my kitchen window and see my neighbor's front door, and she can look out of her's and see my car in the parking lot. All five of the messages wanted to know if we were open yet. Because it's way easier evidently to navigate my employer's voicemail labyrinth than it is to look out of your window to see if I've left for work yet. Surprise! She wanted to pick up some Norco

If anyone out there knows a good Realtor, please drop me a line. 

The sixth voice mail message was, in it's entirety, "I just need my Premarin filled, that's the only message I have" That was every bit of information someone out there thought I needed to fill their prescription. So I just filled some random person's  Premarin and declared mission accomplished. 

The first written prescription of the day was for Tobradex, which Tricare, the entity responsible for protecting the health of those we've hired to snuff out the health of others, seems to believe is available in a generic form. It is not. Woe to the pharmacist who gets a prescription for Tobradex that is to be billed to Tricare, that is all I can say. Although navigating the Tricare, ahem, "help" desk is a good way to kill an hour. If only I could look out of my window at home and see the people of Tricare in the parking lot. 

First numbnut question of the day came during the hour I was doing battle with the entity that covers the people who do battle; "WHERE ARE THE COTTON BALLS????" screamed in the ear that wasn't on hold. 

"Aisle two, under the sign that says cotton balls"

The customer then thanked me for insulting them. Be very careful about pulling this maneuver my friends, and don't ever do it unless you have the security of a pharmacist license. 

The community college dropout who runs the cash office gave us a register drawer with no nickels, thereby providing a clue as to why he didn't make the community college cut. "We need change in the pharmacy" called my trusty technician.

Someone tried to phone in a fake prescription for Vicodin with instructions "must last one month" I thought that was a nice touch. 

Actual question from an actual customer: "Yeah, on this painkiller here, it says to take 1 or 2 every 6 hours, how will I know when I should take 2?" 

Think that was the dumbest question I had all day? Not even close. Here's the days winner:

"This label says to take 1 tablet. How do I take 1 tablet?"

I shit you not. I spent a good week memorizing the Krebs cycle some time in 1990 so I could be prepared to tell someone how to take a tablet. 

"We need change in the pharmacy" called out my technician.

I was once again given a demonstration that my lingual skills are not nearly cunning enough as the old Hispanic man showed me a box of Monistat and asked "Will she still be a lady?" 

I really didn't think the old man thought the Monistat was some sort of over the counter sex change device, but I was without a clue as to what he was trying to ask, until my trusty technician stepped in. "He wants to know if she'll still be a virgin" she said. I should have known, as the word "Monistat" does translate loosely into Spanish as "filthy cum-drenched whore" 

Customer to me: "Do you have a fever? You look like you have a fever." They then moved on down the aisle, never giving me a chance to tell them if I had a fever or not. 

My trusty technician once again called for change in the pharmacy, but change did not come, the only result of her pleas were that they brought nickels and ones and pennies, but not once did they bring any fundamental change, so it looks like I am destined for more of the same tomorrow. 

Stick with the Gyne-Lotrimin if you want to maintain your virginity.


Wednesday, December 10, 2008

File This Under The "Might Not Be The Best Idea" Department.

I swear I'm not making this up. I always tell you guys when I'm making stuff up:

The developers of a conceptual, ergonomic 9mm handgun -- designed for people crippled by arthritis, muscular dystrophy, or similar conditions that render them too weak to operate normal handguns -- hope it will eventually be considered a Class 1 Medical Device.


"That's pretty fucked up" I hope you're saying to yourselves. And you'd be right.

 "But ultimately pretty harmless" you may also be saying. You would be wrong:

If the gun were designated as a medical device, doctors could eventually write prescriptions for it and then be reimbursed by Medicare.


Now....I know I've fantasized about keeping a large cache of firearms in my happy pill room for many a year now, but my plan was always to use them on my customers, not to give them to them. 47 million people have no health coverage at all in this country and we're seriously looking at the possibility of spending taxpayer health care dollars for some that do...... on providing them with guns.

Which tells me the way to a minimally acceptable health care system in The United States may be through the Bureau of Alcohol, Tobacco, and Firearms. I must be drunk.

Or the person at the FDA who took this application seriously must be drunk.

Or both.

Monday, December 08, 2008

With Speed As With So Much Else, All That's Old Is New Again.

Awhile back I wrote a little amateur book review of On Speed: The Many Lives Of Amphetamine, mostly because they flattered my ego by sending me a free copy. I did like the book though, and gave it mostly a thumbs up. Today I'm going to change my opinion a little:

Read the book. Especially if you are a medical professional. Buy it, borrow it, find the words Nicholas Rasmussen wrote somewhere my friends, because the many lives of amphetamine are far from over. From Sunday's AP wire:


NEW YORK – Healthy people should have the right to boost their brains with pills, like those prescribed for hyperactive kids or memory-impaired older folks, several scientists contend in a provocative commentary.

