Highlights From The Weekend's Pill Counting Action.

Friday started as a day of hope. Because as you have no doubt picked up on if you have spent much time at all here in my little blog garden, I am nothing if not a creature of hope. Perhaps as I slept, I thought to myself, a cure for everything had been developed, rendering me obsolete in the new state of health care nirvana the world now found itself in. True, I would be unemployed, but thanks to the cure for everything I could be assured that I would always have my health, plus I could sleep in. I decided I would take that deal, and I crossed my fingers. A guy's gotta have hope. 

Then I realized that even after the cure for everything was developed, my employer would still need someone at the back of the store to tell people where the bathroom is. I got out of bed and left for work. 

Fifteen minutes into the workday my keystone tech informed me there were no bags. In the pharmacy or in the backroom. This happens a lot. The fact we will need bags to put the purchases of each and every customer that buys something into seems to come as a complete surprise to the store's management each week. Perhaps they were expecting no customers for the next 7 days. That would explain their staffing level. I walked to the front of the store, where the only non-pharmacy employee on duty was manning the cash register. I stole his bags. Right in front of him. I took them all and did not apologize. On my way back to happy the pill room I held the bags over my head as if they were the head of a vanquished enemy. Later on I wondered what the store did to meet their entirely predictable bag needs. I never asked, and the store's management has learned not to bother me with trivial details like the fact I steal their supplies. 

As I entered the cure center, the day's first customer was having a lengthy discussion with my keystone tech about whether you could tell if he was a woman dressed up as a man. "There are places in San Francisco where you totally can't tell!" he made the point with great emphasis, and while I don't doubt this is true, I couldn't help but wonder why he seemed so anxious to talk about it. On a Friday morning. This is usually the subject matter for a Friday night. 

Then the same customer didn't want to touch the store's pen to sign his credit card slip because "it's diseased," leading me to believe he was still up late from the night before.  His type usually aren't early birds.

Later that day I waited on a mall security guard who requested easy open lids for his prescriptions. That made me feel more secure.  

Customer approaches with two bottles of Mylanta. "Which is stronger, Ultimate strength or Maximum strength?" I really couldn't blame the customer on this one. Turns out Ultimate trumps Maximum. Unless you have gas. 

Sometime Saturday a man approached the counter, again with two products, one an ointment and the other a cream, and asked, "One of these is creamy, right?"

"Yes, the other would be more like Vaseline" I said. 

"Well which one's creamy?"

Sometimes my friends, you will find yourself in situations dealing with the general public where you really don't want to be a smartass, but you have no choice. I didn't know how else to say it. 

"The one that says cream"

"OK, thanks a lot!" said the happy customer. Like I had just enlightened him on the principle of quantum mechanics. I went to college 5 years for that. I skipped a lot of class, but believe it or not, it never catches up with me most days. 

Also on Saturday a lady whose insurance claim rejected asked "Do you think it could have something to do with how I haven't paid my premium this month?" I said maybe. Didn't want to put any words in the insurance company's mouth. 

Maybe that actually happened on Sunday. Fuck, I can't remember anymore. 

Also on Saturday and/or maybe Sunday the fat lady who waddled up to the counter said she just couldn't understand why no pharmacist she had ever talked to recommended the Hydoxycut to lose weight. Seriously, she was well north of 300 pounds. I just weighed myself today and discovered I've dipped under 170. It made for such a great visual. Maybe I can steal the stores security camera footage the way I steal their bags and post it here for you. 

It was definitely Sunday when I had my frustrating conversation with the insurance company help desk wage slave who sounded like he was talking to me from Mumbai. Way too friendly to be an American this dude was. After mad investigation of an incredibly perplexing problem, Mr. Mumbai and I determined its source to be my employer's software. Meaning I would have to call my employer's computer help desk. My employer's computer help desk would be about as helpful at solving problems on a Sunday afternoon as my cat Spooky. "Ah shoot, I was afraid you were gonna say that" I semi-sighed. "Wish me luck."

"Very good luck on your quest Sir" said Mr Mumbai, and the weekend ended as it began, with a glimmer of hope. Not from me, but from halfway around the world. It certainly wasn't the cure for everything, but I decided I would take it. 

Because I am nothing if not a creature of hope.    

