'Tis The Season For Sticking It To Your Employer. Two Guys In The Trenches Simultaneously Inspire And Infuriate Me.

Tonight I feel I should turn in my MENSA card. I no longer deserve it.

We'll get back to that in a bit, but first a report on some chain drugstores who have been more naughty than nice when it comes to their dealings with taxpayer dollars. First we go to the smog-choked depths of Fresno. Home of the worst air quality you've never heard of, probably because to report it would mean admitting to having visited Fresno. While passing out the stacks of albuterol to the people of the San Joaquin valley though, it seems like Walgreen's was up to a bit of no good:

A federal judge in Fresno has reinstated a jury award of more than $1 million in punitive damages against Walgreens for firing a pharmacist who blew the whistle on alleged billing fraud...In August 2011, a jury awarded Fresno pharmacist Sami Mitri $88,000 in general damages and $1,155,000 in punitive damages. 

According to court documents, Mitri began working as a pharmacist for the company in 1996. He later was promoted to pharmacy manager in Walgreens’ Fresno district. The court documents say he first brought the billing fraud to the attention of Walgreens officials in the spring of 2009; Jones said Mitri learned of the illegal practice because he frequently filled in for Walgreens pharmacists throughout the Valley. 

After he was fired in January 2010, Mitri sued for wrongful termination under the whistle-blower statute that protects workers who report employer misconduct.
In a nine-day trial in August 2011, evidence revealed that more than 20 Walgreens stores from Atwater to Tulare and Coalinga to Porterville were found to have fraudulently billed the government involving Medicare and Medi-Cal patients, Jones said. 

For example, if a patient needed 30 pills, Walgreens would give them 10 and give them an IOU for the rest of the pills, Jones said. Walgreens would then bill the government for 30 pills, he said. 

This illegal practice also involved expensive and time-sensitive medication done by injections, he said.

This one baffles me. I did some time back in the day working for the pharmacy America trusts when they're too lazy to get out of their car, and it was very...very...clear how partial fills were to be handled. The company had just been busted for this exact thing not long before and had re-tooled its software to handle these "partial fills,"  billing only for the amount given to the customer at the time, and for the balance owed only when it was actually dispensed.

Furthermore, they were adamant to the point of crazyness that any new hires complete their computer-based training on this partial fill procedure RIGHT NOW!!!, and the documentation that they had done so was put in their permanent personnel records. So for them to get busted for the exact same thing, while firing the guy who brought it to their attention, seems incredible. I suspect the problem was an ignorant District Manager or two. Ignorant District Managers are about as rare as that smog over Fresnoville.

Anyway, whenever I hear a story like this my reaction is always the same. "Goddammit why couldn't that have been me." Cashing in while striking a blow against the corporate bastards that have ruined our profession, what a true win-win that would be. I had a set of standing orders for my keystone tech to periodically rake her memory for things the corporation could have done in the past, as well as keep her eyes out for anything in the present we might be able to cash in on. And until today, I figured we just weren't lucky enough to be in a location where any shenanigans were happening. If you're thinking the same way, prepare to read this one and weep:

Rite Aid Corp. recently agreed to pay $2.99 million to settle federal charges it used gift cards to entice Medicare and Medicaid beneficiaries to transfer their prescriptions to its pharmacies. 

According to the U.S. Department of Justice, from 2008 to 2010, Rite Aid “knowingly and improperly” influenced the decisions of Medicare and Medicaid beneficiaries to transfer their prescriptions by offering them gift cards.

Everyone who works in a chain pharmacy just gasped right now. I heard it. Every single one of you has gone through the gift card bullshit, and many of you noticed the fine print that says these cards were not to be given to Medicaid or Medicare beneficiaries. Those silly few who actually tried to enforce that restriction were universally....universally he said, meaning every time, by everyone, told to give them the cards anyway.

At least, I used to think those few attempted enforcers were silly wasters of time:

The case stemmed from allegations made by pharmacist Jack Chin. The Justice Department said that as a whistleblower, Chin is entitled to $508,300 of the funds recovered from Rite Aid.

GODDAMMIT!!!!!! GODMUTHERFUCKINGOFCHRISTDAMMITT!!!!! IT WAS IN FRONT OF MY FACE THE WHOLE TIME!!!!!! THE WHOLE GODDAMN TIME I WAS TOILING AWAY FOR THOSE ASSHOLES THE ABILITY TO KICK THEM IN THE NUTS WAS DANGLING RIGHT IN FRONT OF ME!!!!! EVERYONE KNEW ABOUT THE GIFT CARD SCAM!!!! EVERYONE!!!!!!!

Except......only one person was smart enough to do something about it. Sigh.

I'd like to blame my old keystone tech for the fact that 500 large isn't headed our way, I did issue those standing orders after all. but....no....the buck stops here. So instead of being able to hire a pharmacist to run my store so I can go into the mountains and hang out with the bears, I will be going in to my store tomorrow as usual.

Which still beats the shit out of working for them.

So the best I can do now my friends is to pass on a little advice.  The gift card thing will come around again, and when it does, there will be irate customers who don't understand why they can't have one. When that happens, it might not be a bad idea to ask your District Manager for guidance as to what to do. Ask him in writing. And keep his reply for future reference.

Because evidently getting busted for something, and putting procedures in place to keep from getting busted again, isn't always enough to overcome the power of ignorance when it rests with a District Manager type.

I know a good pharmacy lawyer. When the time comes drop me a line and I'll put you in touch.

Do You Know Why I Have Now Inherited The Title Of Best Pharmacy Columnist In The World Now That Jim Plagakis Is Gone? Because Neither One Of Us Ever Wrote A Paragraph Like This.

Look at it:

Clinical community pharmacist (CCP) has begun to appear recently in various venues. It was in the title of a continuing education (CE) session presented at the recent National Community Pharmacists Association convention. The CE session was presented by a panel of innovative community pharmacy practitioners who have been leaders in new direct patient care services.

I just want to point out a few things here:

1) That is the entire opening paragraph, complete and unchanged, of a column in the current issue of Pharmacy Times about, well...who the hell knows? Some character called Clinical Community Pharmacist evidently. Maybe some sort of superhero that can appear in multiple venues at once? If I want to learn about him I guess I'll have to take one of those CE lessons, because there sure isn't much who,what, when, where, or why in this sorry example of news reporting.

2) This was written by a college graduate. He claims to have a masters degree.

3) This illiterate still has a regular gig writing for a national pharmacy trade magazine and Jim Plagakis does not. Chew on that awhile.

4) This also presumably got past an editor at some point. If I ever sent her a turd like this my editor would probably fly out to California and make me eat a dictionary.

I have to go put some water in my eyeballs now, because that piece of work made them hurt and I'm afraid they are about to catch fire.

JP At Large Cut Loose. My Reflections On The First Great Pharmacy Writer.

There was a time when I hated Drug Topics, the pharmacy trade magazine pretty much everyone in the profession is familiar with. I mean seriously hated it. Every time it was delivered to my store it invariably ended up being leaved through, cussed at, and hurled towards the garbage. What burned my ass about the mag most during of the era of George Bush The Lesser was the incredible platform they had earned over the years, a magazine delivered to and read by almost every pharmacy employee in the country,  and how they were in the process of just blowing it. The magazine got smaller every year. It was printed less frequently. The writing....was bad. Really bad. Here's an actual example pulled from my little blog garden's archives. Keep in mind this was the lead paragraph of a news story:

Can metered-dose inhalers containing flunisolide, triamcinolone, metaproterenol, pirbuterol, albuterol and ipratropium in combination, cromolyn, and nedocromil be phased out because they harbor ozone-depleting substances? If there are alternate products that provide the same benefits as these drugs, they are nonessential and can be removed from the market by, say, Dec. 31, 2009, after a transition period. So proposed the FDA in the June 11 Federal Register. The agency said it would hold a public meeting to discuss this matter. For now, please send your comments to the FDA by Aug. 10.

Reading that hurts my eyes to this very day.

It wasn't only witnessing the self-destruction of what was once the main communication channel for pharmacy that stuck in my craw. It was knowing that I could improve it. If I could only get a shot at writing for those guys, I knew.... KNEW... I could be a part of its renaissance. But I also knew the chances of breaking into the world of actual paid print writing were long and hard. I had even sent Drug Topics a Viewpoint piece once and had heard nothing in reply. So I continued to seethe. Another dip into the archives:

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.

