Pfizer Says They Are Inspired By A Single Goal, Your Health, Which Somehow Led Then To Try To Shove Cardura Down Your Throat.

Because heart failure evidently fits in with that single goal. Your Health. 

I mean, Pfizer wouldn't lie. It's like the first thing you see on their web page.

At Pfizer, we're inspired by a single goal: your health.

Keep their inspiration in mind while I tell you a story.

Many people believe that in healthcare, new automatically equals better. Even many in the professions work off that assumption. Thing is, no one, anywhere, has ever claimed that, and in reality, new just means better than a placebo. That's the standard a new drug has to meet in order to be let on the market. If Old Maid Drug is 90% more effective than a placebo, and Young Sexy Drug is 30% better, the FDA is required by law to approve Young, Sexy, Inferior Drug. Guess which one Big Pharma will be promoting though?

And in most cases we would never even know that Old Hag Drug is 60% better than Young Sexy Drug. Because the incentive for Big Pharma is to stop its studies the very second YSD is shown to be *any* better than a sugar pill, and start buying new low-cut dresses for its sales staff in anticipation of YSD's immediate approval.

Bottom Line: we usually don't have nearly enough information to know just how effective a new drug is, or how it measures up against what's already on the market. We only know that it's better than nothing.

Someone in the bowels of the scientific bureaucracy in the federal government, namely, The National Heart, Lung and Blood Institute, had an idea to change that, or at least change a little part of that. The feds organized a huge clinical trial to rate and compare treatments for hypertension, how effective they were at preventing heart attacks, strokes, and other cardiovascular problems, you know, the whole point of putting someone on a hypertension medicine in the first place. Everything from old-school diuretics to medium-school calcium channel blockers to new school ACE inhibitors were gonna get a look at. Even alpha blockers.

"Alpha blockers, WTF?" Some of you young whipper snappers might be saying. "Who takes alpha blockers for high blood pressure?" Well this old man's here to tell you there was a time when people did. A biggie back in the day was Pfizer's Cardura. Nice name. Makes it sound like it's gonna make your heart all durable and stuff. I bet someone was really proud of themselves for thinking up that name.

From the New York Times Article describing the federal hypertension med study, named Allhat:

Cardura was added only after Pfizer, which had already agreed to contribute $20 million to the trial’s costs, increased that to $40 million, Dr. Cutler said.

"We're so inspired by our single goal, your health, that we didn't think twice about kicking in an extra $20 million to promote our single goal, your health" A Pfizer spokesman never said.

Pfizer’s bet on Cardura proved a big mistake. As the Allhat data came in, patients taking Cardura were nearly twice as likely as those receiving the diuretic to require hospitalization for heart failure, a condition in which the heart cannot pump blood adequately. Concerned, the Heart, Lung and Blood Institute announced in March 2000 that it had stopped the Cardura part of the trial.

Now everyone out there who thinks that this disastrous clinical data immediately led Pfizer, who says they are inspired by a single goal, your health, to stop promoting Cardura for hypertension raise your hand.

Ok, everyone with your hand up, I've been hammering away at this blog for going on 4 years now. Have I taught you nothing?

Rather than warn doctors that Cardura might not be suited for hypertension, Pfizer circulated a memo to its sales representatives suggesting scripted responses they could use to reassure doctors that Cardura was safe, according to documents released from a patients’ lawsuit against the company.

And in an e-mail message unearthed in those same court documents, a Pfizer sales executive boasted to colleagues that company employees had diverted some European doctors attending an American cardiology conference from hearing a presentation on the Allhat results and Cardura. “The good news,” the message said, “is that they were quite brilliant in sending their key physicians to sightsee rather than hear Curt Furberg slam Pfizer once again!”

Asked for comment, a Pfizer spokesman didn't say, "Ummmmmmmmmm.......well......have you heard about Viagra? It makes your Willie hard and stiff!!"

Sales of Cardura held up through 2000, when it lost its patent and became an old hag, making it no longer profitable for Pfizer to send doctors to go do things like get drunk in the French Quarter so they wouldn't see actual science at scientific conferences.  

Not an old hag like chlorthalidone though, the oldest of the old school hags in the Allhat study, which was also the most effective med in preventing heart attacks, strokes, and heart failure combined. Good luck getting someone besides me to tell you that though. Use of meds like chlorthalidone rose a paltry 5% after the study.

