Friday, May 27, 2011

Monday, May 23, 2011

A Few Random Thoughts That Should In No Way Be Confused With Those Of My Employer.

I know the profession has its ups and downs. Its frustrations and pitfalls. But I was thinking today, I really take pride in the work my fellow pharmacists and I do day in and day out. It's such a pleasure to be able to serve people and to know that I'm making even a small difference in the fight against things like cancer, heart disease, diabetes, and HIV. To know that I can use the talents I have honed over the course of my career to contribute to the good health and wellness of humanity is a feeling almost impossible to describe to someone not lucky enough to be in a health care field. I'm a big fan of pharmacy.

I should mention though, that the other day my employer came out with a new social networking policy that made it very clear that we were to leave no confusion when we post something online that we are speaking only for ourselves, and not as a representative of the company. So please, don't assume my employer agrees with anything I've just said.

I'm not just a pharmacist though, I'm also a citizen of the United States, and I'd like to think, the world as well. That's why my heart was filled with joy when I heard the news that Osama Bin Laden is no longer a threat to the planet. I really swelled with pride knowing our brave troops had brought evildoer number one face to face to his maker. I'd like you all to join me in honoring our brave men and women in uniform who all played a part in this "Mission Accomplished!," especially the Navy Seals, who may be the most heroic people who have ever lived.

Again though, my employer feels it is very important for me to say that what I write here does not necessarily reflect their views. I'm not sure why, but they definitely want you to know that.

Life isn't all happiness and triumph over evil though. I think we can all agree that there are some truly awful people in society. Take pedophiles for instance. The crimes they perpetrate against our children are among the most horrific things one person can do to another. Pedophiles should be severely punished, not only for the acute physical trauma they inflict on our most vulnerable, but for the lifetime of emotional scars they leave behind. I am no friend of the pedophile.

And I am in no way speaking for my employer. If you want to know what my employer thinks of pedophilia, you'll have to ask them directly. I'd recommend talking to someone in the legal department.

I also recommend you always wash your hands after defecating. But that's just me talking.

Thursday, May 19, 2011

A Heartwarming Story Of Johnson And Johnson And Their Commitment To Their Credo.

It's a thing of beauty, that credo of Johnson and Johnson's. A shining example of how those in business can strive to make it in the competitive world of commerce while benefiting the world as a whole. The perfect illustration of why capitalism is the system that will lead us to the heights of human potential. You can almost cry reading over the Johnson and Johnson corporate credo.

You can also cry reading this press release from Doctors without Borders, but for a different reason:

Pharmaceutical giant Johnson & Johnson is putting the lives of people living with HIV at stake by refusing to participate in the Medicines Patent Pool, a mechanism designed to lower prices of HIV medicines and increase access to them for people in the developing world, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today.

Wait, I'm sorry. I started off here talking about how great the J&J credo was without giving any examples. Here's how the credo starts off:

We believe our first responsibility is to the doctors, nurses and patients, to mothers and fathers and all others who use our products and services.

Well, I guess if you keep the price at a point where people can't afford your products, then technically they are not users, and you don't owe them anything according to the credo.

Still, there's a lot of good stuff in that credo. Now back to Doctors Without Borders:

Johnson & Johnson, which holds patents on three key new HIV drugs desperately needed throughout the developing world, has so far refused to license these patents to the Medicines Patent Pool. The Pool has been set up to increase access to more affordable versions of HIV drugs 
Johnson & Johnson holds patents on HIV medicines rilpivirine, darunavir, and etravirine...Even at Johnson & Johnson’s so-called reduced “access” pricing, the cost of these drugs is prohibitive; darunavir is priced at $1,095 per patient per year, and etravirine at $913 per patient per year in the world’s least-developed countries, most of which are in sub-Saharan Africa. Many developing countries have to pay even higher prices.

I'll remind you here that 2,700,000,000 people on this planet currently live on less than $730 a year. I'll also remind you of another part of J&J's credo:

We must constantly strive to reduce our costs in order to maintain reasonable prices.

Could that be the scent of bullshit in the air? To Doctors Without Borders:

In December 2010, the National Institutes of Health, which holds the intellectual property rights for a manufacturing process for darunavir, put its patent for the AIDS drug in the patent pool. Johnson & Johnson holds the drug’s remaining patents, and is effectively blocking other companies from manufacturing and making darunavir available at prices affordable for patients in the developing world.

To the credo:

We are responsible to the communities in which we live and work and to the world community as well. We must be good citizens – support good works and charities and bear our fair share of taxes.

Yeah, definite bullshit.

Not all is lost though. It is thought that J&J's refusal to license it's products may drive a desperate black market in which amateur chemists and people who don't really know drug manufacturing from a hole in the ground would attempt to make versions of needed AIDS meds in basements, garages, under bridges and in kitchens.