Jim had been writing a column for the magazine since I was a zit-faced frat boy who didn't know which end of a spatula to count with. He was the last echo of what they used to be. Kind of like Christiane Amanpour at CNN. And unbeknownst to me he had noticed this angry little monkey man and his blog. Drug Topics was looking for someone to write an op-ed for them, and Jim brought me to their attention. When they balked at the, how do we put it, periodic immaturity of what I was posting to the web, Jim assured them that I could write like a grownup when the situation called for it.

So one day I got an email from Jim Plagakis asking if I was interested in writing an article for the magazine. For those of you not in the profession I'll tell you this was the equivalent of Paul McCartney taking an interest in your garage band and asking if you'd be interested in signing to his record label. And so it began:

The idea came to me while I was waiting for my weekly Andy Rooney fix. I had long ago decided that I can't just tune into the last segment of 60 Minutes to catch the ruminations of the cranky old grandfather I never had. That would be cheating, like reading Drug Topics solely for "JP at Large."

That was the first paragraph of the first article I ever wrote for Drug Topics. I was so proud of myself for getting in that JP reference.

The rest my friends, is pharmacy wordsmithing history. I have proven both myself and Jim right. I got my shot, and I HAVE had a part in moving that magazine towards where it should be. Drug Topics is a  better read today than back when it was breaking the news that Tylenol is a popular brand of acetaminophen. And you know what? My awesome columns are part of the reason why.

This isn't a happy post though, because there is a sad ending to this for Jim. He has been let go from Drug Topics, and in a way that has left him hurt and feeling insulted. That breaks my heart, as he doesn't deserve to be made to feel that way. He carried that publication through the time it was...there is no other word, awful. And to not be given the chance to say goodbye to his many fans reminds me of how they cut off Frank Sinatra's speech when he was accepting a lifetime achievement Grammy.

Paul McCartney, Christiane Amanpour, Frank Sinatra. Have I made the way I feel about Jim clear?

It won't be the same next month when I'm struggling to find something to say before deadline the way I always do, and I can't imagine it ever will be. There'll be a tinge of sadness with every article zapped to the magazine from now on. A little emptiness you can't fill with words.

I wish it had ended better than this.

Sometimes, My Friends, The Jokes Just Write Themselves. That Won't Stop Me From Taking A Crack At It Though.

During the tour of CVS corporate headquarters, it was indeed obvious Foulkes takes her butts seriously.

"No one, and I mean no one, has assembled a bigger collection of assholes than we have right here in this building"  She gushed. "And not just in the drugstore industry. I'll go on the record right now in saying that I don't think there's a company in the history of commerce that has had more butt openings than you see in front of you right now"

UPDATE 1- So here's a real quote from the butt-stopping issue. (God why am I actually reading this magazine?)

After 22 years at CVS, and a multitude of different experiences throughout the organization, Foulkes has “gotten comfortable living in ambiguity,” she told DSN. “I’ve been thrust into situations where I just don’t know, and I have gotten comfortable not knowing."

I think what we just learned here is that the CVS President in charge of stores freely admits to, as many of her employees might put it, having her head up her ass.

Wow, I need to be breaking stories like this, These executives never seem to want to talk to me for some reason though.

Hey, Are You A Chain Pharmacist In/Around Boston? Wanna Talk To Someone About Your Working Conditions?

.....someone who can maybe do a little something about it? If so, drop me a line and I can put you in touch with someone.

Of Ham Sandwiches And Burning Walgreens

If there's nothing else I want you to know about what's going on in Ferguson this night, only one point I could get across to you before you drift over to the Fox News Fear and Loathing Manufacturing Company, it would be this:

That was no Grand Jury Darren Wilson faced. Not in any sense that the American legal system defines one. Not in any way you or I would ever face one if we were ever charged with a crime.

For one thing, you or I would never "face one." That's not how any Grand Jury except this one works.

Let me bring you up to speed with what a Grand Jury is, and let's see how long it is before you smell the bullshit in the case of Darren Wilson. By all means double check anything I am about to say while you're here on the information superhighway.

Grand Juries have their roots back in the days of jolly olde England, when they were instituted as a check on the power of the Crown. Anyone arrested had to be charged with a crime and the prosecuting attorney had to go before a group of citizens and explain that there was some evidence that the person might have actually committed a crime. This was to keep the King from being able to lock up whoever he wanted for however long he wanted for no reason.

Except...Darren Wilson was never arrested, was he? There's your first clue something smells a little rotten here. No need to check the power of the government to keep someone locked up if no charges have been brought.

Hang with me here, and I'll tell you how Grand Jurys work in the world of the unconnected and unimportant. It's something like this:

Prosecutor: Ladies and Gentlemen, now we have the case of Drugmonkey, charged with narcotics possession. When arrested, he was found to have a hundred OxyContin in his pocket. I'm sure you'll agree that's enough evidence to proceed with the charges.

Grand Jurors: Yup.

Prosecutor: NEXT!!!!

That's it. As soon as the prosecutor can give the slightest reason why Drugmonkey was arrested, we move on. This is NOT the place where Drugmonkey says "I own a drugstore you dipshit, and I was delivering a prescription to one of my customers. Here's all the paperwork, which I'm sure you will find in order"

That part happens at the TRIAL. Where the prosecutor lets loose with all the evidence he's got, and Drugmonkey and his lawyer get to tear it to shreds, perhaps by putting Drugmonkey on the stand. Drugmonkey DOES NOT GET TO TELL HIS SIDE OF THE STORY AT THE GRAND JURY HEARING.

There's a saying in the legal profession that a prosecutor can get a Grand Jury to indict a ham sandwich. Because all he's doing is giving a reason why the person was arrested and should be charged. The way it works in the real world, it's nothing but a formality. In all of 2010, out of 162,000 federal court cases, a Grand Jury refused to indict someone 11 times. You read that right. A whopping 0.007% of the time, a Grand Jury thought there wasn't enough evidence for the government to have its day in court.

Are you smelling the bullshit yet? Because Darren Wilson DID get to tell his side of the story, didn't he? Instead of a prosecutor saying, "ladies and gentlemen the accused shot the victim 12 times, and there are conflicting eyewitness accounts as to what happened, I'm sure you'll agree we should sort this out in court." What we got was a mini-version of a real trial, where only one side got to tell its story, uninterrupted, with not a Grand Jury, but a group of people acting as a regular criminal jury making a decision.

A mini-trial that could only end one way. because if the jury doesn't go along, then Darren Wilson gets another shot at full blown trial.

They say a prosecutor can get a Grand Jury to indict that ham sandwich because what they mean is a Grand Jury will do whatever a prosecutor wants it to do. Which is exactly what happened here. This wasn't a Grand Jury hearing in any sense that it is known to the law. This was nothing but an elaborate cover-my-ass legal ruse by the prosecutor who had no intention of ever bringing a case against Darren Wilson.

And that's why you have a lot of angry people running around the streets of Ferguson, Missouri this night, doing things like burning down the local Walgreens to give white people an education. Because if it weren't for the riots in Los Angeles back in 1992 most of you honkies would still be ignorant of the way cops can act when they think no one is watching them. A riot seems to be the only way people who have been shit on for hundreds of years, fighting inch by blood soaked inch towards the promises this country makes its citizens, have of educating you snoozing in complacency what it's like in the parts of the system you never see.

Yesterday's riot lesson was the reality of police brutality, tonight's is the function of a Grand Jury in a society that clams to have equal protection under the law.

Let's hope you learned something.

Dear Person At Rite Aid Corporate Headquarters Whose Job It Is To Scour The Internet Looking For What People Are Saying About Your Company.

Guess what? My numbers are in, and my Rx count is up 15% from October of last year.

You haven't put out your numbers yet, but I'm gonna go out on a limb and say you'll be patting yourself on the back pretty hard over a figure that's a lot lower.

So whatever you say about your results, that goes like double for me, huh?

And to think you once had this wizard of business, who I'll repeat, now regularly outperforms the vast majority of your managers, right in your ranks. Every bit of potential that is now flowering used to belong entirely to you.

I just wanted to make sure I put that somewhere where I knew you'd see it. You can go back to your part in ruining the profession now.

It's A War Of The Corporate Cocksuckers At Walgreens. Pull Up A Chair And Root For Lots Of Injuries.

Holy crap all hell is breaking loose at the Pharmacy America Trusts For Some Reason. Chaos in the corporate suites, anarchy in the executive ranks, a food fight in the corridors of power.