I Think The Last Part Of Me Died This Weekend.

It's been happening bit by bit for the last 17 years. With every prior auth, with every "that's not what I paid last time", with every "where are the....tubes.....you know....that you put under your car....?", a little bit of me has passed into the great beyond. But when I told the nice lady customer that it would be about 20 t0 30 minutes to get her prescription filled and she responded by asking, 

"So when can I pick it up?"

I felt the last part of me go. Dying isn't nearly as negative of an experience as we've been led to believe. I felt myself being pulled upwards. Soon I was floating, up towards the pale fluorescent glow tubes ubiquitous in any large scale commercial retail setting, up towards a world where babies don't spit up and puppies don't have accidents on the floor. There's no food after you die. Which sucks if you appreciate a good ribeye the way I do, but the trade off for an existence minus any vomit or poop makes it worthwhile I think. I looked down and saw a little old grinning man. He was approaching the pharmacy......slowly......slowly....grinning and hobbling....waving a card as he inched towards the counter. 

I continued upwards. Past the glow tubes and towards a rainbow. Not a rainbow that shines off a pot of gold, as there is no need for gold after you die. And not a CVS rainbow either. Witnessing the CVS rainbow was in and of itself cause for a couple pieces of me to die awhile back. My rainbow was beautiful. I was at peace. 

"DRUGMONKEY LINE ONE!!!" snapped me out of it. It took me a second to get my bearings. The old man was in front of me now. Still grinning, and waving his card for Mucinex-D in front of my face. My keystone tech must have given me CPR. Bitch. I'll have my revenge, even though I'm sure she thought she was doing the right thing. 

Or else I'm some sort of zombie now. Which would be kinda cool really. Does that mean I have to eat brains? I don't think I've ever had brains before. What about mad cow disease? 

Wait. I'm already dead. I forgot. I guess I'll have to start worrying about the contents of my GI tract and disposing of them properly again. I wonder what poop made out of brains looks like?  

Savella.™ The Wonder Drug That Works The Wonder Of Emptying Your Wallet For Little Apparent Gain.

I'm excited about the upcoming release of Savella™ (milnacipran), the new drug from Forest Laboratories and Cypress Bioscience to combat the suddenly oh-so-fashionable plague of fibromyalgia. I'm not excited because Savella offers the prospect of relief mind you, but for precisely the opposite reason. Something tells me this med is gonna warrant the unveiling of the hottest sales reps ever in order to convince much of anyone to actually write a prescription for it, and hot sales reps are cause for excitement in the happy pill room. If you saw the customers I have to look at all day long you'd know why. From The Rx Consultant, which for some reason gets mailed to me every month. I have never once to my knowledge asked for a copy of The Rx Consultant.  Maybe I subscribed when I was drunk or something. That would be depressing. Getting drunk and subscribing to trade journals. At any rate:

In the 15 week trial, response rates were about 19% in both milnacipran groups and 12% in the placebo group. At the 15 week point in the longer study, response rates with milnacipran (both doses) and placebo were about 15% and 9%, respectively....At 27 weeks, however, there was no significant difference between milnacipran and placebo.

Now I know what the fibromyalgics amongst you are saying; Wow! A 7% chance this stuff will work better than a placebo! And a whole 6 months before there's no difference from placebo at all! Tell me more!*

Happily:

The most common adverse effects of milnacipran, compared to placebo, have been nausea (37% vs. 20%) ... constipation (16% vs. 4%),  hot flush (12% vs. 2%)....

So.......lets recap. You ask your doctor if Savella™ is right for you, and if he decides it is, he'll hand you a prescription for something that's over twice as likely to make you feel like puking than it is to give you any relief. About 25% of people in the clinical trials of Savella™ dropped out because they couldn't handle the side effects by the way.

Oh, and it blew some people's livers out too. No word yet on how much Savella™ will cost, but I mean really, can you put a price on the value this type of thing adds to the practice of medicine? Hell, I wish I had fibromyalgia now so I could get me some of this action.  Actually, I think I do, since the most common way to diagnose fibromyalgia is for the patient to announce they have it, yes, I definitely do. 

On second thought never mind, I'll just look forward to seeing the sales reps. 

