You May All Write In And Tell Me What A Wise Person I Am Now.

Why? Because back in November I wrote this:

ask yourself what Merck and Schering would be doing if they were looking at numbers that suggested Zetia and/or Vytorin were clearly lowering heart disease risk more than any other therapy. They'd have an ex-college cheerleader sales rep in every doctor's office in the country waving those numbers in front of their cleavage, that's what they'd be doing.

You see, Merck and Schering, far from deploying the cheerleader corps, was instead sitting on data from the Enhance trial, which had been completed over a year and a half ago. My point then was that this behavior, coupled with the fact that Merck and Schering tried to change the definition of what they were measuring, made me just a tad bit suspicious of what those numbers might say.

Today we have this:

Merck and Schering-Plough, which make the drug Zetia, and a pill that contains it, Vytorin, said Monday morning that Zetia had failed to benefit patients in a two-year trial that ended in April 2006.

In a press release, Merck and Schering said that not only did Zetia fail to slow the accumulation of fatty plaque in the arteries, it actually seemed to contribute to plaque formation — although by such a small amount that the finding could have been a result of chance.

Dr. Steven E. Nissen, the chairman of cardiology at the Cleveland Clinic, said the results were “shocking.”

Shocking to you maybe professor egghead, but not to the readers of this blog. I am the wisest person in the universe. Give me a damn medal to show the world how smart I am.

“In light of today’s results, which were released nearly two years after the Enhance trial ended, it is easy to conclude that Merck and Schering-Plough intentionally sought to delay the release of this data,” said Representative Bart Stupak, Democrat of Michigan,

Ya think?

It's not all negative though, Schering used this whole episode to provide us with a teachable moment:

Lee Davies, a spokesman for Schering, said the delay was unrelated to the negative findings and that the companies had not known the results until two weeks ago.

For those of you who don't know the sound of bullshit, Lee Davies just gave you a textbook example. Bookmark that quote when you need an example of bullshit.

In the meantime, I shall look forward to the praise, laurels, and accolades of my grateful readership. I shall assume that you will realize that I am right not only in matters pharmaceutical, but most other subjects as well, including politics. So I shall expect none of you will vote for Hillary Clinton in your state's Democratic primary or caucus.

Because to vote for Hillary in your state's primary or caucus would be to doubt my wisdom. Ask Merck and Schering what happens when you find yourself on the other side of my wisdom.

A Pause In The Political Process Provides A Good Opportunity To Share Highlights From Today's Pill Counting Action, But Hillary Clinton Still Sucks.

Actually I take that back, I'm pretty sure Hillary doesn't suck. That's how we ended up with that whole impeachment mess. But I digress, this post is about freaky customers, not about how much Hillary Clinton doesn't deserve the Democratic Party's nomination for president. Here we go:

First call of the day asked me what the date was. "NOT THE DAY OF THE WEEK....THE DATE!!!!" The woman said. "I'VE BEEN IN BED!!" She specifically asked to talk to the pharmacist for this.

I've learned what to do. "The 9th" I said, as if she were asking me a question related to her prescription medicine. Trust me young pharmacists, it's the best way to handle this type of situation.

The woman immediately hung up.

The best highlight ever though.....was yet to come.

A couple hours later a customer wanted to know if we sold DNA testing kits. "I need to know if I have any African blood in me" he said. "It's the first day of Kwanzaa."

Kwanzaa was last month. The customer looked as white as me. I am the whitest white boy in the history of whitedom. OK you young pharmacists out there...tell me how to handle this.....

If you said "tell the customer we do not sell DNA tests......and let those be the ONLY words out of your mouth" you win a prize. Under no circumstances are you to say anything other than "I'm sorry sir, we don't sell DNA tests" Nothing good will come of any other words. Don't ask. Don't tell.

The best highlight was still to come though......hang with me.....

Mid afternoon brings a message on the voice mail

"Hi, this is Joe Dumbass, and my doctor was going to call in a prescription for me. When he does, I need you to call me and tell me how to pick it up" He wasn't asking me to tell him when it was ready. He actually wanted to know how to pick it up.

I have worked in both the ghettoest of ghettos and in some of the most affluent neighborhoods on the planet, and I can tell you that not one time has a poor person ever asked me how to pick up a prescription. You have no idea how glad I am I wasn't born rich.

A customer gave me $40 cash for a $60 prescription and wanted to put the $20 balance on her debit card. As part of the debit transaction, she asked for $10 cash back. Pop quiz for young pharmacists.....what do you do?

Answer: Give her the $10 back. Do not ask any questions.

An hour before closing the ultimate asshole comes to the counter.

"YOU NEED TO CALL MY DOCTOR RIGHT NOW!!!!!!!!!" shouted the ultimate asshole from across the pharmacy. Another sign I was in the land of affluence. The doctors office was closed, but the customer was not the type of person who hears "no" often, if at all. I was to call his doctor right now.

