I Will Try To Remain Calm In This Post. It Will Be Hard. I Have Issues With Medical Professionals Who Think Certain Classes Of People Deserve To Die.

From the pages of this month's Mother Jones. An absurdly inexpensive and extraordinarily well written magazine you should go subscribe to right now:

One winter night in 2000, Danny, who was 21 at the time, went home with a guy he met at a crowded bar in San Francisco. Random hookups weren't out of the ordinary for Danny, but this one ended badly: As he was buttoning up to go home, his new friend mentioned he was HIV positive. Usually conscientious about safe sex, Danny hadn't been, and he panicked. " I was in shock" he says. "I just couldn't believe it." He vaguely remembered reading about an emergency treatment that could prevent infection, so when he got home he called the California AIDS hotline. Memory served. A monthlong regimen known as post-exposure prophylaxis treatment (PEP)- usually given to health care workers who have been stuck with needles-was available at local clinics and emergency rooms to people who had recently been exposed to HIV. The side effects of debilitating nausea and fatigue were a small price to pay for its potential benefits: A study of health care workers published in the New England Journal of Medicine linked the rapid administration of the drug to an 81 percent decrease in the risk of contracting the virus.

Danny went to a city clinic, where after a consultation, he was given a prescription for two antiretroviral drugs-the same kind that HIV-postive patients have taken since the 80's

Remember that. The same kind patients have taken since the 80's

"Why did you say you'd have to remain calm Drugmonkey?" some of you are no doubt saying. "This story is what medicine is all about, the prevention of disease and maintenance of health are the very essence of medicine, at the very core of what health care professionals do. This is a happy story Drugmonkey. You must be a bad man. "

Read on:

Danny was lucky that California is one of the few states (along with New York, Massachusetts, New Mexico, and Rhode Island) where policies ensure that the general public-not just hospital workers who have been exposed on the job-can access the drugs. Elsewhere, the desicion is up to individual hospitals, clinics and doctors.

You read that right. The decision as to whether to take action to prevent a chronic, fatal if left untreated disease is left up to each individual hospital, clinic, and doctor. Unless you're a hospital worker.

"Oh cut the drama Drugmonkey. So some egghead rule writer never got around to updating policies no one looks at. What ethical clinician would not try to prevent disease?"

Surveying all 50 state health departments and more than 50 ER's nationwide, I (MJ writer Justine Sharrock) encountered STD clinicians and workers at AIDS hotlines and Planned Parenthoods who did not know PEP could be prescribed to the public. An Alabama health department official told me "It's not available" A nurse at a North Dakota clinic said he all but encouraged patients to fly to San Francisco.

Let me......go over a few things as those last two comments sink in.

It's not like PEP is some sort of exotic, special treatment where the meds have to be flown in from the factory within 72 hours. Remember the part about the drugs being the same ones that patients have been taking since the 80's? Here's a common PEP regimen, usually to be taken for 1 month after possible exposure:

Kaletra 400/100mg 1 tablespoonful twice a day.

Plus one of the following:

Epivir 300mg/day or 150mg twice a day or Emtriva 200mg/day

Topped off with Retrovir 200mg three times a day or 300mg twice a day.

There are others, but those of you in the profession get the idea. Any doctor, any Physician's Assistant, any Nurse Practitioner can write prescriptions for these meds. I can almost promise you a pharmacy in your town stocks them. If you have prescription insurance, they're probably covered. They are literally just like any other prescription that goes through my hot little hands in the course of a workday.

Yet a nurse in North Dakota tells people to fly to San Francisco, which is more useful advice than you'll get at certain health departments in Alabama.

As we ponder why, let's apply what I call the "rabies test." Let's say there was a drug protocol that was shown in the New England Journal of Medicine to be 81% effective in preventing rabies after a dog took a chomp on your leg. There were no other proven ways to prevent rabies. The regimen was FDA approved and widely available, yet there were hospitals and clinics that said "unless you're a dogcatcher, we don't feel like giving it to you."

That'd be pretty fucked up wouldn't it?

You wouldn't stand for it would you?

So why is this allowed to stand?

You know why.

It's because gays and lesbians are the new niggers of the 21st century, and if you think they are not in a liberation struggle against the very same forces that held down those of the 20th, I just proved you wrong.

And I remained calm for the most part.

It's Not The Coneheads.... And "Cheesburger Cheesburger" Is Long Gone. But For Today's "Saturday Night Live?" Not Bad.