Maybe I should get me a low-cut dress or two.

Wal-Mart. Low Prices To Die For.

NEW YORK (AP) — A Wal-Mart worker was killed Friday when "out-of-control" shoppers desperate for bargains broke down the doors at a 5 a.m. sale. Other workers were trampled as they tried to rescue the man, and customers shouted angrily and kept shopping when store officials said they were closing because of the death, police and witnesses said.

So, I've thought a lot about dying ever since I got my pharmacy license, and up until today I would have said drowning would be the worst way to go.  Getting trampled by the type of people who get excited by a sale at Wal-Mart however, would definitely be worse than drowning.

Items on sale at the store included a Samsung 50-inch Plasma HDTV for $798, a Bissel Compact Upright Vacuum for $28, a Samsung 10.2 megapixel digital camera for $69 and DVDs such as "The Incredible Hulk" for $9.

Yeah, If I'm gonna get trampled, I would at least want to be trampled by people who like movies that don't suck. I suppose getting trampled by people who actually read books would be too much to ask.

In what I would nominate as the most insincere statement ever, Wal-Mart Senior Vice President Hank Mullany had this to say:

Despite all of our precautions, this unfortunate event occurred, our thoughts and prayers go out to the families of those impacted.

How eloquent and touching. Especially the part where the first thing mentioned is the (ineffective) precautions taken. I can only dream that my eulogy will be framed in such a way that seems to imply the thoughts and prayers going out to my family are mostly concerned that they will be open to a quick out of court settlement.

Civilization is doomed. That is a pretty good deal an a vacuum cleaner though.

It Rained Today.

So because it rained I got out the umbrella. It'd been a long time since I thought about the umbrella.

Never really.

But today I noticed the umbrella looked as tired and as old as I feel some mornings when I leave for work. I noticed the parts that faced up towards the car window and took the beating of the summer sun were faded, which gave the umbrella an unintentional two-tone look. And I thought about the rainy day in Pennsylvania. 

The rainy day in Pennsylvania when I was young and newlywed and honeymooning. Privileged and educated and nearer to the top of society than I'm sure my grandfather who couldn't write his name ever would have thought a grandson of his would be. Normal. If you would have known me on that rainy day in Pennsylvania in 1994 you most certainly would have thought me normal. 

I might even have been happy. I don't really remember. Other than going into an outlet store with my new wife and picking out an umbrella that would be big enough for both of us I really don't remember a lot about that day. The umbrella is a time capsule from another world. I know I was there, but damn if I remember a lot about it. I look at wedding pictures and I wonder who that normal looking guy is in there. 

'Cause I don't feel so normal anymore. I haven't for a long time. It really is a big-ass umbrella though. 

Thanksgiving is the hardest day of the year to not feel normal. That's why I've always worked them. My employer screwed me this year though by closing for the holiday, but that's not your concern. I'm just writing this to let  you know if you ever see someone doing something weird like sitting around and staring at an umbrella, sometimes that's the kind of thing that's going through their mind. 

I should try to get some sleep. Even though the sleep helps less and less, I should try. 

Screw This. I'm Gonna Go Look For Some Gold.

I've decided I'm gonna become a professional gold miner. Seriously. There's no way they've gone over every inch of California since the original gold rush. Back in 1849 people were shorter, they didn't have access to the variety of foods to provide vitamins and energy that we have today, and they didn't have cell phones. Think how much more efficient a modern gold miner could be! I'm sure there still has to be a big chunk of gold out there somewhere, but I'm not greedy.  At current prices I would only need to find like 5 ounces a month to have enough money to get by. How the hell hard could that be? Five fucking ounces! 

The hours would also be very agreeable. Basically, anytime there's daylight. Once I find my first ounce, I'll buy one of those little headlamp thingys and have 24/7 capability. I suppose I'll need one of those pans or something too. 

And if worse comes to worse, and all I find is fools gold, then I'll just find some fool to sell it to. One thing my pharmacy career has taught me is that there is no shortage of fools. I'm gonna head to the Sierra Foothills as soon as I sober up. I'll try not to laugh at you suckers when I'm rich. 