Experts estimate the result would be a dramatic increase in the quality of medicines that reach the patient.

"Indeed, we have already seen a large quantity of unregulated darunavir making its way through the public health clinics of Johannesburg" said fictitious AIDS expert Joseph Kabinga. "None of which has been contaminated with mold, tiny shards of glass, bacteria, or manufactured in such a way that required its removal after installation. Which, of course, is more than you can say about Motrin, Tylenol, Benadryl, Zyrtec, Rolaids, Sudafed, St Joseph's aspirin, OB tampons, Pepcid, Topamax, Invega and the DePuy replacement hip."

"It is our hope that if we can persuade Johnson and Johnson to stop donating these products to us and simply allow untrained random people picked from the street to make them, the resulting improved product reliability would have an immediate and dramatic impact on the health of our people."

And it is my hope... that someone at Johnson and Johnson may actually read that credo of theirs one day, and perhaps even understand it. That maybe someday they will realize that selling something for a dollar is still better than not selling it at all and watching a person die. That idleness in the face of a preventable, demographic-changing epidemic puts an awful lot of blood on their hands. I wonder how the executives of Johnson and Johnson sleep at night. If maybe they don't stroll down the aisle of a 24 hour drugstore at three in the morning looking for a package of Simply Sleep™, only to find a hole in the shelf where their recalled product once was. I wonder if they then buy an alternative made by a company that actually believes that in meeting customer needs everything they do must be of high quality.

I'd like to think so, but part of me thinks they just don't care. And that they sleep like babies.

Wednesday, May 11, 2011

An Exclusive, Imaginary, Interview With KV Pharmaceutical CEO Greg Divis.

Drugmonkey- Thanks for taking the time to talk with me Mr. Divis.

Divis- Thank you for the opportunity Drugmonkey, I'm really excited to share some wonderful news. We've cut the price of our blockbuster FDA approved product, Makena, by over 50%!! I know how passionately you believe in affordable, accessible health care for all Americans, so I'm sure we can both agree this is incredibly exciting!!

DM- Well, first let's back up a little bit for those people who may not be familiar with Makena and what it does. Maybe you could tell us a little bit about it.

Divis: Absolutely! Makena is our brand name for the drug 17-hydroxyprogesterone, and it's the only product approved by the FDA to reduce the risk of premature birth, a devastating event that happens to one in eight babies born in this country. Drugmonkey, that is one in eight babies too many. While we're proud that our FDA approved product will reduce the risk by around 20 percent, we will not rest until each and every child in the United States enters this world healthy and with all the advantages modern medicine has to offer.

DM- I see. And this price cut of yours is part of your effort to help you get some rest at night?

Divis- Well, I'm not sure I'd put it that way, but a 50 percent price cut will make a big difference for everyone involved!!

DM- A price cut to around $700 a week.

Divis- Yes.

DM- Meaning at one time you were charging over $1400.

Divis- A small price to pay for a healthy child I'm sure we can both agree.

DM- Do you think I'm stupid?

Divis- Excuse me?

DM- I said do you think I'm stupid? Do you think that I don't know that pharmacists have been compounding  17-hydroxyprogesterone themselves for years and selling it for around $20 a week? And let me tell you something about compounding pharmacies. They are not known as outposts for value. If they're charging $20, I can assure you the cost of this stuff is a tiny fraction of that. Where the fuck do you get off charging $700?

Divis- Ours is FDA approved!!

DM- Meaning?

Divis- Meaning Makena is manufactured in an FDA-regulated and FDA-compliant, sterile facility.

DM- You mean ones like a company such as Johnson and Johnson would use to make their medicines?

Divis- Yes.....wait... no!!

DM- Isn't it true you're just taking advantage of expectant mothers who aren't savvy enough to realize the only difference between your product and what a compounding pharmacy would dispense are the papers you pushed around to get some bureaucrat's seal of approval?

Divis- We feel that in the current political climate, people really want to depend on Big Government. That people are craving to be told exactly what to do by far away impersonal power.

DM- Good luck with that.

Divis- Say, are you writing this as a representative of the large corpro-pharmacy that employs you?

DM- I'm actually glad you asked that sir. You see, I've always operated under the assumption that you would have to be a fucking idiot not to realize that everything I write using my personal social media accounts represents only my own personal views. But evidently, my last, small shred of faith in the intelligence of the human race is not one that's shared by some large pharmacy corporations.

Divis- If it's one thing those of us in the business world know Drugmonkey, it's that there is no shortage of fucking idiots on this planet. They are a powerful force, and while that power most often leads to awesome destruction or at least incredible frustration, properly harnessed, it can bring you riches beyond your wildest dreams.

DM- And that, sir, is finally something we can both agree on.