I Bet Being A Pharmacist For Torturers Would Suck, But Probably Not As Much As A Gig With CVS

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Keystone Techs Are Not To Be Confused With Keystone States.

Keystone techs are indispensable. No dispensing happens without your keystone tech.

Keystone states are very dispensable. Especially after tonight.

Keystone techs run my business. Keystone states are full of those business left behind.

Keystone techs are fearless. They can stare down the most ferocious of crackhead customers and ensure that the Vicodin is not filled early.

Keystone states are full of fear. Fear that allows the ruling elite to divide the ruled against themselves, in part by tagging those that oppose the rulers.....elitists. The Keystone state continues to sacrifice its young to wars both literal and economic, because the Keystone state does what it's told.

Keystone techs are whip-smart. Keystone state voters don't quite get it.

So when assigning blame for what happened tonight, make sure it goes to the appropriate Keystone.

I never in my life thought I would say such a thing, but it's up to you to save us Indiana.

Big Pharma Joins Forces With The Insurance Industry. The Surprise Result? A Synergistic Aquafuck For You.

Of course when I say "surprise result" what I mean is "completely predictable result"

Doctors treating children with a rare and severe form of epilepsy were stunned by the news. A crucial drug, H.P. Acthar Gel, that had been selling for $1,600 a vial would now cost $23,000.

The price increase, put in place over last Labor Day weekend, also jolted employers that provide health benefits to their workers and bear the brunt of drug costs.

As it turned out, the exclusive distributor of H.P. Acthar Gel is Express Scripts, a company whose core business is supposed to be helping employers manage their drug insurance programs and get medicines at the best available prices.

But in recent years, drug benefit managers like Express Scripts have built lucrative side businesses seemingly at odds with that best-price mission. A growing portion of their revenue comes from acting as exclusive or semi-exclusive distributors of expensive specialty drugs that can cost thousands of dollars. And the prices of such medicines are rising much faster than for the mainstream prescription drugs available through a wide variety of distributors.

Wait..... you mean you take a product that people have to have in order to live, and make one corporation, an entity that by definition has as its most important responsibility making as much money as possible by any legal means necessary for its shareholders, the sole distributor of that product, and the price goes up?

Really?

But.....but.....Express Scripts says on its website that its mission is to:

make the use of prescription drugs safer and more affordable for more than 50 million Americans through thousands of employers, managed care plans, governments and labor unions.

Express Scripts says its mission is to make prescription drugs more affordable. And surely Express Scripts wouldn't lie. Because pharmacy benefit managers have a proven track record of holding themselves to only the highest ethical standards:

Medco Health Solutions, the largest U.S. pharmacy benefit manager, paid more than $200 million in kickbacks to a large unnamed health plan to obtain contracts, according to court documents filed last week by the U.S. Attorney's Office in Philadelphia, the Newark Star-Ledger reports. Federal prosecutors filed the documents as part of a civil lawsuit against Medco. The lawsuit alleges that Medco defrauded the Federal Employees Health Benefits Program. According to the lawsuit, Medco cancelled prescriptions, switched prescriptions without physician consent, did not fill prescriptions completely and failed to inform physicians about adverse medication interactions

And conducting themselves with only the utmost integrity:

The American Federation of State, County and Municipal Employees sued the nation’s four largest PBMs (PCS, Express Scripts, Medco and Caremark), alleging that they violated California’ Unfair Competition Law. The complaint charges that the four PBMs have negotiated rebates from drug manufacturers and discounts from retail pharmacies, yet have not passed those savings on to healthcare plans and consumers.

I mean, until now, the conduct of Pharmacy Benefit Managers was beyond reproach:

Caremark Rx, the prescription drug plan manager, agreed yesterday to pay $137.5 million to settle federal lawsuits filed by whistle-blowers that accused a company it acquired in 2003 of improper dealings with pharmaceutical manufacturers.

Maybe I should go back and change what I just said about corporations making money by any legal means.....

I should also change what I said about there only being one rat-bastard corporate monopoly involved. In the case of these specialty drugs there are two. Only one corporation is allowed to make the med. Then only one corporation is allowed to sell it to you.

In the case of H.P. Acthar Gel, an injectable anti-seizure medication derived from hog hormones, the fourteenfold price increase came after the maker, Questcor Pharmaceuticals, gave exclusive distribution rights to Express Scripts’ CuraScript unit last summer.“This sort of puts the spotlight on the greed angle of the business,” said Dr. Robert R. Clancy, a pediatric neurologist at Children’s Hospital of Philadelphia.