*You and I both know this is wrong. Most of the fibromyalgics among us are probably saying things like, "Bring me some ho-ho's!!" or "My dog ate my Vicodin!!," but for the sake of this post I'm pretending like fibromyalgia is a real condition. 

His Giant Pointy Nose Burrowed Into My Very Soul.

It was disturbing. Tonight's Jack In The Box mystery.  I know my diet isn't what it should be, and I always kinda knew I spend too much time with Jack,  but still...something happened tonight, and I have to admit, it kinda shook me there for awhile. 

Because there was no reason for him to know. The drive through guy. He had "chicken teriyaki bowl" up on the screen before the words came out of my mouth. Yes, I'll complete the confession here and tell you I eat at Jack In The Box....a lot. But I don't always get the chicken teriyaki bowl. I quite often get the egg rolls. Sometimes I get the appetizer sampler, because every once in awhile setting your mouth's nerve endings on fire with jalapeño is the perfect end to the masochistic experience that is work. I don't have the greatest variety in my ordering habits, true, but I don't always get the teriyaki bowl. Yet there the words were, staring back at me before they escaped from my mind into the world. The drive-through dude had nailed it, and not for the first time. It was a tad frightening. I couldn't help but wonder if  perhaps I was becoming schizophrenic, as the idea that maybe Jack In The Box was monitoring my thoughts in conjunction with the CIA and Queen Elizabeth with the latest in spy-satellite technology started to make sense. I'm not quite prepared for insanity yet though, so I had to convince myself everything was OK by finding an alternate answer. Asking the drive through dude was out of the question. Asking a question like that is very close to asking for directions, and I don't have to tell you men are honor bound to never ask for directions. It makes you look weak, and I could not let drive through dude know he had this power over me. So I started to ponder as I picked out the broccoli lying on top of its bed of rice. 

Always eat the healthiest part of a fast food meal first, as it frees you up to take in the full joy of fat and MSG that awaits you. Especially when you're as hungry as I was this night. 

Especially when you're as hungry as I was......yes.....I was starved tonight....seeing as how I had been awake 15 hours and all I was running on was a downsized Denny's omelet platter. And when I'm starving....I always get.....the  bacon and cheese ciabatta burger. An obscenely large sandwich. And I couple it with the biggest side I can find. Because I'm starving. 

The teriyaki bowl. The largest side I can find. An order for the ciabatta burger is always followed by an order for the teriyaki bowl. Drive through dude had figured this out before I did. This night I have come to the realization that the people at Jack In The Box may know me better than I know myself. I'm not sure knowing the answer to the teriyaki bowl mystery does a lot to put my mind at ease quite honestly.

Evidence The New York Times Monitors My Every Move.

From Today's Op-Ed by Paul Krugman, written, I shall point out, one day after this post by myself:

Republicans have become embarrassing to watch. And it doesn’t feel right to make fun of crazy people.

While I share the feeling, I do wish The New York Times wouldn't rip me off.

Dipping Into The Mailbag And Feeling The Love.

Got this one in response to my last post about Scott S. Reuben, the Massachusetts anesthesiologist who's been faking drug studies for the last 13 years:

Why don't you associate your beloved administration with these issues? Four months ago you had no problem tagging the evil Bush Empire as the cause of all your rants.

Let me guess, this administration needs some time to sort it all out right? Interesting your blog continues the same rant but you disassociate the current administration from having any involvement in the exact same activities as the last.

The anonymous one is right of course. The Obama administration has totally dropped the ball on the obvious solution to this problem. Building a time machine to travel back to 1996 to stop Dr. Reuben at the point where his career went wrong. Call the White House comment line at 202-456-1111 and demand an end to the time machine delay.

More incriminating is the fact that Obama served as a research assistant for Dr. Reuben starting in 1997. If of course by "research assistant" you mean "member of the Illinois State Senate" No one can deny the fact that the best position from which to stop a researcher from making up data is as a member of a state legislative body 1000 miles away. Yeah. This one totally falls on Obama. If he had any sense of responsibility, any desire at all to fix this problem, you'd think he'd be trying to shore up the dysfunctional agency responsible for overseeing the approval of new drugs in this country.

Except he is. To the tune of an extra $1.1 billion to go towards the review of new drugs this year. Which makes this particular hate mail kinda.....bizarre. And to think four years ago I was scared of these right wing fucks. These days....I just kinda feel bad for them, almost like I want to help them come up with an argument that is at least coherent.

