Sometimes Fucking Up Your Prescription Can be A Good Thing:

As far as I know, I've never killed or seriously injured anyone by misfiling their prescription. On the other hand, I've never been responsible for the creation of a multi-billion dollar business empire by misfiling your prescription either:

In 1886, pharmacist John Pemberton was making a mixture of leaves of the South American plant coca and African nuts cola known by their tonic qualities. The pharmacist believed the syrup he made could help relieve stress, weariness and toothache. Pemberton took the mixture to Atlanta's biggest drugstore where the first portions were sold at the price of five cents per a glass. But the world-wide known drink that we know today appeared through negligence. A seller incidentally opened a wrong tap and diluted the syrup with soda water instead of ordinary fresh water. That is how Coca-Cola was born.

Let me be clear. Should I ever mess up your prescription in such a way, I retain all rights to resulting product. Unless it kills you. Then it was your doctors fault.

My Vioxx Rant: Shed No Tears For Merck

Maybe I should just start a separate blog about Drug Company evilness. From today's New York Times:

ATLANTIC CITY, April 5- Delivering a sharp blow to Merck, a New Jersey jury found Wednesday that the company had not properly warned patients of the dangers of its drug Vioxx and had caused a heart attack suffered by John McDarby in 2004. The jury awarded Mr. McDarby, who had taken Vioxx for four years, $3 million in compensatory damages and Irma, his wife, an additional $1.5 million.

Merck stock skidded 3 percent in after-hours trading after the late-afternoon verdict, the second multimillion-dollar award against the company in the four Vioxx cases that have reached juries. Lawyers for plaintiffs predicted that the victory, which came after a month of testimony, would cause the number of lawsuits against Merck to soar.

Poor Merck....Not. Had they not acted like fat little piggies who couldn't get enough of your or your insurance companies money, these lawsuits probably never would have happened, and they more than likely would be making a profit on Vioxx right up to today. It's a long story I know, but read on to see why.

Psst...wanna know a secret? Vioxx and it's cousins, Bextra (also pulled from the market), and Celebrex (still around) DON'T WORK ANY BETTER THAN OLDER PAIN RELIEVERS. Don't believe someone who goes around calling himself a Drugnazi? Let's take a look at the official Vioxx prescribing info for osteoarthrits:

At doses of 12.5 and 25 mg, the effectiveness of VIOXX was shown to be comparable to ibuprofen 800 mg TID and diclofenac 50 mg TID

(TID incidentally, is a medical term that means "we're too lazy to write out 3 times a day")

for rheumatoid arthritis:

VIOXX 25 mg once daily and naproxen 500 mg twice daily showed generally similar effects in the treatment of RA. A 50-mg dose once daily of VIOXX was also studied; however, no additional efficacy was seen compared to the 25-mg dose.

for general pain relief, including menstrual pain:

The analgesic effect (including onset of action) of a single 50-mg dose of VIOXX was generally similar to 550 mg of naproxen sodium or 400 mg of ibuprofen.

Seeing a pattern? Those new, fancy $100 a month meds you saw on TV worked no better than plain old Ibuprofen, naproxen, or diclofenac, which go generally for less than $15.

Not that Vioxx and friends were useless. A problem some people run into with Ibuprofen and other meds in its class (called NSAIDS) is stomach upset. Sometimes people can suffer serious GI (gastrointestinal) complications from taking NSAIDS. Sometimes. Millions and millions of people however, have taken NSAIDS for years with no problem. If you've ever taken Aspirin, Motrin, Aleve, Advil, or Orudis over the counter, you're one of them. But boy, it really would be nice if we could help those people who can't tolerate them, wouldn't it?

That's where Vioxx and friends came in. They were undoubtedly easier on your stomach. According to the VIGOR study (drug companies love to give cute little names to their clinical trials), GI problems were reduced around 50%. Whoo Hoo! We've got us a miracle drug! No need to read any more...seriously...just go and talk to your doctor about Vioxx. Hopefully just demand that he write you a prescription....so you can dance around the ice the way you saw Dorothy Hamil do in the ad on TV.

If you did read more of that VIGOR study however, you would have seen this:

The VIGOR study showed a higher incidence of adjudicated serious cardiovascular thrombotic events in patients treated with VIOXX 50 mg once daily as compared to patients treated with naproxen 500 mg twice daily. This finding was largely due to a difference in the incidence of myocardial infarction between the groups. Adjudicated serious cardiovascular events (confirmed by a blinded adjudication committee) included: sudden death, myocardial infarction, unstable angina, ischemic stroke, transient ischemic attack and peripheral venous and arterial thromboses.

