Thursday, July 31, 2014

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.



Or come stalk me at the store.

Lucky you.

Sunday, July 27, 2014

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.

Friday, July 25, 2014

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.