Dr. Robert R Clancy gets the Drugmonkey "Plain As The Nose On Your Face" award for outstanding accomplishment in stating the obvious.

He has been using H.P. Acthar Gel to treat a severely ill 3-year-old girl, Reegan Schwartz. Employer health plans bear most of the drug’s steep cost, with individuals in many cases making only a standard co-payment. In the case of the two courses of Acthar treatments for Reegan, the cost to her father’s health plan was about $226,000.

I bet if we gave FedEx exclusive rights to handle the delivery of H.P. Acthar Gel, we could get that price up to $400,000 or so.

Crap. I was trying to make a joke but probably just gave them an idea.

I'll let Questcor have the last word, because quite honestly, they make my point better than I ever could:

“We did some market research,” (Questcor executive vice president) Steve Cartt said. Talking to pediatric neurologists and others about various pricing options “gave us some comfort that the strategy would work, and physicians would continue to use the drug, and payers would pay,” he said. “The reality was better than we expected.”

The reality was better than they expected.

Wake up.

The Iraq War Explained In One Sentence From An Elected Official, Part 2

President Bush on Iraq, December 12th, 2005.

"I think we are welcomed. But it was not a peaceful welcome."

The sad part is, if we had a competent individual serving in the office of President Of The United States that quote would have been big news. As it is, we've become so used to an idiot President that stupidity like this can drift like a cloud for over two years before even a political nerd such as myself catches wind of it. The occupant of the nation's top office has become the recipient of the soft bigotry of low expectations. Does that make you happy?

Here's to idiocy being big news again someday soon.

Highlights From This Weekend's Pill Counting Action. One Day Before The Weekend Is Over.

The first customer of the day slammed his vial on the counter. "THESE DON'T WORK!!" He semi-screamed. "ALL THEY DO IS MAKE ME PISS!"

The prescription was for furosemide. Time for my counseling star to shine baby.

The customer also had a prescription for Prozac that ordered me to "dispense 60 tablets by mouth" Maybe the act of me forming a nice little Prozac spitball then getting them to the patient like a mama bird was supposed to help snap him out of his depression. Anyway, after I puked Prozac all over him I explained that furosemide is a diuretic, which means that it does in fact make you piss a lot.

As this was going on a lady asked the high school kid mopping the cough/cold aisle where the Nasonex was. I watched them search the allergy section together for a good 10 minutes. Nasonex is prescription-only. I'm a bad man.

--------------------

"Do you have any allergies to medicines?"

"You mean right now?"

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A fax showed up from a doctor's office intended for the Safeway on the other side of town. I forwarded it to it's intended recipient and was rewarded for my good deed with a phone call a few minutes later:

"I'm not filling this! I can't be sure it really came from the doctor!!"

Good call Safeway. Because you really can't be too careful when you're dealing with ibuprofen prescriptions on a doctor's letterhead faxed to you from a licensed pharmacy. Sometimes the customer is not the idiot.

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"Hi, I'm calling from Dr. Dumbass' office with a prescription for a patient. Do you need the patients name?"

I decided I didn't, and just gave the pills she ordered to the next person who came up to the counter. Sometimes the customer isn't the idiot two times in a row.

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"Is this the first time we've filled prescriptions for you?"

"Yes....oh....you mean today?"

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My technicians love the netflix. I don't know why. I never did hop on the netflix bandwagon even though I'm white enough to glow in the dark. This morning though, my technicians were talking netflix yet again.....

"You have to see 'No Country For Old Men' next"

"They made a movie about Drugmonkey?"

Middle age approaches like a towing thundercloud on the horizon.....

--------------------

The woman at the counter had tried to dress professionally but looked rather unnatural in her clothes. Go to any office park during lunch hour and you'll see no shortage of her type trying to powerwalk around the parking lot while wondering what Oprah would have eaten. "Is this the best thing to deal with stress?" she asked. She was holding a box of store-brand Ducolax.

I've learned the best thing to do in these situations is to get them talking. "What kind of stress are you dealing with exactly?" I said the words slowly, biding for time so I could think why on earth this woman thought she needed a stimulant laxative to deal with the burdens life was putting upon her.

"It's nothing in particular. I just need some help to relax sometimes so I can sleep."