Drugmonkey shakes his head and walks away, nostalgic for a time when Republicans were at least smart enough to come up with a lie. Sigh.

Big Pharma Steps In To Tackle A Problem That Threatened To Rot The Foundation Of Medical Science.

So.....I knew this day was coming. I've known this day was coming for years. This is probably the least surprising bit of information I've ever written about. From the Health Blog of The Wall Street Journal:

A prominent Massachusetts anesthesiologist allegedly fabricated 21 medical studies involving major drugs....

...Baystate Medical Center in Springfield, Mass., has asked several anesthesiology journals to retract the studies, which appeared between 1996 and 2008, the WSJ reports. The hospital says its former chief of acute pain, Scott S. Reuben, faked data used in the studies.

Some of the studies reported favorable results from use of Pfizer’s Bextra and Merck’s Vioxx, both painkillers that have since been pulled from the market. Others offered good news about Pfizer’s pain drugs Lyrica and Celebrex and Wyeth’s antidepressant Effexor XR. Doctors said Reuben’s work was particularly influential in pain treatment and that they were shocked by the news.

Yeah. Shocked. Because the line from manipulating data you don't like to just making up your own data would be such a hard one to cross.

Not to worry though. The Pharmaceutical Research and Manufacturers of America is on top of things, and has taken bold, decisive, action to address this problem. No more free pens.

"It was the free Celebrex pen that started it all" Dr. Reuben said in an interview that took place only in my mind. "It was such a pretty blue and it clicked up and down way better than the cheap-ass Motrin pens I had to put up with when I was in med school. I grew to hate Motrin, and once I had that sweet, sweet Celebrex pen in my hand, I knew I must have revenge on Motrin and its crappy 80's pens"

So rest assured medical consumers of America, the fact that a doctor will never again have a pen emblazoned with the logo of Viagra, even though it will be legal for him to cash checks for tens of thousands of dollars from Pfizer for "consulting" work, will somehow keep researchers from ever making shit up again. After all, making shit up in drug studies is without a doubt the biggest problem the pharmaceutical industry could face. So I'm sure whatever they're doing, like banning free pens, is meant to address the problem of researchers making shit up.

Either that or the pen ban was meant as a distraction to take up space that would otherwise be used for stories about things like researchers who make shit up. One of the two.

Fuckers.

I Wonder If I Sold Shares Of Stock In Myself, The Way Pfizer Did, I Could Get Away With Murder, The Way Pfizer Did?

I think I would list my shares on the NASDAQ. It seems like all the young, hip, sexy companies are listed on the NASDAQ, and I am nothing if not young, hip, and sexy. On the other hand, Pfizer is listed on the New York Stock Exchange, and if I want to kill people and get away with it, the way Pfizer did, maybe I should list myself on the NYSE, like Pfizer does. Maybe there's something in the fine print of the contract that gets your stock on the big board that lets you kill people. Like Pfizer did. 

At this point, many of you are probably waiting for an explanation. Here it is, from Saturday's Washington Post:

Pfizer has reached a broad agreement to pay millions of dollars to Nigeria's Kano state to settle a criminal case alleging that the drug company illegally tested an experimental drug on gravely ill children during a 1996 meningitis epidemic.

The details remain private, but sources close to the negotiations said the total payments -- including those to the children, their families, the government and the government's attorneys -- would be about $75 million under the current settlement terms. Other details, including how the money will be distributed, are to be worked out within weeks.

Nigerian authorities say Pfizer's infamous trial of the antibiotic Trovan killed 11 children and disabled scores more. The world's largest drug company says the deaths and injuries were the result of meningitis.

Here's a neat game. Imagine what would happen to you if you were responsible for the deaths of 11 children. Or for that matter, what would have happened if Pfizer had killed 11 American children. Visualize this for awhile and you'll start to see why I am so anxious to get my IPO off the ground. Because when you're a multinational corporation, as opposed to a mere human, you can go shopping for where life is the cheapest. Kinda like when I go to Wal-Mart to save a nickel on Windex. Except when Pfizer goes shopping people end up dead. I would like to have this ability. The way Pfizer does. 

