I Just Knocked My Benicar Down The Sink.

Seriously. Right down the fucking sink. If it were Xanax I just did that with not one of you would believe me. I still don't believe it myself, and I saw me do it.

Next thing I know my cat Spooky is gonna start chowing down on the refill, the way the pets of people who take narcotics seem to think of the Vicodin an animal treat.

Maybe I'm really dreaming, and everything will be OK in the morning.

Benicar's fucking expensive. Dammit.

An Incident From My Prescription Past Predicted My Future Greatness.

"So I wonder if my pharmacist used to make fun of me the way we sit here and make fun of pretty much everyone" I said to my keystone tech of the week. My real keystone tech is on vacation. So I guess really this tech would be the first stone that is slightly to the left or right of the keystone.

"Probably" she said. "Pharmacists seem to make fun of almost everybody"

I thought about it, and while she's right, we do make fun of almost everybody, I think I might have been an exception that proved the rule. I'll tell you why.

I remember the first prescription I ever had filled, long before the thought of toiling away in a pillshop had even entered my mind. I was probably 11 or 12 years old and I had some sort of asthma/breathing thing going on. After I left the doctor's office I went to the nearest drugstore and handed the prescription to the person behind the counter. I answered the questions they asked me and understood when they said how long it would take them to fill the med. I had a little fever as well, and the doctor had told me to get some Tylenol. You know what I did? I went to the shelf and picked out a bottle of Tylenol. All by myself. Then I sat in a chair in the waiting area until they called my name. Then, I made out a check my Mom gave me that morning, and left.

Those of you in the profession are probably gasping in disbelief. At 12 years old I was able to pull off what 90% of pharmacy customers of any age cannot. Looking back, I see now that I was a child prodigy amongst drugstore clientele. Many of you reading this probably do not believe that a person has ever simply dropped off a prescription and bought the correct over the counter product recommended by their doctor. I can't say that I blame you, as I have never seen it happen myself other than when I did it.

Little did I know, as I walked out of the drugstore that day with my Medrol dosepack and Tylenol capsules, how close I was to the apex of human development. I was so not made fun of.

Dear 16 Year Old Kid I Never Had In 1992 The Second I Got My License The Way The Rest Of My Breeder College Friends Did.

Just take the Goddamn car you little shit. It's only a matter of time before you get yourself into a mess your old man won't be able to get your sorry ass out of. We might as well get it over with. Just take the goddamn car.

Do you really think I don't know what you're up to with that little ho of yours? Or that weed is odorless? Just because I'm too fucking tired to see straight after getting my head pounded in for 12 hours at the store doesn't mean I'm blind. Here's a tip; lambskin condoms don't stop AIDS. Not that I have any illusions you'll start listening to me now.

You know what I'm gonna do tonight while you're busy finding a way to wrap the car around a tree? I'm gonna catch up on all the sleep I lost walking you around in circles when you were crying with the colic. I'm gonna doze off in between sheets that aren't the least bit stained with spit up. Spit up is the most disgusting substance known to humankind, and I have seen the last of it. I'll probably be so goddamn nice and cozy I'll sleep right through the call from the sheriff's department asking me to bail you out of the pen. Think of your night in jail as the karma go round for you registering as a Republican to try and get under my skin. Christ, I wish I would have turned around and shot you on the wall. Totally, totally, wish I had never had you.

Wait. I didn't have you. I forgot there for a second. I feel better now.

I've Written Earlier About How Your Fat Kid Is Ruining My Life. Fortunately, Your Fat Dog Is Getting The Message.

Not making this up:

Introducing the first proven and dependable veterinary medication for the management of canine obesity.

"medication for the management of canine obesity" means just what you think it does.

SLENTROL (dirlotapide) is a solution formulated at a concentration of 5 mg/mL of dirlotapide for oral administration of dogs. Dirlotapide is a selective microsomal triglyceride transfer protein inhibitor that blocks the assembly and release of lipoprotein particles into the bloodstream (via the lymphatic system) in dogs.

