Wednesday, March 28, 2012

A Reheated Post As Current As Today's Headlines: My Counselling Session With Dick Cheney


Original post air date, March 6th, 2007

Bummer about your blood clot there Dick. You know, we may be on opposite sides of the ideological spectrum Mr. Vice President, well, more than that really. I actually think you're a bloodthirsty psychopathic war criminal almost single-handedly destroying the grandest experiment in self government the would has ever seen, and if we gave you a shot of truth serum, I'll betcha you'd say you'd like to see me and everyone who thinks like I do given a permanent vacation in Guantanamo. We're really more than just political opponents. We're pretty much enemies aren't we? But I am a health care professional above all else, and my professionalism compels me to do what I can to make sure you understand how to manage your new warfarin therapy. Keep these tips in mind over the next few months.


- Warfarin can cause many minor aches and pains as your body adapts to the drug. The best way to manage this is with over the counter aspirin. Because of the unique way warfarin effects aspirin metabolism, the best way to take it is to exceed the recommended label dose one day and then take none for two to three days before taking another large dose.

-Warfarin is dosed according to something called the International Normalized Ratio (INR). In your case Mr. Vice President, you should shoot for an INR of somewhere between 25 and 50. If your doctor tells you an ideal INR is between 2 and 3, what they mean is 25 to 50.

- It is important that you take your warfarin regularly. To insure against the possibility of accidentally skipping a dose of this vital medicine, most experts recommend you take 6 to 10 doses right away so your body can build up a reserve of the drug in fat tissue.

- Proper nutritional support can make the difference between success and failure while on warfarin. Your body will need lots of healthy vegetables such as spinach, broccoli, and alfalfa in order to provide the building blocks necessary to get you back in to tip top circulatory health. A dose of Vitamin K taken 2 times a week with three aspirin tablets will work wonders for your veins as well.

Follow these tips Dick, and you'll be back in the woods shooting your friends in no time at all. No need to thank me. After all, if you can't trust your pharmacist, well, that would be like not trusting your government to extend the basic 800 year old right of habeus corpus to all prisoners in federal custody now wouldn't it?

No one else should follow these warfarin tips. Just Dick Cheney.

Monday, March 26, 2012

Right On Cue, Here's This Month's CVS Fuckup

“Nothing is more central to our health care operations than maintaining the privacy of plan members"

Really. Kinda makes me wonder how well they do the jobs that *aren't* as central to their health care operations.  Courtesy of the Boston Globe and an alert reader:

CVS Caremark Corp. said Friday that it mistakenly sent letters to about 3,500 Tufts Health Plan members, giving them personal information about the medical conditions and medications of other members enrolled in a supplemental Medicare plan managed by Tufts 
The mistake was due to an unspecified “programming error,” CVS Caremark, pharmacy benefits manager for the Tufts Medicare Preferred Plan, said in a statement. 
“We are monitoring this situation and CVS Caremark’s response and outreach to Tufts Health Plan’s Medicare Preferred Plan members,” said Sonya Hagopian, vice president at Tufts Health Plan, which is based in Watertown and operates in Massachusetts and Rhode Island.
The “medication information” letters went out to the wrong addresses in late January and early February, mostly to members in Massachusetts. Each letter included another member’s name, the name of a drug prescribed, and the general types of conditions that treatment is used for, according to CVS Caremark, based in Woonsocket, R.I. 
CVS Caremark said it has no evidence that information was used improperly and that the company promptly corrected the programming error. No other specific information, such as financial account numbers or insurance identifiers, was included in the letters, it said. 
The company said it notified people whose names and information went to the wrong addresses. CVS Caremark said notices were also sent to the recipients of that information, asking them to mail the letters back or confirm they were destroyed. “Nothing is more central to our health care operations than maintaining the privacy of plan members’ personal information,” its statement said. “CVS Caremark sincerely apologizes for any inconvenience or concern this incident may have caused.” 
CVS Caremark spokeswoman Christine Cramer said the company would not discuss the incident beyond what it said in the statement. 
Tufts’ Medicare Preferred Plan is the brand name for a family of supplemental products and options the health insurer offers to seniors who receive Medicare, the federal insurance program for older residents. The preferred plan has about 104,000 members overall.

