An Earth Shaking Change Of Paradigm That Will Rock The Foundation Of Medicine.

Or a least Western medicine. Because the developed world seems to be where all the fatties are.

I'm sure you've heard the news by now my friends. In one fell swoop we are about to take a big chunk out of the nation's obesity rates, and the corresponding complications of diabetes, heart disease, strokes, and people who just look gross. 

For those of you unaware, I will let the cover of the latest issue of Glamour magazine fill you in. The great news is on the left hand side, right under the "8 Really Good Sex Ideas" 

Who would have figured? All we have to do to tackle the biggest public health problem this country faces is get some more sleep.

"I knew my theory seemed counterintuitive to many" Dr. Eric Faulk, a fictional person, didn't really say in the accompanying article. "But when I noticed that many extremely obese people seem to spend every.....goddamn....waking....moment of their lives stuffing Ho-Ho's, Doritos, Ding-Dongs, Funyuns, whipped cream, ham...pretty much any organic material they can get a hold of really, down their throats, then washing it down with a couple liters of Pepsi, I knew that getting these people to pass out would be the only way to cut their calorie count." 

"Some of them did manage to eat in their sleep" He didn't add. "This method will not work for everyone"

Timothy Rothwell, US chairman of the international drug manufacturer Sanofi-Aventis, hailed the new groundbreaking research in a press conference to introduce his company's new product, Bandecal®(zolpidem succinate)

"Sanofi-Aventis is committed to improving the lives of people around the world, and Bandecal® will do just that, for the fat ones, by letting them get the sleep they need to melt away those unwanted pounds. And at only $300 a month, it is quite the bargain, I mean, how much is a totally improved, new, sexy you really worth?" Rothwell,  who by all indications is extremely unattractive, didn't really say.

When asked how Bandecal® differed from the widely popular and inexpensive zolpidem tartrate now used as a prescription sleep aid, Rothwell didn't say "it has succinate on the end, and a picture of a fat person getting skinny on the bottle." The reporter was then escorted from the room.

In the same issue, Glamour's "8 Really Good Sex Ideas" broke the news  that women usually climax during the first 10 seconds of intercourse with little or no foreplay, and that a good way for a woman to arouse her male partner is to ask him to picture his mother sitting naked on the toilet shortly before making love. 

-Special note. Everything in this post is made up except for the picture of the Glamour magazine cover and the unattractiveness of Timothy Rothwell . I hope to hell you knew that already. 

An Ode To Ex's. Or, A Single 40 Year Old Dude Looks Back, Because It's Easier Than Looking Forward.

C1- I hope we never meet again. I always want to remember your perfect 18 year old body the way it looked that night, with the soft morning sunlight starting to filter through the window. The image of you lying there while I wrapped a blanket around your sleeping self will never leave my mind. If I ever see a body that perfect again in the real world, it'll mean I'm an old pervert. Because I'm sure I'm saggier and wrinklier and much greyer than I ever thought I would be back then. I want to remember you the way you were that night though. I hope we never meet again. 

C2- I'm sorry. I'm so sorry and I will never be able to make it up to you. We were too young to get married, although you never seemed to come to that realization the way I did, which evidently shows where the problem was. You're a good person and I sincerely hope you're happy. The best way I can contribute to that though, is by staying out of your life forever. I'm so sorry.

S- I don't wanna be mean, but honestly, if it weren't for what happened for a few nights there, I probably wouldn't remember you at all. I don't want to call anyone a mistake, but what happened was a sign of my failure. 

M- You were a mistake. A big, fucking mistake. You were gorgeous. And selfish. And irresistible. And incredibly cruel. And beautiful. Physically beautiful.  You made me feel special and made me feel like crap at the same time. That takes talent. You taught me the most unnatural way to cry. Staring at a wall while tears just fell out of my eyes without a single sob for hours at a time. I always thought of that as C2's revenge. You didn't destroy me, but I really don't think you made me any stronger either. I was kinda happy the last time I saw you though, and noticed how you hadn't lost any of your baby fat.  You were gorgeous.