Some definitions, for you non-medical types:

myocardial infarction= heart attack
unstable angina= unpredictable bouts of chest pain
ischemic stroke= a blod clot blocking flow to your brain
transient ischemic attack= a blood clot slows or temporarily blocks blood flow to your brain. Also known as a "mini stroke"
peripheral venous and arterial thromboses= blood clots get stuck in other parts of your body.
sudden death= sudden death

So what all this boils down to is this. When you took Vioxx or one of it's friends you were trading lower GI risks for higher cardiovascular risks. Common sense would say that Vioxx & friends should only have been prescribed for people at serious risk for GI problems or who couldn't tolerate the older NSAIDS. I'll sign my next paycheck over to anyone who ever heard that from a Vioxx sales rep though. Merck ran those TV ads for you and gave your doctor a song and dance that had them writing Vioxx or one of its cousins for every little owwie that came into their office, then had no problems cashing the checks that came in the door as a result. Had they made the slightest little effort to make sure their med was being prescribed appropriately, it would probably still be on the market as an alternative pain reliever for people at risk for GI problems. But in the end greed ruled, and destroyed.

I know I'm supposed to be a funny guy, and this post wasn't very funny. Especially for the people who are now dead. Merck, however, was at one point was laughing all the way to the bank. I guess humor all depends on your perspective.

Drug Company Rip Off of The Day Number 2

Damn I hate it when the women are PMSing. That moody, cranky, bite your head off for nothing time of the month. At least I have the decency to be that way pretty much all the time, but with the PMS thing you just never know when your wife, coworker, girlfriend, coworker, sister, coworker or coworker is gonna be pretty much unbearable. I'm sure it's no fun for the ladies either. Wouldn't it be nice if there was maybe;

an FDA-approved prescription treatment that relieves both the mood and physical symptoms of PMDD (Premenstrual Dysphoric Disorder). Many physicians believe that Sarafem helps to correct the imbalance of serotonin that could contribute to PMDD.

Well good news pilgrims! Those words of hope were cut and pasted from the website of Warner-Chilcott, sellers of the wonder drug Sarafem, which has been shown to reduce the symptoms of PMDD (the official scientific name for what normal people call PMS) by 38%. Whoo Hoo! If you're interested in learning more you can look at the official Sarafem website or do some research under its generic name.....fluoxetine.

Of course the first thing you'll probably find when you do a web search for fluoxetine will be lots and lots of results for Prozac, the world famous antidepressant. Let me save you some confusion. They're the same thing. Except for the box. That's different. And the price. You'll pay an extra $96.07 a month for that nice box and a brochure so people won't think you're crazy or something because you take Prozac. (Prices from Drugstore.com)

But um....you know, at least you're getting a good, solid cure for the PMS that ails you, right? Take another look at what I cut and pasted. Notice they haven't proven anything there. "Many physicians believe that Sarafem helps to correct the imbalance of serotonin that could contribute to PMDD." it says. Well slap my ass. Define "many"....2....4? I could probably find a couple doctors who believe Elvis is alive. Serotonin "could" contribute to PMDD? Well the author of this blog "could" be Elvis himself according to the "many" doctors who "believe" he is alive. How about some clinical studies? If we dig into the official Sarafem prescribing information, we'll find that 38% reduction number I cited. We'll also see that a placebo achieved a 30% reduction. Translation into English: You're paying $1331.88 a year for an 8% chance that your symptoms will go down. Not go away, an 8% chance they will not be as bad as they were before.

Oh...and the prescribing info also says that the lower 10 milligram strength "was not shown to be significantly more effective than placebo." That doesn't stop them from offering it to you at $117.13 a month though. A price $6.14 HIGHER than the slightly effective 20mg dose.

So as we can see, taking Prozac doesn't mean you're crazy. Taking Sarafem probably does.

State Government, Sensitive Above All To The Feelings Of It's Citizens

Jesus I'm full. I still have enough of that Midwestern financial frugality bred into me that I have to make damn sure I get my money's worth whenever I find myself at an all you can eat buffet. Can...barely...move...my......fingers...to...type....not going to eat again for days I think.

