I Hope Some Doctor Somewhere Who's Written A Prescription For Cambia Reads This Post

Because I have a question for you I seriously would like to have answered.

Why?

Now don't get defensive, I'm sure you have your reasons, and I would honestly like to know what they are. I won't judge you. Think of this as like when a mistake happens in a hospital and the people investigating are more interested in finding out what went wrong than in assigning blame.

Because you made a stupid decision. And I mean that of course in a totally non-judgmental way.

It's diclofenac. I'm going to assume you know this, you're an educated professional and you fully understand diclofenac is one of maybe a dozen NSAIDS out there. Cambia is marketed to treat migraine headache, so the first thing you did when you wrote that prescription was decide that diclofenac was the most suitable option for treating your patient's migraines.

You'll see a bigger push to avoid ORAL diclofenac.  

   Think of it as a "three-strikes" NSAID.  

   Strike one...it increases the risk of cardiac events as much as rofecoxib (Vioxx) or high-dose celecoxib (Celebrex).  

   Strike two...it causes more liver toxicity than most NSAIDs.  

   Strike three...it causes more GI toxicity than celecoxib, etodolac, nabumetone, or meloxicam.  

   Recommend naproxen or ibuprofen if an oral NSAID is needed. 

That came from the Pharmacists Letter. A totally non obscure newsletter mailed to pretty much everyone who knows anything about drugs in this country. There's references in the article if you're interested.

Remember what they said there about ibuprofen also. It'll come up again later.

But it's OK to go with the NSAID that competes for both the highest liver and GI toxicity in its class. There are exceptions to every rule, and there can and will be perfectly good reasons to prescribe diclofenac to certain patients.

Assuming you knew Cambia is simply a form of diclofenac. Nothing more, nothing less. And at 50 milligrams, it's a strength less than that of the strongest tablet.

Hit that migraine hard, doctor.

Here's the thing I really want to know though. The thing that separates Cambia from the diclofenac we all know and love is the dosage form. Cambia is a powder. It's powdered diclofenac. Like diclofenac tablets after you crush them with the back of a spoon. That's what the Cambia is. Pre-crushed diclofenac.

So pulling together what we know so far, when you prescribe Cambia, you have decided to use the NSAID with the highest toxicity profile and that it would be a clinical advantage to have the drug pre-crushed at the factory.

"Yes" I hear you saying, good doctor. "Because of a superior pharmacokinetic profile"

That's a fancy way of saying that a powder should get absorbed faster than a tablet, and while that is certainly intuitive, I'll point out that the makers of Cambia offer no actual proof of that when they would have every incentive to do exactly that should any proof exist.

I'll also point out the existence of liquid ibuprofen, a dosage form that should be the most rapidly absorbed of all, in a drug with fewer cardiac and hepatic side effects.

But you are nothing but a creature of science, right doctor? And your decision to use Cambia would have nothing to do with the fact that at $450 to $500 for nine doses, it just must be better 'cause it costs more than the diclofenac tablets you can find for less than $20. I won't insult you by suggesting that, or that a smokin' hot sales rep is playing you for a tool.

But it's just that, if I don't go with any of those ridiculous explanations, I'm not left with a whole lot, which is why I'm hoping you can help me.

Why did you write that prescription that made you look so stupid? Not that there's anything wrong with being stupid. Unless you're a doctor maybe. Doctors probably should be smart.

Which I guess means I really am judging you.

Dumbass.

Wisdom Teeth Are Proof Of Intelligent Design. Because God Had Every Reason To Give You Too Many Teeth To Fit In Your Mouth.

Not to mention tonsils and the appendix.

Psalm 139:14 -I praise you, for I am fearfully and wonderfully made. Wonderful are your works; my soul knows it very well.

Except for the fact that the openings of the esophagus and trachea are too close together. Easy to choke and die that way.

  Matthew 5:48  -You therefore must be perfect, as your heavenly Father is perfect.

And cholesterol that can build up in coronary arteries is then somehow an instrument of perfection, even though a guy working for General Motors who came up with a system like that would have been fired.

Hangnails. The fact that a little piece of snot can make it hard to breathe. Lenses in your eye that wear out and make it harder to focus on things up close. I'm on a roll now.

I see god in the fact that my testicles are hanging out there for anyone to take a whack at. A turtle has a friggin' shell over his whole body for chrissakes. Putting a little protection over the boys was too much?

Ever see a leopard with a twisted ankle? Then why the hell are ours made like that?

Menstrual cycles? Really? And tartar that builds up on the last set of teeth you're ever gonna get.

Not to mention my favorite. Who the fuck designed the prostate gland? WHO. THE FUCK. DESIGNED THE PROSTATE GLAND???? Let's take a thing that gets bigger with age and wrap it around the pee tube. THE PEE TUBE! What a great fucking idea. How do you get rid of a good chunk of your body's metabolic waste? YOU PEE IT OUT! How do you regulate the body's osmotic balance? BY BEING ABLE TO PEE OUT EXCESS WATER! WHICH MEANS IT'S KIND OF IMPORTANT TO BE ABLE TO PEE! YET YOU BIBLE THUMPING IDIOTS CLAIM PUTTING SOMETHING THAT'S GONNA SWELL AND GET BIGGER AROUND THE PEE TUBE IS A GRAND IDEA!

WWWWWWWWHHHHHHHHHHHHHHYYYYYYYYYYYY????????????????????

It's an interesting little catch-22 really. Belief that god made you prefect is evidence in itself of your imperfection. If this is what your little imaginary friend came up with when he went for perfect, I'm kinda glad it's us people who design airplanes.

Here's A Reason Why You Have to Be Reminded That Certain Lives Matter.

Kenneth Foster was no saint. He was once young and dumb and stupid and did some dumb and stupid things. Hung out with bad people. Committed crimes. No one disputes that.

Just like no one disputes that he didn't kill Michael LaHood. No one. Not even the man who prosecuted Foster for LaHood's murder. He freely admits that Foster did not pull the trigger. That he was 80 feet away in his car when his friend gunned LaHood down.

He never got out.

He never pulled the trigger.

He had to ask his friend what happened when his friend came running back to the car.

And he was convicted of murder and sent to Death Row. He came within three hours of being executed. I shit you not.

He was convicted under the Texas "law of parties" which holds that anyone who had any part in a crime can be held responsible for murder if they "should have anticipated" that one of their accomplice's actions would lead to someone's death.

Which means Kenneth Foster was basically set to be put to death for failing to be psychic. Had he not managed to attract the attention of the media he most likely would have been. Norman Evans Green was not so lucky. He was executed in 1999 for his part in a botched robbery. When another man was the actual shooter.

I'm not making any of this up.

Now let's go to Cleveland, where Michael Brelo was accused of firing 49 times through the windshield of a car in which, unsurprisingly, both driver and passenger died. For the last 15 shots  he climbed on top of the hood of the vehicle and was firing inside. This man had accomplices too, who also were firing. A total of 137 bullets were sent the victims way, and no one disputes this man was responsible for 49 of them.

Of course he was charged too. With...voluntary manslaughter. And acquitted. No one disputes he shot at two people 49 times, and he was found not guilty. 

Norman Evans Green pulled no triggers, and he's rotting away today in his grave.

Kenneth Foster pulled no triggers, and is rotting away serving life in prison.

Michael Brelo pulled a trigger 49 times and for all we know could be screwing his wife right now and planning to go out to dinner afterwards.

Now take a wild-ass guess as to the respective races of Foster, Green, and Brelo. And maybe a guess as to what Brelo did for a living. I bet you'll get it.

Now ask yourself why these Black Lives Matter people seem to be so angry. Take a good look deep into yourself and ask that question.

I'm not as confident you'll get that one.

A Bit Of Nazi History And An Insight Into My Mind.

Adolf Hitler came to power through a series of free and fair elections.

He worked his and his Nazi party's way through the German parliamentary system, gradually gaining votes and seats until his was the biggest bloc in the Reichstag, or German parliament.

But he wasn't quite where he wanted to be. There were still people who could legally tell Hitler to piss off, and Hitler didn't like that. Then came the Reichstag fire. Right during the runup to the next set of elections someone went and burned down the Reichstag building.