Woman whose name I can't remember #1- You were the opening number in my phase. Under different circumstances, yeah, I would have called you back. It takes awhile to recover from a headfuck like the one M put on me though, you know? 

It is kinda cool to say I did it with someone who worked for Victoria's Secret though. 

Woman whose name I can't remember #2- Yeah, I was in my phase, but honestly, under normal circumstances, no, I probably wouldn't have called you back. Jesus I never knew a woman could snore so loud. 

Woman whose name I can't remember #3- I'm kinda sorry. Maybe. It was probably wrong, after we saw that Sikh man wearing his turban, and you said. "God those Arabs who go around with that shit on their heads after what happened on 9/11 piss me off," to make the decision to woo your heart so I could purposely crush it. I only say that because I remember how much it hurt staring at that blank wall with silent tears rolling out of my eyes. But the fact remains not only were you a bigot, you were too stupid to even direct your bigotry towards the correct ethnic group. I suppose I'm sorry. A little. 

D- When we met I couldn't figure out if you were hitting on me or just trying to sell me a house. I guess since you vanished after the final papers were signed I have my answer. Jesus it was hot though. Your hair alone almost makes it worth considering buying another place. 

Woman whose name I can't remember #4- An encounter at an airport hotel with a PETA activist and model. The luckiest goddamn night of my life. Christ I can't believe I lost your number. Like you would have called me back anyway.

Woman whose name I can't remember #5- How many guys can say they've scored with TWO models! TWO! Jesus I had no idea you models smoked like chimneys though. Being with you was a constant search for where you were in all that smelly tobacco haze. That's what I remember most. 

M2- I was still in my phase, and you were not. I'd feel worse about it if you wouldn't have turned out to have been nuts. 

Woman whose name I can't remember #6- This one's embarrassing, as I really should remember your name. I mean, we saw each other a lot. I did work around your house. I think this one's a sign of me getting old as opposed to the impression you left on me. I liked you, really. And you did give me the best reason ever for being late to work. 

K- The end of the phase. An attempt at a real relationship that never should have been made. Three years and at the end all there was to show for it were two people who tore each other up emotionally like two cats put in a sack. We would have made great friends, but we sure as hell never will be now. Sigh. I hope you're well.

A- The undisputed, unchallenged, queen of hair. My dear you were a hair freak's dream come true. I wish circumstances had been different, and I hope things are better for you now. If they're not, for the love of God give me a call. 

H- I liked you, and ummmm.....yeah....it was way hot. I don't think I was ready for you yet though. You gotta admit we live on two different planets. I've got your book though. Autographed and everything...:)

To be continued.....I guess. 

Happy fucking Valentine's Day.  

I'm Not In A Good State Of Mind, But Still, A Good Quickie Is A Good Quickie.

So, I know I've been off of late, and I know why. Personal stuff. The kind of thing that consumes you when you're a part of it, but doesn't make for very interesting reading when you're not. I'll give you a clue. Here's how a good percentage of my thoughts at work of late have gone......

Looking down the card aisle from the happy pill room.....

"YOU'RE looking for a Valentine? YOU? Awww Jesus Christ monkey....."

5 minutes later........

"Oh holy mother of fuck.....look at that disgusting fat slob. You mean to tell me HE has someone who calls his sweaty ass a Valentine?"

I then go and check outdates for 15 minutes. I haven't checked outdates since I was an intern. I have to sneak another look......

"I am seriously going to hang myself. If that son of a bitch is getting some I am totally going to hang myself"

Not that I'm bitter. 

And not that I still can't appreciate part of a serious news story that sounds like a joke. From yesterday's New York Times coverage of allegations of possible wrongdoing in the recent corruption trial of Alaska Senator Ted Stevens:

For example, a witness for both the government and defense, Rocky Williams, was sent home to Alaska by prosecutors who did not tell defense lawyers, an act that angered Judge Sullivan. Ms. Morris said the decision was made because Mr. Williams was gravely ill, not because prosecutors, after interviewing him, had decided he might help the defense case.

Still, there is considerable evidence that Mr. Williams was truly sick, including the fact that he has since died.

