Tuesday, June 30, 2009

I Noticed It Again Last Friday.

My Fridays have fallen into a pattern, as that is the day of the week when I put in my 12 hour shift in the happy pill room, and after a 12 hour shift, I'm not interested in looking at a wine list, or hearing about how the carmalization of the sauce on some piece of meat the food section of The New York Times has elevated to a status symbol will mix perfectly with the organic fruit dessert flown in this morning from Peru. I just want to get some calories in my stomach and get the hell home. That leaves me one and just one choice in the den of affluenza where I sling the pills these days. Subway. I miss my days in the ghetto where I had a wide variety of empty calorie houses from which to choose and the people were far more interesting, but Subway it was again last week whether I liked it or not. The home of Jared has become part of my Friday night ritual by default.

As had the family on the other side of the room. Father, mother, and four little ones all munching away on subs or chips or cookies or whatever else the Subway peddles these days. One little girl was playing away with some sort of toy promotion for the Land of The Lost movie, which I've heard is terrible. I figured the little girl would never see it though, as the family didn't look like the type that spent much time at the theatre. From the enthusiasm of the little ones and the fact that I've seen them there every Friday night for a couple months now, I'm pretty comfortable in saying that Friday night at Subway was the big family outing for the week.

The same way a trip to McDonald's was a big outing for the little drugmonkey's family.

The short sleeved plaid workshirt the father wore looked awfully familiar.

I was looking through a mirror into my childhood, because you see, before the agents of capital started luring the hablaers of español northward to provide cheap labor, they were luring the hillbillies out of the holler to do the same.

.....To the jobs that lay waiting in those cities' factories
They learned
readin', rightin', roads to the north
To the luxury and comfort a coal line can't afford
They thought
readin', rightin', route 23
Would take them to the good life that they had never seen
They didn't know that old highway
Could lead them to a world of misery


Dwight Yoakum wasn't singing about today's immigrants, although the story sounds kinda familiar, doesn't it? I know exactly where route 23 is. It leads up from the hollers of Kentucky to the spirit crushing jobs of the North. I've driven on it many a time. Up from the land of poverty to the promise of work it goes.

Up from the land of poverty to the promise of work. Sound familiar? Does it? Because honest to God it seems like sometimes I am the only person on earth who can make a connection between yesterday's Tom Joads and today's Felipe Hernandezes. The only one who sees that Sabado Grande looks an awful lot like the Hee Haw we used to watch on Saturday nights. I used to work in the ghetto, and although I couldn't understand a word they were saying, a lot of my customers in the ghetto reminded me an awful lot of the hillbillies back home.

But it feels like I am the only person who can see it. Because the grandchildren of Tom Joad can't get past the fact that the people who took their place on the economic ladder came north hablaing español. So the grandchildren of Tom Joad are duped into thinking they have far more in common with the white people on Wall Street than they do with the people who currently do the work their grandparents did. The work that laid the foundation for the grandchildren of Tom Joad to be elevated into the upper middle class. Where they were taken advantage of by the Barons of Wall Street they thought they had so much in common with. Checked your 401k balance lately?

It's kinda like the way Tom Joad was taken advantage of by the Barons of Agriculture.

I watched as the little girl in Subway happily showed off her dinosaur cup to her brothers, and I could almost hear the voice of soul rotting affluence on the other side of the mall angrily sending back his meat of the moment. I could imagine the meat of the moment wasn't cooked the way the New York Times said it should be cooked, and the grandchildren of Tom Joad are all about showing their status, which is defined by whatever the New York Times says it should be. You know it happened.

And I know I'll look forward to heading back to Subway this Friday.

I think that little girl's gonna turn out all right.

Monday, June 29, 2009

Pharmacy Junk Mail In More Than One Sense Of The Word. Look How Much Better Glumetza® Is Than Regular Metformin

I mean seriously, just look at this graph. You'd have to be stupid not to realize how much better Glumetza™ is.

You probably don't even need or want to be told at this point that Glumetza™ is simply an extended-release version of the diabetes medicine metformin, which also goes by the brand name Glucophage. It doesn't matter. Look at the graph. Glumetza is way better. That's why the Glumetza® bar is orange and the numbers at the top are way bigger. Because Glumetza® is obviously way better.