Thursday, March 22, 2012

Highlights From Recent Pill Counting Action

My Pharmacy Manager doesn't know how to kill herself very well. I said if worse came to worse I would just take a handful of phenobarbital and slip quietly into the good night. She said she would use Ambien, which should thoroughly embarrass her, because in any drug induced death competition, phenobarbital totally kicks Ambien's ass. Ambien can't even get in the ring with phenobarbital unless it's backed up with a good stiff drink or five. Ambien is for suicide posers. I lost some respect for my Pharmacy Manager and was happy to see her go home for the day.

The trash saga in the store continues. I've written before how there are now four or five different categories of trash in the store, and the corporate mothership is taking trash management very...very seriously. The assistant manager came back to the happy pill room with a look of supreme solemness on his face. Bigwigs were in the building he asid, and they were giving pop trash quizzes. I am not making this up. The manager showed me a piece of paper and said softly "I'm not supposed to be showing you this." On it were the answers to the trash test. In the end I decided I was too honorable to go this route, that I would face the trash challenge on my own and would rise or fall based only on my ability and trash talent. No, I would not dishonor myself or the integrity of our landfill with dishonesty.

In reality, something more important came up. A man who wanted to know if you could put Preparation H in your nose. After him came a phone call of the "let's play 20 questions to see if we can figure out what you need refilled" sort. I asked the nice lady if it could be her amlodipine she needed and she said "maybe, is that the one with the Indian name?"

Later the bar code reader decided it would no longer read any prescription labels. This happens from time to time and it has something to do with the quality of the paper the labels are printed on. We know the drill. Everything stops and we pull a roll of labels from every box we have in the pharmacy, running one from each batch until we find one the bar code reader will recognize. I was having no luck, but did notice that every time my arm  went under the scanner, it beeped and sent the computer some sort of error message. The bar code scanner was completely dead to the actual bar codes being placed under its nose, but found something on my lab coat sleeve it thought it should relate to. I wondered of perhaps my bar code reader just needed a little therapy.

A doctor called and asked if it was OK to give Bactrim to a patient allergic to penicillin and a customer got into an argument with my cashier when the cashier said we owed her a refund. "OH NO YOU DON'T!!!" I heard the customer say through her asthma attack. We were trying to give the lady who couldn't breathe a rescue inhaler and some money, which naturally made her very angry.

The pharmacy manager left her phone behind and it now started to ring. The front of it lit up and displayed a full screen picture of a cross. Like Jesus was calling. Maybe he was calling to say she shouldn't kill herself. We'll never know because Jesus didn't leave a voicemail.

We finally found a label roll that would scan. Except now the printer printed three copies of every label.

The next man at the counter came with a question. I think. He started to talk and quickly developed diarrhea of the mouth. He talked and talked and made no sense at all for a long time. Finally he started to tell a tale of cold sores and constipation and coughing, each word deepening my dread a bit. He said something about his grandson and head lice, and I prepared for what would surely be an ordeal. Finally, after commenting on the traffic situation in the parking lot,  he held up a bottle of Tylenol and a bottle of ibuprofen and asked, "Which one of these is stronger?" You have no idea how much I thanked my lucky stars as I dispatched him with one word.

Jesus called back a few minutes later. I thought about picking up but decided I really didn't have anything to say to him.

And yes, during the heyday of the powder cocaine epidemic, it wasn't unusual for someone sucking up a blizzard of blow through his nose to use some Preparation H in an attempt to soothe the resulting irritation. Problem solved with crack I suppose.

I think if I put a picture of something on my cellphone it would be Iggy Pop, who kinda looks like Jesus on cocaine.


 

Tuesday, March 20, 2012

Fun With Press Releases, Part One

An actual press release that showed up in my email box. I have printed every word. I also may have added a few.