Now imagine the US Congress burned down right before a presidential election. Let's say it would have happened in 2004, right as W was trying for another term. Can you imagine how the feds would have reacted? Actually you don't have to if you just remember what happened after 9/11. I'm looking at you PATRIOT act, warrantless phone tapping, military detention without trial and Guantanamo.

Now imagine it wasn't W in charge during a time of national crisis but Hitler. You don't have to be a genius to see this Reichstag fire thing came at an awful convenient time for a power hungry fiend looking for a reason to consolidate his rule.

And you don't have to be much of a conspiracy theorist to speculate as to who might have set that fire.

Which is why every time I hear this song, I always imagine a scene in a Mel Brooks-like "History of The World" type movie. It would be  a kind of dance number thing, with uniformed Nazi's holding torches moving in perfect choreography as they set torch to the last speck of German democracy. The flames go up and the lights go out for Europe.

I can see it it my head. The whole dance number. Every time I hear this song. Tell me it isn't perfect.

I Bestow A Roadmap For APhA to Follow

To: Thomas E. Menighan. CEO, American Pharmacists Association.

RE: Your ongoing public relations disaster.

Tom,

Good Lord. I had no idea you would be so stupid about this.

I admit, when I first read the APhA Foundation's press release announcing the "Bowl of Hygeia" award given to Lloyd Duplantis, I thought it would be fun to sit back and chuckle as you scrambled around to do the right thing. But I never thought you would not know what the right thing was. Seriously, this is 2015, and a man who says the birth control pill leads to an increase in "effeminate men" and homosexuality now has a trophy with your name on it on his mantle.

And you're OK with that? Seriously? I haven't even mentioned his bizzaro theory about how gay Haitians contracted the AIDS virus in Africa and brought it to North America.

This is actually getting painful to watch. Have you noticed it's not just me giving you a hard time anymore? You are getting pummeled in the court of public opinion, and rightfully so.

But I'm here to help. I'm not quite sure why it's up to me to get you out of this mess of your own creation, but no one else seems to be lifting a finger. Thing is, putting all this in your rear view mirror really wouldn't be that hard. Here's your complimentary session with the Drugmonkey consulting service:

1) Make a statement. Now. Making it crystal clear that the views of Lloyd Duplantis do not in any way reflect the values of APhA. That your organization is for equality for all, and stands against all forms of discrimination and ignorant hatred.

2) Put in your legalese about not being responsible for making the decision to give him that award. BUT...follow this with an announcement of a change in your policy that will ensure this will never happen again. What those changes are I'll leave up to you. I can't solve all your problems after all.

3) Make a large donation to an organization that works for the advancement of the LGBT community. And I mean large. More money than you gave the Louisiana Pharmacists Association to award a bigot.

There you go buddy, PR disaster dealt with. I solved your damn situation with about five minutes of thought while I was waiting for my wife to finish brushing her teeth. Now why the hell couldn't you, with your access to the best PR professionals in the country right there in your DC neighborhood, come up with something other than cowering in silence?

Unless...the values of Lloyd Duplantis really do in some way align with those of APhA. I guess that would explain it.

Until you open your mouth Tom, the world will never really know.

Do. Something.

____________


Sign a petition calling  on APhA to do something about their boneheaded move here. 

Words APhA Has Honored. YouTube Edition.

You know, I'm just gonna step aside here, put away all the snark, and let this dramatic reading from the book The American Pharmacists Association chose to plug from the author they chose to honor speak for itself. This guy isn't Lloyd, but he's preaching right out of Lloyd's work.

Before you hit play, remember:

The American Pharmacists Association's Foundation gave this author an award. 

Since this book has been brought to their attention they have done nothing and said nothing. 

Here's a petition where you can ask them to do something about this. 

Without further ado, lets roll the tape. 

Let's Have Some Fun With Lloyd Duplantis While We Wait For The Cat To Untie APhA's Tongue.

Here's where we stand on APhA "awardgate" as of this afternoon:

1) The APhA Foundation gives an award to our old friend Lloyd Duplantis, who, it turns out, is about more than keeping birth control pills away from people he feels aren't smart enough to know the risks. Turns out he's a horrible homophobe as well. Go here to catch up on the details if you're just tuning in. 

2) APhA cites Lloyd's homophobic book in the press release announcing their award.

3) The fact that they are supporting bigotry is brought to APhA's attention, whereupon they do...

...absolutely nothing. Not one word from them so far.

Go here to add your name to a petition asking APhA to take back their bone-headed move. 

4) I take that back. They are doing something. They are taking down critical comments posted on the blog of their CEO, Thomas Menighan. Go here, quickly, before they erase the comment field again. 

So to sum up, APhA makes stupid move, refuses to own up to it, and is now trying to erase online evidence of what they've done.

But you can't erase this Thomas Menighan. So today we'll start a new series I'll call "Words APhA Has Honored." We'll take an actual, real excerpt from the book APhA plugged in their press release and put it up here for all the world to see, followed by a little debunking, commentary, or maybe just uproarious laughter

Ready? Here we go:

Here is one sentence from a pill insert- a powerful, real statement which alone should cause many pharmacists to shy away and opt out of filling prescriptions for such dangerous chemicals.  

"The use of oral contraceptives is associated with increased risks...of myocardial infarction, thromboembolism, stroke, hepatic neo-plasia, gall bladder disease, and hypertension." 

Wow. That is scary. But wait, there's more:

Serious cardiovascular, cerebrovascular, and vascular events, including myocardial infarction, sudden cardiac death, ventricular arrhythmia, cerebrovascular hemorrhage, transient ischemic attack, hypertension, subarachnoid and intracerebral hemorrhages, and pulmonary hemorrhage have been reported post-marketing 

Holy crap I'm even more scared now. Except that second quote wasn't from Lloyd's book. I cut and pasted it from Viagra's "pill insert," more commonly known among real pharmacists as the prescribing information.

Because real pharmacists know you can find a a scary line in the "pill insert" of any drug on the market. I could write you up a description of aspirin that would scare your socks off.

APhA knows this too, but chose to honor this guy anyway.

There's plenty more where this came from Thomas Menighan. Enough material to literally keep this thread alive for years. And it'll keep coming, one by one, post after post in a place where you can't erase it, until your organization owns up to what it's done.

It's up to you how long this goes on.

A Quickie From The Morning's News.

We'll have more on APhA, Lloyd Duplantis, and "awardgate" later on, but Sunday mornings always start with the Sunday newspaper around the Drugmonkey household, which today contained this line:

"The county is budgeting about $14 million more for 2015-16 than this year's $45.3 budget. The mental health funds are from a California state tax on millionaires that voters approved in 2004."  

You have no idea how happy that makes me.

Today is a good day.

Carry on.

So Here's An Idea About This Whole APhA Awardgate Thing

Tell me what you think.

First, we get a bunch of the books where American Pharmacist's Association Foundation award winner Lloyd Duplantis espouses his theories that birth control pills lead to more gay men, which led to the whole Horny Haitian Homos bringing AIDS to North America thing.

If you're just tuning in, I'm not joking. Click here to get the scoop, or just keep reading the next few posts here.

Then, we get the book's covers stamped with something like "By APhA Foundation award winning author Lloyd Duplantis." Like how Oprah stamps her book club picks.

Then we show up at the APhA convention and give 'em away for free, and let Lloyd's own words do the talking.

The only downers; this would involve Lloyd getting royalties, and I'd have to go to the APhA convention. I'm not sure which is worse.

I'm open to other suggestions.

Petition Started: Call APhA On Their Boneheaded Move To End All Boneheaded Moves

Click. Look. Sign. Spread around.

My Grown Up Letter To APhA

It's odd sometimes, the duality of the Drugmonkey/real life thing. You think Steven Colbert ever got confused as to which Steven he was? Probably not, but others sure as hell do over this type of thing. Rite Aid couldn't figure it out, and I will be forever grateful to them for it.

Anyway, this APhA/Lloyd Duplantis situation calls for more than the snarky Drugmonkey treatment. It's a serious problem that they seriously are gonna have to deal with. So this is the serious, grownup, not in character letter that I sent to CEO Thomas E. Menighan and the PR person who wrote the press release announcing the award.

Serious and grownup, posted at the home of the snarky Drugmonkey. You figure it out.