Mystery solved. Relax. You see, the box of the store-brand Dulcolax was labeled only as "Corpo-pharmacy laxative"

Relax/laxative. Get it? Welcome to my world.

A full weekend of pill counting highlights and still a day to go....

Sometimes When I've Had A Bad Day, When I Hate Life And My Job, I Thank God I Am Not The Tostitos Fiesta Bowl Corporate Stooge.

I'm not sure really why I had the game on in the first place. I had long ago lost interest in the way large men play fight over a leather sack. Background noise I guess. The game was over anyway, and it seemed like the only thing happening was a bunch of the large men were happy because they playfought better than another bunch of large men. They were screaming and hollerin' and really looked like they were on the verge of being out of control they were so happy. I guess I couldn't blame them. Evidently this was the playfighting national championship game, and they had just shown the world that they playfought better than anyone else in the country.

Then I saw the guy in the suit. He was positioning a bag of chips for the camera. I'm not making this up. The man was desperately trying to find the best angle for the Tostitos while another guy in a suit interviewed the leader of the playfighters. The interview taught us that:

The playfighters were a good group of young men.

They had worked very hard during the school year at their playfighting.

The other group of playfighters were also talented, and deserved credit for playfighting to the best of their ability.

I became obsessed with watching this interview, not because of the revelations I was getting concerning the playfighters, but because the first suited man continued to make sure the Tostitos were always in the camera shot. I knew there had to be a memo somewhere regarding the placement of postgame Tostitos. Tostitos had paid a lot of money to have their name splattered all over this playfight, and Johnson in the suit's job was to make sure they got every pennies worth.

When the interview was over, Johnson stepped forward with all the enthusiasm he could muster, and said :

"How about some Tostitos coach?"

He was still holding the bag so the logo was perfectly angled for the camera. My heart broke for Johnson's teenage children. Coach gave Johnson a "you fucking die" look and walked away, leaving Johnson on the stage with his smile still frozen in place. Never in my life had I seen someone so completely prostitute out every shred of self dignity they possessed in service to the soulless entity that is the multinational corporation.

It's not even like he was plugging Doritos. Tostitos suck.

So no matter how bad your day was my friend, no matter what indignity life has thrown your way, no matter what you had to do to put some food in your stomach so you can continue that futile doomed quest that is life, just know that you are not the Tostitos corporate stooge. Neither am I.

I think we can both feel good about that.

In The Latest Recount Of My Blogpoll Data, ES&S® Corporation Tells Me 98.2% Of You Actually Wanted To Hear About Big Pharma Skullduggery

Which works out pretty well, as in this Olympic year, we may have a new gold medal winner for Pud-sucking by a pharmaceutical corporation. You'll recall our previous co-champions were Merck and Schering, who are accused of withholding scientific data that would have made their product, Zetia, look bad.

Just a shame they didn't go the extra step of actually changing the numbers, or they could have won it all.

The key to our story is this:

"High doses of estrogen are known to raise the risk for blood clots that can cause heart attacks and strokes."

We've known this for awhile now. Estrogen levels have been getting lower and lower in Oral Contraceptives for years, as drug companies push the envelope to see how far down they can go and maintain effectiveness. Good for them. Heart attacks and stokes tend to suck. Twelve years ago, Johnson & Johnson had an idea to push that envelope a little lower, at least to hear them tell it:

In 1996, the company told (The FDA) it planned to develop the Ortho Evra patch in part because it would be likely to expose women to less estrogen than pills. The company suggested that the body would not break down hormones delivered via the patch as readily as the pill, so lower doses could be used to achieve contraception.

There was, of course, the formality of actually proving that women would actually would be exposed to less estrogen, which as you'll remember, was known to raise the risk for blood clots that can cause heart attacks and strokes.

But a crucial trial completed in 1999 showed that the patch delivered 30 to 38 micrograms of estrogen into the bloodstream each day, according to company documents. Because up to half of the estrogen in pills is lost in the digestive tract before it reaches the blood, the study suggested that the patch delivered an amount of estrogen that could be as high as a pill containing 76 micrograms of estrogen. In 1988, the F.D.A. banned birth control pills with more than 50 micrograms of
estrogen.

Wait a minute! That's more estrogen! Which is known to raise the risk for blood clots that can cause heart attacks and strokes! Johnson & Johnson was wrong! Boy I bet they felt silly as they immediately scrapped plans for Ortho-Evra and went back to the drawing board. I mean, that's what any ethical company would do.