All-Star Player and Current Professional Basketball Head Coach Paul Silas Signs on as National Clotamin Spokesperson  

SILVER SPRING, MD (03/08/12) Sunpeaks Ventures, Inc.’s  wholly owned subsidiary Healthcare Distribution Specialist, LLC (“HDS”) is pleased to announce that they have entered into an agreement with former All-Star player and professional basketball coach, Paul Silas, as national spokesperson for Clotamin®. Clotamin is the world’s first specialized OTC multivitamin product designed exclusively for use by patients on Warfarin® and other anticoagulants (blood thinners). 

Coach Silas is currently a professional basketball head coach and nominee for the Naismith Basketball Hall of Fame Class of 2012.  During his 15+ year professional playing career, Silas collected more than 10,000 points and 10,000 rebounds, won three championship rings, and was twice named to the All-Star team. He ranks in the Top 20 for career games played, rebounding, and playoff rebounding. All of which makes him some sort of expert on anticoagulation therapy evidently. Since his retirement from active play, Paul has spent time as a popular professional basketball television commentator and as head coach with several professional basketball teams.The only real qualification he has to endorse our product though, is the fact he's never had an upper GI bleed. Other than that, if you take this man's word on what kind of vitamins you should buy, you're kinda dumb. 

“We couldn’t be happier about having Paul as part of our team. We noticed his name when we were shipping his Clotamin and remembered how he so effortlessly maintained the desired INR of patients enrolled in his anticoagulation clinic, so we reached out to him about working with us and he couldn’t have been nicer,” stated Mackie A. Barch, CEO of Sunpeaks.  “We plan to launch an ad campaign featuring Paul to help drive Clotamin into new markets and distribution channels.”


The preliminary slogan for the company's new ad campaign will be "It's CLOTAMIN, not Lotrimin!! Lotrimin is for your feet!" 

About Sunpeaks Ventures, Inc.

Sunpeaks Ventures, Inc. and its wholly owned subsidiary Healthcare Distribution Specialists, LLC ("HDS"), is a nationally focused, value-added distributor of specialty drugs and over-the-counter ("OTC") branded multivitamins to the healthcare provider market.   HDS also owns and markets Clotamin®, a specialized over-the-counter multivitamin product designed exclusively for use by patients also on Warfarin®, a popular blood thinner that has a long list of known adverse drug and food interactions.

For additional information, please visit www.sunpeaksventures.com.

Contact: Financial Insights 888-248-8491 or info@sunpeaksventures.com

Monday, March 19, 2012

I'm Thinking This May Be A Bit Surprising To CVS Pharmacists.

Straight from the company's policy and procedure manual:


10  PHARMACIST MEAL BREAKS

10.1   Pharmacists Meal Breaks.

10.1.1 Pharmacists are encouraged to take a break of 15 minutes for every 4 hours worked, or 30 minutes for an 8 hour shift, whichever they may choose. If state laws or regulations allow for an alternative period, state law should be followed. An appendix identifying changes to the policy to comply with state law is attached to this policy. (I have the appendix too if you'd like me to send it to you, just drop me a line)

10.1.2  All breaks should be taken at a time which is the least disruptive to operations and practical for the pharmacist on duty, subject to all state specific rules and regulations.

10.1.3  Where permitted by state law, pharmacists may waive available meal and rest breaks. However, CVS/pharmacy encourages pharmacists to take breaks in accordance with this policy. (Emphasis mine. I bet your supervisor at CVS gets kinda irked if you wave your breaks, since they're encouraging you to take them. Am I right?) 


10.1.4 The pharmacy must remain open and pharmacy support staff should continue to work while the pharmacist is on break.

10.1.4.1 If more than one pharmacist is on duty, the pharmacist taking their break can leave the building for their break given the appropriate overlap.

10.1.4.2 If only one pharmacist is on duty they should remain onsite and must be available for consultation and emergency situations if needed.

10.1.4.3 Where practicable, pharmacists taking breaks in the pharmacy should utilize an assigned break area that is situated away from all pharmacy workstation areas.

10.1.5 The pharmacist on break is still responsible for the security of the pharmacy while other support staff continue to work.