_________________


Mr. Menighan,

I am writing to you to express my utter dismay at the selection by the Louisiana Pharmacists Association of Lloyd Duplantis as that state's recipient of the APhA Foundation's "Bowl of Hygeia" award. While Mr. Duplantis has gained some notoriety as a member of a movement by pharmacists to refuse to dispense oral contraceptives to women, there is another, far more disturbing aspect to his work that I can only hope you are not aware of.

In 2010, Mr. Duplantis self-published a book entitled "The Pill, America's Sacred Cow" in which he outlines his opposition to hormonal birth control. While a complete debunking of the inaccuracies, use of pseudo-science to mask religious dogma, and flat out wrong statements presented as fact in this book is beyond the scope of this letter, there is a particular part of this work, which now has the tacit endorsement of APhA, that you need to hear. I start with the following quote:

"It is proposed by several researchers that the constant bathing of the female ovaries with exogenous female sex hormones affects the complex chromosome balance of the ovum while still in the ovary. This is hypothesized as a factor in the increased occurrence of effeminate men in the American population with the subsequent practice of homosexuality resulting in the rampant spread of HIV and AIDS infections."

Lest you think that was a quick statement of a fleeting thought. Later in the book there is an entire chapter espousing the bizarre theory that:

1) High dose estrogen contraceptives produce "effeminate men,"  which leads to an increase of the number of homosexuals in a given population.

2) These pills were tested in Haiti in the 1950s, leading to an above average number of gay men by the 1970s

3) A large group of Haitians traveled to the African nation of Zaire in the 70s, where errant vaccine experiments had led to the creation of the AIDS virus.

4) These Haitians then contracted the virus, brought the disease back to Haiti, and from there it spread throughout North America.

I can assure you Mr. Menighan, that is only the most egregious thing to be found in that book. There is plenty more where that came from. And now, through the APhA Foundation, these ideas have the implicit support of your organization. It would be one thing if you could claim lackluster vetting led to your foundation being unaware of this toxic work, but it is listed front and center on the press release announcing the award!!

Let me be clear. APhA has praised the notion that homosexuality is a medical disorder and lent credence to an incredulous "theory" about the start of the AIDS epidemic in the United States. You have no idea how much I wish I could go back to simply calling your organization ineffective.

I understand that you personally were most likely not involved in the decision to bestow this award on Mr. Duplantis, but that award has the name of the American Pharmacists Association on it, and as its Chief Executive Officer you are responsible and are to be held accountable for everything the organization does. It is up to you to limit the damage that has been done, and only a revocation of the honor given out in your name and complete repudiation of the repugnant ideas of Mr. Duplantis can begin to remedy this situation.

I look forward to hearing how you plan to act in this matter.

I will follow up this email with a certified letter to ensure you receive this important communication.

Lloyd Duplantis Of Gray, Louisiana Is Far Worse Than I Thought. That's Not The Problem Though. If APhA Is Capable Of Shame They Need To Bring It Out Right Now.

Fans of the blog know all about Lloyd Duplantis. For those of you that don't I'll tell you the condensed version. He was front and center in the movement a few years back of pharmacists that refused to dispense birth control prescriptions. What made Lloyd a little different though, was that it wasn't enough for him to say you couldn't have your Ortho-Novum because it went against his moral beliefs. He essentially ignored that part of his argument one night on national radio, saying he didn't dispense them "in the name of science," calling what's in your birth control pack "the most dangerous chemicals on the market."  He spewed forth bullshit and his bullshit got called here. That's old news.

There's more to Lloyd than we knew though. And thanks to the American Pharmacists Association, we all get to find out.

It seems that our friends at APhA, who seem to do nothing other than give out awards, build new headquarters, and shake hands while taking pictures,  saw fit to give out one of their awards to Lloyd. Specifically, a "Bowl of Hygeia," which is some sort of thing given out by each state association in the name of the APhA Foundation. I was gonna write me a little letter to that Foundation to ask them things like how honoring Lloyd fit in with one of their self-proclaimed values. I quote:

 "Respect for the patient’s role in managing their health is central to care."

Except when some slut wants to have a little control over her woman parts evidently, but I'm getting off track. I thought I could write a better letter if I had a copy of the book Lloyd wrote a few years back. Unfortunately I had to buy the damn thing. It isn't popular enough to be anywhere where you can borrow or steal it. Unlike mine, which can be acquired in all ways legal and otherwise.

Lloyd abandons all pretense of not basing his opposition to sexy pills on moral grounds in this page turner, but what immediately struck me was how he tried to have it both ways on the science stuff. Here's a quote from the introduction:

I have placed my own emotions and my own hypotheses here and those are based upon empirical and anecdotal observations. Since modern science and the politically correct establishment does not accept or rather has a general disdain for that type of science, I chose to call this compilation of my musings and articles that I have found interesting regarding "the Pill," a story rather than a scientific work. 

Got that? That fancy liberal science doesn't accept things like what some guy saw or thoughts he pulled out his rear end to be good enough, so this here type of science is called a story. A story about the type of science that isn't good enough for those eggheads. And a story that uses a lot of words like "empirical" and "clinical" and "hypotheses" to remind you it's just a story.

Just for kicks, let's take a look at a few of the places Lloyd's type of science leads to. These are just warm ups. The main one is coming:

-All contraceptive products have much more potential for harm rather than the possibility of benefit. 

Eh, no surprise there. We kinda figured he'd be saying stuff like this.

-In his practice, Lloyd says "every side effect listed on the package insert presented itself" 

That, my friends, is bullshit. No pharmacist has ever seen every side effect listed for any drug on the market, and every pharmacist reading this knows that as fact.

-"Oral contraceptives are steroid based chemicals and therefore create an immune-compromising situation which makes individuals more susceptible to infections of all kinds." 

Proof please. Oh I forgot. Wrong type of science.

-"I am very pleased to be able to share...some of the information I have garnered through my own personal research, clinical experience, and assessment of material done by others"

But remember, in no way am I trying to call this science.

-"The blood of women taking oral contraceptives often takes on a green color." 

Wha?

-"Any pharmacist practicing for any length of time has been approached and asked whether he has any outdated birth control pills for use on plants." 

OK this is just weird now. I've been at it 23 years and no one has ever asked me for birth control tablets for plants. So if you're interested in the world of reality you're gonna have to at least say "Every pharmacist except one..."

I could go on all night my friends, hell I could go on for a week. You wouldn't believe the amount of material in here. But that's not my point. Here's what I want you to take away from this book. I also want you to remember APhA gave this man an award

"It is proposed by several researchers that the constant bathing of the female ovaries with exogenous female sex hormones affects the complex chromosome balance of the ovum while still in the ovary. This is hypothesized as a factor in the increased occurrence of effeminate men in the American population with the subsequent practice of homosexuality resulting in the rampant spread of HIV and AIDS infections." 

Whoa. So, this guy is saying being gay is like some sort of birth defect. And APhA honored that.

"Well, APhA is incompetent remember" some of you are saying. "They probably had no idea about this book when they dished out that award."

Except it's listed front and center on their press release announcement. 

We're not done yet though. Hang with me and you'll find out how AIDS came to the United States. It's all covered in one of the last chapters, but you're gonna have to stick around for a bit. This is probably the most complex theory Lloyd comes up with. It goes like this.

1) The initial version of the birth control pill contained much more estrogen than the ones that eventually made it to market, which had much more estrogen than the ones on pharmacy shelves today. 

OK. That much is true.

2) The initial, experimental, versions of high-estrogen oral contraceptives were tested in the slums of Haiti, because there was a large, accessible population that was poor and wouldn't cause much trouble if things went wrong. 

Don't know about that, but certainly not implausible.

3) Remember, there's totally a link between high estrogen birth control and more "effeminate" men. And homos. 

That's what you said earlier. Yes I remember.

4) These experiments were done in the 50s, which means by the 70s there were more....

homos?

...than would be in the normal population. 

OK, I'm gonna quit commenting here and just let this thing play out to the end.

5) There were several vaccines being tested in the Belgian Congo in the 50s and 60s which "are offered as a catalyst for the beginning of HIV" 

6) In the 70s, which would be when the homos created in Haiti would be at peak horniness, a "unique population transfer" occurred as 47,000 Haitians were brought to Zaire to work on "health and welfare activities"  

7) Remember, there were more homos in this population than there would be normally.  