I'll be better soon. Just as soon as the dregs of humanity stop rubbing their public acts of the birth ritual in my face. Which may be never. 

I wonder if there was a Mrs. Williams? 

Book Review #3. I Bet No One Has Ever Told The People At Q-Fever They Are The Onion Of Medicine.

I'm kidding. The phrase "The Onion of Medicine"  is the obvious one that comes to mind upon seeing Q Fever!: Medical Humor & Satire For Healthcare Professionals. I'm sure it's been said a lot. That's really not fair to Q Fever! though, because comparing something to The Onion is a sure fire way to make something look inferior. The Onion is the funniest fucking entity on God's green earth, and anything that goes up against it will be crushed.

So I totally won't say anything like Q Fever! Is like The Onion of medicine. Even though it's a book full of fake news stories. Kinda like The Onion. Except about medicine.  

And I won't point out that just like in The Onion's early days, sometimes the entire joke of a Q Fever story is contained in the headline, "Study: Obesity a Risk Factor for Pants Ripping in the Ass." Chuckle chuckle. Really no need to read the rest of the page though, you get the joke. There are more than a few shoot scotch through the nose moments however, such as when my sinuses got the alcohol rinse treatment upon seeing "Heart Transplantation Study Halted Abruptly; Transplant of placebo 'a disaster' researchers concede."

There are also parts that aren't like The Onion. There are top 10 lists, which are more like a rip off of David Letterman. I don't mind that though, as I kinda wish Dave himself would rip himself off from 20 years ago more. And the lists are kinda funny. Five of the "Top 10 Ways To Quit Smoking:"

-Cold Turkey

-Nicotine Patch

-Smoking Cessation Classes

-End-Stage Emphysema/COPD

-Widely Metastatic Lung Cancer

There are also case studies that invariably end in bad puns or photoshop gags, which you won't find in The Onion. Which means you could maybe kinda make a case for Q Fever! not being The Onion of medicine. Even though it kinda is. 

Or I should say was. The book is a collection of highlights from the Q-Fever! website, which is kinda like The Onion's, except geared towards medicine, and work on the website seems to have abruptly halted in 2005. There's some good stuff there though, and I would totally recommend you check it out. And if you're the type, like me, that keeps a little reading material around at work so you don't have to look at customers when not actively filling prescriptions, then the Q-Fever book should be right up your alley. 

Just like The Onion. 

Special Thanks to The Alert Reader who sent a copy of the book my way. 

A Quickie. It's Late And My Time Is Short.....

From today's New York Times......

Demand for lithium, long used in small amounts in mood-stabilizing drugs and thermonuclear weapons....

Some nights you catch a break and the posts just write themselves. Even if they are short. 

I Decide It Is Better To Light A Candle Than To Curse The Drug Topics Darkness. Drug Topics Blows Out My Flame.

I've abused Drug Topics, the leading pharmacy trade magazine, here in my blog garden more than a few times now, and like I've said before, the only reason I do is because they suck. The writing is sub-par, the topics less relevant to actual practicing pharmacists with each passing year. You may be shocked to hear this, but there was a time when I took Drug Topics home with me to read after work. That time is long gone. The only thing Drug Topics gets these days is a quick glance through to see if I can find any mockable potential blog material. I usually do. 

Now you all know Jim Plagakis is the exception that proves the rule. Jim is an outstanding writer and by all indications a stand-up guy. Drug Topics could save a lot of time and expense by just mailing out Jim's column and sparing us the rest of the magazine. 

I'm looking to eliminate negativity from my life though. Instead of just sitting around bitching, I thought awhile back, why don't I look for a way to help? I went to the Drug Topics website and found this under "Author Guidelines": 

"Viewpoint,"... consists of guest editorials written by pharmacists who have strong views on a given pharmacy-related subject. These commentaries should be 750-1,000 words long, and should be accompanied by a photo of the author

Hmmmmm.....well.....I have been known to have strong views on subjects from time to time, and I certainly should be able to string together 750 words. Gosh darn it, I'll do it!! Drug Topics, I'm here to help!!