I'll point out here, rather rudely, that 2 to 3 million children die every year from acute diarrhea. In most cases you can make sure a person with severe diarrhea doesn't die at a cost of a few pennies. Let's go back to thinking about your fat dog now.

I managed not to score an interview with Jeffrey Kindler, CEO of Pfizer, the manufacturer of Slentrol. In it, he never described the ideal candidate for canine obesity treatment.

"A dog who's developed thumbs" Kindler didn't say. I asked him to explain in my imagination.

"Well, as you can imagine, once a dog grows an opposable thumb, there's nothing to stop them from being able to work a can opener or open the refrigerator at will. Free from dependence on humans to control their caloric intake, in almost all cases a thumbed dog will eat until its health is adversely affected."

"We were particularly excited about thumbed dogs with self-esteem issues that caused them to down quarts of Ben & Jerry's at a time" Kindler didn't add. "But it looks like those bastards at Lilly may have got to that market first."

"Do you really think there are enough dogs with thumbs out there for you to make a profit?" I never asked.

"Of course. The proof is in the tremendous level of pre-marketing interest in Slentrol we've seen from both veterinarians and dog owners. I mean, who else would buy it? For dogs without thumbs, all the owner would have to do is give the dog less food."

Somewhere in the two-thirds of this world that is ruled by poverty, a child just felt a pang, and realized something is wrong with her stomach. Ask your veterinarian if Slentrol is right for your dog.

I'm Not So Sure I Should Admit This.....

.....but for lunch today I walked over to the grocery store on the other side of the parking lot. It's the most expensive grocery store in town, so much so that they would probably be insulted at the very idea that they be lumped into the same category as Safeway and the commoners that establishment caters to. The main appeal of this grocery store is that rich people can go there and show how much more in tune with their bodies they are than you, because they spend twice as much on food, wait, I'm sorry, nourishment, than you ever will.

That's not the part I'm afraid to admit to. I just bought a sandwich. Of course it wasn't called a sandwich. It had a name that was almost a compete sentence that I can't remember now but made me feel good about spending $10 on it at the time.

It was when I sat down at a table after buying my sandwich that was too full of itself to call itself a sandwich, half looking at the newspaper, half looking around at the crowd of people who made up this store's customers, and asked myself a simple question:

"If I lost it right now and had access to an assault weapon, which of these people would I shoot?"

Because honestly, playing out that scenario in your mind is a lot of fun, and it's more of a challenge than you would think.

Of course some answers are obvious. About 20% of the time a person walks by and you say "Oh hell yeah." Sometimes it's a no-brainer let-em-live. Most of the time though, it's not as cut and dried as you'd think. You start asking yourself things like:

"What's my ammunition status?"

"Are the cops closing in, meaning I'm only gonna have a few shots left? If that's the case, yeah, the asshole in the beret gets it, if for no other reason than for thinking he looks good in a beret"

The lunch break flew by, and I hadn't been so entertained during the workday since the time I saw a dog bite some retarded kid. What I learned is that to be a successful serial killer on a rampage, you have to have very good on the fly decision making skills.

That's the part I'm not so sure I should admit to. Anyway, I'm back at it tomorrow.

Work that is. No lunch on Sundays.

You Knew This Was Coming.

......or at least, you should have known this was coming. You should have known this was coming ever since we lost the battle of the hanging chads. From the editorial page of the Charlotte Observer:

Bush's latest: Birth control pills are abortion

Proposed rule at HHS would broaden definition of ‘abortion.'

The Bush administration is proposing a rule that defines abortion so broadly that it even includes prescribing or dispensing birth control pills. The rule would likely make it harder for many women to obtain legal contraceptives.

A draft regulation circulating at the Department of Health and Human Services might not appear, on the surface, so threatening. It would cut off federal funds to hospitals and states that try to compel medical providers to offer legal abortion services to women.

The wording is what's troubling. It defines abortion to include a number of commonly used birth control methods, including pills, IUDs and emergency contraceptives.