8) And they would do homo things. Because they would be at peak horniness.  

9) And so they would catch the AIDS, and bring it back to Haiti.  

10)  Then it spread throughout North America. 

OF COURSE!!!!!!!! IT MAKES TOTAL SENSE!!!!!!!!!! Big Pharma experimented on the poor people of Haiti, creating a pool of homos, who then grew up and got horny and went to Africa, where there was some sort of mad scientist or something who accidentally created the AIDS virus, and the horny Haitian homos picked up the virus and took it back to Haiti and then into our own country!!


THERE SIMPLY IS NO OTHER WAY!!!!!!!!!!!!!!!!!!!!!!!!!!


OK lets all laugh at that for awhile, and then remember something.

APhA gave that man an award.

And they knew about this book. It's featured in the press release announcing the award's presentation.

Which means whether they meant to or not, the American Pharmacists Association just gave a tacit endorsement to the theory that horny Haitian homos caused AIDS.

This goes way beyond birth control now.

This goes way beyond calling APhA ineffective.

They have some explaining to do.

An Unhappy Customer.

Brevity seems to be the soul of wit these days in the mailbag my friends, as this message came in today. Again, complete and unedited:

"If I wanted politics I would go to another and better written blog. Stick to pharmmacy (sic) workplace issues."

Your plight tugs at my heartstrings sir. I can only imagine how terrible your online experiences have been of late. And while I, of course, am more that willing to take my share of responsibility for your discomfort, your real problem may be with whoever is putting a fucking gun to your head and forcing you to read this blog.

I certainly sympathize. It must be some unique version of hell to sit there, cold steel pressed against your temple, as you are forced to read every word I write and never to be able to just skip to the posts that interest you. How it must rip your soul to know that others can simply click on one of the category links on the right, for example, the one that says "An Insider's View Of The Profession" when they want to see only pharmacy related posts while you sit there reading left-wing viewpoints constantly in fear for your life.

Does he quiz you? This man who sits there with cocked handgun making you read my words? Is that how he knows you haven't skipped anything? If so maybe we can work out some sort of arrangement where I can provide you with a cheat sheet. Let me know how I can help. Because while I appreciate the traffic, making someone read my blog at gunpoint is wrong. You can tell that man I said that. If you're not afraid he'll shoot you.

Moving on, you may have a secondary issue with whatever internet service provider is blocking you from accessing the other, better written blogs. I've heard of this thing happening in China, but perhaps the NSA is closer to having its electronic tentacles wrapped around our collective necks than I realized.

Or maybe you could just try Comcast.

I'd probably deal with the gun at your head first though.

Asshole.

 

From The Mailbag, A Reader Concerned With The State Of My Relations To Federal Affairs.

The message, in its entirety:

So....How's Obama working out for you?! LOL

Glad you asked my friend, as I haven't had much of a chance here to tell folks  how many more prescriptions I'm filling these days from the Obamacare. Funny thing how people tend to give me more business once they're finally able to afford to see a doctor, and a little ironic how the reason I haven't had the time to tell you about all the extra prescriptions I've been filling is because of...all the extra prescriptions I've been filling.

That's the main effect I see as to how the Obama's working out for me. I'd call it a win win for me and my customers.

Of course there's more to a presidency than money for me, so I suppose we should take a minute and ponder some of the other workings out of the Obama administration:

-A quantum leap forward in rights for gays and lesbians.

- A solution to a vexing problem in the Middle East that doesn't involve a bunch of dead people.

-Long overdue recognition that pretending that the government of Cuba doesn't exist is kinda stupid.

-Acknowledgement, at the top federal level, of the idiotic gun culture so unique to us.

-Net neutrality is now federal policy.

-AT&T and T-Mobile were stopped from combining to make your cell phone service even worse than it is now.

-Comcast and Time Warner were stopped from combining to make your cable/internet service even worse than it is now.

-No more federal cheer leading for the likes of Lloyd Duplantis and his ilk. Pharmacists, you'll remember, who got their 15 minutes of fame during the Bush administration for denying women birth control prescriptions.

We'll classify those under "things you definitely wouldn't have got under a President McCain or Romney."

By the way, there have been developments on the Lloyd Duplantis front. Stay tuned.

Back to the Obama workings out though:

-A president who addresses the out of control criminal justice system we've created, and the personal, spiritual, and financial toll it takes on every American.

-An economy that didn't collapse after it was left on the brink by George The Lesser.

Those will go under "things you probably wouldn't have got under those other two guys."

It hasn't all been roses and sunshine though, to wit:

-George The Lesser's wars in Afghanistan and Iraq are still limping along, although another way of looking at it would be two fewer wars have been started than during the previous administration.

-Guantanamo's still there.

-Zero action, at the federal level, regarding the idiotic gun culture so unique to us.

-A monstrosity of a trade deal is working it's way into law. If you haven't read about the Trans Pacific Partnership you should.

Those will go under "things that probably would have happened under a Republican administration."

All in all I'd give Obama a "B," mostly for the increased foot traffic going through my business these days. If I were rotting away in Guantanamo or humping around in Afghanistan, I'd be inclined to grade him a little lower.

Not quite sure why you care about my views so much my anonymous friend, but there you go.

Testify To Pharmacy Jesus My Friend......Testify......

I QUIT RITE AID!

And it was the best thing I could have ever done for myself.


Hello Mr Monkey, I asked advice from you a few years ago about leaving Walgreens for a Rite Aid position located where I wanted to live. I thought you would like to hear what happened.

It lasted 3 years. During that time, I was miserable. It got so bad, I was forced to flex my brain muscles more than I did in pharmacy school, to figure out how to get out. It is so pathetic, to spend $150k on student loans and pass classes that took all of my efforts for so many years, only to find myself equally pressured to get the fuck out of the very place I dedicated my life to be in.

I was threatened with trivial write ups over mentally ill customer complaints, sending a personal fax, putting a flu shot sign in the incorrect location, etc. These write ups, I was told, would lead to a final meeting that would possibly result in termination. I put my keys in the lock box, called the DPM and informed him I would never be back. They did not deserve a 2 week notice.


I started a home business with my wife, and all is well. I still Rph, doing some floating for the new Haggen stores. I now own my life again, sleep well at night, and wish the best for all of my pharmacy friends that are stuck in the corporate trenches.

I appreciate all of your thoughts and writings over the years, and they no doubt had a huge influence in my ultimate decision to leave and stand up for myself. For that, I thank you very much Mr. Monkey.

From The Archives, And With a Special Dedication To A Certain Mr. Trump.

We've reached bottom now, right?

Surely we have. I've said that so many times over the course of the last decade, and been proven wrong every single time. But tonight it has to be true.

Because let me recap for you where we stand in the political life of this country right now. A commie, left leaning, profane half crazy blogger who calls himself a monkey and would call John McCain a butcher of innocent lives in the service of empire, who would have surely taken part in any and all demonstrations against the stupid, unjust, illegal dance of death this country was responsible for in Vietnam.....

....who wouldn't have hesitated to shout in John McCain's face what he thought of his career choice had he been 20 years older and ever had the chance....

....still has more respect for John McCain.....

Than the man who was at the top of the last set of national polls of likely Republican voters.

Surely we can't sink any lower.

Original blogpost airdate  November 05, 2008

A True Story About John McCain I Can Tell You Now That The Election Is Over.


I don't have to tell most of you that John McCain was a fighter pilot in the Navy during the Vietnam War. I don't have to tell you that he was shot down, captured, held prisoner and tortured by the Vietnamese for 5 and a half years.

And I don't mean the kind of torture that we do in Guantanamo where we're careful not to leave any marks. The Vietnamese didn't care anything about leaving marks. They beat the living piss out of John McCain and then would hang him from the ceiling in his cell by his broken arms when they were done. That's why you never saw him raise his arms during the campaign. He can't. At one point during his captivity he weighed less than a hundred pounds. That's not the story I want to tell you though. The story I want to tell you starts in that prison cell, with the voice of a person named David Ifshin.

Ifshin was president of the National Student Association, and in 1970 he went to Hanoi to urge American troops to turn against the war. His words were broadcast over Radio Hanoi repeatedly and into the cell that was John McCain's living hell.