But wait, it gets better:

Nigerian lawyers close to the negotiations, held over the past year in Nigeria, London and Dubai, told The Washington Post that Pfizer set a number of conditions, specifics of which remain undisclosed.

Soooooo....when you're a corporation, as opposed to a human,  on the off chance that there is some modicum of accountability when you kill people, you get to set conditions before agreeing to your own punishment! Sigh. I'm tired of being snarky. Fuck this shit. 

An attorney for the Nigerian government who spoke on the condition of anonymity said a sticking point in recent negotiations was Pfizer's request that authorities absolve the company of wrongdoing.

Absolve the company of wrongdoing. 

...the company relied on a falsified ethics approval letter. Researchers also gave children substandard doses of a comparison antibiotic, the articles added.

Fuck. You. Pfizer. I don't care if you can make my willy hard. 

Wait, maybe I'm being unfair, after all, this company does have the power to make my willy hard. Let's see what Pfizer has to say:

Pfizer defended its drug trial in a 2007 statement, saying it was conducted safely, legally and "with the full knowledge of the Nigerian government." The company said Trovan demonstrated the highest survival rate of any treatment at the field hospital.

Remember the part about substandard doses of a comparison antibiotic?  Yup. Pfizer defended itself by saying its antibiotic did better than than another that was being given at too low of a dose. The result? Pfizer gets fined about 14 hours of its fiscal 2008 revenue. The equivalent of fining me about $750. 

Except I didn't forge anything. Or design a flawed scientific study. Or kill anyone. Like Pfizer did. 

I need to talk to a lawyer about incorporating myself tomorrow.  

Thanks to The PharmD Student for pointing me to the story. 

It's A Short Night For Me, Which Means You Get A Quickie.

From an op-ed in Tuesday's New York Times exploring the legacy of the ancient Greek philosopher Diogenes the Cynic:

When asked by Lysias the pharmacist if he believed in the gods, (Diogenes) replied, “How can I help believing in them when I see a god-forsaken wretch like you?”

Somehow......I find it comforting to know the respective attitudes of pharmacists and customers towards each other have remained remarkably stable through the millennia.

I'll bet you anything Diogenes' prescription got moved to the back of the line after that. And that Lysias may have "forgot" to send a prior auth fax to Diogenes' doctor.

Not that I've ever done such things.

Good Communication Is Vital If You Are Running A Rouge State.

Because honestly, if you are a member of the axis of evil, you have an image to uphold. You need to sound ominous. Fearsome. You want to send a chill up the spine of the world with your words. When you do something that shows your contempt for civilization, like stomping on the right of free speech by arresting journalists in the midst of their work, you don't want to ruin the moment by saying something like this:

Ms. Ling and Ms. Lee, reporters for Current TV, a San Francisco-based media venture founded by former U.S. Vice President Al Gore, were arrested by the North Korean military on March 17 on charges of illegally crossing the border from China. They were in China to report the plight of North Korean refugees who fled hunger at home and were living in hiding there.

The North’s state-run Korean Central News Agency accused the two of “illegal entry" and said, "their suspected hostile acts have been confirmed by evidence and their statements, according to the results of intermediary investigation conducted by a competent organ.”

"The organ is carrying on its investigation and, at the same time, making a preparation for indicting them at a trial on the basis of the already confirmed suspicions," it said.

Wow. All that work to show the west what a bad-ass you are goes down the drain because you're too cheap to hire a real translator. It's the little things that make champions North Korea. Better luck next time.

Although I gotta admit the thought of being drug from my cramped prison cell to face questioning by a giant, competent pancreas is kinda frightening. I'm assuming it would be a pancreas running the investigation, as I think the pancreas is the most competent organ in the human body. Just kinda does it's thing you know, doesn't really seek any glory like those hot-dogging kidneys. Kidneys are attention whores. And do I really have to say you can't trust the penis in a situation like this? Yeah, I'm thinking this is definitely a case for the pancreas. Maybe the spleen.

Lesson learned, if I ever become the head of a brutal communist dictatorship, and I arrest some journalists, I'm gonna have them proofread the press release announcing their own detention.

Then I'll make a nuclear bomb and cruise the capital looking for chicks. I bet having a nuclear bomb and being dictator of your own country is a total chick magnet.