I submitted a piece on January 3rd. And have heard absolutely nothing back. So much for that. Instead of using the term "rejection" though, I prefer to think of it as "The article too hot for Drug Topics to handle." Here it is:

I’m going to start by going out on a limb here. I’m going to say that the magazine you are holding in your hands right now is full of images of smiling, happy, pharmacists calmly serving happy, smiling patients. Probably as part of an article about how we can help patients manage their lives with diabetes or maybe make ten dollars by telling people to quit smoking. Why can I say this? Because almost every pharmacy magazine I have seen since the day I entered pharmacy school has covered some sort of story like this, with pictures of happy, calm, pharmacists and happy, calm, patients, in almost every issue they have printed. They are doing the profession a disservice.

Did you have a happy, calm day at work today?

Put down this magazine and take a look around the pharmacy blogosphere, where actual working pharmacists speak their mind every day without fear of rocking the boat or upsetting advertisers. What you’ll find is a plethora of blogs with names such as “The Angry Pharmacist”, “The Angriest Pharmacist”, or “Your Pharmacist May Hate You” You won’t find many pictures of smiles or serenity, or much talk about the latest ideas to implement Medication Therapy Management. At the point where the rubber meets the road, or rather, where the pharmacist meets the patient, pharmacy is a powder keg ready to explode, and everyone reading this magazine knows it, even if this magazine never bothers to mention it.

Something needs to change, and we can start by stopping the OBRA charade. I have no doubt that any pharmacist worth the paper their license is printed on will intervene to stop a dangerous situation. A serious drug interaction, an overdose, drug seeking behavior, none of that gets out the door, but I also know next to none of you are doing the complete nine-point OBRA counseling required with each new prescription. If you are, you work for an independent with a revenue stream separate from the filling of traditional prescriptions or for a chain outlet that is falling far short of its corporate business goals, Because you can’t do complete nine-point OBRA counseling and meet any corporate business goals that allow that corporation to raise its stock price. Because the insurance industry does not value your professional obligations enough to pay you to meet them. Neither do the corporations that pretend you can meet your professional obligations for $4. So we end up holed up behind the computer watching its productivity graph turn red, telling us we’re spending too much time with each prescription, trying to keep up with the flood of faxes, trying to keep up with the number of phone lines that exceed the number of pharmacy employees on duty, and hoping that our technician who just had his hours cut can steer the patient towards checking the box that says they didn’t want any counseling anyway.

Because there isn’t a graph on the computer that tells us when we’ve met our OBRA mandates, only a graph that tells us how many prescriptions we’ve managed to get out the door.

It doesn’t have to be this way. I used to work the graveyard shift for one of this country’s major pharmacy chains. I had a regular customer who told me she woke up early on days when she had to go to the drugstore because she knew if she came in at 5 in the morning she’d be able to talk to an actual pharmacist. A small chain in the city where I now work has advertised among its “5 reasons to being us your next prescription” “The ability to talk to a pharmacist” If a little old lady will get out of bed to make sure she can talk to one of us, if a nimble, start up business free from the constraints of old thinking can advertise access to one of us as a competitive advantage, that tells me people want us to meet our professional obligations, and there is money to be made by doing so. My gut tells me most of us want to do so as well, but first we have to break the paradigm that says professional obligations and corporate business goals are incompatible. The truth you’ve yet to read in this, or any other trade magazine, however, is that the gap between corporate business goals and our professional obligations to the public seems to be growing by the hour.

I’m afraid an explosion is coming.

I guess I can't blame Drug Topics for not publishing an article that kinda insults them. I'll also guess however, that it's better than anything you'll see in their next issue. 

Except maybe Jim's column. 

It All Started With The Intern.

Note to those not in the profession. Clomiphine is a commonly used fertility medicine. Clomipramine is an anti-depressant with a rather interesting side effect. Keep that in mind as you read the following story, which is completely fictional. 