College students are already illegally taking prescription stimulants like Ritalin to help them study, and demand for such drugs is likely to grow elsewhere, they say.
"We should welcome new methods of improving our brain function," and doing it with pills is no more morally objectionable than eating right or getting a good night's sleep, these experts wrote in an opinion piece published online Sunday by the journal Nature.

Now, to be fair, the actual Nature commentary is a little more nuanced than the impression of it being left by the popular press, but here's the thing, to your average American, reading the AP article alone would constitute scholarly activity. Far too many people are gonna see only "Taking Ritalin is like eating right!!" Far too few people, including far too few doctors, are gonna read the actual Nature article. Or even the part of the AP story, at the end, that says:

Dr. Nora Volkow, director of the National Institute on Drug Abuse, said she agreed with the commentary that the nonprescribed use of brain-boosting drugs must be studied.

But she said she was concerned that wider use of stimulants could lead more people to become addicted to them. That's what happened decades ago when they were widely prescribed for a variety of disorders, she said.


Addicted and psychotic and dead of heart attacks and strokes. We've seen all this before. If you're not old enough to remember, read the book.

In addition to adjusting the plane to the needs of the aviator, war research also worked on modifying the man to fit the machine. Special suits to prevent blackouts under major forces were one major project. Another was biological enhancement of fliers: vitamin supplements were studied, as was testosterone for its reputed strength-building powers. However, the steroid hormones of the adrenal gland commanded the greatest attention......amphetamine seemed another likely possibility for high altitude performance enhancement.....


The military eventually cooled to the idea of speed as "biological enhancement", settling on a small role for it in keeping pilots awake. Today though, we have this:

Many of the medications used to treat psychiatric and neurological conditions also improve the performance of the healthy. The drugs most commonly used for cognitive enhancement at present are stimulants, namely Ritalin (methyphenidate) and Adderall (mixed amphetamine salts), and are prescribed mainly for the treatment of attention deficit hyperactivity disorder (ADHD). Because of their effects on the catecholamine system, these drugs increase executive functions in patients and most healthy normal people,


I wonder if by "increase executive functions in most healthy normal people" the authors of that Nature article meant "make healthy normal people want to mow the lawn at 3 in the morning" 'Cause I've seen Ritalin do that.


The authors pay lip service to safety concerns, but not nearly enough. They talk of a new medical paradigm of better living through amphetamine, which has been talked about before. It did not end well before, and it won't end well this time if it's allowed to take root. Machines and lifestyles need to be modified to meet the person, not the other way around.

Unless maybe you're really into lawn care.

I Don't Know What's Gotten Into Me, But This Night I Make The Decision To Share Back Door Santa

I told you about "Back Door Santa" last year. The most unintentionally hilarious song ever. I swear, I cannot, for any reason, stop laughing from the moment this song starts until the tune is done. Jon Bon Jovi is in his hairband excess, which is hilarious enough, but he is also covering on old blues number, which is a match made in hilarity my friends.  The cherry on the sundae is how you can just tell that Jon is taking himself very, very seriously. I can almost hear a Jon Bon Jovi adviser saying....."OK Jon, act like you're having fun, concentrate on looking like you're having fun!!!"

I also told you how I play "Back Door Santa" exactly one time a year. Tonight was the night I was overcome with the "Back Door Santa" craving. There's something different about this year however. I'm not sure what it is, maybe it's the spirit of Baby Jesus that's gotten into me, but this year, I will share "Back Door Santa"with the world. There's a playlist on the right of this page. "Back Door Santa" is at the bottom of the playlist. Enjoy.  

Sunday, December 07, 2008

I Feel As If I Haven't Been Doing My Part In The Hunt For Osama Bin Laden

I mean, there's a storage unit right next door to my condo, and I haven't checked it one time since the attacks of 9/11. I have also failed to look in the wooded area between my condo complex and the highway. 

I'm almost afraid to go look now because it would be really embarrassing if he were there. 

"Drugmonkey, you idiot, Osama Bin Laden is holed up in the tribal areas of Pakistan, and is nowhere near your little rathole condo" some of you may be saying. To which I would reply; "If you know so much about where Osama Bin Laden is, why haven't YOU found him?" It's been seven years, so obviously it's time for a little outside the box thinking here. 

Back to my point though. I'm afraid this whole Osama Bin Laden fiasco may be as much my fault as George Bush's. I'm going to go check out that storage unit as soon as I sober up. I don't think one should risk an encounter with Osama Bin Laden when even the slightest bit intoxicated. 