You might expect that the two men would have gone on to become bitter lifelong enemies. You would be wrong. Ifshin went on to be general counsel of Bill Clinton's presidential campaign, a fact that didn't sit very well with many of the veterans of the war Ifshin had railed against. Some of these veterans heckled the president during his first Memorial Day speech, waving signs that read "Tell us about David Ifshin"

John McCain gave a speech on the floor of the Senate that day. “Let me tell you about David Ifshin…" McCain said. "David is a friend of mine.”

"I wanted the protesters to know that they were bearing false witness against a good man." McCain said later."His friendship honored me and honors me still."

 You see, although both McCain and Ifshin came to radically different conclusions, both men passionately believed in doing what was best for the country. Both men came to see that in the other and to respect the others' commitment.

I was going to write a tongue in cheek post tonight about kicking the Republicans when they were down. It would have been really funny. But after hearing Obama's victory speech tonight, I decided to tell you this story instead. Because my friends, I can't help but feel there was a tectonic shift in this country tonight. A much welcome shift in the tone we are going to get from our leader over the next 8 years. After hearing the man I had hoped so long for, finally making the speech that I so longed for him to make, well, a post about kicking the Republicans when they were down just seemed so.........Bushy.

And Bush already seems like ancient history, doesn't he?

I'll be dammed if there isn't a little hope in the land tonight.

The Spawn Of Lloyd Duplantis Of Gray, Louisiana Are Back. And Wal-Mart Tells A Big Fucking Lie.

The Drugmonkey is pissed this night my friends. The kind of spit in your eye hellraising pissed that was so common in my Bush administration prime. If you've been with me that long you may remember Lloyd Duplantis of Gray, Louisiana. The "pharmacist" who had his 15 minutes of fame back in the day for refusing to fill birth control prescriptions, once telling National Public Radio they were "the most dangerous chemicals that have ever been put on the market." The Drugmonkey viciously destroyed Lloyd afterwards. To the point where if you Google "Lloyd Duplantis " right now, the first two results are posts from this very blog,  above his own store's website. 

Awesome.

But I also knew the work of vigilance against these pharmacy pretenders is never done. I wrote this back in 2009:

...don't think you should stop kicking the likes of Lloyd Duplantis of Gray, Louisiana and his ilk. 

Because you and I both know they'll be back. Pat yourself on the ass for awhile and get ready to huddle up for the next play. 

Well it's playtime again my friends. From Mother Jones, the magazine that once broke the story of Mitt Romney's "47 percent" foot in mouth episode: 

When Brittany Cartrett lost her pregnancy in March, her doctor prescribed misoprostol to help her complete the miscarriage. The drug, which would allow her to avoid a more invasive surgical procedure, is the same one used to induce many abortions. Which is why, Cartrett suspects, two different pharmacies in central Georgia refused to fill her prescription.

Yup, we've been down this road. See if you can detect a difference this time though:

Cartrett slammed one of those pharmacies, the Walmart in Milledgeville, Georgia, in a Facebook post published last week. When she asked the pharmacist why she wouldn't fill her prescription, Cartrett claims, "She looks at me over her nose and says, 'Because I couldn't think of a reason why you would need that prescription.'" Cartrett says she then explained that she'd had a miscarriage, and the pharmacist replied, "I don't feel like there is a reason why you would need it, so we refused to fill it."

Did you see it? Not even pretending to have a good reason anymore. No trumped up safety concerns. No thinly veiled medical rationale. Just "I don't think you need it and you don't need to know why"

That is, until it gets to the level of the corporate spin doctor. This is where it really gets crazy folks:

Walmart, however, disputes that its pharmacist refused to fill the prescription on principal. She refused, says Brian Nick, a company spokesman, because the prescription did not follow FDA guidelines.

Everyone in the pharmacy profession just shot scotch out of their nose. Even if they were drinking water, scotch is what came out. Even if no beverage at all was around, the sheer ridiculousness of this explanation caused single malt to flow through sinuses. Because Wal-Mart, through its spokesman, just seemed to say that prescriptions that do not follow official FDA guidelines should not be filled.

Which is unadulterated bullshit. Lloyd Duplantis wasn't allowed to spew bullshit into my profession and you're not either Wal-Mart. Prepare to be called.

It's estimated 76% of all prescriptions of Seroquel are for off-label, non FDA approved uses. Which I'm sure means Wal-Mart dispenses 76% less Seroquel than its competitors. Right Wal-Mart?

Right?

I bet you never allow any amitriptyline for neuralgia to ever leave your place either, right? And no trazodone to treat insomnia. Because there are no official FDA guidelines for that either.

I could go on all night. Because the list of prescription drugs used off label is endless, and Wal-Mart knows it.

But for some reason......only the off label use of misoprostol seems to show up on your radar. What could that reason be?

Because.... that off label use of Seroquel I mentioned really has raised some serious safety concerns, unlike anything to do with misoprostol.  Yet... I don't see any Wal-Mart pharmacists taking a stand on off label Seroquel.

So again, what could the reason be?  That just this one drug......out of zillions that are used off label.....is the one to be concerned about?

Everyone reading this now knows the reason Mr. Wal-Mart corporate hack, so you can cut the crap. That pharmacist of yours didn't fill that prescription because she's an anti-abortion zealot who thinks she's entitled to put her beliefs above the people she is obligated to serve, and is also too stupid to know misoprostol has a myriad of uses that wouldn't raise her self-righteous, hypocritical hackles.

Tell the truth Wal-Mart. If you're going to take a stand and give cover to your employees when they attempt to force others to live by their moral code, at least don't lie.

Because while not everyone agrees on the abortion issue, there's a pretty clear consensus among all faiths that liars go to hell.

Fuckers.

The Potential Posts Are So Many, The Time Is So Short.

So I just got back from Hawaii. Which is awesome. I cannot change the fact some colonial imperialist stole the place awhile back so I might as well take advantage. You should too.

Many things going on in the world of pills while i was away evidently. If I don't write soon about me calling bullshit on APhA and the spawn of Lloyd Duplantis of Gray, Louisiana again rearing their ugly heads please start prodding me to do so. For now though I only have time for this quickie. This is the actual first sentence of an actual story that appeared in The Wall Street Journal I was perusing  through on the flight home:

Exxon Mobil Corp Chief executive Rex Tillerson received total compensation valued at $33 million last year, up 18% from $28 million given in 2013. 

 Hold on though, 'cause you don't get the whole picture until you read the last sentence:

In February, Irving, Texas-based Exxon Mobil, the largest and richest U.S. oil company reported that its quarterly profit dropped 21% as production declined. 

Read that first and last sentence again. Do it.

And so it goes my friends. Sigh......

The Socialist Invasion Has Begun, And Rubber Bands Are The New Symbol of Surrender.

Big changes reportedly happening at the Pharmacy America used to trust my friends, first and foremost, that artificial corporate person is no longer an American citizen. Remember that vaguely patriotic Walgreen's logo that used to abound in the pill counting world?  Well it no longer fits the global monstrosity that is the new "Walgreens/Boots alliance," and has been relegated to the trash heap of history. Right wing Fox news types take note, the country's largest drug chain is no follower of the doctrine of American exceptionalism, as evidenced by the new logo scrubbed of every trace of red, white, and blue:

Holy crap that thing looks like some sort of campaign sign for the Green party. Could European pussies be replacing good old American corporate assholes? 

NEVER!!!! I hear the Fox newsies screaming. EUROPEANS ARE SOCIALISTS!!!! AMERICANS ARE THE FREE MARKET JOB CREATING BUSINESS CHAMPIONS!!!!! USA!! USA!!! USA!!

Let's break away from the Foxy type of reporting for a minute though and check in with reality. This comes from a source deep in the bowels of the new company who says:

As you’re probably aware, Walgreens “bought out” Alliance Boots. Bought out being the most vague of terms, as (Former Boots and now acting CEO of the new corporation) Stefano Pessina is a much, much smarter businessman that Gregory Wasson was, as the latter was a pharmacist who kissed asses all the way to the top. So Pessina outmaneuvered him at every turn, and now the “Walgreens Boots Alliance” still keeps the Walgreens name, but the upper level of finance is 85% people from the Boots dominion.