Disclaimer- While the story of Makena is true, this interview took place only in my imagination.


Also, thank you to the alert reader who tipped me off to this story. A long time ago. If I had a paid staff i could get these things out quicker, and if you'd buy my book that would put me a step closer to having a paid staff. Just sayin' 

Sunday, May 08, 2011

The Irresistible Force And Immovable Object Are Both Defeated. By Me.

It's hard to tell what started it on the right side. Some sort of irritation perhaps, a gas bubble, a cold draft, a need for a nap or some food in the stomach. No one but a mother can really know these things.

On the left it was crystal clear what the beginnings were. It was important to know what kind of potato chips to get for dinner.

A baby screaming out to the world versus someone doing their screaming into a cellphone. Two of the biggest pain in the asses in the universe were squaring off right in front of me this pill counting day. Head to head. Mano y mano. Just like Godzilla versus King Kong in one of those late night horror flicks.

Except, isn't one of the monsters in those flicks usually a force for good?

To my right a baby's world was collapsing. It's face turned crimson as it struggled to let the world know of the horror it was facing. A soiled diaper I theorized. If I was sitting in a pile of my own shit I might be tempted to scream like that too.

To my left I heard "I DON'T THINK THE PRINGLES ARE ON SALE!!"

I now received a warning that my customer waiting for his Bactrim prescription has been taking warfarin from another doctor. I cranked up the phone while able to hear every detail of the numbnut to my left's potato chip decision making process. Knowing that sound travels equally well regardless of direction, I felt good about my employer's HIPAA compliance procedures.

Things were getting no better in the baby's world.

While waiting to be put through to the on call physician, I realized the baby's mother was not waiting for medicine. She had no prescription and was not looking for an over the counter remedy. She appeared unfazed as her offspring assaulted the ears of all around. She pretended to be shopping for 7-UP but I knew her real purpose. She was an agent of the grim reaper sent to claim the life of the oldster in my waiting room. Obviously, a drug interaction was how it was supposed to go down. Satan himself was probably appearing before the wee one, terrifying him with visions from the depths of hell in order to distract the pharmacist from the risk of major bleeding.

The cellphone talker was not part of any Satanic plan. He was just an ass, but I'm sure Satan welcomed the additional backup.

The on call doctor was reached and was clueless. He sheepishly took my suggestion of cephalexin and I only had to ask him to repeat himself twice. Cellphone man wanted to know if he should grab some milk while he was in the store. I wondered how people in the 70's ever managed to put dinner on the table. Maybe that's why they were less obese back then. They never knew if they needed milk or should buy the potato chips that were on sale.

Satan sent one last wave of panic through the infant, probably hoping he could get me to grab the wrong bottle from the shelf. It was decided that milk was needed and the old man's name was called.

He was disappointed it only took 13 minutes. He was hoping for a gift card.

Wednesday, May 04, 2011

Highlights From Friday's Pill Counting Action.

The day began with a phone call. I heard the ringing as I approached the drugstore gate, fumbled with my keys, logged into the various types of electronic equipment throughout the happy pill garden and put on the cheesecloth lab coat provided by my employer, through it all the ringing continued. It must be very important.

"Thank you for calling corpro-pharmacy, this is Drugmonkey, may I help you?"

"IS THIS ROBERT?"

I had told the nice lady my name as part of my phone answering and it was not Robert.

"No ma'am. This is Drugmonkey"

"ROBERT????"

I've worked at my current gig for almost 5 years now, and no one named Robert has been employed here during any of that time. The man I replaced had been here two decades, and his name was not Robert either. I knew what I had to do.

"Robert's not here today ma'am"

"PAUL????????"

I have no idea who Robert or Paul might be, but told the nice lady we did stock eyeglass repair kits. As I hung up the phone the Assistant Manager walked by.  "I just want to set someone on fire" he muttered as he went off to the storeroom. I've learned not to ask.

You know how infants have that specific type of new baby smell? You know you do. There is nothing that quite smells like a baby, except for this old man who came to the counter about an hour into my shift. What the hell could an 80 year old man be doing that would make him smell like some sort of combination of diapers, baby powder, spit up and formula? I know the obvious answer is that he was incontinent and wearing his own giant baby diaper or something, but other old men who pee their pants don't smell like this. I went out and bought a soda after he left just so I could tail him and smell baby man again to make sure my nose wasn't messing with me. The baby smell mystery may occupy me for the rest of my life, or at least the next week or two.

The morning also brought a prescription for Zocor to be taken as needed and hard evidence that not every doctor has received the Darvocet memo yet. Also a message from an insurance company that read as follows in its entirety: "INTERACTING MEDICATION: 50111043401" Some computer programmer out there probably really thinks he's saving lives.