This is how politics is done my friends. A quiet changing of a definition by the under assistant deputy to Secretary No-Name. Right as they're headed out the door. When everyone's paying attention to very little other than who the next president is gonna be. Because the guy that next president puts in charge of the Department of Health and Human Services? He or she is gonna have a lot more to do than to comb through every word that was inserted or deleted into the Code of Federal Regulations during the previous administration. Chances are that once it's put in there, that definition stays on the books, even if specific policies get changed.

Then, after a quiet period, a judge somewhere says "Well, the federal government has defined oral contraception as a method of abortion for some time now. And according to the Women's Health Assurance Act of 2013, there can be only one abortion provider per county. We therefore find it illegal for there to be more than one pharmacy per county in the United States to carry birth control pills."

And you end up having to take all the Ortho-Novum off your shelves.

You think I exaggerate. That I'm wild-eyed and crazy. Well you know, 15 years ago, if I would have told you there would be pharmacists like Lloyd Duplantis, of Gray, Louisiana, you would have thought me wild-eyed and crazy too. These right wing idealogical lunatics are not to be underestimated, and this is how they work. Unless enough people notice and say something. Before that judge says something.

Do me a favor. Notice. Say something.

(Thanks to Asian Friend for that last link. It takes a village.)

You Wanna Know Why I Get Paid So Goddamned Much? I'll Tell You Why I Get Paid So Goddamned Much

"Yes, I'm calling to get a refill of my blood pressure medicine." I could have just done what the woman wanted and filled her blood pressure medicine. One more prescription to get credit for and one more sale in the cash register. That's what I'm here for you know, just to put pills in a bottle.

Instead my super-spidey pharmacy sense kicked in.

"Well, I see we haven't filled these for you since October, has everything been going alright with your medicine?"

"Oh yes, it seems to work just fine, it's just that I don't need it that often"

Yes. This was definitely going to be a case for super-pharmacist.

"Hmmmmmm......well, blood pressure is usually a type of condition that's treated all the time....."

One of the reasons I make so damn much is because I know stuff like that.

"Well sometimes it gets up over 150 you know. And I'm scared I'm gonna have a stroke or something."

"I see, well do you have a blood pressure machine at home?"

I will point out again, I could have just filled her pills. That's all she was looking for. If I had just put some pills in a bottle I would have had a happy customer.

"Uh-huh. I usually measure it once a week or so, and most of the time it's OK, but sometimes it gets up to 150 or so."

"Well it's normal for a person's blood pressure to go up and down over the course of a day. The problem is when it goes up and stays up"

"Really?"

I'll also point out, that I was putting other people's pills in their bottles the entire time this conversation was going on.

"Oh sure, your doctor probably told you something like that when he wrote the prescription." I needed to find out where the hell the doctor was in this mess.

"He said he wasn't sure if I was gonna need 'em or not, but honey, he went over everything so fast, I can't remember half of what he said." So now I knew. The doctor's role here was similar to that of a sperm-chucking father, in that he started the process and then was nowhere to be found the next time he was needed. I was on my own here. So was she. That's why I now became a honey.

"I tell you what."

"OK...." I could hear the happy anticipation in her voice that someone in a white coat was actually going to give helpful guidance. I could have told her to hop up and down on one foot and cluck like a chicken at that point and she happily would have.

"Take your blood pressure a couple times a day here for the next few days. Mix it up.....sometimes in the morning, afternoon, sometimes in the evening, after eating, before eating, you get the idea, right?"

"Oh sure"

"Keep track of it in a notebook or something, then call me back in a few days and we'll figure out what to do about these high blood pressure pills"

She called me back today and has better blood pressure readings than I do. That's why I make so goddamn much. Not because my blood pressure's higher than hers, but because I can figure out when it's best not to make a sale.

Now why mail-order pharmacists make so much I have no idea. All those fuckers do is put pills in a bottle.

Am I A Prophet Or Am I Just Really Smart? It's Hard To Say Sometimes

I'm leaning toward prophet this night. Totally towards prophet. Because you know what the first thing I said was when I read about Reclast?