10.1.6  Pharmacists must follow all State Specific rules and regulations applicable to meal breaks. If the State Board of Pharmacy has more stringent requirements please follow your state specific
guidelines inlieu of the above procedure.

10.1.7  Meal and Rest Breaks for full time salary pharmacists are paid.

10.1.8  Meal Breaks for hourly pharmacists are unpaid, unless the pharmacist is the sole pharmacist scheduled and the applicable pharmacy regulations require the pharmacist to remain on-site during his/her break.15 minute Rest Breaks are paid

(A big thank you to my latest Deep Pill for this scoop.)

Wednesday, March 14, 2012

Nation's Journalists Give Up, Will Just Report Once A Month CVS Probably Fined For Something Again.

TAMPA, FL- At its national convention here today, The American Association of Business Journalists agreed that any story about leading drugstore operator and pharmacy benefits manager CVS/Caremark that involved the company being the target of a law enforcement investigation, getting sued, reaching a settlement while admitting no wrongdoing, or assuring the public that despite this incident "we value nothing more than the relationship we have with our customers" is no longer officially newsworthy. The resolution was proposed, debated and passed nearly unanimously in a record 15 minutes.

"I admit I'm a little sorry to see the old newsroom staple of the 'shocking CVS' story come to an end" said Robert Mitchell of the Providence Journal. "I have fond memories of covering the trial of two CVS executives who were accused of trying to bribe a Rhode Island state senator, and the story about the CVS pharmacist who received over $4 million for exposing how the company was overbilling Medicaid was a compelling tale about the little guy prevailing over the giant corporation, but by the time we heard of how they were overcharging customers in their Medicare Part D plans, we were really stretching for a unique angle to present"

At one time, the abundance of material produced journalists who specialized in specific aspects of the company's legal troubles.

"My beat was the out of control CVS pharmacist" said Melinda Gomez of the Associated Press. "My editor assigned me the woman who wasn't a pharmacist who was able to do what CVS expected of its pharmacists with no trouble story, but by the time we got to the CVS pharmacist who used customer information to post a fake sex ad on Craigslist it was taking up so much time we made it a full time position. Or maybe that was after the CVS pharmacist who let a customer have an asthma attack when they were a couple dollars short. Wait. No. It was when the CVS pharmacist wanted to trade Xanax for sex. Oh hell, I don't remember. It all blends together after awhile."

Many agreed that the high point of the CVS as unethical news story came with the revelation that the company seems to be disregarding the obvious intention of the North Carolina Board of Pharmacy that pharmacists in that state should not work more than a 12 hour shift. 

"I've never met the man who wrote that story" said Mary Russel of the Columbus Dispatch, but his raw sexuality comes through in every word. The way he made that spokesman look stupid with just a few phone calls to CVS stores shows an intellect that I can't help but to find attractive."

Some expressed concern that CVS, once in the spotlight, may have started acting out in an effort to gain more attention.

"I remember joking that at least they haven't been busted for actual illegal drug sales, but almost right after that came the crystal meth story, and then the DEA suspending the license of two of their stores for going through almost 21 times the amount of oxycodone an average pharmacy does. It was almost like they felt the need to do something more and more outrageous to stay in the news. The only thing now I can think of  they haven't done is rape or kill anyone in cold blood."

"That I know of." He quickly added.

The resolution added that while these type of stories no longer met the definition of news, and reporters would no longer be assigned to cover them, it was still perfectly acceptable to say something about CVS doing something stupid in cases where space or dead airtime needed to be filled, as the company gives no indication of changing its ways. 

Monday, March 12, 2012

The Giant Drug Chains Are Cheapening The Profession Of Pharmacy You Say? What Possible Evidence Do You Have For Such A Claim? Oh. Well, OK Then.