Santaris Inc. and Depomed, the makers of Glumetza® would like you to stop reading now. They would also like you to not notice or pay attention to the top of the graph, where it clearly says that they used a daily dose 33% higher to get that pretty orange bar.

Or at the very least, they would not like you to think about how maybe it's not all that surprising that when you give a dose of a drug that is higher, it might be more effective.

Here are some other tidbits from the text of the same Glumetza® ad:

Unlike generic immediate-release metformins, Glumetza® uses advanced polymer technology, which provides controlled release of metformin targeting the upper GI system. As a result, more drug enters the bloodstream and less unabsorbed drug remains in the lower GI tract. This may help reduce GI adverse events.

I see. Well I think Glumetza ® may make your penis fall off. And I have provided as much proof for this claim as Santaris Inc. and Depomed have for theirs.

In the clinical trial above, Glumetza® was well tolerated at higher doses. The overall incidence of drug related AEs (adverse effects) was 35% for Glucophage 1500mg/day BID and 33% for Glumetza® dosed up to 2000mg QD.

Sweet. A 2% reduction of the chance of any side effects is totally worth paying $190 extra dollars a month for. Which is what Glumetza® will set you back as opposed to the dirt cheap metformin.

The regular metformin's bar in the graph isn't orange though.

Less than 1% Glumetza® patients discontinued treatment due to GI AEs in the first week of the study, when the assigned dose was 1000mg/day.

Except that pretty orange bar was for a dose of 2000mg/day. Santaris Inc. and Depomed don't seem to want to mention how many people discontinued treatment at this dose. So I'll just assume it's somewhere around 95%.

Sigh. You know, the fact that a drug manufacturer massages some numbers around isn't what bothers me here. Drug manufacturers have massaged numbers around at least since I was a drunken frat boy. They used to be far sneakier about it though. Now it's like they don't even care, and I miss being respected enough that they would at least try to spray some Lysol on their bullshit. These days it's like Big Pharma is giving bulls a special diet to make their shit extra stinky or something.

And evidently extra stinky bullshit works on someone out there. Because I filled a prescription for Glumetza® yesterday. That's what bothers me.


Sunday, June 21, 2009

85% Of People Say The Health Care Systen In This Country Needs To Be Destroyed. Today We Let The Other 15% Have A Say.

That 85% number comes from a poll published in Saturday's New York Times:


85 percent of respondents said the health care system needed to be fundamentally changed or completely rebuilt


Fuck yeah. Now we're talking. We must be about ready to steamroll the last few remaining pathetic bastards defending the status quo and finally make some progress towards joining the rest of the civilized world in ensuring our citizens don't have to worry about losing their house to foreclosure if they have the rudeness to become ill. Right?

Right?

Not necessarily. Would you have guessed that only 15% of people support the present system? I'm betting not. The right wing is very skillful at the construction of Potemkin villages to make it appear they are far more numerous than they really are. You can do that kind of thing when you control Fox News, The Murdoch newspaper publishing empire, and pretty much the entirety of the AM radio dial. It also helps to shout a lot. There is another level to right wing media though. Publications like the National Review, founded by William F. Buckley to be the flagship of intellectual conservatism. In other words, to serve the people who actually benefit from right wing ideology, as opposed to the white trash mindset that Bill O'Reilly is paid big bucks to whip into a frenzy to think they are better off shunning those dreaded liberals and their sense of fairness.

The National Review recently took its best shot at defending the system that is bankrupting us both individually and as a nation, which isn't really surprising, since our bankruptcy is by and large their reader's profit. Gather round folks, and get ready to listen to the extinction cry of those who build their mansions with our blood money.

I wrote back in December of 2007 that our heathcare *cough* system produces fewer doctors, fewer nurses, and fewer hospital beds per capita than the average country in the Organization for Economic Co-operation and Development, which any human would interpret as a sign of trouble. Remember though, that right wing conservatives, while having opposable thumbs, rudimentary tool-using and speech capability, and binocular vision, are not fully human:

One gets a better measure of how much countries spend by looking at the real resources used; and by that measure, the U.S. system is pretty good. For example, we use fewer doctors than the average developed country to produce the same or better outcomes. We also use fewer nurses and fewer hospital beds, make fewer physician visits, and spend fewer days in the hospital.