This afternoon though, I sat on hold with my local Walgreens for about 45 minutes with no human contact, which means it's pretty much business as usual at store level.

Alert readers of this blog may remember my poking fun at two Walgreens executives who were given the boot, along with a generous severance package, after apparently making a billion dollar profit projection error.

However it now seems that one of those executives, former Chief Financial Officer Wade Miquelon, takes exception to the term "error," when applied to him.

The lawsuit, filed on Oct. 16, was in response to allegedly false and defamatory statements about Miquelon, including that he was responsible for a $1.1 billion forecasting error. Miquelon says Walgreen CEO Gregory Wasson and Alliance Boots chairman Stefano Pessina made the statements during meetings with investors between Aug. 5 and Aug. 8. The Wall Street Journal... reported that Walgreen directors told the investors that they had no idea the forecasting change was coming.

   Walgreens CEO Gregory Wasson, addressing the media from a fort he made of apples. "Ain't no doctor gonna come within a mile of me."

Miquelon's probably gonna have to come up with some evidence that this billion dollar forecasting screwup wasn't all on him though. I don't envy him in that task. After all, he's going up against a very sophisticated titan of the business world, skilled in the ways of corporate culture and surely not likely to leave much help lying around for a lawyer trying to find proof that his client wasn't the only one involved.

 There are numerous other claims in the decidedly juicy lawsuit, such as that Wasson pressured Miquelon to forecast what the CFO thought was an entirely unreachable $6 earnings-per-share figure for fiscal year 2016. According to the court filing, on June 11 Wasson sent a text message to Miquelon that stated, “Let’s push for a 6 somehow.” Miquelon says he responded, “I don’t think there is any way we could ensure that,” to which he says Wasson replied, “No choice. Need a 6. We’ll find a way.”

D'OH! The dreaded Text message ploy! Whoever would have known such a thing would persist and have the ability to be recalled after it has been sent! Well played Mr. Miquelon, well played indeed. 

"I am sad. I wish I had more money. Also, that I had heard of Snapchat before right now."

One thing's for sure though, no matter where the facts take us, we can look forward to a thorough, fair hearing conducted on both sides by men of character and honor. 

 Miquelon’s lawsuit alleges that in a conference call on June 24, one activist hedge-fund investor told him that if he did not start “doing his job,” two other activist investors would “stop at nothing to get you out of the way, including getting personal dirt on you and embarrassing you publicly.

Wait. Forgot who I was talking about there for a second. Never mind. 

So, let's recap. Walgreens is off by a billion dollars or so on a recent profit projection, and promptly blames the Chief Financial Officer, who then leaves the company with a $4.7 million dollar check. Chief Financial Officer then says, "Oh no you don't! you were putting pressure on me to make that projection after I didn't want to, and now I'm going to sue you for a lot of money!" Which evidently $4.7 million doesn't qualify as. "See you in court bitch!"

And I didn't even get to the part where Miquelon claims he was promised the CEO job if he would just play ball. We could just be getting warmed up here my friends.

Reached for comment, a CVS spokesman issued a statement that read in part: BBBBBBWWWWWWAAAAAAAHHHHHHAAAAAAHHHHHAAAAAAHHHAAAA!!!!!!!!! THIS IS AWESOME!! Meanwhile, in Lima, Ohio, Walgreen's customer Larry Heisen said meekly, "I just wish they'd pick up the phone." 

I Stand This Night In Awe Of The Evil Brilliance of CVS. Or, Maybe Republicans Aren't Always Wrong About Everything.

"Drugmonkey there's some sort of typo in your headline" you're saying. "You've never once had anything good to say about CVS,  I know you make more than your share of slips on the keyboard, but this time is the whopper of them all. "

Except it wasn't a typo. Yes, I once made a joke about the company getting into a new scandal every month that turned out not to be a joke because they seriously do seem to get busted for something with every turn of the calendar page.

And yes, the second most visited page in the history of my little blog garden is that in which I gave space to a CVS employee who opens up on the company with both barrels. I've said it before and I'll say it again, I've never....seen anything....like the hatred CVS employees seem to have for their corporate master.

But I meant it when I just said I am in awe of them this night. They may have just made the move from evil to evil genius.

Let's back up a bit and remember the last time the company made national headlines, getting even the President of The United States to notice they were no longer going to sell tobacco in their stores. Speculation ran rampant as to the motivations of such a move, which was estimated to cost them $2 billion in annual sales. "Well, tobacco is a no growth category" the conventional wisdom went, "they evidently feel the good publicity will be worth whatever loss in revenue will occur, and it probably will help their Minute Care clinics pick up a contract or two. "

Oh how you underestimated these guys mainstream business pundits. It's more than just a contract or two at stake here.

For those of you playing along at home who don't follow the prescription processing industry, I'll mention here that CVS also owns Caremark, the second largest prescription benefit manager  in the country.

Now hold onto your seats, because here it comes, via The Wall Street Journal's Pharmalot blog: 

Caremark... will soon require some customers to make an extra co-payment, in some cases up to $15, on any prescription that is filled at a pharmacy selling cigarettes and other tobacco products

...and in one fell swoop my friends, CVS can potentially cripple it's two main rivals though the 1 in 4 Americans whose prescriptions are managed by Caremark. Absolutely fucking brilliant. "We'll be agnostic [about] where the consumer fills their prescription," said CVS CEO Tom Ryan when the merger with Caremark was under regulatory review. " Well, it looks like they just found religion.

And I'm just....not sure how I feel about this. Other than being awed by the evil brilliance of the plan. I mean, there's no way you can say this isn't using the power of oligopoly to deliver Walgreens and Rite Aid a kick to the nuts, but ...if I were in a position to do it, I'd be more than happy to crush either one of those company's testicles. And you know, tobacco in pharmacies IS stupid. It was a burr up my ass every day I worked for Rite Aid and had to stare at the cigarettes on the other side of the store while selling people asthma meds. I even once wrote my State Representative and Senator, who was on the health committee at the time, making a case for the California pharmacy board to deny a license to any location that sold tobacco. Never heard back from the Representative. Got a letter full of nothing from the Senator.

Yet here we have a brutal bastard vs bastard vs bastard free market business free for all accomplishing what impotent government officials gave nothing but lip service to. The other "Big Two" are gonna either give up tobacco or lose a shitload of prescriptions.

Which... is exactly what should happen. I guess the free market wins this round, said the pinko pharmacist who never did sell tobacco in his store.

The Return Of Rick Scott, Who May Finally Get The Karmic Payback He Deserves, For The Most Incredible Of Reasons.

The political junkies among you may already know which direction the wind is about to take this post, but stick around, I want to make sure you get the whole recap here, not that it will matter.

I've warned you, and those of you in Florida in particular, about Rick Scott more than once. Rick Scott is a crook. A thief whose company, a chain of for-profit hospitals by the name of Columbia/HCA, ripped off Medicare and Medicaid to the tune of over a billion dollars, and then had the chutzpah to enter the debate over President Obama's health care plan with privately financed commercials emphasizing that any solution had to be built on "accountability and personal responsibility"

I'm not making that up. By all means do a Google search and double check me.

I asked you to remember this the next time you start to judge the Medicaid momma who comes in your store looking for some free Tylenol for her feverish kid. To maybe keep some perspective when comparing her actions to the rich white crook. Instead, you made Rick Scott the governor of Florida, which I understand some may consider a fate worse than death. In Rick Scott's world though, it is considered a validation of his lifestyle.

He went on to refuse to take any of the free money the federal government was offering states to expand their Medicaid programs. Perhaps because he was no longer in a position to steal any of it.

But Rick Scott may be about to get his comeuppance. Not because of his unethical business practices mind you, nor for his rank hypocrisy. Rick Scott my friends, has finally done something far worse in this day and age.

He looked stupid on television.




According to saintpetersblog.com, Scott's hissy fit "cost him two or three critical points" in the opinion polls, flipping his slight lead into a slight deficit.

Christ on a cracker.

So here's our lesson for the day. I want you to imagine what would have happened if Rick Scott had a political instinct that was even slightly honed. If he had just acted like a grown up and ignored the fan, or even if he brushed off some charm skills and make a little joke about it. Holy cow depending on the quality of the quip he could have crushed his opponent right then and there. After stealing a billion dollars. And shouting for all that would hear, after stealing a billion dollars, about the need for "accountability" I want you to think about that for awhile and what it says about the viability of our democracy.