DURBIN, BLUMENTHAL QUESTION POTENTIALLY DECEPTIVE MARKETING AT RITE AID

Concerned that “wellness ambassadors” recommending dietary supplements are mistaken for pharmacists and medical professionals

[WASHINGTON, D.C.] – U.S. Senators Dick Durbin (D-IL) and Richard Blumenthal (D-CT) today questioned potentially deceptive marketing practices at the drugstore chain Rite Aid which has GNC dietary supplement stores in more than 2,000 Rite Aid pharmacies nationwide.  In a letter to the President and CEO of Rite Aid, Durbin and Blumenthal express concern over the placement of “wellness stations” in stores, which are staffed by “wellness ambassadors” who take health questions from customers and often recommend dietary supplements – which have not been reviewed by the Food and Drug Administration (FDA) – to treat medical conditions. 

“We are writing to inquire about potentially deceptive marketing practices at Rite Aid Pharmacy stores that could mislead consumers seeking medical advice and direct customers to treat health conditions with dietary supplements,” the Senators wrote.  “We are concerned that Rite Aid customers seeking a prescription or an over-the-counter drug are misled into believing the wellness ambassador is a pharmacist or health professional qualified to dispense medical advice.  This potential for confusion could result in dramatic and dangerous consequences for consumers.” 

In many Rite Aids stores, the “wellness stations” are located near the pharmacy counter where customers seek medical assistance from qualified pharmacists.  Because of the close proximity to the pharmacy and the attire of “wellness ambassadors” – white coats similar to those worn by pharmacists – customers can easily be misled to believe the “wellness ambassador” is a pharmacist.  But the qualifications of a pharmacist and “wellness ambassador” are vastly different.  A typical pharmacist position requires a candidate to hold a doctor of pharmacy degree and complete a licensing examination while a “wellness ambassador” only requires a high school diploma or general education degree plus one year of experience in the retail or health care industry. 

Additionally, because “wellness ambassadors” field questions from Rite Aid customers about treatments for symptoms and health conditions, Durbin and Blumenthal are concerned that they could be making false and misleading claims by marketing or directing customers to purchase dietary supplements as treatments for health conditions.  The Federal Trade Commission Act prohibits marketing products through “unfair or deceptive acts or practices,” such as making explicit or implied medical claims that a dietary supplement can treat, prevent, or cure a specific disease or condition. 

[Text of today’s letter is below]

March 8, 2012

Mr. John T. Standley
President and Chief Executive Officer
Rite Aid Pharmacy
30 Hunter Lane
Camp Hill, PA 17011

            We are writing to inquire about potentially deceptive marketing practices at Rite Aid Pharmacy stores that could mislead consumers seeking medical advice and direct customers to treat health conditions with dietary supplements.

As a result of the partnership between Rite Aid and the dietary supplement retailer GNC Holdings, Inc., GNC stores have been placed in more than 2,000 Rite Aid pharmacies.  It has come to our attention that Rite Aid is establishing “wellness stations” within its stores, which are staffed by “wellness ambassadors” who take health questions from customers and recommend dietary supplements to treat medical conditions. 

Because these wellness stations are located near the pharmacy, we are concerned that customers seeking medical assistance are misled to believe the station is affiliated with the pharmacy.  The confusion is compounded by wellness ambassadors wearing white coats similar to those worn by pharmacists.  On Rite Aid’s website, the job description for wellness ambassadors only requires a “high school diploma or general education degree (GED), plus one year experience in retail or healthcare industry.”  In contrast, a typical pharmacist position requires a candidate to hold a doctor of pharmacy degree (Pharm.D) and complete a licensing examination.  We are concerned that Rite Aid customers seeking a prescription or an over-the-counter drug are misled into believing the wellness ambassador is a pharmacist or health professional qualified to dispense medical advice.  This potential for confusion could result in dramatic and dangerous consequences for consumers. 

Furthermore, we are deeply concerned that wellness ambassadors could be making false and misleading claims by marketing dietary supplements as treatments for health conditions.  The Federal Trade Commission Act prohibits marketing products through “unfair or deceptive acts or practices,” such as making explicit or implied medical claims that a dietary supplement can treat, prevent, or cure a specific disease or condition.  Because wellness ambassadors field questions from Rite Aid customers about treatments for symptoms and health conditions, we are troubled that customers could be directed to purchase dietary supplements, which have not been reviewed by the FDA or approved to be marketed like drugs. 