USA!!! US....wait....wha? But you thought any country with universal health care automatically had a system on the verge of collapse because evil bureaucrats didn't let anyone make a profit, didn't you? Well guess what dittohead, the land of the National Health Service produced a corporate asshole that just took your home grown one to the cleaners.

Perhaps those Europeans did overestimate American competence just a bit though:

As you also probably know, Walgreens as a company has pledged to cut some obnoxious amount of money.  This is because, when they were preparing for the merger, they were talking out of their ass as much as they could in order to inflate their expectations.  This fell pretty flat on its face, and I’m sure Pessina was thrilled to see the forecasts that he inherited.

Before you get too flustered though, you might be happy to know that some of the language of business is Universal. Mainly the stupid micro-managing bullshit part:

So the initial plan to recoup this billion dollars of loss was to minimize amber vial returns. Logic being that while we only get minimal credit for open stock bottles, we get no credit for pills that are in store prescription bottles. So make sure you use the pills that are in those vials (from return to stocks et. al) before anything out of the stock bottles. This makes sense, right? 

Except the fact that they literally paid someone 50,000 dollars to come up with the idea of.....

Get ready for this. This is great.....

  “rubber banding amber vials to the stock bottle it belongs to so technicians know to use it first” 

BBBBWWWWWWAAAAAHHHHAAAAHHHHHAAAHHAAAAAAAA!!!!!!! I seriously put this in contention for some sort of  "stupidest bullshit directive of all time" award, but upon reflection, I realized the current champion, Rite Aid's "no more than 5 labels printed at a time" rule, had absolutely zero impact on revenue, while this time-waster at least is grounded in an attempt to maximize credits. The rubber band thing will have to settle in at number two.

This part of the experience will be no surprise to those of you plugging away inside a corporate swamp though:

they’re so committed to the idea that I receive eight e-mails a week about making sure those rubber banded vials are all over your shelf, and I actually had a visit from a guy from Deerfield because my store was “a high risk store.”  

I wonder if they sent each store a supply of official rubber bands to be used in this program, in order to keep the risk as low as possible? My money says there's a good chance.

There's more than rubber bands afoot in the new order though. It seems the Europeans aren't too bad at good old American downsizing:

Now, obviously, unless 75% of your stores are completely inept (which, in all fairness, I have met some of my peers and walked away wondering that sometimes) they’re not wasting a billion dollars a year on drugs that the technician just doesn’t pick up off the shelf.  So they went to plan B, which is “firebomb every level above store level.”  This is honestly kind of nice, because it gives us the nice thought that maybe they realize they can’t cut any more from store level (I know this is a pipe dream). 

Walgreens initially had a position known as a community leader - this position was a front store manager somewhere that was also responsible for the six stores around them and making sure things ran smoothly.  Walgreens has “pumped up” this position to take the manager out of the store and responsible for about 15 stores instead of about 5, and is calling them the “District Manager” - based on my experiences with the former community leaders, they are going to have the basic pharmacy understanding of a technician school graduate on their first day.  They’re also slashing the “district manager / district pharmacy supervisor” positions in almost half - the half that doesn’t make it can step down to the new “district manager” position (at a pay cut), and the half that does make the cut is now responsible for twice as many stores.  They did the same trimming for the level above them, and cut out 4 markets, evenly dispersing them over the rest.

And now a war on District Managers, which actually.....makes sense. When I was at Rite Aid we went through an extended period where we were District Managerless, and during that time company emails consistently ranked "vacant" as the second or third best district in various company metrics. I'm pretty sure Vacant even kicked everybody's ass and came in first a few times.

Let's sum up:

So end-game here is a couple things:
1)  The suits who have been trying to make us do more with less now all the sudden have to cover more ground with less help, which is a nice twist on what we’ve had to do for a while. 

2)  Someone, somewhere in this merger has given me hope that someone might have a glimmer of the idea that “you can save as much money by cutting a middle-management paper-pusher who is making 150,000 a year as you can by cutting 15,000 tech hours in his spot, and the tech hours are more productive” 

3)  I’m going to have a whole new level of high school graduate telling me how a pharmacy should be run, and complaining that I’m overpaid.

 Time will tell how profitable the British socialists will be. In the meantime, I think I might buy stock in a rubber band company. Whichever one Fox News says will never succeed. 

Let's Go For The Trifecta. Stuff That Somehow Didn't Get Me Fired Part 3.

Blogpost original air date December 21st, 2007


I May Be Single Handedly Responsible For Every Chain Pharmacy In This Country Being Woefully Understaffed

Why? Because Corpo-pharmacy bigwigs know that the very second I am not drowning in prescriptions, things like this start happening to their displays.



The horses have been going at it for two days now. If anyone bothers to notice, and figure out the source, It'll probably make my lobbying for more tech help a little harder.

Does make the 12 hour day go a bit quicker though.

Stuff That Somehow Didn't Get Me Fired, Part 2

Blogpost original airdate: Saturday, October 20, 2007

A Story Of Unparalleled Customer Service. In Your Face Walgreens.


I had been getting the living piss beat out of me for about 9 and a half hours. A customer interrupted the filling of another's prescription to ask if we had a product called "air." I shit you not. If there is a company out there that is dumb enough to name a product "air," I don't want to know about it and will happily blow off anyone wanting to buy it. Then the phone rings. This is the unedited beginning of the conversation:

Me: Thank you for calling corpo-pharmacy, may I help you?

Dumbass: IS THERE A (name of corpo pharmacy chain here) OFF THE LAWRENCE EXPRESSWAY??

Here is a summary of my thoughts over the next two seconds:

Well hello to you too.

There is one highway in this little town. Its name isn't Lawrence.

The nearest city that is big enough to name its highways would be at least 80 miles away.

There is no guarantee that is the city this person is talking about.

Fuck this guy.

"Yeah, you take the first exit after the big overpass, make a right at the light, and it's in the strip center with the McDonalds. " Is what I said. Or something like that. I don't remember exactly, as it was a totally random set of directions for a city that existed only in my mind. If I had been given the name of a real city maybe I would have done better.

The sound the dumbass made before he hung up the phone was something like..."hhhuuurroookk"

I immediately felt bad. What if I just steered some prissy-ass white boy into the ghetto and a carjacking? What if he was trying to get a prescription filled for a kid who didn't know Daddy was both extremely dumb and extremely rude? Crap. Maybe this time the Drugmonkey had gone too far.

Another call about 10 minutes later. "YEAH, I'M AT THE COUNTER HERE AND THIS PHARMACIST SAYS THEY DON'T HAVE MY INSURANCE ON FILE."

He found it. The dumbass fucking found it. I think the key was my mentioning of the McDonalds. "Take a right and look for the McDonalds" just might work in any situation really. I wondered if Burger King might be the key to getting the guy's insurance card to work.

I suppose I could use Google to find out where the Lawrence Expressway is, but at this point I really don't want to know. I also don't want to know where you can buy air.

I hate all people.

We'll File This Under "Stuff That Somehow Didn't Get Me Fired"

Blogpost original air date : Friday, October 20, 2006


My Employer Really Needs To Give Me More To Do......


.....because when it gets to the point where I'm bored enough to clean, bad things can happen.

Such a point was reached a couple weeks ago. It was a beautiful day and most people had sense enough not to waste it in a drugstore. This left me with a choice of staring blankly at the family planning section while listening to the likes of John Mayer serenade me through the in store music system, or do a badly-needed reorganization of the miscellaneous "we don't need this but don't want to throw it away" section at the back of the happy little pill room. I went with option one as long as I could, about an hour, before the sound of "No Such Thing" was like that of an icepick being driven through my eardrum.

Fine. I'll clean something.

One of the first things I found was a pile of old auxiliary labels. You know, the "may cause drowsiness" type stickers we put on your vial so our ass is covered when you take 10 Xanax then wrap your car around a tree. These days, most of them are printed along with your label and not put on separately, meaning the half empty box of "for anal use only" tags I found would probably never be used. How sad. If only there were some way for these little stickers not to go to waste.

I looked back at the family planning section.

Why not a little experiment? You know, in the name of science, the way the TV show "Candid camera" was all about science. I discreetly slipped over to where my favorite type of Trojans were on display. Two rows side by side, perfect. One row got the "for anal use only" stickers on their front corner, one didn't. After two weeks, here's what I can report:

3 boxes of anal condoms picked up and put back when the customer realized they weren't designed for the planned hole.