UPDATE, 3:14 AM- So far I have checked both under my bed and in the hall closet, and I have found no gold. It may be because I do not yet have one of those pans. Should these disappointing results continue, I may be forced to expand my search to silver, or perhaps uranium if I can get a good market price. 

Highlights From Friday's Pill Counting Action.

I started the workday pledged to have a new attitude. A realization snapped into my brain during the morning commute that there are kids working their ass off at college campuses across this nation hoping only to eventually have the chance to do exactly what I would be doing this day. Today, I told myself, I will honor their commitment, their hard work, and most of all their dreams. I would be a good pharmacist. I would cherish this workday. 

First question: "What's the best way to remove hair from around my anus?" 

Second question, asked in the thickest of French accents:

 "Yes.....if I uh...kiss ze woman, who has smoked ze pot.....then I take ze, how do you say? Drug test? Do I fail?"

Yes indeed, my new attitude was paying off. Thank you pharmacy students of America, for providing me with the inspiration to get through this. 

I glanced down the cleaning aisle quickly while taking a phone-in prescription and saw what appeared to be a man flossing his ass with a feather duster. It was shaping up to be an anal kinda day. 

Me: "We'll have to send a fax over to your doctor's office to see if we can get you some more refills"

Customer: "But she has insurance to cover that."

Really. I didn't realize they sold those types of insurance policies, seeing as how a policy like that would be pretty pointless. Seriously, if you're paying an insurance company a premium to cover the expense of doctor refill faxes, you're totally getting ripped off. 

In non-pharmacy related store highlights, a customer parked their car in front of the store's front door and laid on the horn. And laid on the horn. And laid.......on the horn. That horn got laid the way I get laid only in my dreams. An employee went outside to investigate and was presented with a demand to go back inside and get the customer some cigarettes. Reports indicate the customer was using an oxygen tank. 

That's way you stay in school pharmacy students of America. Because it's better to answer questions about anal hair removal than it is to fetch an emphysema sufferers' next pack of cigarettes. I think. 

As the sun set over the parking lot of my happy pill room, I took a phone call from a customer very upset that someone had stolen their medication. Friday night, stolen medication. I started to scan over the customer's profile looking for the Vicodin and/or Soma that would be too early to fill. Nope. Today was anal day:

"THE ONE THAT CAME IN THE BIG JUG! THAT'S THE ONE I NEED!!!"

"We filled that for you in April ma'am."

"I NEED IT!!!!!"

The customer was talking about a prescription for GoLytely.  For those of you not in the profession, I'll tell you that the person who came up with the name "GoLytely" did it with the sole purpose of being cruel. GoLytely is indicated "for bowel cleansing prior to colonoscopy and barium enema X-ray examination." You take it the night before your examination so there's no poop in your colon any pre-cancerous lesions can hide behind, and you will not, my friends, go lightly. Columnist Dave Barry once described his experience with a similar product:

 

I don't want to be too graphic, here, but: Have you ever seen a space shuttle launch? This is pretty much the MoviPrep experience, with you as the shuttle. There are times when you wish the commode had a seat belt. You spend several hours pretty much confined to the bathroom, spurting violently. You eliminate everything. And then, when you figure you must be totally empty, you have to drink another liter of MoviPrep, at which point, as far as I can tell, your bowels travel into the future and start eliminating food that you have not even eaten yet.

Me: "Are you having another colonoscopy ma'am?"

"NO!! I NEED IT!!! IT WAS STOLEN!!!"

"Are you maybe thinking of another medication?"

"FUCK YOU!!!! I NEED IT!!!! ARE YOU GOING TO FILL IT OR NOT????"

"No, I'm not."

"ASSHOLE!!!!.........ARE YOU LAUGHING AT ME????"

"Yes. Yes I am."

And that, my friends, was the anal coup de grâce of my anal kinda day. A day that saw thousands of pharmacy students across this land doing everything in their power to someday stand in my shoes. Pharmacy students to whom I can say only one thing: 

You are completely insane.

It's A Small World After All.

And in that small world we don't all speak the same language. Which can be a problem when you've gone through 17 years of school that prepared you to help the public while simultaneously pretending 100% of the public speaks English. 