Saturday, December 06, 2008

I've Decided What I Want For Christmas.

I don't shop anywhere near where I work. I never have. I've split my career between the ghetto and the bastions of some of the world's most affluent people and I don't like to hang around either place for any longer than I have to. A guy's gotta eat though, and when that guy's too lazy and organizationally inept to pack his own food, that means he gets to spend his lunch time blending in with what passes for the elite in our society. Getting mistaken for one of them when all I want is a sandwich or something.

I also get to see the interaction of classes in our society. As even the most snobby of snobby shopping centers cannot function without hiring people to take care of the garbage, fix the potholes in the parking lot, paint the wall across from Macy's. Of course when I say "interaction of classes in our society" what I mean is the total lack thereof, as the janitors, the maintenance people, and the painters have all been trained to be nearly invisible so as to not disturb the people with the money. I see one woman almost every day with a broom and a dustpan walking the grounds, sweeping up cigarette butts and other little bits of miscellaneous trash. She's a little part of my life almost every working day, and she's almost as good at averting her eyes from the customers as she is at keeping the grounds butt-free. Just once I'd like to give her a little smile and a hello, but short of tackling her I don't think it's gonna happen. She's been trained to be invisible. The only hellos I ever get are from the affluent assholes. 

For Christmas I would like that woman to not expect to be invisible. I'd like to look her in the eye and smile and say hi, like you would think would happen between any two people in a civilized society. To mark the holiday, I want her to not turn her head. To not feel as if that's what's expected of her.  That's pretty much the whole of my list this year. I'm not into tackling anyone though, so I'll settle for her having a good holiday in whatever world it's acceptable for her to be seen.

I guess you should have a good holiday too. 

 

Wednesday, December 03, 2008

Finally, Someone Steps Up With Concrete Action To Take On This Nation's Health Care Crisis

Insurance for insurance. I swear I am not making this up:

For these economically uncertain times, the UnitedHealth Group has a “first of its kind” product: the right to buy an individual health policy at some point in the future even if you become sick.

Called UnitedHealth Continuity, the product is not actual medical insurance, but is aimed at people who may have insurance now but are worried they may lose it — and may not be able to obtain replacement insurance on their own.

People who are already sick will generally not be eligible for the new product. Those who do pass a medical review, will pay 20 percent each month of the current premium on an individual policy to reserve the right to be insured under the plan at some point in the future.

Dear Mr. Smith,

Thank you for your recent insurance insurance application. We at UnitedHealth Group realize you have a choice in insurance insurance companies, and are delighted you chose us for your insurance insurance needs. In order to get the most out of your new insurance insurance policy, keep these tips in mind:

- Your insurance insurance benefits will be greatly reduced if you choose an insurance company not in our Preferred Network. Insurance companies that work with insurance insurance plans such as UnitedHealth Continuity negotiate lower rates, which helps keep costs down for everyone.

- Should you choose to buy an actual insurance plan, you must call our pre-approval desk at 1-800-DENIED!. Failure to call before buying an actual insurance policy will reduce your benefits.

-Breathing or failing to breathe will also reduce your benefits, as will blinking your eyes.

-Please bear in mind that we are not your actual insurance company, and are responsible only for denying your claims for insurance. Actual insurance claim denials are someone else's problem. Yours most likely. Any problems you may have with prescription drug claims however, are solely the fault of the pharmacist on duty when you try to pick up your prescription.

Thank you again for making a desperate effort to obtain some sort of care through the American health system. While we assure you this effort will be entirely futile on your part, it has contributed toward a successful fiscal third quarter for our company, and we think the pride you can feel at having become a vital part of our free-enterprise healthcare system is a great first step towards the healthy lifestyle you seek.

Please accept this free body mass index refrigerator magnet as a token of our appreciation. Sucker.

Sincerely,

Unitedhealth Group.

I don't have to tell you that letter is made up. But you know it or something similar to it is coming. At what point my friends, do we finally admit this is fucking insane? Insurance....was invented.....to protect you from a catastrophic event that could wipe you out financially. Fire. Flood. Smacking into someone with your car by accident. And now, the catastrophic event you must be protected against.....

is having to buy insurance.

At what point do we finally admit this is insane?

Tuesday, December 02, 2008

I Think It's Sad There Isn't An Edge Of the Earth.....

.....because I think I'd really like to go there. Have a drink maybe. Just kinda sit at the edge of the earth, dangle my feet over and think about stuff. 

I think sitting at the edge of the earth, with a drink in your hand, would be conducive to thinking of a lot of ways to make things better. 