Because the answer my friend, with apologies to Bob Dylan, is quite literally, blowin' in the wind.

Back When It Wasn't So Busy, Ebola Made A Guest Appearance In This Very Blog.

Original blogpost airdate January 31,2008

President Wankerhead Will Release A Budget Proposal For The Federal Government Monday, Prompting Joy For Reasons Other Than He'll Never Do It Again.


From this morning's New York Times:

In his new budget to be unveiled Monday, President Bush will call for large cuts in the growth of Medicare, far exceeding what he proposed last year, and he will again seek major savings in Medicaid, according to administration officials and budget documents.

Reached for comment in the lung of an elderly woman at Grady Memorial Hospital in Atlanta, Mycobacterium tuberculosis said "While on the surface the cut in health care funding for America's elderly and poor would seem to be a good thing, we have to remember that the conditions setting the stage for my comeback are not all financial. It is my sincere hope that the money my prey spends for health care will not only not cover the cost of inflation, but that Americans will never realize that they could actually spend less and be more effective in their genocidal campaign against my species by simply copying the health care system of Canada."

"Overall, I'd say the president's budget makes me cautiously optimistic" concluded the bacterium.

At its headquarters in Kinshasa, Democratic Republic of Congo, the Ebola virus issued an emotional, short statement:

"HUMANS DIE!!!!! said the virus through an interpreter. "ME FIND YOU! YOU MAKE JOB EASIER!!!!!"

Sources said Ebola was especially excited about the president's proposal to to reduce special Medicare payments to teaching hospitals by $23 billion dollars*

"THEY KNOW NOTHING OF ME NOW" said Ebola. "THEY NO WANT TO LEARN? ME KILL THEM!!!!!!"

Meanwhile, a spokesman for bird flu promised that if Bush's funding proposals were accepted by Congress, it would limit its effects only to those without good health insurance once it developed a way to cross the species barrier.

"We have our best viruses working on how to infect humans more effectively" said the spokesman. "But we are willing to spare the rich among you if you only give us a chance to taste sweet, sweet, human blood"

"You can trust the word of a bird flu virus" he concluded. What's in your wallet?

*You know the quotes are made up. The special cut in funding for teaching hospitals, however, is real.

Jazzfests And Milestones.

I heard the note and held on to it as long as I could. Held on until the last one of the night was played I did, the gloom slowly settling inside my mind as it came just as assuredly as the fog was settling in outside on the bay. One last trumpet blast and the Monterey Jazzfest was over for another year. Maybe my last year.

Unemployment is like slowly spiraling down a drain. You wake up the next day and almost nothing has changed, you've probably slept in a little and actually feel a little better than when the alarm clock ruled your life the day before. You work on your resume' a little and fantasize about landing that position that has none of the problems of your now ex-job.

The day after that you wake up and realize you're getting low on coffee and empty on cash. The drain on your resources begins. You make the first withdrawal from the ATM that has no assurance of ever being replaced.

The trappings of affluence slowly start to fall away. The day before Jazzfest I had used the last of my Laphroaig and begun my unemployment gin in the plastic bottle. As much as CVS wants the world to think of them as some sort of health center now that they stopped the tobacco it remains a wonderful place to find cheap ways to rot your liver.

Jazzfest tickets are a crown jewel perk of the affluent. Being used that night two years ago in a different world from when they were purchased. There had been no bites on the resume'

And I wasn't kidding myself that there ever would be. I had just spent the last seven years flipping the middle finger to the decision makers in my industry and there wasn't any assurance I wasn't in a long, slow drain spiral, spinning off the comforts of the comfortable until I slid into homelessness with nothing but a pair of once-fashionable eyeglasses.

That was probably an exaggeration I kept telling myself. But make no mistake, life is different when the soul-crushing large checks those pharmacy chains can write you stop coming in.

At least I had an uncrushed soul now.

I couldn't hold on to that last trumpet note forever so I picked up the bag with the vinyl copy of Miles Davis' Bitches Brew that I probably shouldn't have bought and started walking and when the lady at the gate said "see you next year" I almost cried.

And I kept walking home and thinking and walking and falling and spinning a little closer to that drain. The money isn't the worst part of being unemployed. It's that persistent feeling of uselessness. When you wake up and make that coffee run you are surrounded from the moment you leave your condo with people with a purpose. The gardener. The plumber that just drove by. The people riding the bus to work. They all have a function this day, a role to play in this world that is humming along and you do not.  The most you can think of yourself is as some sort of spare part.

That's what it feels like from the moment you get out of bed. So the day after Jazzfest two years ago I didn't get out of bed.

But...that was two years ago. Tonight, I just got back, from this years Jazzfest. The Roots kicked ass and I'm getting married in April and I haven't been this happy in a long time.

And to the decision makers in my industry, or, should I say, my fellow decision makers now, this middle finger's for you. I haven't forgotten. Here's to a good many more years of it being right in front of your face.

I Am Nothing If Not A Man Of My Word.

I needed a favor and I mindlessly threw in a deal sweetener. It probably wasn't necessary. The Angry Pharmacist is actually much nicer than you would think, and he probably would have done it for me anyway. But I said it.

"If you do this for me I'll even write something Republican friendly on the blog"

Crap.

OK, let's see here.................

thinking.....................

Ummmmm....Oh. I think I have something. Here we go:

Neither Marco Rubio, or any other Republican, has ever cut off the head of anyone on a video broadcast on the internet throughout the world.

That I know of.

I think the fact that the bloodthirsty religious whack jobs of the GOP limit themselves to abortion clinic bombings, and the occasional doctor assassination, and that they choose not to film their acts for propaganda purposes, reflects somewhat positively on their character when compared to the bloodthirsty religious whack jobs of ISIS.

Glad I got that off my chest. I must be more careful with my promises in the future.

Area Blogger Traumatized By Threat From Anonymous Douche.

DRUGMONKEYLAND, CA-  In a development that might shake the pharmacy blogging world to its very core,  longtime publisher of the "Your Pharmacist May Hate You" blog Drugmonkey received an email today that may forever change his relationship with the completely never sarcastic blog he has been publishing since February, 2005 (Longer than The Angry Pharmacist, regardless of what he says on his Twitter feed) The potentially earth shattering message read, in whole:

Your writing style usually rides a fine line between informative and entertainment in the form of satire. Lately, your use of sarcasm has been taken to such heights that it feels like I'm reading The Onion. I don't like The Onion. 

I am a long time fan of your page and satisfied owner The Pharmacy Rip Off List, but if this is a sign of things to come then you may loose me as a an advid reader.

"It was like my world had ended" Drugmonkey said from his undisclosed location deep in The Sierra Nevada Mountains. "I mean, I realize I had taken the blog in a completely different direction with my post about Walgreens executives getting millions of dollars in severance pay after making a billion dollar error, but never in my wildest dreams did I realize an Onion rip-off article, which I had never, ever attempted before, might alienate one lone reader the way it seems to have done here."

"So after I read this I realized I had a choice. Have my writing style associated with an award winning, incredibly popular, wildly successful cutting edge comedy publication, or take a chance on "loosing" an "advid" reader.

(Look, I realize I may need a copy editor more than most people, but is anyone on the internet ever going to get this right ever again?   Loose is the opposite of tight for fuck's sake, and lose is the opposite of gain or win)

After a bout of weeping The Drugmonkey continued. "I was lost and unsure how to handle this. I prayed and cried. I went on a Native American visionquest journey and reached deep into my soul, and finally, I think I may have the answer."

"I will offer a full refund to this unsatisfied asswipe who is evidently the center of the universe. Every penny they have ever paid to access my blog shall be returned. I will also realize that anyone who claims to be a "long time fan" and never seen an Onion-like post is full of shit. "

At press time The Drugmonkey was unsure if he should change his mind and beg forgiveness from the asshole.

An Innovative, Outside The Box Incentive Program From Industry Leader Walgreens

Deerfield, IL- Corporate executives at Walgreens, the nation's largest pharmacy chain, today announced a new employee bonus program that they promised would "shake up the retail industry, if not the entire business world" at a press conference at its Zug, Switzerland Illinois corporate headquarters.  "We're turning conventional thinking upside down" stated company CEO Greg Wasson. "How? Well hang on to your seats. By rewarding.....failure"

According to Wasson, effective immediately, all Walgreens employees will receive anywhere from 0.75 to 1.2 percent of any financial errors they are responsible for in direct payments from the company. "Now granted, to a cashier whose drawer is off by ten dollars at the end of a shift, a payment of an extra dime may not mean much, and let's face it, a store manager getting an extra ten dollars for a deposit off by $1000 certainly won't be a game changer. That's why I'm announcing the start of this program with two executives who we think will become emblematic of what we're trying to accomplish. Wade, Kermit, step on up here."  