First you should probably know though, before I amaze you with my brainpower, that Reclast is a treatment for osteoporosis. It's a member of a class of meds called biophosphates, like Fosamax, Actonel, and Boniva, that have been around for years. Reclast's claim to fame when it hit the market was that it only had to be given once a year. Seriously. They stick it into your veins and it does its thing for a full 12 months. So, getting back to my amazingness, you know what the first thing I said was when I read about this?

"Holy crap, what happens if you find out there's some freaky side effect to this stuff the day after they shoot you up with it? Screwed for a whole friggin year you are"

Of course I didn't say it here. But really, I said it. I'll bring in my keystone tech to verify if I have to.

Anyway, here we go:

New questions have emerged about whether long-term use of bone-building drugs for osteoporosis may actually lead to weaker bones in a small number of people who use them.

The concern rises mainly from a series of case reports showing a rare type of leg fracture that shears straight across the upper thighbone after little or no trauma. Fractures in this sturdy part of the bone typically result from car accidents, or in the elderly and frail. But the case reports show the unusual fracture pattern in people who have used bone-building drugs called bisphosphonates for five years or more.

Some patients have reported that after weeks or months of unexplained aching, their thighbones simply snapped while they were walking or standing.

Welcome to the information vacuum. The first thing to pop into your head when you read that was probably something like "Well how likely is it that someone taking biophosphates can be standing around and have their leg snap in half?" I'm sorry, but even my supernatural mental prowess can't give you an answer on that one. This is the kind of situation you'll find yourself in when you approve a drug for sale based on tests on 3 or 4 thousand people, then require absolutely no follow up as it's sold to 3 or 4 million:

Last year, The Journal of Bone and Joint Surgery published a Singapore report of 13 women with low-trauma fractures, including 9 who had been on long-term Fosamax therapy.

“I have several similar patients myself,” said Dr. Susan M. Ott, associate professor of medicine at the University of Washington. “Prior to these recent articles, there were a few cases here and a few cases there, but they are kind of starting to add up.”

My spidey sense tells me Big Pharma won't hesitate to say that there's very little evidence of leg snapping while taking the biophosphates. They'd be right. There was also very little evidence the earth was round before Christopher Columbus set sail. And until you start to look, you're not gonna find much evidence. Not many people have been looking until now.

And here's the thing Big Pharma. We can't trust you anymore. After Baycol, after Bextra, after Duract, Posicor, Propulsid, Tequin, Redux, Trasylol, Seldane, and Vioxx. After you withheld evidence that Paxil may raise the suicide risk in children, After the way you sat on data in order to prop up sales of Vytorin and Zetia, after we found out the estrogen you were pushing on the MILFS was giving them breast cancer, your words aren't nearly as reassuring as they were when I was a wet behind the ears new graduate telling patients not to be overly concerned about their Rezulin.

Don't get me wrong. Osteoporosis and hip fractures are not to be fucked with. They can kill you. As long as you take into consideration the risks involved, preventing or slowing osteoporosis is a good thing. In order to do that though, you kinda have to know what those risks are.

Oh, and I haven't even mentioned the jawbone rot yet.

Good luck.

Highlights From Today's Pill Counting Action.

Holy bejesus I hadn't been cut off in traffic like that in years. A full-scale, California-style I'm not gonna look cause you're gonna stop cutoff. The kind of thing I did all the time when I drove a piece of shit. This person was hellbent on getting somewhere in a hurry, and I began to fantasize about following them to find out what could possibly be so urgent. And to beat the shit out of them. My fantasy was becoming reality with every turn however, as it gradually became apparent that the piece of shit was desperate to get to......my own little happy pill room. When I saw him waiting for me to unlock the gates, I did what I normally do in these situations. I went to Starbucks and was 15 minutes late.

Turns out he was a tweaker looking for some Sudafed. God I miss the days when heroin reigned supreme. Heroin addicts are much better drivers, even if they do tend to be a bit slow.