So, next time you go to the ER and get yourself stacked up in the hall waiting to see a doctor for 6 hours, the next time you're lying in your own urine in a hospital bed desperately pressing a call button that the nurse handling a crisis at the other end of the hall can't hear, just remember, it's a sign that the U.S. system is pretty good! I bet the editor of The National Review checks to see which hospital in his area has the fewest doctors and nurses per patient whenever he needs care. I bet he also picks an insurance plan for himself that boots him out of the hospital as soon as possible, because hitting the street in a post-op state where you can barely stand up would definitely be sign you are in a health care system that is pretty good.

By the way, many of you may have shot a beverage out of your nose when you saw the National Review assert the U.S. system produces "the same or better outcomes," as that flies in the face of every single fucking piece of evidence on the planet. We'll get to that, but first:

Other countries are far more aggressive than we are at disguising and shifting costs — for example, by using the power of government purchase to artificially suppress the incomes of doctors, nurses, and hospital personnel. This makes their aggregate outlays look smaller when all that has really happened is that part of the cost has been shifted from one group (patients and taxpayers) to another (health-care providers). This is equivalent to taxing doctors, nurses, or some other group so that others may pay less for their care.

Soooooo.....other countries have their health care workers in oppressive chains, paying them slave wages so other people can get recreational coronary bypasses. Except....um.....as we just saw, the U.S. has fewer healthcare workers per capita than other countries in our peer group. So....when you pay people less to do something, you get more people who are willing to do it?

My God, The National Review just turned the basic tenet of Economics 101 on its head. I bet they'll win a goddamn Nobel Prize or something. Or else they're just full of shit.

The National Review also comes up with a little outside the box thinking to explain why health outcomes in the U.S. just never seem to measure up to the rest of the industrialized world:

Critics point to the fact that U.S. life expectancy is in the middle of the pack among developed countries, and that our infant-mortality rate is among the highest. But are these the right measures? Within the U.S., life expectancy at birth varies greatly between racial and ethnic groups, from state to state, and across counties....

All too often, the heterogeneous population of the United States is compared with the homogeneous populations of European countries. A state such as Utah compares favorably with almost any developed country. Texas, with its high minority population, tends to compare unfavorably. But these outcomes have almost nothing to do with the doctors and hospitals in the two states.

Uh-huh. Now those of you out there who aren't white won't need me to translate that for you. The honkies amongst you though, may not be used to the thin veneer of subtlety applied here to what they are actually saying, which is:

All those brown and black people shouldn't really count. Because they're not real Americans.

Which is bad enough. The buttwipe who wrote this article though, a near-human by the name of John C. Goodman, also happens to have his facts wrong. Let's take a look at the "homogeneous populations" of a few European countries:


17% of the population of France isn't white.

Germany? 18 percent.

Netherlands. 20 percent. That's one in five.

All those countries beat the living piss out of the United States, whose minority population is 26%, in almost any way you wanna measure their people's health. John C. Goodman evidently feels that somewhere between a minority population of 20 to 26 percent, there is a point that will trigger the collapse of a country's health care system.

Or he happily wallows in the mud if ignorance.

Or he's just a racist.

So there you are my friends. Everything is just fine. We really need fewer doctors and nurses, and if we wanted more we could always just pay them starvation wages like the Europeans do in some fantasy world. And people who aren't white really don't need medical care anyway. That's the position of the publication that considers itself the pillar of serious conservative thought in this country.

That's seriously the best they can do. If this fight is fought on just the facts, we will win in a landslide.

Let's make sure the fight is fought on just the facts.

Thanks to some asshole who can't write or form a coherent argument named Chip for sending that article my way, even though he was just trying to be a dick.

Saturday, June 20, 2009

I Take Issue With One Of My Literary Heroes, And Other Highlights From My Vacation



“The vainest, most slap-happy and irreverent of men, in the presence of redwoods, goes under a spell of wonder and respect.”

-John Steinbeck, "Travels With Charley" 1962








This redwood tree totally looks like it has a penis. And considering the scale of the redwood penis versus the size of the redwood tree, I kinda feel sorry for Mrs. Redwood. It was also located maybe 500 feet from a sign with that Steinbeck quote, making me wonder if it wasn't some sort of test that I failed.