But the study’s author, Dr. Larry Abrams, who has since retired from Johnson & Johnson, decided to apply a “correction factor” to the results of the 1999 trial, according to documents. He claimed that the patch actually delivered about 40 percent less estrogen than the trial results showed — about 20 micrograms a day.

Dr. Abrams made the change, according to his deposition, to adjust for the different ways the body metabolizes hormones from pills and patches. This adjustment was never part of the study protocol, a plan filed with the F.D.A..

Johnson and Johnson was so proud of the scientific breakthrough that led to the discovery of this "correction factor" that they mentioned it one time in 435 pages filed with the FDA, buried as part of a mathematical formula. Fancy High-falutin' scientists with PhD's and paychecks signed by Big Pharma can come up with terms like "correction factors," but simple pharmacists with Bachelors degrees and roots in the hillbilly land that is Southeastern Ohio call it "pulling numbers out of your ass"

After the patch was approved, the company marketed it as releasing 20 micrograms of estrogen to the blood every 24 hours, a figure it now acknowledges was inaccurate. It also acknowledges that the patch releases more estrogen than the pill

Yeah, definitely pulling numbers out of your ass. Which makes this part not surprising at all:

Since then, an epidemiological study has shown that women on the patch can have as much as double the risk of blood clots than those taking pills.

Reached for comment in an alternate universe that doesn't actually exist, Johnson & Johnson Chairman and CEO William C. Weldon said in my mind, "but it's sticky....Ortho-Evra is sticky and you can wear it"

"Just try sticking a tablet on your skin" he added in my imagination.

Thing is, Johnson & Johnson totally got this bullshit past the FDA, whose job it is to protect the public from things like "correction factors" Which means you should take total comfort in the following:

....because the Food and Drug Administration approved the patch, the company is arguing in court that it cannot be sued by women who claim that they were injured by the product — even though its old label inaccurately described the amount of estrogen it released.

This legal argument is called pre-emption. After decades of being dismissed by courts, the tactic now appears to be on the verge of success, lawyers for plaintiffs and drug companies say.

Allow me to translate:

1) Johnson & Johnson pulls numbers out of its ass and uses those inaccurate numbers to market a product.

2) The FDA, underfunded, understaffed, and incompetent because it is run by political appointees who believe that government shouldn't do anything but start wars, looks at the numbers and says...."ddduuuhhhhh"

3) The Supreme Court, now packed with political appointees who believe government shouldn't do anything but start wars, may be about to say that if something approved by the underfunded, understaffed, and incompetent FDA injures or kills you, than tough shit. You have no choice other than die.

Enjoy your tax cut.

Vinyl As Life As Love.

I'm asked, over and over, what is it about my obsession with music on vinyl. I'm asked, over and over, about my refusal to own an iPod. It makes perfect sense in my head, but I know for most of you it doesn't.

If you have to ask I know you've never heard the magic of a needle sliding through well made, perfectly pressed grooves. There are so many things that have to go right to get that feeling. If the recording isn't mixed for vinyl in the first place, you can forget it right then. If it is, you've got a chance.

If the person doing the mixing got it right, if they listened and obsessed and twirled here and slid a lever there and listened and obsessed a little more and got the final mix right, which a lot of people don't, and if that final mix is pressed onto a good piece of vinyl, which it sometimes isn't, and if that vinyl is clean, which can take a little effort sometimes to accomplish, and if your needle is in shape and at the right angle and the right pressure and you have a good cartridge and all your connections are good and you have speakers that match the acoustics for your room in the right spot.....it might happen.

You can chase the sound...that perfect sound that cannot be digitized...sometimes for months, through various recordings and equipment configurations before everything that has to go right for it to happen falls into place. But when it does.....you'll understand.

You should also know it will never happen again. Not in quite the same way. Because the needle just wore on the grooves a little. New vinyl is quiet. Next time there'll be a little rumble in the grooves, no matter how much you clean them, it'll never quite sound like that first time. But you'll always remember that first time. When it all came together.

Vinyl, like love, is destined to break your heart in the most delightful of ways. It fades away gradually and everyone sees it but you. Because you remember it in a way no one else can understand.

Owning an iPod is like giving up. An iPod is friends with benefits. I will reluctantly accept CD's when I have no choice, but I will always.....always.....be chasing the needle.

In life as well as music.