Mr. Wasson was then joined at the podium by Company Chief Financial Officer Wade Miquelon and President of pharmacy, health, and wellness Kermit Crawford*

"Now, these two men were recently responsible for a billion dollar forecasting error when projecting our upcoming Medicare business" Mr. Wasson continued. "And there's no company where a billion dollars isn't a good sized chunk of change, so naturally, we have to let them go. But not before, and I want everyone to know this, we load them up with payments and compensation worth $8.5 million and $12 million, respectively."**

"That's right" Wasson said "Write that down for the whole world to see. Make a billion dollar fuckup at Walgreens and walk away rich!"

Asked how a plan that rewarded failure could possibly further the company's interests, Wasson replied "That's the genius of this whole thing. Like I said, this won't mean a whole lot to the vast majority of our employees. Right now that is. But what it does is let them know that if they work their way up to a position where they are responsible for a whole lot of dollars, well...then the world is their oyster. So what we're gonna have here is 250,000 employees striving every day to reach a position of greater responsibility so they too can have a $10 million screwup payday. And quite honestly, 250,000 store-level employees giving their best is worth far more than one fuckup at the top."

While executive-level business people were almost universally positive in their reaction to the new bonus program, others were more skeptical.

"I don't see how this changes current executive compensation practices at all" said Harvard business professor Camfield Rosenburg. "And to be effective, the expansion of fuckup bonuses to store level employees would have to be coupled with a policy where promotions to positions of great responsibility were based on positive performance. And I didn't see anything in today's announcement to indicate such a change has taken place."

After the press conference, Miquelon and Crawford issued a joint statement that read simply "Moneymoneymoneymoney Brrrraaaahhhhhaaaahhhaaahhhaaaaaaaa!!!!!"

*As much as I would like to say I made this up,  "Kermit Crawford" is the guy's real name. 

** I didn't make  this up either. In case you were too lazy to click on the link, these guys made a billion dollar screwup and were rewarded with millions of dollars in severance money. 

Why The Fucking Flexeril Isn't Covered Anymore.

More than a few of you have come across this situation by now I bet. In the midst of a chaotic, stressful workday you finally snag an easy one. Thirty flexeril. Yay. Two seconds and we'll have this one right out the.....

Then you see the insurance reject. Prior auth required. What. The. Fuck.

We've all come to expect this with the bullshit drugs of course. And the expensive meds  with cheap alternatives. I'm looking at you Lyrica. One of the missions of the insurance companies is to save money after all.

But Flexeril? Are you kidding me? The generic is cheap as dirt. So I repeat, what the fuck? "They must be doing this for no other reason than to get me to crack" you might be thinking. "They've decided they must make each and every prescription a herculean effort to get out the door. There is a war on my sanity. Because there can be no logical reason to slap a prior auth on a seven dollar med."

Oh but there is a reason my poor underinformed retail drone. Logical or not can be a matter for debate, but read on to find out  why that insurance company pain in your ass just got a little bigger.

I'm going to go out on a limb here and say that rejected Flexeril claim was for a Medicare Part D patient. I know this because while you, my poor pillcounter, are still stuck in that outdated world where insurance companies obsess about nothing but money 24/7, I have seen the future, that bright new paradigm where the health care powers that be now obsess about.......money. But in completely new and innovative ways. Where an obsession with the dollar can lead to scrutiny of the most absurdly inexpensive of insurance claims.

It works like this. Someone got the bright idea that Medicare should do more than just sit there and pay claims sent in by the health care professional types. That since he who pays the bills can make the rules, they should use their bill-paying influence to try and influence quality of care. It was decided that Medicare would start to rate its Part D plans like AAA rates roadside motels, with a one to five star system.

So far this sounds OK, right? After all, who could argue with an effort to improve medical outcomes?

Next step involves how to go about being able to show how a large, paper-pushing, figure obsessed bureaucracy is improving things for the oldsters. How do we do that? We can't really just go around saying, " 'Ol Doc Johnson over there at Blue Cross of Lower Damnation does a pretty good job, Five stars for them!!" now can we? We need things to measure, so as we can compare like to like. Outcomes this year versus outcomes last year, Blue Cross versus Humana. In short, we need a way to generate numbers we can use in place of that unreliable human subjectivity.

I'll stop here the throw in the olive in the martini. Those star ratings are worth big bucks to the insurance companies, as Medicare pays bonuses to the highest rated plans.  It's estimated that the difference between a 3 star and 5 star rating is worth about $200 million to the plan getting rated.

That's right, the principle of using metrics to judge performance that has been such an unqualified success in making chain drugstores efficient customer service utopias has now been expanded to the realm of clinical judgement. In this case, Flexeril, the muscle relaxant that been part of the standard treatment plan for all sorts of painful conditions for longer than I have been alive, has been classified by some bureaucrat as a "high risk" medication for the oldsters. And a plan that goes over a 3% threshold of "high risk" meds is ineligible for a 5-star rating, and all the megabucks that goes with it.

So yeah, good luck getting them to approve that claim.

Except chances are, if you have a brain in your head and no desire to torture yourself, you won't even try. You'll notice that even if you moved heaven and earth and got that claim approved, the five dollar copay that would result isn't all that much less than you would normally charge a person with no insurance at all. As a matter of fact,  you could just say hell with the insurance company, charge the person five bucks,  make just a little less on the prescription than you would have anyway, and save yourself a hell of a lot of hassle.

It's a win win. And if grandpa gets a case of brain fog after popping a pill or two and falls down the stairs, it still goes down as a win for the insurance, as they don't have a claim for the "high risk" med on file, and therefore won't get dinged.

Meet the new health care order my friends. Where everyone wins, except the drugstore who made a little less on a prescription than they normally would have. And Medicare, who just paid out a big bonus that had zero impact on quality of care. And grandpa, who just fell down a flight of stairs.

Which means no one really won except the insurance companies.

Which means the new health care order looks a lot like the old health care order.

But at least you know why that pain in your ass is a little bigger now.

You're welcome.

Into The Mailbag We Go.......

Got this one as a comment to this post about the fun times people have working for CVS. Thought it deserved to be out front on its own:

Being a regular pain medication customer of CVS, I find it hilarious that not one single pharmacist will take ownership for their own fuck-ups. After getting rear ended at a stand still by a car traveling 60+ mph last year I was left with 8 bulging discs and an immense amount of pain that I will have to endure the rest of my life. My insurance won't work with Walgreen's so I got stuck with having to deal with CVS. I have a prescription for Tramadol and I don't know how many times I was supposed to have a script ready only to be told by my pharmacist that it can't be filled! You want to talk about a living hell? Try going through a Tramadol withdrawal on top of serious back pain! I am going through it again as we speak. I went back to my prescribing doctor and even pleaded to be put on anything else and he told me that there was nothing else that would help. He adjusted my prescription to where the frequency was 1 to 2 tablets every 4 hours as needed on a 120 count bottle. I have had one refill and one renewal since the adjustment and just had the online app tell me that my script was ready for a refill. I only had a few pills left so this seemed right. I put in the order online and was told it would be ready at 11:00 am. I show up at 1 pm and get told that they can't fill my script because it is too soon! They try to tell me that it was supposed to be a one month supply and I look at the label on my bottle and see "1 dose every 4 hours as needed". I talked to my prescribing doctor and he verified that he did not change the script. So some fuck head pharmacist filled out the script wrong the last time I renewed and I'm left to suffer until I can get this mess sorted out. Having just started a new job, this is the worst time to be going through this and I hope there is a special place in hell for all the fuckers at CVS who have repeatedly fucked me over. I am lodging a formal complaint with the pharmacist board. I have had enough. Meanwhile you fucktards whine about corporate pressure and how horrible it is. Then fucking quit! I can't quit my pain! Stop bitching and take ownership of your actions. Jesus Christ what a bunch of whiny fucking babies you all are . . .