Problems can be dealt with tough, in a variety of ways, some effective, some not so much. I have a rather.....um....non-keystone tech who chooses to deal with a language barrier by, and I'm totally not making this up, adding the letter "O" to every other word and speaking at twice her normal volume. I was on the phone this afternoon and heard this in the background:

PRESCRIPTIONO????

NUEVO CUSTOMER???

Um.....yeah....I appreciate your effort here...... But maybe we should call for José......

Which was done. In response one of 5 people on the planet who may be whiter than myself showed up. 

"No, we were calling José. We need a translator"

"I know. He 's out to lunch, but I had a year of Spanish in high school" 

My hopes were not high, but I let her take a shot. "Ask him if he's filled prescriptions here before or if this is the first time" This is what the translator said. Again, I am making nothing up:

"Ummm.....es usted Nuevo Customer?"

The main distinction that makes a person a translator in my store would seem to be one of volume only. The translator was dismissed, I spent a good 5 minutes looking for my "Spanish For Healthcare Professionals" book, and with a lot of pointing to various phrases, the prescription was filled. Which was fine this time, but made me realize that my lingual skills are not nearly cunning enough. I'm thinking of maybe taking some classes to become a more cunning linguist.

Although I've heard there is no substitute for practice if you wanna be a cunning linguist. I've also heard it's a lot of fun. I don't know what I'm waiting for.  

One Reason Why What You Did On Election Day Was Only The Beginning Of Your Work.

From the November 14th edition of The Washington Times. That's right. I said The Washington Times. Sometimes it pays to keep your enemies close:

The nation's largest pharmaceutical lobbying group is preparing a multimillion-dollar public relations campaign to tout the importance of free-market health care and undercut an expected push by the Obama administration for price controls of prescription drugs.

The effort, which will include a national television commercial scheduled to begin airing next week, is the first salvo in what likely will be a huge battle over health care reform during the Obama presidency.

Other major industries are also gearing up for the fight, including big businesses and insurance companies.

You really didn't think they were going to go away did you? Think of it as good news, in that we'll have an opportunity to continue kicking their ass.

PhRMA says its upcoming advertisement, which will feature TV talk show host and PhRMA spokesman Montel Williams, doesn't criticize the pending Obama administration or any of its health care proposals.

"We're going to do an ad campaign that is designed to make people aware of the importance of preserving your free-market health care system," Mr. Johnson said.

I'm going to pass over the obvious joke that is Montel Williams expecting to be taken seriously about anything. Because there is a far more important point here.

THE IMPORTANCE OF PRESERVING YOUR FREE-MARKET HEALTH CARE SYSTEM? ARE YOU KIDDING ME?

The importance of the United States having fewer doctors, fewer nurses, and fewer hospital beds per capita than the average country in the Organization for Economic Co-operation and Development?

The importance of a system that results in significantly higher rates of chronic, preventable disease than the epicenter of socialized medicine, The United Kingdom?

The importance of preserving a system that gives us the 45th highest life expectancy in the world?

All while spending more on per capita health care than any country in the world? Is that what's so important? Continuing to spend more and get less? Because that really doesn't seem like that's very important to me.

Giving Medicare the authority to negotiate drug prices - a provision that they currently don't have - would cause the pharmaceutical industry to lose $10 billion to $30 billion in annual revenues, according to a report released last month by the Boston Consulting Group.

"If you start to take a pretty big price decrease out of that large market, it has an enormous impact on drug companies and really their ability to generate their type of shareholder return that they have had in the past," said Peter Lawyer, a senior partner with Boston Consulting.

Oooooooooohhhhh......I see what's so important now. I was working off the assumption that the function of a health care system was to maximize health. Stupid me. How could I have forgotten it is always.....always.....about generating shareholder return.

Remember that if you or someone you love ends up in the ER with a heart attack. It's nothing but an opportunity to generate shareholder return. Why would we want to change that? Because that shareholder return provides money for research and development some of you are saying. Wrong.

A new study by two York University researchers estimates the U.S. pharmaceutical industry spends almost twice as much on promotion as it does on research and development, contrary to the industry’s claim.

Once we know the facts about our current health care system, changing it will be a no brainer. Which is why Big Pharma is about to do everything in their power to keep you from knowing the facts.

Maybe Montel Williams is the only person they could find who'd lower himself enough to take the job. 

One Reason Why What You Did On Election Day Was So Important.