At any rate, I had a great time on vacation. There were days on the hiking trail that I never saw another human, a feeling I could get used to. The local population of the area did go out of their way to make me feel welcome though:




I'm sure it was just a little good natured humor between Native Americans and the people who stole their land and killed most of them. Ha ha ha.

Here are some elk that scared the living piss out of me by appearing out of nowhere on a day the fog was so thick it was a challenge to see the hand on front of my face:



The elk started to make some sort of grunting noises, which if my elk language to English skills are up to par, would translate something like:

"I know our species has been a vegetarian one for thousands of years Bob, but seriously, would a little meat kill us every now and then? The bears look like they have so much fun when they maul one of these things"

The elk eventually decided to let me pass, which is a good thing for you, otherwise you would have no one to ask next week why your copay is so high.

Sigh. Back to work on Tuesday. I guess I'm glad the elk didn't trample me. For some reason.

I have my memories though, and the promise of a return trip someday when the humans get to me and I decide I'd rather hang out with the elk. When I do make it back I think I'll help out Mrs. Redwood and slip some Viagra into the root system of the penis tree.

Out of respect of course.

Wednesday, June 10, 2009

The Story Of The Doctor Who Falsified His Scientific Research. Because There Are No Losers In Drugmonkey Elections

Three of you cared. Three of you out there looked past the easy entertainment of the everyday circus that is my worklife and said "Drugmonkey, while tales of drugstore sales clerks who direct customers looking for corn medicine to the gardening section never fail to amuse us, we are concerned about any threat to the objectivity of the scientific method, and we take seriously our obligation to stay part of an informed citizenry." I have heard your pleas, and you will have the story you so deserve to hear.

Of course one person demanded that I write both stories, which I am about to do, so I guess you could really say I am just caving into this particular person's demands. Perhaps you are about to read this tale of scientific skulduggery only because I am spineless and weak. At any rate, from last Saturday's New York Times:

Dr. Romney C. Andersen, a Walter Reed Army Medical Center surgeon, was surprised last summer when his neighbor, a fellow doctor, congratulated him on a new medical journal study bearing his name.

“What study?” Dr. Andersen asked.

Soon, he was not the only person asking questions. Army officials, alerted by Dr. Andersen, began an investigation. They uncovered an apparent case of falsified research by a doctor who had befriended Dr. Andersen when they both worked at Walter Reed, treating American soldiers severely injured in Iraq.

The disputed journal article was written by a former Army orthopedic surgeon, Dr. Timothy R. Kuklo, who is now a medical professor at Washington University in St. Louis. Dr. Kuklo, the investigation found, forged the signatures of Dr. Andersen and other Army doctors on his study and never showed it to them before it was published.


I won't say anything about bad karma coming from an illegal war started by an incompetent president, because quite honestly, compared to slaughtering a hundred thousand or so people who didn't attack us for no good reason, something like this wouldn't even register on the karma payback scale. Karma has bigger plans for us I'm sure.

In his study, Dr. Kuklo, who has not responded to repeated interview requests, reported that a bone-growth product sold by Medtronic, called Infuse, performed “strikingly” better than the traditional bone-grafting technique used to heal soldiers’ shattered shin bones. Other Walter Reed doctors told an Army investigator that claim was overblown.


But.....but....why would someone do such a thing? Forge signatures to get a scientific paper published? Maybe because he just wanted to look smart, and wanted some of the honor and prestige that comes with being a smart person.

Medtronic financed some of Dr. Kuklo’s research and travel while he was at Walter Reed and hired him as a consultant in August 2006 when he took his current academic post.

Or maybe he just wanted to get paid. Seriously, how much honor and prestige comes with being a smart person in today's society?

Medtronic has said that it had no involvement in the disputed Infuse study, despite its business ties to Dr. Kuklo.


Oh, well that makes it OK then. Because, I mean, if Medtronic was dropping off truckloads of cash in front of someones door for purposes that were not directly related to a study that person was doing, I can't think of any incentive that person might have to make Medtronic's products look good. Really, I'm sitting here racking my brain and just can't come up with a reason at all.