Clomiphene, Clomipramine. You have to keep an eye on your interns. They are more often than not good souls, but words like clomiphene and clomipramine can look alike to them. The intern didn't know. He grabbed the clomiphene, and the woman was so excited she didn't notice. Excited because she was one of the lucky 5% or so of regular clomipramine users who got the side effect of spontaneous orgasm upon yawning. She wanted to get her prescription and get home to yawn as soon as possible. Yes, the pills looked different, but she yearned to yawn. 

Last night though, the yawning wasn't enough. She decided she needed some good sex. Fortunately she was happily married, which meant it would be easy to slip off to the meat market while her husband slept in front of the TV. She was marketed, but there was Plan B. The intern dutifully checked her ID, and the woman went home to wipe out the memories of the night before and to yawn. Except she got the wrong med. Clomiphene and Plan B were both making their way to the woman's ovaries. The woman yawned deeper and deeper, unaware of the battle that was about to rage inside her. 

The clomiphene arrived first and did what the clomiphene does. Any estrogen that didn't flee the neighborhood was immediately put on lock down. Follicles were stimulated. Eggs were released. Far too many eggs. 

The Plan B pulled up in a tricked-out Honda Accord, blue bandanas flying freely in the ovarian breeze. As soon as they saw the red colors of the clomiphene showing, they knew there would be trouble. Disrespect was in the air. Signs were exchanged. Slogans shouted. There was a shotgun blast. And then the flood. 

The yawning just wasn't working, and the woman decided she would have to settle for sex with her husband. It would only last a little longer than a yawn anyway. Sperm cells are the worst thing to inject into a gang war between clomiphene and Plan B. 

P'dawg made a mistake. He ordered his troops to concentrate on altering the tubal transport of sperm. But there were too many goddamn eggs. He should have focused on altering the endometrium. Before he realized this he was stabbed to death by C'diddy in the gang fight. There were too many eggs. 

The intern was drunk at an after work party failing to get laid. A baby girl named Wendy was born 9 months later.  Wendy would go on to become a pharmacist for CVS, the promise of her young life traded for a $20,000 signing bonus. The intern became her District Manager. 

Always check your labels carefully my friends. 

You Were Wrong My Friend

It came to me the other day:
Were I to die, no one would say, 
“Oh, what a shame! So young, so full
Of promise — depths unplumbable!”

Instead, a shrug and tearless eyes
Will greet my overdue demise;
The wide response will be, I know, 
“I thought he died a while ago.”

For life’s a shabby subterfuge,
And death is real, and dark, and huge.
The shock of it will register
Nowhere but where it will occur. 

-JOHN UPDIKE

No. The fact an old man was able to string together such a set of words gives me hope, cause I'm getting kinda old. 

You'll be missed Mr. Updike. I hope you knew that. 

Go buy a copy of Rabbit, Run right now. 

Maybe There Is Something To This Astrology Stuff.

I may be the only person left who subscribes to the paper version of The Onion. I love The Onion. I would marry The Onion and have all The Onion's babies.  I recently let my subscription lapse, and today got my first issue in about a year or so. This was my first Onion horoscope:

Avoid confrontation at work today. Sneak up behind your boss and slowly strangle him to death.

 

BWWWWWAAAAHHHHHAAAAHHHAAAHAHAAAAAA!!!!!!! 

And so fitting.....

Updated: I Am Fucking Tired, So The Quality Of This Post Will Suck. But I Feel Bad For Teasing You. My Personal Story Of Trying To Do The Rite Thing.

Because at work I like to keep things personal. 

I think most of us in the profession can agree that making an effort to not have our customers become addicted to benzodiazapines would be the Rite thing to do. Our duty as health care professionals even. I think we can all agree on that. 

At least I thought we could all agree on that. Evidently there is at least one exception. My Pharmacy District Manager, with whom I really don't have a personal relationship. I've never met him. He was of no Aid to me when I tried to do the Rite thing though. Benzodiazepines are high markup items, so maybe he's thinking the company needs the money. He could be right about that part.

Customer wanted a refill of temazepam that was filled 4 days ago for a 90 day's supply. While the other pharmacy was being contacted to confirm said 90 day supply was indeed picked up, the customer EXPLODES, and contacts the corporate office. She managed to find the Rite number to call without much Aid. 