The label printer started the day printing everything about a half an inch below where it should be. My keystone tech tried valiantly to fix things, but seeing as we were already 20 prescriptions behind, we didn't have the luxury of being able to do a full-scale printer takedown. I suggested we call our corpo-pharmacy technichal support desk and we both had a good laugh.

People from the corporate mothership were here to help though. Some dude in a suit was leading the store manager around making her write things down on a clipboard. They got to some little shelf-thingy next to the pharmacy register and suitman wasn't happy at all. "Drugmonkey, didn't we get the end piece for this display in our last order?" nervously asked the store manager. "I'm pretty sure we did."

"I don't know" I replied. "I don't pay attention to that stupid thing" and I think I heard suitman audibly gasp. I learned later he was some sort of Vice-President. Evidently in charge of little shelves.

The label printer was now printing everything half an inch above where it should be. "Can't you just go back and undo half of what you did?" I asked keystone tech. Her look told me to back off now.

The next customer at the counter handed me a piece of paper on which a Nurse Practitioner had written these words exclusively ...."Needs malaria pills" I assumed the Nurse Practitioner was stupid enough to think "malaria pills" were over the counter. I was wrong. The Nurse Practitioner charged the patient $30 to write out a note the Nurse Practitioner intended the patient to give to her doctor. Who would then probably charge the patient another $50 to write out another note the patient would then give to me so I could sell her some Malarone and be reimbursed by her insurance company for $5 more than the Malarone cost me.

At least the customer wasn't on welfare though, Because getting the shaft business-wise from Medicaid is way worse than getting the shaft from a private insurance company for some reason. Plus then I would have had to notice what kind of car she was driving. It's some sort of requirement that drug store employees take careful notes on the type of car everyone on public assistance drives at all times. I'm glad Malarone lady had Blue Cross, as I was too busy to follow her out to the parking lot.

Michael Bolton came on the store radio, and I knew it was a sign my label printer would soon be working good as new. Even though I had just heard my keystone tech cuss for the first time ever.

"Take 1 capsule at bedtime" read the next prescription. USE SPARINGLY was in caps and underlined. It was made out for 45 capsules with 5 refills.

Later on, I filled a prescription for a child whose actual first name was "Rum".....and the printer alignment gap narrowed to about a quarter of an inch. My keystone tech was defeated. She dialed the number, incorrectly it turned out, for tech support on the speaker phone......

"LIVE.....HOT......LOCAL.....LADIES!!!!!!" blared out of the speaker phone for those in the waiting room to hear. I made a note of the incorrect number.

I also came across another way cool disease name today. Sick Sinus Syndrome. I think it would be cool to go around telling my friends that I had Sick Sinus Syndrome. Or maybe name my band "The Sick Sinus Syndrome"

Half an hour before closing time the labels started to print correctly. The next to last customer at the counter asked me how much they should feed their new cat. I was able to answer her. The last asked if I had to go to college. That's the absolute best way to be my friend. Ask me if I had to go to college. I said no just to fuck with him.

If I remember correctly the shelf thingly got fixed way before the printer. Release the scotch.

Big Dollar Payments To Prescribers And At Long Last, A Big Pharma Ethical Crackdown.

From Saturday's New York Times, a totally non-shocking story of Big Money, Big Pharma, and the stink of corruption that will surprise everyone except those who pay attention:

It seemed an ideal marriage, a scientific partnership that would attack mental illness from all sides. Psychiatrists would bring to the union their expertise and clinical experience, drug makers would provide their products and the money to run rigorous studies, and patients would get better medications, faster.

There's your first sign of trouble right there. The words "drug makers" and "rigorous studies" in the same sentence. Big Pharma only has to show a med meets a minimum standard of safety and works better than a placebo to bring it to market. They don't even have to show it works a lot better than a placebo. Which means "rigorous studies" and "drug companies" go together like "Ambien CR" and "good value."

But now the profession itself is under attack in Congress, accused of allowing this relationship to become too cozy. After a series of stinging investigations of individual doctors’ arrangements with drug makers, Senator Charles E. Grassley, Republican of Iowa, is demanding that the American Psychiatric Association, the field’s premier professional organization, give an accounting of its financing.