From Tuesday's New York Times:

WASHINGTON — A last-minute Bush administration plan to grant sweeping new protections to health care providers who oppose abortion and other procedures on religious or moral grounds has provoked a torrent of objections, including a strenuous protest from the government agency that enforces job discrimination laws.

The proposed rule would prohibit recipients of federal money from discriminating against doctors, nurses and other health care workers who refuse to perform or to assist in the performance of abortions or sterilization procedures because of their “religious beliefs or moral convictions.”

You know what? It's against my religious beliefs and moral convictions to get off my ass and go fill any prescriptions today. Because I am morally and ethically opposed to fat, ugly, people like my customers.

I'm getting off point though. Had you not done what you did on Election Day my friends, this wouldn't have been a last minute rule change.

But three officials from the Equal Employment Opportunity Commission, including its legal counsel, whom President Bush appointed, said the proposal would overturn 40 years of civil rights law prohibiting job discrimination based on religion.

Had you not done what you did on Election Day my friends, we would not be at a point where President Wanker has lost control of his own political appointees.

Pharmacies said the rule would allow their employees to refuse to fill prescriptions for contraceptives... State officials said the rule could void state laws that require insurance plans to cover contraceptives and require hospitals to offer emergency contraception to rape victims.

Had you not done what you did on Election Day my friends, I may have been stuck working with a Lloyd Duplantis wannabe at some point in the future, whom I would have had to then beaten the shit out of. Thank you, voters of America, for keeping me out of jail.

Because, voters of America, President Obama.....that's right....I said Pres-i-dent O-bama...will undo this regulatory turd, but had you not done what you did on Election Day, this turd would not have been the last gasp of Bush The Lessor. It would have been him passing on the turd baton to a whole new crop of women haters.

I thank you.  Future rape survivors probably thank you as well.

Bayer Pharmaceuticals Sends Me A Message That Warms My Stone Cold Heart.

It came in the form of an ad In Drug Topics to mark National Pharmacist's Month. Or National Pharmacists Appreciation Month. Or something. Whatever it was it was in October. The ad made it off my pile of unread mail yesterday:

The text on the right is the usual blah blah blah about pharmacists being the most trusted of professionals, which I don't think we are anymore by the way, the gatekeepers of healthcare...yadda yadda yadda....but then there's the disconnect at the end which you can probably make out:

Thank you, Pharmacists. We couldn't have done it without you.

Um, I don't want to appear ungrateful when presented with such a heartfelt token of your appreciation of me, but I do have to ask, because you don't really say....

You couldn't have done what without me exactly? Slightly changed the formula of Yasmin as it was about to go off patent?

I'm pretty sure you did that without me.

Obtain a couple new indications for your *cough* new oral contraceptive, and then not bother to get the same indications for the slightly different version that was about ready to lose its patent protection?

Again, I wasn't involved, and you totally seem to have pulled it off. 

So I can only conclude, Bayer Healthcare Pharmaceuticals, that we either have a major problem with communication here, or you put about as much thought into expressing your, ahem, "appreciation" as goes into those "special gift boxes" of Brut aftershave my employer will sell so many of to the "gotta buy something for the dude I drew in the office gift pool" set this season.

At least with the Brut I could have smelled like a cheap man-whore for a couple hours. I'll think of you Bayer, every time I substitute the Yasmin.  Which I can easily do without you. 

 

I Know It's Not Nice To Make Fun Of The West Virginians, But The West Virginians Make It So Damn Easy.

From The AP wire:

W. Virginia town shrugs at poorest health ranking

HUNTINGTON, W.Va. – As a portly woman plodded ahead of him on the sidewalk, the obese mayor of America's fattest and unhealthiest city explained why health is not a big local issue.

"It doesn't come up," said David Felinton, 5-foot-9 and 233 pounds, as he walked toward City Hall one recent morning.

"But enough about my sex life" he quickly didn't add. "I thought this was going to be an interview about Huntington's ranking as America's unhealthiest city"

God I crack me up. Unlike the West Virginians. Who usually just piss me off every time they put themselves in a position where I can't ignore them. They did do the right thing on election day however by showing the country they are nothing like me or my type. They can continue to show how different they are by dying early while the rest of us live a long and healthy life.

A rare win win situation. You go West Virginia.