Me: "I don't think your VIAGRA qualifies as an emergency sir. I'm not going to interrupt your doctor for a VIAGRA prescription." It was shouted back at an equal volume as his demand was shouted at me, with a little extra emphasis on the word VIAGRA. The waiting room was crowded. My voice has a way of carrying. People snickered. The smirk on my face communicated to the customer I knew exactly what I was doing. The customer learned the value of politeness when dealing with a pharmacist. He slithered away.

And that my friends......was the ultimate fucking highlight of my day. Don't vote for Hillary.

The State Motto Of New Hampshire Is "Live Free Or Die." After Yesterday's Primary I'd Prefer They Do The Latter

Hillary Clinton says she's been an agent of change for over 35 years. Am I the only person who sees the irony of that? Hillary says she's been working for change since before I learned you didn't have to poop in a diaper. And now I feel old.

I feel old sometimes because I see things. Stupid things. Things that need change. I see homeless dudes when I look out the drive through window every time I pull a shift in the ghetto. They're picking through the store's trash, and that needs to change. I see addicts come in the store trying to tell me they're diabetic so they can score some needles and maybe not die of AIDS. That needs to change. I don't want to imply Hillary Clinton has been totally ineffective at changing things though. Today I saw a man the age of my nephew who was a missing a leg. He left it in Iraq as a result of a policy change Hillary Clinton was instrumental in making happen. I felt old when I saw the one legged young man. Old and tired and a little hopeless.

This is what happens when you limit yourself to what you judge to be possible. Those dudes will always be homeless. AIDS will always be with us. Nothing you can do, so I'll just put an earmark in the budget for a half-ass homeless shelter and claim a great victory so I can get elected again. Four years from now I'll do the same thing. Hillary Rodham understood how abandoning hope to the pragmatic thoughts of the possible could be toxic. The year I was born she chided the commencement speaker at her college graduation:

“For too long our leaders have used politics as the art of the possible,” she said that day. Maybe that was the day Hillary claims she became an agent for change.

Somewhere in the three and a half decades since, Hillary Rodham became Hillary Rodham Clinton became Hillary Clinton. And after "35 years of working for change" she said on Sunday when asked what she had to show for it was that she added a few more kids to the ranks of the insured. She also chides her main opponent these days for offering "false hopes."

There's no such thing as false hope. Hillary Rodham knew that.

You don't dream big anymore Hillary. You don't hope anymore and I'm tired of being hopeless. I'm tired of feeling old.

Next up are my neighbors in Nevada. I know you want to hope as well. I know you want a goal of what is right.....not what is "possible." Let me know if you need a ride to the caucus.

You Suppose There's A Little Tension In The Clinton Household These Days?

The scene, inside an airplane somewhere between Iowa and New Hampshire last Thursday night, the laughter of Bill Clinton as he chats with a campaign aide is heard above the sound of jet engines:

Bill Clinton: "......oh man...what a week. I almost forgot how much I liked the mayor of Davenport. It was good to reconnect.....kinda wish I had made him Secretary of Agriculture now like I promised I was going to. Lots of good memories...." He knocks back the last of a scotch and soda.

Campaign Aide: "Remember when we went through.....where was it? Des Moines or Cedar Rapids? At that rally in '96 and a chick lifted her shirt and had "Bob Dole can suck these" written across her boobs? That's about all Mr. Viagra could have done with that woman."

Bill and the campaign aide again burst out in inappropriately loud drunken laughter. The rest of the plane is deathly silent. Hillary Clinton stares out of the window and snaps a pen in half.

Bill walks to the back of the plane and returns minutes later with two handfuls of food and drink. After settling into his seat he looks over at Hillary .....

"Doughnut?" He asks.

Hillary lunges across the aisle and grabs Bill by the testicles.

"I SWEAR TO GOD IF YOU DO NOT SHUT UP RIGHT NOW YOU WILL NEVER USE THESE AGAIN!!!!!!"

The tensest of all silences now engulfs the cabin. Hillary releases her death grip after about 30 seconds. Bill finishes his doughnuts and rises once again from his seat.

"We'll see how they get used" he mutters under his breath. He casually makes his way to the room where the stewardess is preparing coffee. They share a sly smile. Bill closes the door behind them.

Disclaimer: None of this actually happened. I'm just poking some fun at Hillary because she voted for the war and I hope she loses again on Tuesday.

You know what to do New Hampshire.

Tonight The State Of Iowa And I Will Have The Best Make Up Sex Ever

Hi Hillary,

How does it feel? What goes around comes around......tell me how it feels.

Actually you don't have to tell me. I know. I've known since October 10th, 2002. You know what I'm talking about. That was the day you looked us in the eye, the people who knew, the people who were out on the streets raging against the lies of George W. Bush, taking all the vitriol and hate and venom that Joe Dumbass Sixpack could throw our way, and you told us to fuck off. I've never had much hope for Joe Dumbass Sixpack, but at one time I had hope for you.