Now that I feel like a fat slob I'm reminded of a customer I had a few years back. This guy was the real thing. I'm not kidding you when I say his car leaned over to one side when he was driving. Five hundred pounds at least. Jimmy Hoffa might have been buried in the folds of his flesh. To his credit though, he decided he needed to make a change for the better, so he talked to his doctor about the best ways to lose some poundage. Doc writes him a prescription for Meridia and sends him over to me. Thing is, Meridia is way expensive, and Medicaid wants to make sure you're actually losing weight before they shell out the bucks for it, so they require the patient to be weighed every month before they'll approve the claim. Fair enough, but this guy was so fat he was off the scales at his doctors office, making it impossible to get a reading of his weight. I explained the situation to my friendly Medicaid bureaucrat, and they OK the prescription for a few months, but then decided they had to get some sort of measurement of this guy's girth before they would pay anymore.

"Well, what do you suggest?" The drugnazi asked.

"Maybe he could go to a slaughterhouse" was the reply. It took a second for that to sink in. I mean, what if the slaughterhouse mistook him for one of their clients and he ended up in Kroger's vacuum pre-pack for freshness section? Now I've had to explain to women that they were too late in getting their morning after pills, I've had to explain to a woman that the only way she could have acquired her STD was from her cheating husband when she didn't want to believe it, and day after day I have to tell people who can't afford it that the only person who can help them is a doctor. But I have never had as hard a conversation as when I had to go to the counter and tell a guy that his state government wanted him to go to a place that processes dead animals to get weighed.

That didn't stop me and my chief tech from mooing softly whenever we saw him from that point on though. I think he ended up going to a moving company.

The 4 "D's" Of Pharmacy.

Ok, so I'm googling myself, why? Because my ego is the size of the Grand Canyon, that's why, and I find that......I have a fan. Seems like a potential young Drugnazi has come across my little blog garden, decided that I'm pretty "freaking funny" and that they "can't wait to be a pharmacist." Time for an intervention.

While I wholeheartedly agree about my freaky funniness, I think a recounting of a lecture I had to attend shortly before graduation may be in order before it's too late for all you pharmacy students out there. The lecture was entitled "The Four D's Of Pharmacy; What You Weren't Told When You Applied To Pharmacy School" The said D's were, in no particular order:

1) Drunkenness

2) Divorce

3) Death By Suicide

4) aDDiction

All of these 4 D's happened at a greater rate among pharmacists than in the general population the lecture said, and I can report today that I have 2 of the D's down. I used to drink my weight in Milwaukee's Best pretty much every weekend in frat-boy college fests, and there has been an ex-Mrs. Drugnazi for a few years now. (Shocking, just shocking that there was a woman who couldn't put up with my shit...heh)

Learn from me future drugnazi's of this country. While drunkenness can be at times quite fun, divorce is expensive, I have heard nothing but bad things about addiction, and if the Christians are right, death by suicide is the surest way to get your ticket punched for hell. (Which in a pharmacists case means spending all eternity answering questions from fat old diabetics as to how to work their blood glucose meter. The One Touch customer service department is my fate unless I straighten up before judgment day.) The only consolation of course, is that with the drugnazi-size paychecks I'm knocking down these days, I long ago traded in the $1.98 a six-pack swill for a bottle of good scotch. So if you do end up washing your life away in an alcohol induced fog, at least you won't be on the corner with a cardboard sign pretending you'll work for food. Damn I need a martini all the sudden. We'll have to finish this later.

Not Sure If This Was False Advertising Or Not.....

Anyone here remember the bygone days of your friendly corner druggist diligently grinding away with his mortar and pestle, compounding the exact prescription written just for you? Probably not, as the only places where that kind of thing happens these days are independent stores whose owners have found the only way to stay in business is to play to the more-money-than-brains demographic. Friend of mine has one of these stores. They're a rip off, but that's not the subject of this post. My point here is that in most modern pharmacies, the mortar, if anyone knows where it is, is probably under 2 inches of dust under the bathroom sink. The only compounding I've done in years is the occasional Rx for something called "magic mouthwash," used to soothe your oral type parts when they're irritated. Compounds are a major pain in the ass to enter into our computer, as you have to create a new product from scratch every single time, because the electronic wizard doesn't have the ability to remember a simple fucking recipe. This means you have to give it a name. I'll usually try and list as much of the ingredients as I can in the space I have , something like "Diphen/Mylant/Lidoc 1:1:1", so when you show up in the emergency room after having shoved some up your ass because you decided what you really needed was an enema, the Doc will have some idea what he's dealing with if you were smart enough to bring in the bottle. (You may laugh, but I would bet my next paycheck someone, somewhere has tried the enema thing) That's just me though, you can put any name you want on the label, and most pharmacists will just put something like "magic mouthwash recipe #3" Sometimes though my coworkers can get a little lazy....as evidenced yesterday when I was going through someone's profile and saw they had been given a prescription of ........"magic" The label actually said to use a teaspoonful of magic four times a day as needed for pain.