It's taking awhile to confirm the 90 day prescription. It was dispensed from a big mail-order outfit. I don't have to tell you what it's like to navigate through an organization like that to even find a person, much less one whose head is not up their ass. 

I should say at this point I am asleep while all this is happening. I usually sleep until around 2 in the afternoon. 

I should also say at this point the Pharmacy District Manager ORDERED THE OTHER PHARMACIST TO FILL THE PRESCRIPTION. Ordered the other pharmacist to dispense a 30 day supply of a controlled, habit forming medication when there was reason to believe a 90 day supply may have been dispensed 4 days before. A Pharmacy District Manager ordered this, which makes me think he may not be the Rite man for the job. Or perhaps he needs some Aid in his position. 

The other pharmacist buckles. Don't blame her. She's here on an H-1 visa and if she's fired she's deported. She's also a good person and perhaps the best pharmacy manager I've ever worked for. 

In stumbles the Drugmonkey in a caffeine-deprived haze. The other pharmacist is upset and doesn't want to talk about it, then leaves. At this point, the refill Rx has been filled, just as the District Manager ordered, and is ready to be picked up. The staff fills me in on the situation. 

Step 1) Grab that refill off the shelf and make sure it ain't going nowhere. 

Step 2) Sharpen the Drugmonkey claws. 

I called the large mail-order operation and found someone with their head nowhere near their ass. There is a person working at a large mail-order operation whom if I ever meet in the real world, I will take out for dinner and as many drinks as they'd like. They were able to confirm delivery of the 90-day package and that it was signed for. As Kramer would say, Giddyup. 

Oh, and the two prescriptions were from two different doctors. 

I called the customer to tell her we would be unable to fill her 30 day refill request. You know what the customer said? The crazy customer who went ballistic only hours earlier? 

"I understand. Thank you for calling."

Do you know what my District Manager said when I told him this? After putting me on hold for half an hour? That we still didn't have the power to deny the customer an early refill. My conversation with the customer was far more rational than the conversation I had with my District Manager. That's the saddest part of this whole episode.   

The conversation with the District Manager quickly devolved into a semi-screaming match, at the end of which I reminded my District Manager there was a poster in every pharmacy in the state of California that spells out in clear terms the circumstances under which a pharmacist can refuse to fill a prescription. Preventing harm to the patient is one of them.

"Send me what this poster says in an e-mail" Said The District Manager who has sent out dozens of e-mails to every store he manages telling them the exact place to hang these posters. This was his way of blowing me off and ending the phone conversation. 

My first thought was that my District Manager was a rookie under pressure from above to kiss customer ass who had a decision to make and blew it. After this phone conversation however, I realized I was wrong. He is a smug, arrogant, cocky power hungry bastard who has turned this into a pissing contest for no other reason than the need to feel his dick is bigger. He also is not an unintelligent man, which concerns me. I'm used to District Managers being kinda dumb and overwhelmed. 

At any rate,  I spent Friday in a nasty flame war with my District Manager. If I get fired, maybe I'll publish some of what I wrote here. There's some good stuff in there. 

That's where it stands at the moment. A District Manager for a major pharmacy corporation maintains he has the power to order pharmacists to give out early refills of controlled medications. 

Again I ask you Dear Readers, who the fuck needs cable? There is drama all around. I'll keep you posted. 

Update 1/30- After almost a week, the District Manager decided to say he did not, in fact, order the other pharmacist to fill anything. The other pharmacist had documented in the patent's profile notes, however, that the DM did indeed order her to fill the early 30 day refill. Determined not to let him slip out of this, I sent an e-mail to the DM pointing this out, and thanking him for teaching us the importance of documentation. A meeting was held between myself, the other pharmacist, and the DM. The District Manager claims it was a case of miscommunication. The other pharmacist maintained she most certainly felt as if she was being ordered to fill this prescription. I made the District Manager look me in the eye and say he did not have to power to force a pharmacist to fill a prescription against his or her professional judgement. Outcome acceptable. Situation stable. For now.