"Where else you gonna go?" you figuratively said as you cast your vote for death. "What are you gonna do....., vote for a Republican? You've got nowhere to go and I need the mushy middle far more than I need you losers."

Then you kicked us in the teeth.

The thing is..... you knew too. You're not stupid. You knew the war was for nothing. You saw George Bush for what he was. You could have led and stood and fought for the most important things that are worth fighting for. Instead you calculated.....and projected......and concluded that the best way back to the White House was to pretend to believe the lies.

You thought we'd forget, even though I said at the time I never would. I've been sharpening my boot for over 5 years now to deliver your kick back. Tonight you got it. May you get a few more.

Tell me how it feels.

Another Reason Every Chain Pharmacy In This Country Is Woefully Understaffed

"Hello Drugmonkey?" It was my District Pharmacy Manager. I was expecting the call. Actually I had been expecting the call for so long I had forgot I was still expecting it.

"What's up bossman?" The DM really isn't a bad guy. I think he's younger than me, which probably represents some sort of milestone in my life.

"I got a complaint from a customer.....I........"

"I'll bet I know exactly who it is"

"Wanna give me your side of the story?"

"Sure. Addict forged a Vicodin prescription and I told him to never come back. Guy threw a fit and wanted your e-mail address. "

"Are we talking about the same person?"

"What, did he give you some sob story about me refusing to give him his blood pressure medicine and him ending up in the hospital?"

Silence on the other end of the line. I could hear my boss' confusion in the nothingness.

"So remember last time you were in the store, and we talked about how we were both Seinfeld fans?"

"Yes........." the confusion was now turbocharged. If I had a regular job I may have been fired by now.

Do you remember the name George used whenever he needed to lie about something?

"No"

"Art Vandelay"

"DAMMIT DRUGMONKEY!!!!" The words "Art Vandelay" cleared up all confusion. Because, you see, Art Vandelay had filed the complaint. Or someone using the name Art Vandelay. That someone would be me. For those of you a little dimmer than average, I filed the complaint against myself for fun.

It's been a crappy couple weeks, for reasons both professional and personal. I got my boss to use a swear word though, which tells me I really don't need friends. I do a pretty good job of cheering my own damn self up sometimes.

Once Again, The Drugmonkey Gets Results. Merck and Schering's Head Partially Emerges From Their Ass.

It was a little over a month ago that I wrote the two titans of Big Pharma a public letter in this very blog:

Dear Merck/Schering.

Your bullshit has been called. Please remove your head from your ass and do the right thing.

Sincerely,

Drugmonkey, Master of Pharmacy.

Regular readers of my little blog garden already know that what had my boxers in such a bunch was Merck and Schering's decision to alter the definition of the Enhance study's "primary endpoint." For those of you playing along at home, that means they started this study with one definition of what they were going to measure, then when the data actually came in decided that no, they changed their mind and they were going to look for something else. This kind of thing is not done in science, and the Drugmonkey was not going to let them get away with it.

Behold, the caving of Big Pharma:

The lead researcher of a long-delayed drug study says he regrets not standing up to Merck & Co. and Schering-Plough Corp. when they first told him last month that they planned to alter the statistical analysis of their jointly sponsored trial.

Under mounting criticism, the companies last week reversed the earlier decision to change the primary measure to evaluate the drug. The study, called Enhance, tested 720 people to determine whether a combination of Schering-Plough's Zetia and Merck's now off-patent cholesterol fighter Zocor works better than Zocor alone.

John P. Kastelein, a cardiologist at Academic Medical Center, Amsterdam, and principal investigator of the study, said he breathed a "sigh of relief" when the companies told him last week they were reversing course.

"It's never, ever right to change the primary endpoint of a study," especially after all the data are in, he says. "It is statistically not good and it gives the wrong impression to the outside world." He says he initially went along with the plan but now regrets not firmly resisting it from the outset.

You are now my bitch John P. Kastelein. You now say you wish you had opposed this cockamanie plan from the moment you heard of it. I did. I own you.

Big Pharma is so afraid of me they couldn't even personally tell me of their decision, leaving it up to an alert reader to inform me of my triumph. That was kinda rude of them. Not to mention they are still hiding the extent to which they know Zetia can harm your liver. We know that the number of people who had to stop taking Zetia in the Enhance study due to elevated liver enzymes was somewhere between 1 and everyone. Merck and Schering will not be more specific than this. We also know Merck and Schering have done other studies that raise questions about Zetia's risks to the liver, but never bothered to publish them. It's time for another letter:

Dear Merck/Schering,

While your head appears to have moved, possibly to the part of your large intestine just above the rectum, it still has a ways to go to get completely out of your ass.