Actually it was the answer I wanted to make sure everyone saw. Here goes:

Dear Whiny Douchebag:

Imagine you just got a letter from your insurance company about your tramadol coverage, and in it it said for you to get any more refills, you had to suck my dick. I bet you'd be all like "No way!! You guys can go to hell!" Right? Or at least something similar.

At least I hope so, 'cause I'm not getting any kind of hot chick vibe from your writing style.

Now, let's say I came to you and said for $15 a month, I'll tap you with a magic wand that will make sure your pain is under control and you will never have to go through tramadol withdrawal ever again. Assuming you're not a liar, (Many, many people with these type of stories are.) I bet you'd say something like "Wow! tramadol withdrawal sucks so bad, and I have this new job now with some dough coming in, and I work better when I'm not in pain, That's a bargain!! Sign me up!"

Well guess what Mr. Whineyfuck, this is your lucky day. because I am about to give you a clue as to how you should have been able to solve your problems all along.

I brought up my first point to show you that there is no law that says you have to do what your insurance company says. You wouldn't (I hope) suck my dick to get your tramadol, and you don't have to go to a pharmacy run by incompetent clowns. I'm not about to defend CVS here. The obsession with short staffing that permeates the chain drug world ensures that many people go through your type of experience.

Notice I said chain drug world, which means I wouldn't count on your Walgreen's being any better.

So what's a hurtin' tramdol dependent dude supposed to do? That's my second point. If you came into my place, I'd have you fixed up in about 5 minutes. Ten tops. And I'd charge you around $15 dollars a month without your insurance. If I happened to be in your fucky company's network, it'd be even less.

I'd also tell you the maximum dose of tramadol is 8 tablets a day, so your doctor kinda fucked you if he really did make out a prescription for 1 to 2 tablets every 4 hours. Do the math.

Which brings us to our conclusion. I'm not sure why I have to tell you this, but you don't have to be your insurance company's little bitch boy. Take some ownership of your own life, get your head out of your ass, and find yourself a real pharmacy. It'll cost you less than a Jackson. And if avoiding a life of pain and withdrawal isn't worth that much to you, then you'll get no sympathy from me.

You're welcome asswipe.

A Random Book Excerpt, Because Not Everyone Should Pay To Experience My Wisdom.

Actually, now that I read that, very few people do. Pretty much anyone at anytime can come up to me at the store and pick my brain. Now that I think about that I'm kinda jealous of these people now. Able to ask me a question whenever they want. Lucky them.

Wait, now that I think about it even more I realize I can ask myself a question and experience my wisdom anytime I want. Whether it's 2 in the morning or during my morning shower or even in the middle of sexual intercourse.

I am the luckiest man on earth, and it would be mean of me not to share me.

Here you go:

Chapter 7: Atralin

The Med

Atralin is a brand name for the topical acne medicine tretinoin, and tretinoin was my teenage savior. Regular use, a little peeling to let me know I was using too much, a sunburn or two to teach me those warning stickers put on by the pharmacy weren’t just for show, and the volcanic mountain range that had erupted on my face eventually went into submission. The fact tretinoin can make acne worse before it makes it better was a little disconcerting, but after a few weeks, this pimply faced future professional was convinced tretinoin was a gift from heaven. I was now free to become socially awkward based only on the merits of my actions and not on the condition of my skin. It felt better somehow to know my awkwardness was now earned.

To make it even better, as I approach middle age, tretinoin has now also come into wide use in the treatment of facial wrinkles, making it easy to think of it as some sort of lifetime sex appeal in a tube. There are some people who would pay a lot for lifetime sex appeal, no questions asked I bet. Valeant Dermatology, the same company that brought us the rip-off acne med Acanya I talked about earlier, seems to have made that bet as well.

The Scam

Some of you more astute readers may have read the above description of tretinoin and wondered if I wasn’t talking about Retin-A. I was. Retin-A was the original topical tretinoin, and is now saving the complexions of the children of its first generation of users. Drugs this old have generally lost their patent protection and are available as money-saving generics, and Retin-A is no exception. Funny thing about this med though, even though it’s sold in different strengths, including 0.05%, and even though it’s available in both a cream and a gel formulation, one way you can’t get it is as a 0.05% gel. This is where Valeant saw its opportunity.  It introduced Atralin, a 0.05% gel form of tretinoin and marketed it as a new product not substitutable for a generic. The price? $250 for a 45 gram tube. Over four times the price I found for the same size 0.05% cream with a little shopping around.

Neither the cream nor the gel has been shown to be more effective by the way. Keep that in mind when you’re making your purchasing decisions.

Once again however, a little looking around will lead you to a “savings offer,” where insured patients, most insured patients that is, will pay $25. If you’re one of the lucky ones who qualifies for that $25 copay though, just remember your pharmacy has submitted a claim to your insurer for $250. Uninsured patients will pay $75 with the savings card. Which means Atralin is a product whose primary purpose it would seem, is to drain money away from your insurance company and those people not savvy enough to look for coupons, and into the coffers of Valeant Dermatology.

What To Do

Unless you’re just a really big fan of topical gels, there’s little if any reason to buy Atralin. Just stick with the generic Retin-A.

Actually, let me take that back. The box design on the generic tretinoins can be a bit boring. They have plain old boxy letters and tired plain color schemes. So if it's important to you to have stylish graphic artwork in your medicine cabinet, then by all means, go for the Atralin.

The rest of us though, can take the money we save on our lifetime sex appeal in a tube and spend it wining and dining our soon to be many suitors.

If that whets your appetite, you can get the whole thing here.

Or come stalk me at the store.

Lucky you.

The Makers Of Dulcolax See Your Ass As A Penitentiary, And Their Mission As A Humanitarian One.

This, my friends, is an actual ad for the actual laxative Dulcolax, which ran in newspapers and bus stations in Singapore.

I am not making this up. There sit a pack of imprisoned turds, marking time around your asshole until they are, as the text in the corner says, set free by you.

"Well I should start shitting right away" you're probably thinking. My turds have done no crime, and therefore don't deserve to be doing time."

Not so fast there bubs, let me tell you what's gonna happen to those poor turds once that Dulcolax kicks in. It's a stimulant laxative, you see, and in this case, what's stimulated is the smooth muscle of the large intestine.

Which means those poor turds are gonna get crushed as the walls of their prison close in around them. Crushed until there is enough pressure to force them out of that little asshole in the floor. Look at the size of that asshole and look at the size of the turds. It ain't gonna be pretty.

I am going to go to bed now, but not before I say a little prayer for my turds. They are in for an ordeal the torturous quality of which I cannot even imagine.

Godspeed to you, innocent shit.

Once Again, Real Life Takes Away My Material. I Also Call Out Some Chicken Shit Compounding Pharmacists

Those of you who've picked up a copy of my awesome first book no doubt remember how I opened it with reminiscences of how I used to mock healthcare professionals who couldn't poison someone.  A doctor who tried to kill his mistress with strychnine for example, or a nurse who might use morphine to off a patient or two. It worked as humor because you'd assume that anyone who spent a few years studying the combination of how the body works and the chemicals the world of medicine puts into it oughta be pretty good at figuring out the poison thing. Basic stuff, right? Right in these people's wheelhouses and they screwed it up.....ha ha ha.....

Yeah....ha ha fucking ha.

The execution of a convicted murderer in Arizona lasted for nearly two hours on Wednesday, as witnesses said he gasped and snorted for much of that time before eventually dying. 

This drawn-out death of Joseph R. Wood III in Arizona prompted the governor to order a review and drew renewed criticism of lethal injection, the main method of execution in the United States, just months after a high-profile botched execution in Oklahoma.

And another one before that in Ohio. Right in the people's wheelhouses and they screw it up. Time after time. Once again I have underestimated the incompetence of others, and once again, real life robs me of comedic material.

Midazolam is the common denominator in all these fuckups, used with the narcotic hydromorphone in Ohio and Arizona and with a muscle relaxant (vecuronium) and potassium chloride (to stop the heart) in Oklahoma. So let me tell you a little bit about midazolam. It's what's known as a benzodiazepine, related to the Xanax and Valium so many people have made friends with. All in all they're a pretty good class of meds, gaining popularity in no small part because they are safer, particularly in overdose, than the class of meds they replaced, known as barbiturates.

Now, I'm gonna pause here, and place a large bet that even if you haven't had a day of any kind of medical training in your life, you can read that last paragraph and figure out the problem here, and offer a possible solution.