“I have come to understand that money from the pharmaceutical industry can shape the practices of nonprofit organizations that purport to be independent in their viewpoints and actions,” Mr. Grassley said Thursday in a letter to the association.

"I have also come to understand that fecal material from mammals can emit a foul odor, and that the sun will rise at the beginning of the day at a point along the easterly horizon and set in the west, to the complete exclusion to the north" Grassley didn't really add.

Speaking of emitting a foul odor:

One of the doctors named by Mr. Grassley is the association’s president-elect, Dr. Alan F. Schatzberg of Stanford, whose $4.8 million stock holdings in a drug development company raised the senator’s concern. In a telephone interview, Dr. Schatzberg said he had fully complied with Stanford’s rigorous disclosure policies and federal guidelines that pertained to his research.

Blocking or constraining researchers from trying to bring medications to market “will mean less opportunities to help patients with severe illnesses,” Dr. Schatzberg said, adding, “Drugs that are helpful may not be developed by big pharmaceutical companies, for a variety of reasons, and we need some degree of communication between academia and industry” to expand options for patients.

Now I'm just a hillbilly boy with a Bachelor's degree.....but it seems to me, Dr. Schatzberg, that I'm communicating right now and I didn't have to buy anyone's stock to do it. The problem......doctor.....is that it appears you stand to personally profit from the sales of a product you can influence through your professional decisions.

Did I really need to explain that to you? Or did you just think that by dazzling us with some fancy Stanford doubletalk you could get us to miss the point? You're either really stupid or you think we really are. One of the two. I think I know which one it is you condescending prick.

While the pompous assholiness of Dr. Schatzberg is grating to the nerves. The honesty of some of his colleagues can be a bit entertaining:

After The Times reported on such an arrangement involving Dr. Melissa P. DelBello of the University of Cincinnati, Mr. Grassley asked the university to provide her income disclosure forms and asked AstraZeneca, the maker of the antipsychotic Seroquel, to reveal how much it paid her.

In scientific publications, Dr. DelBello has reported working for eight drug makers and told university officials that from 2005 to 2007 she earned about $100,000 in outside income, according to Mr. Grassley.

But AstraZeneca told Mr. Grassley it paid her more than $238,000 in that period. AstraZeneca sent some of its payments through MSZ Associates, an Ohio corporation Dr. DelBello established for “personal financial purposes.”

Which is exactly how I think Vito Corleone would have described his olive importing business in "The Godfather." A corporation he established for personal financial purposes.....

Anyway, Big Pharma's finally making an ethical stand:

Come next year, doctors may start to see a problem they've yet to experience -- a pen shortage.

New guidelines released on Thursday by the Pharmaceutical Research and Manufacturers of America (PhRMA) prohibit drug makers from giving out pens, as well as other "non-educational" items such as mugs, to healthcare providers and their staffs.

I swear.....I am not making this up. Truckloads of money are being sent by drug companies to prominent prescribers who have the power to make or break a new med, but the problem is the Ambien CR tape dispenser/stapler I have on my desk.



My God just look at it. The very symbol of decedent corruption. I feel like such a whore.

By the way, The head of Pharmaceutical Research and Manufacturers of America? A man named Billy Tauzin. Billy Tauzin was a Member of Congress who held open a 15 minute vote in The House of Representatives for 3 hours so the Medicare Part D bill "written by the pharmaceutical lobbyists" could be rammed through at 3 in the morning. "I've been in politics for 22 years," said one of Tauzin's colleagues, "and it was the ugliest night I have ever seen in 22 years." Big Pharma got what Big Pharma wanted though, and months later Billy Tauzin left his $158,000 a year Congressional job to earn $2 million a year with PhRMA. I hope no pens were involved in that hiring decision. Because that would look bad.

Holy crap I just noticed there's a Levemir pen in that pic too. I am a whore. A whore who didn't ask for nearly enough.