Dr. Kuklo has his defenders though. Like Dr. David W. Polly, who I bet is taking his stance based on scientific principle, or maybe deep friendship and an awareness of Dr. Kuklo's character, or perhaps just on the belief that one is innocent until proven guilty:

Dr. Kuklo, who moved into a $2.1 million home near St. Louis, was not the first departing Walter Reed doctor to get a consulting deal from Medtronic. For instance, it had struck an arrangement with Dr. Kuklo’s former boss, Dr. David W. Polly Jr., when he left the military hospital in 2003.

Dr. Polly is now one of Dr. Kuklo’s staunchest public defenders. Recently, Dr. Polly blocked a reporter’s request that the University of Minnesota, where he now works, release his financial disclosure statement showing how much he made from Medtronic.

Or, maybe Dr Polly just wants to make sure he keeps getting paid. I'll let you decide which is more likely.

Dr. Polly, said Dr. Kuklo was mistaken to sign his co-authors’ names. But he added that was not uncommon in the military for one officer, when it was expedient, to sign for another.


"As a matter of fact, that's how I was deployed out of Iraq" Dr. Polly said in an imaginary interview. "I signed my commanding officer's name to an honorable discharge, and I was headed home the next day. Seriously, it's done all the time."

A spokesman for the Army declined to say when reached for comment in my mind only if this common practice may be responsible for any difficulty in retaining military personnel in active combat theaters.

(Dr. Kuklo's) August 2008 journal article cited other Walter Reed data to compare Infuse with the traditional bone-graft treatment for fractured shins. He declared Infuse the winner by a wide margin.

Dr. Kuklo said he had reached that finding by reviewing the records of two groups of the soldiers with similarly severe leg injuries, who had been treated either with Infuse or a bone graft. But Dr. Andersen suspected that Dr. Kuklo had fabricated the comparison groups, because many soldiers had received both Infuse and a bone graft — not one or the other.

“It was like he was comparing apples and oranges,” Dr. Andersen said. “But there weren’t any apples or oranges to compare.”

Good thing we don't have socialized medicine in this country though. Because if we had socialized medicine scientific research in this country would get all fucked up.

Wake. Up.


Monday, June 08, 2009

By Popular Demand, Highlights From Friday's Pill Counting Action.

The final results from the Twitter poll were 12 votes for pill-counting highlights, 3 for the story of the doctor who falsified his scientific paper, and 1 demand that I write about both. I guess I don't blame you. In today's uncertain world, I would much rather lose myself in tales of numbnut customers than face the cold reality that yet another institution upon which the functioning of our society depends has cracks in the foundation. Yup. I vote for highlights as well. Make that 13 to 3, and one for both.

The day started with an eerie silence. Ominous. Not to mention no messages on the voicemail. There are never no messages on the voicemail. The silence continued and 15 minutes into it I knew something was dreadfully wrong.

The phones were dead. So dead their corpse was cold. And while it was nice to be able to start the day being able to keep up with the workload those at the home office say we should be able to handle for a change, I knew that disaster was looming.

I will pause here and point out that I noticed the impeding disaster 15 minutes into my shift, and that the store opens an hour before the pharmacy. The numbnuts up front had not taken a phone call in an hour and 15 minutes and didn't have the slightest idea anything was wrong. Probably because they never took the class I did my third year in college entitled "How to tell if the phone is ringing."

I stepped into the leadership void and called the corpro-help desk. Disaster was avoided. I stared the day by saving the store.

The first phone call of the day was from a dentist who wanted to phone in a prescription for diazepam, 20mg an hour before the customer's dental appointment. A whopper of a dose. The customer was already taking temazepam 60mg at bedtime. A whopper of a dose. I told the dentist this and the dentist had no idea what the problem could be.

Let's pause again and have everyone not in the profession play a game. I'll call it "See if you're smarter than a dentist" Here are the rules; look at the last three letters in the name of the two meds the customer above would be taking and see if you have any idea what the problem could possibly be. If so, you're smarter than a dentist.

So I started the day by saving the store and then by saving a customer. That's what I do. I save stuff. Which is why I make so goddamn much motherfucker.

Overheard as the day's routine prescription filling got under way:

Customer: "Where is the corn medicine?"

Front-end clerk: "I think over by the seeds"

I now have some sympathy for the customers who insist on asking only me where the random shit they want to buy is located.

"Oh I'm in a lot of pain!!" said the customer who came in shortly before lunchtime. "Where are your stomach medicines!!??"

"Down aisle 2" Replied my keystone tech.