Some 6th grade dropout probably just said something like "um...maybe they shouldn't be using the safer one if they want to kill someone, and maybe go with that barbiturate stuff instead"...and that person... would be smarter than the Ohio, Oklahoma, and Arizona Departments of Correction.

 How many of you have had to have a pet put down? How long did it take? Seconds, not hours, yes? Guess what they use? Read that paragraph again and just take a wild-ass guess.

"Um......a barbiturate maybe?" the dumbest person on earth might say. And he would be right. Pentobarbital to be specific.

The olive in the martini here is that some states have figured this out. You won't hear about botched executions in Texas or Missouri because pentobarbital is exactly what they use.

So let's recap here. There is a successful model of a lethal drug that has a proven track record in both animals and humans. Yet some people in power think it's a good idea to go their own way and come up with a plan that uses a drug that is popular in medical practice in part because it is safer in overdose than the drug that is successfully used to kill lots and lots of living creatures.

And this is the world in which I try to satirize. Which probably says something about my intelligence.

Not that a midazolam/hydromorphone combination is completely inappropriate in theory. Pump someone full of enough of it and yeah, they should kick the bucket you would think. You know, assuming the meds were of the correct potency and actually were what they said on the label. Who knows? Maybe that was the problem here. Let's just check with the manufacturer and clear this right up....

...oh....wait. We can't do that. because no one quite knows who the manufacturer is. The prison people claim they're getting their goods from compounding pharmacies. Which means, if true, there's a colleague or two out there of mine who's a spineless, chicken-hearted, weak, cowering, thumbsucking, lily-livered, yellowbellied coward of a human.

That's right bubs. I'm calling you out. Signing a contract of death with the state is one thing, but doing so while insisting on the protection of anonymity is a whole other level of pussydom. Come out come out where ever you are deathdruggist, because if you can't stand the heat you're generating, you never should have gone into that kitchen and started cooking.

And just in case you are ready to point a finger back at me, I'll point out that I ended my awesome first book by telling the world how to get an abortion using a common anti ulcer medication, and I'll put the backlash whackadoodle anti-choice zealots are capable of generating up against anything you'll face any day of the year.

That part of the book still holds up by the way. No doubt because there I wasn't trying to mock an increasingly unmockable world.

This Is The Business Expertise I Remember From My Former Employer.

From The Motley Fool:

the biggest reason for the profit shortfall is what now appears to be overly rosy guidance for cost-saving benefits tied to Rite Aid's recent deal with generic distribution giant McKesson.

That deal transferred the company's responsibility for buying and distributing generic drugs to stores from Rite Aid to McKesson. When the deal was announced, Rite Aid argued that McKesson's bigger buying power and sophisticated distribution network (allowing for daily shipments direct to stores) would lower purchasing costs and inventory.

Unfortunately, that argument fell short this past quarter given that the company's cost of goods sold totaled 72.1%, up about a percent from a year ago.

You know, I work with McKesson myself, and I've always kinda liked them. They've always treated me fair, they have a lot of resources available for an indy out there in the big, bad, drugstore marketplace, they even gave me a free plant when I opened my account that's still alive.

I don't like McKesson anymore though. Because according to this they kinda fucked my former employer.

Which means I now LOVE them!!

BBBBWWWWAAAAHHHHAAAHHHAAAAHHAAAAAAAA.........

I'll probably kiss my McKesson driver Monday and he'll have no idea why.

My Preliminary MTM Conclusion

So...working through some numbers this night, I see that my MTM revenues to date have netted me about as much revenue as....

Ten extra prescriptions.

Pushing the figures a little further, I remember that when I'm in the happy pill room by myself without technician, ten prescriptions in an hour is a pretty good pace.

And...I've probably spent more than an hour doing the MTM stuff.

Which means....the paradiem  we've been living with since Nirvana was a fresh new band, of desperately grabbing as many prescriptions as we can at any price (including now actually paying for the privilege of filling them in some cases...long story) is actually still ahead of the bright new future of pharmacy being engineered for us by the visionaries of the profession.

To recap, in case you missed it. I can probably make more money in an hour cranking out prescriptions than I can working my MTM cases.

No wonder the chains went ape shit over the flu shots with hardly a peep about making sure Grandma is taking her Lipitor.

I've gotta get that damn Medicare immunization application done.

OK, thanks for helping me work through that folks. Goodnight.

Holy crap I can't believe I'm a businessman now.

Your Small Penis Is The Key To Understanding A Key Tactic Of Right Wing America's Arguments.

Because make no mistake, the right wing media machine is set to dominate the nation's news agenda. In a few short years they've gone from Glenn Beck being the crazy babbling uncle in the journalistic attic to being able to manufacture stories that get traction in normal people's dialogue.

Don't believe me? Bengazi.

Don't worry though, democracy may be at stake, but your small penis will stop them. First though, we'll have to learn a little bit about how they operate.

One of the favorite tactics of the conservative cable goons is the old "some people are saying" trick. It has its origin in the writings of people like Hunter S. Thompson, who wrote this for Rolling Stone while covering the 1972 presidential race.

“Not much has been written about The Ibogaine Effect as a serious factor in the Presidential Campaign, but toward the end of the Wisconsin primary race – about a week before the vote – word leaked out that some of Muskie’s top advisers had called in a Brazilian doctor who was said to be treating the candidate with ‘some kind of strange drug’ that nobody in the press corps had ever heard of.” 

It is entirely conceivable — given the known effects of Ibogaine — that Muskie’s brain was almost paralyzed by hallucinations at the time; that he looked out at the crowd and saw gila monsters instead of people, and that his mind snapped completely and he felt something large and apparently vicious clawing at his legs. 

We can only speculate on this, because those in a position to know have flatly refused to comment on rumors concerning the Senator’s disastrous experiments with Ibogaine.

After the campaign, Thompson had this to say:

“I never said he was (taking ibogaine), I said there was a rumor in Milwaukee that he was. Which was true, and I started the rumor in Milwaukee. If you read that carefully, I’m a very accurate journalist.”

Back then it was funny because of course no one would take that Ibogaine story seriously. But just like the old lady who gets up at a town hall meeting and says "the government needs to keep their hands off my Medicare,"  what was once ridiculous is now considered mainstream.  Listen for echos of Thompson in these actual quotes from Fox News transcripts:

7/14/11, commentator Eric Bolling: "There Is No Question That The Ground Zero Mosque Is In Fact A Victory Mosque."

The same Eric Bolling, 4 days later on Fox Business news: "Some Have Called" Park51 "A Victory Mosque."

On November 21st, 2011 Fox' Martha MacCallum reported "People Are Saying" Obama "Did Not Show Leadership On" Deficit Deal."

Who are some people? Mostly Bill O'Reilly from the day before: "Where Is President Obama On Leadership? He Should Have Laid Out His Vision."

I could give you plenty more examples, as there is no shortage of this kind of thing on Fox, but you get the idea, and you might be saying to yourself, "Wow, that Thompson example is just what I need to expose this bullshit for what it is."

You may be right for a few of the higher functioning ones, but remember who you're dealing with here. If you want to get to the majority of them, you're going to have to go with something far more visceral. Something that plays into their constant need to have something to fear.

Their small penis.

It's actually pretty simple, whenever you find yourself in front of the Fox News with one of their Cro-Magnon fans, just insert the phrase "your small penis" anytime after you hear "people are saying"

For example, Gretchen Carlson's "Some Would Say That It's The Unions That Have Crippled The U.S. Economy And Led To The United States' Debt." Becomes "Some would say you have a small penis"

Later, when they hear Sean Hannity say "And, less than 24 hours after some say that President Barack Obama virtually spat in the face of the State of Israel... " you tell your co-watcher "less than 24 hours after some say you have the smallest penis on the planet....."

Don't think you'll actually be promoting any intellectual growth or understanding of logical fallacies with this though. It'll be effective, eventually, but only because they will develop a Pavlovian fear of the phrase "some say," as it will trigger unwanted awareness of their organal inadequacies.

Take your victories where you can get them my friends, and pick up a copy of Fear and Loathing on the Campaign Trail '72. If for no other reason than to be ready for the next trick the fiends at Fox will have up their sleeve.  

As The Nation Turns It's Attention To Horse Racing, I Retell The Story Of The Greatest Kentucky Derby Ever.

I've told this tale before, but I so love this story, and as much as it's possible to be in love with a horse, I love Mine That Bird.