A customer came to the counter to tell me he had trouble sleeping, and I suggested he might try the original formula of Unisom, which works a little better than the various diphenhydramine preparations in the sleepy section. "I don't want a sleep aid!!" he snapped, so I softly sang him a lullaby as I waited for the next man to come to the counter.

He had his cellphone with him, and on it was a picture of a prescription. It was for Vicodin and the guy seriously thought I would just give him some based on the picture on his phone. I know it's traditional to say you should give them an A for effort, but this one merited a C-plus, max.

During lunch I noticed the ladies at the nail salon wore lab coats of higher quality than I did and was halfway through my sub when I noticed that the man repeatedly saying "How you doing Bob?" was talking to me. He told me the Benadryl I had no recollection of recommending to him had really done the job. I wondered if maybe Bob was the name of some sort of non-evil pharmacy twin. I kinda hope so. I always wanted the role of evil twin.

A lady was waiting for me when I came back so she could ask me the following question, again verbatim: "This is a nose spray? So I should just spray it in my nose?" I wondered what she would have done without me as I fielded the next question from another man, "She's got plenty of Aleve, right?" He was looking right at me. I was expected to provide an answer as to the quantity of Aleve necessary for a woman I had never to my knowledge met. "Can you ever really have too much?" I said, and the man bought a bottle. Just a damn shame I don't work on commission.

I had pretended for a few seconds that the hot chick who was making a beeline for the pharmacy a few minutes ago was coming for me. I now heard her scream into her cellphone "Fine, no condoms!!!" and storm off. It really is best not to always get what you wish for.

After sundown two drunks got into an argument. "Get away from me!! the lady said "I just want to be left alone!!" Whereupon her....partner?....boyfriend?.....brother?.....sheltermate? staggered to the counter to let me know "She's disabled"

"I HAVE FIBROMYALGIA!!! She yelled, and I believed her. No one is as eager to let you know about their condition as the fibromyalgics.

I looked to the other side of me and saw someone asleep in the blood pressure machine. The phone rang and someone wanted to know if they could lower their cholesterol by eating shrimp. I was doing my best to explain that the opposite would be more likely to happen when I heard the happy couple going at it again in the waiting area.

"DON'T POINT THAT AT ME!!!" The fibromyalgic drunk lady yelled. Her partner was holding a walking stick from a nearby display and saying "bam! bam! bam!" Blood pressure man slept through it all.

And somehow I got through it all. Every prescription got out the door and every person was told that nose spray does indeed go up the nose. I closed the gate and wondered about baby man and Robert to the point where it threatened to keep me up that night. I sang myself a soft lullaby and started to let go of the day. To take solace once again in slumber, a place where no one will ask me where the bathroom is.

The lullaby. It works better than Unisom.

Tuesday, May 03, 2011

If I Were Emperor Of The World, This Is What Would Happen, Which Is One Of The Reasons I'll Never Be Emperor Of The World.

Let me be clear. I will shed no tears for Osama Bin Laden. If there is a God or Buddha or Zeus or any kind of supernatural karmic force in the universe, Osama Bin Laden is rotting in hell where he belongs. He met a violent end and was shown no mercy, which is as it should be.

But to my friends in Afghanistan I would say I'm sorry. I'm sorry we put you through this while we were chasing after this guy. Ten thousand of you who didn't ask for any of this are now dead, three times as many people than were killed on 9/11. Many times more have been maimed, shattered, scarred and devastated. And every person directly affected had a mother, a father, a wife or daughter or son. A best friend or lover. That's a lot of bad karma in motion.

This is my promise to you though. The bad karma is broken tonight. Osama Bin Laden was blowback from our policy of arming the Taliban in order to gain an advantage in the global chess game we were playing with the Soviet Union, and there will be no more blowback. From this day forward your affairs are yours, and the only business we will mind will be our own. If you would like a friend to help you progress towards a modern, sophisticated society and all the advantages in daily life it provides, we will be happy to be one. If you prefer to have no further dealings with us, your decision will be respected. No longer will we intervene to pick winners or losers among the people who seek to govern you or anyone else in the world. From this day on you are truly independent, which means you are free to make bad decisions. May you choose wisely.

Because there could be no better memorial to the people who died on 9/11 than a world in which the next Osama Bin laden finds it impossible to get any recruits. From this day forward that is the world we are working towards.

And to my friends in Iraq, I'll say this. That last guy was an idiot. Seriously stupid. You kinda have to live here to understand what happened and even then it's a little hard to comprehend. Hopefully we have learned what happens when one so dumb is given so much power. We're very, very, sorry. If there is a God or Buddha or Zeus or any kind of supernatural karmic force in the universe, one day George Bush will be sharing a room in hell with Osama Bin Laden.

Peace be with you.