1 customer carefully looking over his options and going with the anal prophylactics.

1 customer question to me as to what the difference was. I assured the customer they were both the same product and was shocked, just shocked, that someone could be so immature as to put these stickers on as some sort of sick joke. The customer still went non-anal.

Today I saw the store manager taking the labels off, so these will be my final results. Damn.

Although I do still have some "for the ear" stickers left.......

Here's What The Big Deal Was About At That Bridge In Alabama This Weekend. I Told You About It 8 Years Ago.

Original Blogpost Airdate : January 15, 2007

Free At Last, They Took Your Life. They Could Not Take Your Pride.

At the danger of repeating myself, damn you used to come up with the best lines Bono. Used to.

In case you're wondering why there's no mail today, I'll tell you a little story that might go a ways towards explaining:

In 1965, some smart people in Selma, Alabama noticed something. Only around half of the people in their town were registered to vote, and it seemed that most of those that weren't were black folks. As smart as they were they couldn't seem to figure out why. They all knew Ninety-five years earlier these words were put into the United States Constitution, which meant there was no way the black folks could possibly be being kept from voting on purpose:

The right of citizens of the United States to vote shall not be denied or abridged by the United States or by any State on account of race, color, or previous condition of servitude.

"Maybe it's some sort of typo", some thought. Others said that maybe no one bothered to tell the crackers in the state capital of Montgomery that these words had been put in the document that is the supreme law of this country. They knew the crackers weren't very smart, so maybe no one had bothered to explain to the crackers what the big words in the 15th Amendment actually meant. They decided to walk over to Montgomery to ask the crackers what was up. Here's what happened:





The man in the light coat on the ground is John Lewis. The cops were so jealous of how smart he was they fractured his skull trying to get a look at his brain. Later that year Congress passed the Voting Rights Act, which told the not so bright crackers in language they could understand that they had to let black folks vote. The end of the Voting Rights Act Reads:

"P.S. -We mean it this time. Seriously."

There's one more picture I want you to see that will tell you how the story ended. Take a look:



That's Congressman John Lewis getting sworn in this month to his 10th term by Speaker of The House Nancy Pelosi. That's right my friends, today the Drugmonkey actually told you a story with a happy ending. May you remember it long after the bills resume their flight to your mailbox.

A Rather Unfortunate Name.

Bwwaaahhhahhhhaaaahhaaaaa.....

A Quickie From The Mailbag.

Hi there,

My name is Judy and I'm with the American Recall Center. I came across your blog while researching health safety topics and wanted to say that, as a fellow advocate, I admire your passion for keeping your readers informed, and healthy.

With Patient Safety Awareness Week around the corner (Mar. 8 - Mar. 14), we want to bring attention to a hidden safety hazard found in all of our own homes, our medicine cabinet. It's so important that we understand the medications we take, how to store them securely, and dispose of them properly. That's why we're asking influential writers, like you, to share their thoughts and experiences in a post.

We want to highlight some important facts about medication safety and we're hoping you'd be willing to help us in doing so!

Please let me know if you'd interested,

Inspire,

Judy

Dear Judy,

Strike 1- Use of the word "passion." The new definition of "passion" is "empty buzzword thrown randomly into business jargon"

Strike 2- Exclamation point! Another trendy corporate grammar tool to show how "outside the box" we are!

Strike 3- "Inspire?" Really? What....the......? that is actually worth three strikes all by itself.

The answer is no. Please become very passionate about staying as far away from me as possible!

The word that goes here is sincerely.

DM

A Question Looking to Be Crowdsourced By You CVS Chain Slaves

This one showed up in today's mailbag, and here are those out there who know more about this than me:

I recently had to write about a CVS case that talks about the DUR system. After reading your blog, it seems like you are very familiar with it. I have one question for you: Are these “hard stops” exclusively managed by pharmacists? Or could some of them (the silly ones) be handled or “overwritten" by a trained technician? I mean, could some of them be managed by others and then the hard ones, only be handled by a pharmacist? That way pharmacist be more focused on the more important ones.

As a former Rite Aid chain slave, I know we had to override them all, and there was *something* to override on almost every prescription. (Caution using birth control in reproductive age women was my favorite.) Not sure if CVS is the same way.

Pharmacy Jesus Saves Another Pharmacy Soul

From today's mailbag:

It's been a year since I left CVS behind, in part due to your incisive, honest assessments of the debilitated state of our profession. I now work in a nursing home pharmacy with some of the best people you'd ever want to meet in a sweet little town in the scenic north Georgia mountains. My stress is gone, my arrhythmia is much better, I'm a better husband and father, and generally a better person for leaving that toxic environment. I think for all the complaining retail pharmacists do, I don't think they realize how bad it is until they get out and see how good life can be again. Thanks again and keep fighting the good fight.

Crucified and resurrected my friends. Curing stress and arrhythmias. Making you a better person with a happier life. That's what I do. I'm Pharmacy Jesus.

And I'm waiting for you, Mr. or Mrs. Walgreen's pharmacist just home from a 12 hour shift, your hands still shaking as you reach for the scotch and the Prozac, to come join us. It is doable. You do not have to live like this. 

Your liberation starts here

Oh, How I Have Been So Dreadfully Wrong About The American Pharmacists Association.

....and I'm a big enough man to admit it. Lo these many years I've been hurling mean adjectives at them; useless, incompetent, clueless, out of touch with the profession being some of the most frequent. Little did I know they've been working on a master plan for the pharmacist in the trenches. A cure-all elixir of happiness and harmony that will liberate at last those poor souls chained to the retail world of high volume, no breaks, no room for error and no time to pee.

It was unveiled on page 49 of this month's issue of Pharmacy Today  in case you missed it.

First we tackle the problem of stress. You have it, I had it when I was a chain slave, and it ain't getting any better unless you're able to buy your own place and finally do pharmacy right. Fear not though, as the story's appetizer is a stunningly simple solution to the problem:

In more than a decade working as both community staff pharmacist and manager, Jennifer Davis, PharmD, has found at least one solution for countering the stress that inevitably follows a tension-producing incident like a misfill or an encounter with an upset customer: she presses the pause button. 
 

“Those of you who were involved need to take a break,” Davis, who is now a Fred Meyer Pharmacy manager in Beaverton, OR, will tell her staff. “You need to get off the floor, because the chance of making an error right now is very high.” 


EUREKA!!!!! If only I would have thought of that the time I had to start my Sunday shift as the only person in the pharmacy by dealing with an emotionally fragile rape victim while foaming at the mouth barbarians were demanding their drugs.

My supervisor was disappointed, after 8 hours of playing catch up that day, that the controlled drug inventory wasn't completed. I never forgot their gratitude for my efforts to help that woman. Little did I know it all would have been better if I just would have hung out in the break room for awhile.

But we're just getting warmed up here folks, because The American Pharmacist's Association has been on the case of what ails the retail pharmacy world, and a solution is coming down the pike, baby:

...many pharmacists find it difficult to cope. And rather than promoting the challenges and professional rewards of community practice, many of them advise younger pharmacists to look elsewhere for career opportunities. That was what Mark A. Munger, PharmD, Senior Associate Dean and Professor of Pharmacology at the University of Utah College of Pharmacy, and colleagues discovered in a 2012 survey of more than 300 independent and community chain pharmacists

I just want to pause here and note that it took some egghead until 2012 to realize that pharmacists are likely to tell others to choose another career.

Steps are being taken, though, to reverse these discouraging attitudes, said Munger...

Awesome.

...who is scheduled to lead a discussion, Pharmacist Occupational Satisfaction and Coping with Stress, at the 2015 APhA Annual Meeting and Exposition in San Diego in March

YES!!!!!!!



A DISCUSSION!!!!!!!!!!!!!!!!



PROBLEM SOLVED!!!!!!!!!!!!!!!!


(cue Beethoven's "Ode To Joy" right here)



And what might such a discussion entail? The article goes on to give some tasty previews:

Munger said he had heard from both independent and chain pharmacies. Many of the chains, he said, “have developed internal oversight committees that handle their employee–pharmacist complaints or suggestions and then address them by building a culture that relates around appreciation for their individual work, the individual pharmacist’s ideas, and empowers them to make more individualized decisions.”