I wonder what the customer did with their magic. Did they become invisible? Gain the power to fly? Do like Endora on Bewitched and turn their son-in-law into a braying donkey? One of those questions that will never be answered I suppose, but the magic was refilled 2 times, and they'll need a doctors authorization to get any more.

So if This Fuck Couldn't Even Help His Own Parents......

...you can imagine what hell-like conditions I've been working through since the start of the Medicare part D(isaster) plan. From the Center For American progress:

President Bush's new Medicare drug plan is so confusing "even the parents of Michael Leavitt, secretary of the Health and Human Services (HHS) Department, ended up picking a plan that put their retiree medical coverage at risk. And this after Leavitt helped his parents in making their initial selection."

Got that? This clown WAS IN CHARGE OF THE DEPARTMENT THAT IMPLEMENTED THIS FUCK UP AND HE ALMOST COST HIS PARENTS THEIR INSURANCE COVERAGE BY PICKING THE WRONG PLAN.

The guys parents by the way, were quoted at the time in The Salt Lake Tribune as saying the enrollment process had been “smooth” and the program was “a guaranteed money-saver.” Oh....and the father....made his fortune in THE INSURANCE BUSINESS. Honestly. I couldn't make something like that up if I tried.

So to recap....rich white folks in the insurance industry whose son was in charge of the program get it wrong. And I work with customers who are predominantly poor, many of whom speak English as a second language, and are almost universally stupid. I think you can see why I've started drinking again.

Why Don't Basketball Teams Change Their Names When They Move?

There are very few lakes in or around Los Angeles (the Lakers moved there from Minnesota, land of a thousand lakes) and quite honestly, Salt Lake City is the least jazzy town on the face of the earth (the Utah Jazz moved there from New Orleans) if you're looking for team names that actually reflect the character of the towns in which they play, might I suggest the Los Angeles Silicone Enhanced Boobs and the Utah Osmonds (Utah Polygamists is just too obvious)

OK...I need to get some sleep.....

From The Jihad Watch......Remember This When You're Craving A Pepperoni....

....literally or figuratively. Substitute "Afganistan" for "Florida" and "Taliban" for "Catholic," and you could pretty much run the same story. Please wake up before it's too late people. From the Chicago Sun Times:

New Catholic town may keep birth control out

February 28, 2006


The founder of Domino's Pizza is starting a Florida town where he will build a Catholic university -- and possibly keep out contraception.

Tom Monaghan, who sold Domino's years ago, is using his fortune to help construct Ave Maria, a town and school near Naples, Fla.

"I believe all of history is just one big battle between good and evil," he was quoted as saying this week by Newsweek. "I don't want to be on the sidelines."

Monaghan, a conservative Catholic, controls the commercial real estate in Ave Maria along with a developer, the magazine said.

He wants drugstores to keep birth control off their shelves, and the developer said it would favor pharmacies with such a policy, according to Newsweek. A clinic opening already has said it would refuse contraception to students.

Notice he never says that he's actually on the side of good in the "battle of all of history." Just that he "doesn't want to be on the sidelines" Call him what you may, just don't say he's a liar.

It's Friday Night, Which Means Here Come The Freaks....

Ok, so, all I'm trying to do is grab a sandwich for a little lunch in the middle of the work day, and there's a guy in his underwear standing next to the checkout counter. Seriously. Evidently he was astounded by the bargains being offered on a selection of sweatshirts and pants priced to go, and just had to try them on before purchasing. Because you know, it's really important that sweats have just the right cut to make you look fabulous while you're out on the town decked out, and it would be just a tragedy if the $9 he spent for an outfit went for naught. God forbid a chick should ever try and pull a stunt like this. Oh no, it's always got to be some freak of nature, middle aged, potbellied, wrinkled, hairy man-beast that feels the need to get naked in public.

Right before I was going to eat. And my friends ask why I'm losing weight.