Consider me your laxative.

Sincerely,

Drugmonkey, Master of Pharmacy

Merck And Schering Don't Want You To Know They Have Studies Showing Zetia May Harm Your Liver. Whoops. Maybe I Wasn't Supposed To Say That.

Regular readers of this very blog already are well aware of how these two companies, joint marketers of the wildly popular cholesterol med, appear appeared to be sitting on data gathered to show how well the med works until they can could manipulate it to say what they want.

Readers of the New York Times also know this.

Well today, lucky readers, you will get another scoop concerning Merck, Schering, and Zetia skulduggery. And you will get it a mere 4 days after the readers of The New York Times.

New evidence shows that the drug makers Merck and Schering-Plough have conducted several studies of their popular cholesterol medicine Zetia that raise questions about its risks to the liver, but the companies have never published those results.

The unpublished studies, conducted from 2000 to 2003 according to the F.D.A. documents, were not listed on the industry Web sites where companies are supposed to register the results of all drug trials that were ongoing after October 2002. The New York Times discovered references to the studies in briefing papers on the F.D.A. Web site.

Huh. Wonder why that is. Because you know, the studies that show Zetia lowers cholesterol don't have any trouble showing up in these databases. Or as the first thing you see when you punch up the Zetia information for health care professionals web page. Yet the studies that show Zetia may put your liver at risk seem to get lost. What are the odds really?

A Schering executive, when asked by a reporter about the unpublished studies, confirmed their existence. But the executive, Dr. Robert J. Spiegel, said the companies had not considered the studies scientifically important enough to publish their findings. Some may eventually be published, he said.

I can't believe I just fucking read that. Here's a wild, crazy idea. Publish the studies, the way you are supposed to publish every single study done since October 2002, and let scientists not on Big Pharma's payroll decide what is scientifically important. That's why the clinical trial database was set up in the first place you numbnuts.

There is at least one big-ass scientifically important study involving Zetia going on at the moment though. It's called Enhance. Big Pharma loves to give its studies cute sounding names. Enhance is the effectiveness study I mentioned at the top of this post whose data Merck and Schering are sitting on while they change seriously thought about changing the definition of the study's "primary endpoint" science speak for what they were looking for. The enhance study was completed in April, 2006, but we still don't know the results. Except for this little tidbit:

Schering spokesman Lee Davies, disclosed this week that some patients in the Enhance trial had been dropped from it after tests showed that they had elevated liver enzymes — a potential sign of organ damage. But Mr. Davies said he could not disclose how many.

Why not? If the number were zero I'll bet you he'd be disclosing it. I think the story here is that Schering spokesman Lee Davies would not deny that 100% of patients in the Enhance trial had to drop out because of elevated liver enzymes. If Schering spokesman Lee Davies would like to issue a denial that 100% of patients in the Enhance trial had to drop out due to liver damage, I will happily print it here. Until he does though, all we know is that the number of people who had to drop out of the Enhance trial due to elevated liver enzymes is somewhere between one patient and all the patients. I'm sure Merck and Schering have a good reason for keeping us in the dark about this though.

There are also no studies that show Zetia actually lowers the number of heart attacks or deaths in people who take it. Unless Merck and Schering are sitting on that data as well. Don't bet on it.

Now That I Think About It, There's Really No Need For Me To Be Scared Of Vampires Anymore.

I mean, the AIDS probably killed off most of the vampires back in the 80's I imagine. And quite honestly, even if there are any vampires left, between HIV, Hep C, Ebola and a host of other blood-borne diseases, they are probably more afraid of us these days than we are of them.

In your face vampires.

I Can Think Of No Better Way Of Saying "Merry Christmas" Than By Rerunning An Old Blog Post.

That sounds like a snarky line, but it also happens to be the literal truth. I'm not in a state of mind conducive to writing new stuff at the moment. Don't ask me why. I'm just not. I originally posted this last Christmas Eve under the title Well Tonight Thank God It's Them, Instead Of You. Enjoy it again. Or not.

You got the best line in the whole song Bono. Of course back then you deserved it. You're sorely missed you Irish bastard, all the more so because you're still around.

We're not so different Mr. Bono, you and I. We both saw how the world shits on people who don't deserve it and were beside ourselves as to why. I decided that I wouldn't do anyone any good if I couldn't put food in my own stomach though, and I'm sure you felt the same way about your band; doesn't do any good to bug someone if they're not listening I suppose. But by the time our personal dollars had been stabilized we both found ourselves swept away by forces we no longer controlled. I took a job for corpo-pharmacy and your concerts were promoted by Clear Channel Communications. You sell your red iPods and I write a check to Oxfam and on the day we die the world will be shitting on people who don't deserve it. I miss you Bono. I miss me too.

Merry Christmas fuckers. Tonight thank God it's them instead of you.