BBBBBBWWWWWAAAAAAAAAAAAHHAHHHHHAHAAAAAAAAAHHHHHHHAAAAAAAAAAHHHHHHHHHHHAAAAAAAAAAHHHHHHHHHHAAAAAAA!!!!!! BWWWAAAAAAAA HAAAAAAA HAAAAAAA......oh god...must breathe.......BWWWWWWAAAAAAAAAAAAAAHHHHHHHHHAAAAAAAAAAHHHHHHAAAAAAA........HAAA HAA HAAAH HAAAAA.....oh man......need air.......face is blue.....


BWWWWAAAHHAA!!!!


Ok, stop. Need to focus.


BWWWAAAAAAAAAAAAAAAAAAA!!!!!!


Stop, Drugmonkey. Try to forget what you just saw and move forward.

I just want to say I really want to hear from a chain pharmacist that works in a culture that relates around appreciation of their individual work and empowers them. At all. Any kind of empowerment. I'll put up a reward for anyone who can find me a member of that mythical species.

But wait......the bullshit ain't done being served:

Munger added that many of them are also “building clinical services into their labor projections, which will no doubt improve the workplace environment, as we suggested in the paper, empowering pharmacists to make more clinical decisions. We think that was really one of the major emphases that we got from our survey.” 


Yup, no doubt there, baby. I bet there's noooooooooooooo doubt at all among any of the drugstore schleps beating their brains in to meet their metrics right now.

Alright, one more round of this:

Davis has also learned that diplomacy works best when a patient with urgent needs demands time during a period when patients are lined up at the counter waiting for prescriptions or to be counseled. She will tell the patient: “I would love to spend time with you, but can’t right now. Could I look into this and call you back at a better time?” 
 

“Ninety-nine percent of the time, they’re totally fine with that,” she added.


Excuse me, Dr. Clueless? THERE'S NEVER A BETTER TIME!!!!!!!!! I cut my teeth at a 24 hour Walgreen's that did around a thousand prescriptions a day, and yeah, we might have been able to work a call like that in around 3 or 4 in the morning some nights. I have a feeling 95% of customers aren't gonna be fine with that, though.

"Um, Drugmlonkey?" some of you might be saying. "I thought you said you were wrong about APhA. It kinda looks like they're kinda clueless and out of touch, just like you've always been saying."

No, my friend, they are more than that. Even more than I imagined. Because the only thing worse than a clueless, incompetent oaf who is unwilling to do anything is a clueless, willing stooge who allows others to use them. It's called the American Pharmacist's Association, but it just gave the corporate pinheads who have taken over our profession a platform to tell lawmakers, regulators, public relations agencies, the media and anyone else in the world who will listen about the progressive changes for good they are making in the workplace. Serious decision makers will listen to them, see the APhA stamp on the statement and move on.

That was a knife you just found in your back my friend. Paid for with your dues.

And until today, I never thought APhA willing or competent enough to put it there.

I was very wrong.

He Was The Best Of Motivators, He Was The Worst Of Motivators.

Two actual lines from two actual pieces of fan mail received here at Drugmonkey headquarters, honest to god. First up:

I Enjoyed reading your article .... It Is great to hear someone motivating others to take a risk, stay positive

Staying positive, that's what I'm all about baby. On to the next letter:

it's really inspiring to see someone who realizes just how much of a piece of shit everyone in the world is.

Which is kinda like being positive I guess, in a different sort of way.

Such is the dichotomy of the Drugmonkey experience. I am a meat filling of complexity mixed with the guacamole of mystery, wrapped in a riddle tortilla and served up held together with the tinfoil of enigma.

Which is why you keep coming back. Because understandable is boring.

Now I'm hungry all the sudden.

At Last, The End To Our National Narcotic Nightmare

Leafing through this morning's edition of the delivered on dead tree news in a semi-awake caffeine craving state, little did I know the momentous moment that was in store. Not only for me my friend, but for my patients, for you, for the country, and hell, probably even the world. 

That's why I still get the dead tree news. Because if I let myself just pick and choose my news from the electronic information buffet, I would have missed this, and probably have spent the morning reading about how the latest cost projections from the Congressional Budget Office show Obamacare will be coming in at a 20 percent lower cost than previous estimates, then I would be writing a post rubbing that in your face right now.

You wouldn't have liked that, because you would have been torn away from a post about no-go zones in Europe where non-Muslims are not allowed to instead read some left wing slanted news story, when what you wanted was funny pharmacy material. Perhaps a return of the ever popular "Highlights From Today's Pill Counting Action" posts.

A left wing story that happens to be true by the way, unlike that no-go shit that Fox News pulled out of its ass.

So it's a good thing none of that is happening, and that I still force myself to have my news delivered to me like the Johnny Marzetti that was plopped down on my tray every week in elementary school. Or else neither one of us would have come across the breakthrough solution to the most vexing of modern problems.

I'm talking about painkiller addiction. You deal with it, I deal with it, everyone with a healthcare license deals with it, as well as the millions of Americans whose lives have been upended by this plague. Once we had a bright idea to reformulate the OxyContin thinking that would help. What happened was that drove people to heroin and dirty needles and product cut with rat-shit contaminated baking soda the local pusher had lying around his filthy soon to be condemned meth lab trailer out by the old Johnson farm.

Dammit!! What we thought was a great idea turned out to have zero effectiveness! What is the solution to this Rubik's Cube public health dilemma?  Well there it was right in front of me on the printed page.

First though, is a Johnny Marzetti served anywhere other than elementary school lunch trays? And what kind of life do you have to lead to be honored with a vaguely appleish food product?  

God, so many questions this night. But fortunately one big answer.

Because someone, you see, finally asked leading syndicated health columnist "Doctor K" what they could do to minimize the risk of becoming "hooked" on their newly prescribed painkillers.

And if you know one thing my friends, you know that once Doctor K is on the case, he'll get to the bottom of it.

After giving us the lowdown on the basics of opiate/opioids and their uses, the good doctor gets down to brass tacks. Unveiling after what I'm sure took months if not years of research, the key. That's right, now for all the world to see, we have tips from the National Institute on Drug Abuse that will help not only the letter writer, but everyone on god's green earth avoid the horrors of addiction.

But wait, do they really make tacks out of brass? I would think you'd go with a cheaper metal. And why would you say "god's green earth" when any picture from space clearly shows the planet to be blue? I suspect the answer to the latter has something to do with the religious types and their difficulty accepting what science shows to be true.

That's not why you're here though, let's free the people from their narcotic hell, and then we can move on to why the faithful can be so stupid. Here we go, the answer to how we can finally free ourselves from the chains of drug dependence and be free at last, free free free at last:

Keep your doctor informed about all the medications you take. This includes over-the-counter drugs. 

Take your medication only as prescribed. 

Read the information provided by your pharmacist before taking your medications. 

Discuss your medication with your doctor or pharmacist. Don’t hesitate to ask questions if you are unsure about its effects. 

Throw away any unused pills once your back pain improves.    

Jesus Fucking Christ. This is the last time I start a blogpost about something before actually reading the article I'm writing about. I saw the headline before work and was so excited....but now....I'm stuck trying to defend this bullshit as something other than a waste of space.

Really Doctor K? I trusted you, and you treat me like I'm too goddamn stupid to think that maybe I shouldn't take my fucking habit forming meds as prescribed. Thanks there buddy, because up to now I thought a good way to avoid ending up in a twelve step program would be to force Norco down my goddamn throat by the handful. I also figured that hiding the fact I got Vicodin from my dentist would be a great path to moderation as well.

You fuckhead.

It's more than a waste of space, thanks to this antiquated technology it's also a waste of ink and I probably just contributed to the deforestation of the Indian subcontinent. Fuck me.

And fuck you. Go back to your Fox News, because you're not getting anymore Highlights From The Day's Pill Counting Action. Because I don't hate my customers anymore. Because it's amazing how much more likable people become when you finally have the tools to deal with them as an actual pharmacist and not a cog in a goddamn pill mill trying to keep the numbers on your computer screen from turning red.

Jesus Christ I just wasted my whole night on this. Doctor K sucks ass.