And if I couldn't think of any ways to make things better, then I could just jump off. It'd be a win win really, if the earth were flat. 

As it stands, all I can do is pour another martini and walk around in circles. Damn this planet and all its roundness. 

Monday, December 01, 2008

Pfizer Says They Are Inspired By A Single Goal, Your Health, Which Somehow Led Then To Try To Shove Cardura Down Your Throat.

Because heart failure evidently fits in with that single goal. Your Health. 

I mean, Pfizer wouldn't lie. It's like the first thing you see on their web page.

At Pfizer, we're inspired by a single goal: your health.

Keep their inspiration in mind while I tell you a story.

Many people believe that in healthcare, new automatically equals better. Even many in the professions work off that assumption. Thing is, no one, anywhere, has ever claimed that, and in reality, new just means better than a placebo. That's the standard a new drug has to meet in order to be let on the market. If Old Maid Drug is 90% more effective than a placebo, and Young Sexy Drug is 30% better, the FDA is required by law to approve Young, Sexy, Inferior Drug. Guess which one Big Pharma will be promoting though?

And in most cases we would never even know that Old Hag Drug is 60% better than Young Sexy Drug. Because the incentive for Big Pharma is to stop its studies the very second YSD is shown to be *any* better than a sugar pill, and start buying new low-cut dresses for its sales staff in anticipation of YSD's immediate approval.

Bottom Line: we usually don't have nearly enough information to know just how effective a new drug is, or how it measures up against what's already on the market. We only know that it's better than nothing.

Someone in the bowels of the scientific bureaucracy in the federal government, namely, The National Heart, Lung and Blood Institute, had an idea to change that, or at least change a little part of that. The feds organized a huge clinical trial to rate and compare treatments for hypertension, how effective they were at preventing heart attacks, strokes, and other cardiovascular problems, you know, the whole point of putting someone on a hypertension medicine in the first place. Everything from old-school diuretics to medium-school calcium channel blockers to new school ACE inhibitors were gonna get a look at. Even alpha blockers.

"Alpha blockers, WTF?" Some of you young whipper snappers might be saying. "Who takes alpha blockers for high blood pressure?" Well this old man's here to tell you there was a time when people did. A biggie back in the day was Pfizer's Cardura. Nice name. Makes it sound like it's gonna make your heart all durable and stuff. I bet someone was really proud of themselves for thinking up that name.

From the New York Times Article describing the federal hypertension med study, named Allhat:

Cardura was added only after Pfizer, which had already agreed to contribute $20 million to the trial’s costs, increased that to $40 million, Dr. Cutler said.


"We're so inspired by our single goal, your health, that we didn't think twice about kicking in an extra $20 million to promote our single goal, your health" A Pfizer spokesman never said.

Pfizer’s bet on Cardura proved a big mistake. As the Allhat data came in, patients taking Cardura were nearly twice as likely as those receiving the diuretic to require hospitalization for heart failure, a condition in which the heart cannot pump blood adequately. Concerned, the Heart, Lung and Blood Institute announced in March 2000 that it had stopped the Cardura part of the trial.


Now everyone out there who thinks that this disastrous clinical data immediately led Pfizer, who says they are inspired by a single goal, your health, to stop promoting Cardura for hypertension raise your hand.

Ok, everyone with your hand up, I've been hammering away at this blog for going on 4 years now. Have I taught you nothing?

Rather than warn doctors that Cardura might not be suited for hypertension, Pfizer circulated a memo to its sales representatives suggesting scripted responses they could use to reassure doctors that Cardura was safe, according to documents released from a patients’ lawsuit against the company.

And in an e-mail message unearthed in those same court documents, a Pfizer sales executive boasted to colleagues that company employees had diverted some European doctors attending an American cardiology conference from hearing a presentation on the Allhat results and Cardura. “The good news,” the message said, “is that they were quite brilliant in sending their key physicians to sightsee rather than hear Curt Furberg slam Pfizer once again!”

Asked for comment, a Pfizer spokesman didn't say, "Ummmmmmmmmm.......well......have you heard about Viagra? It makes your Willie hard and stiff!!"

Sales of Cardura held up through 2000, when it lost its patent and became an old hag, making it no longer profitable for Pfizer to send doctors to go do things like get drunk in the French Quarter so they wouldn't see actual science at scientific conferences.  

Not an old hag like chlorthalidone though, the oldest of the old school hags in the Allhat study, which was also the most effective med in preventing heart attacks, strokes, and heart failure combined. Good luck getting someone besides me to tell you that though. Use of meds like chlorthalidone rose a paltry 5% after the study.

Maybe I should get me a low-cut dress or two.