Mine That Bird went into the 2009 Kentucky Derby a 50 to 1 longshot. His trainer was surprised to find out the horse had qualified, and loaded him up in a horse trailer and drove his pickup truck from New Mexico to get him there. Sports Illustrated didn't even bother to find out anything about him for its feature article on the race. He *did* get a mention in New York Newsday however, whose writer said he "should just stay in the barn"

And when the race started Mine That Bird lived up to expectations. Here's the You Tube Video of the race, and you'll see Mine That Bird so far back at one point that the announcer says another horse is in last place, because he can't even see Mine That Bird.

But...watch the rest of the video, and keep an eye on the inside rail as they come around the final turn.




Some days, when I was unemployed and looking increasingly unemployable, as life started to look increasingly bleak,  I'd watch that video just to lighten up a little because I desperately didn't want to go through a whole day with nothing good in it. No matter how bad the suckfest got. That horse never failed to being a little smile to my face.

Someday I want to meet Mine that Bird, give him a big hug around his horse neck and get his hoofprint autograph.

I'm Amazed Sometimes At The Stuff That *Didn't* Get Me Fired.

Blogpost Original Airdate, 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.

Ripped Out Of Today's Headlines, By Me, Eight Years Ago.

In light of tonight's news about the botched execution in Oklahoma, I think we can all agree here that I am some sort of prophet:

Original Blogpost Air Date: June 13, 2006

Government Can't Even Not Create A Bureaucratically Screwed-Up Policy When They Kill You.


Ok, so I'm being a living stereotype this morning, an elitist liberal leafing through his copy of The New York Times, when I come across a story about a death row inmate appealing his sentence to the Supreme Court. Nothing unusual there. Can't blame a guy for wanting to live I suppose. Buried in this story though is a piece of evidence that shows just what a fucking genius I am. Stick with me here. I've been against the death penalty for a long time now. Partly because of the whole "an eye for an eye and the whole world goes blind" thing, but mostly because, and I have 2 different ways of phrasing this depending on who I'm talking to:

1) If you're a member of the general public: Would you trust the same organization that runs the DMV to have the power of life and death?

2) If you're a member of a medical profession: Would you want the same people who run the Medicaid program in your state to decide if you live or die? (OK, their decisions may decide if some people live or die, but in a different way)

Actually I have 3 different ways of expressing my thoughts. Sometimes I'll say that capital punishment is just another big government program that doesn't work very well. That line seems to work especially well with Republicans.

It is the particulars of this man's lawsuit that proves my brilliance. It seems his argument is that the way a lethal injection is carried out in his state is cruel and unusual. According to the Times:

The focus of concern is two of the three chemicals that make up the lethal cocktail used by most states. One is sodium pentothal, an anesthetic, which Mr. Hill argues in his lawsuit is insufficient to make the procedure painless.

The second is pancuronium bromide, which causes muscle paralysis but does not block pain or interfere with consciousness. Studies indicate that while inmates who receive this drug look calm and peaceful as the third chemical, potassium chloride, is administered to stop the heart, they can actually feel intense pain without being able to express themselves.


Anyone who knows even a little bit about drugs is probably saying to themselves right now... "WTF?" Anyone ever hear of long acting barbiturates? hhheeeelllllloooooooooo.......cheap as dirt, and a little IV push sends your condemned gently drifting off to an eternal sleep. The sodium pentothal they already use is a short acting barbituate. Crank up the dose of that alone and you'll do the trick with no problem.

But no. Some bureaucrat gone wild had to come up with an unnecessarily complicated cockamamie 3-step procedure that leaves open the possibility of having someone suffer a heart attack while feeling everything and being able to express nothing. Less effective, more complicated, more expensive. Remember this the next time you're in line at the DMV. At least sooner or later you'll walk out of there alive.

An Ethical Dilemma.

So, let's say one day you're on the road and your baby starts to come down with a cold. And you, the master of all things pharmaceutical, know exactly what product to get to relieve her suffering. Unfortunately, the only place that seems to carry the product to help the woman you love is an outlet of a certain chain drugstore. A chain you're very familiar with. A chain you used to work for. A chain with whom your association did not end well. This leads to quite the dilemma indeed. Namely...

...do you stuff the product in your right or left coat pocket before you walk out the door?  I went with left, but something tells me right is the proper protocol in these situations.  

From The "Someone Couldn't Afford Their Abilify" File

An actual comment just zapped to the email box. Completely unedited.

All pharmacists r murderers plain as that the antidepressants the barium drinks for upper and lower gi they know what's in that stuff they r like the nazis just following orders i call them murderers to thier faces traitors to humanity the nerve of killers acting like birth control is the issue also old dictionary says its witchcraft

I want a copy of that old dictionary. I have a feeling the way to get it involves eating mushrooms or something though.

I Come To The Aid Of Every Hospital Administrator In The Country

Dear Bean Counter,

So, it's the dawn of a new healthcare era. Changes.....big changes coming down the pike. Paradigms to be reworked, strategic innovations to be thought of, or is that innovative disruptions you're so excited about? You MBA types are hard to keep track of with your business speak sometimes, but for this hillbilly pharmacist with a simple Bachelor's Degree, a lot of the new health care world seems to boil down to this:

The people that pay the bills are finally starting to give a shit about quality of care, and not just quantity.

Take Medicare for instance. The part of our health care system that actually is government run has decided it's tired of paying you extra when people you discharge as healthy end right back up in the hospital in less than a month. Stupid bureaucrats. They should understand that as long as a person's patched up when you roll them out the door that's all they really can expect of you, right? Yet here they are gonna start taking money away from you when these inconsiderate sick people get themselves readmitted.

What's a Master of The Universe business school grad to do? After all, real money is on the line here. During the first year of this government intrusion into how you spend its money, over 2,200 hospitals paid over $280 million in penalties.

I know the challenge seems insurmountable, but you know what? I'm here to help. Let me put on my consultant's hat and see what I can come up with.

You really can't think of anything to lower the rate of readmission? Seriously?  Well.....

YOU COULD STOP DISCHARGING PEOPLE ON A GODDAMN FRIDAY NIGHT WITH A HANDFUL OF PRESCRIPTIONS ANY IDIOT OUGHT TO KNOW THEY'RE NOT GOING TO BE ABLE TO GET FILLED!!!!!!!!

Every pharmacy in the country has a story about the Friday night customer who comes in with their Dad who's just had a heart attack sitting in the car and a prescription for some obscure med that no pharmacy in a hundred miles is gonna have on the shelf.

So, Einstein, you know how the pharmacy at your hospital doesn't get deliveries on weekends? Works the same way in the world outside your place. Which means you just fucked 'ol grandpa sitting out there in his Buick. Because Dr. Dumbass, IF you can figure out who he is based on the scrawl at the bottom of the prescription, makes himself unavailable after his shift, and the doctor there now, IF you can even get through, has no idea what's up with grandpa's case. The most likely scenario here is that grandpa's gonna wait until Monday to get his meds. Because you're a stupid fuck whose drug knowledge comes from ads in journals and sales reps expert in the art of flirting.

Bystolic? Seriously? You know what the word "Bystolic" means in English? It means "I hope you like applying for prior authorizations dipshit, because every insurance company seems to know what you don't. This drug is overpriced bullshit"

Livalo, translated from the Latin, can loosely be interpreted as "I hate my patient and am hoping to drown him in red tape"

Again, that's when the numbnut who wrote for this garbage is even around to inform him he gave birth to a paperwork baby.

So, beancounter, you wanna lower your readmission rate? Put in a night cabinet. Remember those? You did away with them when the insurance companies cracked down on your practice of using them as obscene profit centers. But now, even though you wouldn't be able to charge $10 for a Tylenol tablet anymore, making sure every discharged patient had enough meds to get them through a weekend would go a long way towards making sure you're not contributing to that $280 million I mentioned earlier.

Not to mention it would train those brain dead docs you have staffing your ER. 'Cause ain't no night cabinet gonna be stocked with Dexilant. We both know that, don't we?

Look at me, just saved you smarty pants people a lot of money I did. even without knowledge of your strategic initiatives to promote people's passion in the workplace. Just used a little common sense, which in your world is far from common. No need to thank me or even pay your e-consultant here. This one's on me.

Just be aware, the next time someone brings me a Dynacirc prescription on a Saturday morning, it gets shoved up your ass.

And then Medicare will come take your money.

Now go try to do something useful.