"What do you recommend!!!???"

"Let me have you talk to the pharmacist"

"I don't have time!!! I'm in too much pain!!!"

The extra time involved, I will point out, would be about how long it would take for the customer and/or myself to bridge the approximately 10 feet between me and my keystone tech. I always wondered why insurance company helpdesks felt the need to tell you if you were calling due to an emergency to hang up and dial 9-1-1. As I watched the stomach lady run out of the store emptyhanded, I understood.

About an hour later someone called and asked what "buy one, get one free" meant, which made me really happy I went to all that effort to fix the phones.

In the background Barry Manilow sang "Daybreak," and I could not help but to hum along. Someday I will tell you the story of how Barry Manilow is a scar upon my soul.

Tied up on the phone again, I heard a customer ask if he should take his naproxen with food. I banged on the counter to get my tech's attention and nodded "yes." If you're a pharmacy student, take heed. Your professors won't tell you this, but some days, that's as close as you're gonna get to having an opportunity to counsel someone in the real world.

The day ended with a 5-minute till closing time phone call.

"Do you sell something to measure the downward pressure being put on a jar, like peanut butter, when you open it?"

I cannot convey to you with words the urgency that was in this person's voice.

"No ma'am, I'm sorry, we don't"

"I guess I should ask a physics teacher, huh?"

I started the day by saving the phones, which I thought was a good idea at the time.


A Quickie Trip Into The Healthcare Debate Shows Us Just How Completely We Are Ruled By Our Corporate Masters.

From a Saturday New York Times Story on the looming health care battle royale:

But critics argue that with low administrative costs and no need to produce profits, a public plan will start with an unfair pricing advantage.

So.....in fairness, we need to allow the private insurance industry to spend a higher percentage of healthcare dollars on administrative costs. It's somehow unfair if we don't.

And there's evidently some fundamental need for people to make money off of other people's illnesses. It would be deeply unfair if we didn't allow cancer profits.

That's their argument.

The battle is about to begin, and we need to take them down.

Wednesday, June 03, 2009

I Thought Of Clarence Again Today

I don't know how exactly Clarence found a way to stick in my mind all these years. I only met him once, and even then I never actually saw him. Actually I'm pretty sure he was already gone by the time we were introduced, but I have a feeling Clarence will be with me for awhile. Maybe forever. Or at least until I'm old and alone and spending my last days on planet earth like the lady in the cancer ward of the hospital I found myself in sometime in the spring of 1992. 

All I was was a college kid looking to knock off my last few quarters of school so I could start making some bank and begin my life. Jesus it seems like so long ago when everything in my head was new. Seems far longer than it's actually been. My clinical rotations were just something that had to be done to get my degree, so I was doing them, dutifully coming in every morning and making my way through the hospital to follow my patients who had to be followed so I could get out of school. I had just bought a brand new car, because my brand new life was ready to begin. I sat down at the desk where I could see the little old lady who was not a patient I had to follow if the door to her room was opened wide enough. She was dying. 

"Clarence!!!! Clarence could you come in here? Where are you?" The dying woman cried out. She told me far more about herself with those ten words than you would ever imagine. She was a lady of the farm, an echo of the time when a man worked the land from sunup to sundown and sometimes longer taking care of his family and whatever else needed to be taken care of. The carburetor in the tractor that kept gumming up. The cow in the field that was in danger of dying while delivering a calf. That boy up the road not quite right in the head who broke into the barn last year. Before cheap gas, good roads, Wal-Mart, and high fructose corn syrup turned rural America into a wasteland full of mouth breathing fat-ass cretins, the countryside was full of Clarences. Men with good hearts who worked hard and took care of things.  Who took care of their families. 

That's what the dying lady told me with those ten words. In reality she told me far more. Now she was old and alone and scared and desperate, and she called out for Clarence. Because she knew Clarence would make things all right the way he had always done. I sat behind my desk and quietly hoped that Clarence just might show up, and make everything all right. The next morning the door to the lady's room was open wide and I saw an empty bed and dutifully followed the patients I had to follow.

None of us will ever really be gone. We'll all leave behind thoughts and friends and family and people we've touched and influenced in ways we will never realize. I have a little bit of Clarence with me, and now, so do you. I thought of him again today. Probably because I was hoping he might show up and make everything all right.