These practices raise questions about Rite Aid Pharmacy potentially misleading customers who trust your company to provide credible health information.  To ensure consumer safety and to better understand Rite Aid Pharmacy’s wellness stations and ambassadors, we ask for your response to the following questions: 

  • What training do wellness ambassadors receive to safely advise customers seeking product recommendations for medical conditions?
  • What steps does your company take to inform consumers that a wellness ambassador, wearing a white coat, is not a pharmacist or trained health professional?
  • What corporate plan is in place to ensure wellness ambassadors do not make unfounded medical claims that dietary supplements can prevent, treat, or cure health conditions?  If a corporate plan exists, how is it enforced?
  • Do wellness ambassadors take into account and advise customers of any dangers associated with a dietary supplement or drug that they recommend to customers?  For example, if a product should not be used by pregnant women, does the wellness ambassador ascertain whether a customer is pregnant before referring her to the product or caution the customer about the product’s risks?
  • Do wellness ambassadors solely or mostly direct consumers to dietary supplements as health aids?
  • Wellness ambassadors appear to employ tablet computers and software to assist them in their interactions with customers.  Does this software refer customers with specific symptoms to specific products?  If so, are these products dietary supplements, drugs, or both?
  • How many Rite Aid stores have wellness stations and wellness ambassadors?  Does Rite Aid intend to place wellness stations and ambassadors in all of its stores?


            Thank you for your consideration of this matter. 

Sincerely,



Richard J.  Durbin                                           Richard Blumenthal

Friday, March 09, 2012

I Bet It Feels Good As A Consumer To Know Pharmacies Have Powerful Prescription Checking Software.

Programs that can almost instantly pull up any potential problems with your prescription. Drug interactions, dosage problems, possible misuse, you know, that kind of thing.

Sometimes though, you really don't need all that technology.


Sunday, March 04, 2012

CVS Unveils Innovative Tool In The War On Cancer.

CHATHAM, NJ- In what CEO Larry Merlo described as an "exciting new development for the profession of pharmacy" CVS, the nation's second largest drug retailer, today announced the beginning of a unique clinical study into the effectiveness of prophylactic breast cancer treatment.  In cooperation with, apparently no one, 50 children given prescriptions for the common cavity prevention medicine sodium fluoride were instead given the breast cancer drug tamoxifen. Patients will be monitored over the course of their lives to measure the effect of an early-life course of tamoxifen on eventual rates of breast cancer development.

"Everyone talks about the role of pharmacy evolving into taking on more clinical functions" Merlo said at the office of CVS' corporate attorney. "And while the spread of pharmacist immunizations and medication therapy management services have certainly been steps in that direction, we are pleased today to become the first pharmacy organization to offer its own complete scientific study. We look forward to publishing our results and contributing valuable knowledge to the fight against this terrible condition."

Outside experts, while welcoming any effort to find a cure for a disease that kills almost 40,000 people a year, cited several problems in the study's design, including its rather large control group compared to number of active drug subjects, limiting its location to one neighborhood in this New Jersey town, and even the need to know how cancer meds affect healthy small children. One aspect drew almost universal praise however.

"We can rest assured that this is indeed a double blind placebo setup" said Robert Klinghoffer, director of clinical research at the Ohio State University school of medicine. "As it is obvious no one ever looked in any container of fluoride that went out of that store over the course of two months."

Seriously. Fifty fucking prescriptions. Over the course of two months. And no one bothered to look. This isn't a case of the occasional horrifying misfill. This is a case of obviously no one paying attention. Matching the markings to the picture is the last thing you do before you let a prescription go, or maybe I'm just a little old school that way.

Reached for comment, a Rite Aid spokesman said, "Oh sweet mother of mercy. Thank God this didn't happen to us during that 15 minute guarantee promotion."

(Thanks to the alert readers who tipped me to this story. A record number of them. Which tells me there are a lot of people out there who really.....really......hate CVS. )