Dear Every Pharmacy Student Sweating Out Exams Right Now. Working At Save Mart After You Graduate Will Make You Feel Really Good About Your Education.

Especially the physics classes you took. Because if you work at a Save Mart pharmacy after you graduate, evidently you will be expected to bend the laws of time and space. Or just not pay much attention to the prescriptions in front of you, one of the two:

Modesto, Calif., September 17, 2008 – Pharmacies at Save Mart stores now offer customers speed as well as accuracy. Effective today, their “19-Minute Promise” guarantees that they will fill up to three new prescriptions presented at their counters in 19 minutes or less. If the pharmacies fail to meet the mark, the customer receives dinner and a movie – a $10 Save Mart gift card and a coupon for a one-night redbox movie rental.

“Every pharmacy needs to fill every prescription accurately. Our pharmacies already provide excellent customer service, and now our 19-Minute Promise will ensure that we also deliver prescriptions quickly,” said Michele Snider, Senior Director of Pharmacy at Save Mart Supermarkets.

At a press conference that didn't actually happen, Ms. Snider was asked if the 19-minute guarantee was made possible by the addition of new technology, an increase in average store staff hours, or some combination of both. Her answer was a bout of hysterical laughter. 

"Why neither," she didn't say after 30 seconds. "The key to our new program was the realization that our pharmacies were actually filling customer prescriptions too accurately. Our legal department ran some numbers last month and decided we could afford an average of three malpractice suits per store per year. We have several stores that have not had a malpractice payout in over a decade, which coupled with a little 'outside the box' thinking really gives us an outstanding opportunity to distinguish ourselves from the competition." 

"If John McCain's malpractice reform proposal is ever enacted into law, we plan to change our guarantee time to ten minutes!" Snider never said. 

"There is another important plank that made this exciting new program possible" Snider added in my imagination, "and that's respect. Some of you may remember when Domino's Pizza ended its 30-minute pizza delivery guarantee due to concern over accidents. Well at Save Mart, we don't respect our pharmacists nearly that much. They're just a bunch of pill counting monkeys after all. If it weren't for the Board of Pharmacy and their outdated thoughts regarding licensure, we would happily replace each and every one of them with illegal Mexicans tomorrow."

"We also don't respect our customers very much. That's why we're doing something that will increase the chance they'll get the wrong medicine. Or something that will interact with another medicine we never really checked to make sure was the right thing." Snider never said but I wouldn't be surprised to find out she thinks. 

Now get back to your books pharmacy students, and work hard for the prestige a 19-minute prescription filling guarantee will give you. 

Or maybe you could just look into that Domino's job. 

Thanks to the alert readers who tipped me to the story.

It's A Good Thing I Ended My Vacation When I Did, Because I Have A Feeling You're Not Gonna Hear About This Anywhere Else.

This is an actual quote from an actual article written by John McCain for Contingencies, a journal of the American Academy of Actuaries. Seriously. I always tell you guys when I'm making stuff up, and I'm not making this up. It's at the top of the second column of the third page if you click on the link:

Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation

The emphasis was mine. Because I want to drive home the point that we totally want to copy what we've done over the last decade with the banking system. I'll explain if you really need me to.

Ever wonder why your bank's credit card operations are most likely located in Delaware or South Dakota? I mean, what the fuck is in South Dakota other than an in your face mountain carving taunting the Indians whose land we stole? And what the fuck is in Delaware at all? Minimal banking regulations, that's what. Setting up shop in states with the most lax banking regulations lets your bank put the financial rape on when you're a day late with your payment, advertise "fixed" interest rates that change as often as the CEO is up for a new pay package, and otherwise be on the cutting edge of finding new ways to give you the shaft. I'd love to get the shaft from my health plan the way credit cards give the shaft to people. That'd be awesome.

Not to mention deregulation of the banking industry has led to a little problem.......THE COLLAPSE OF THE BANKING SYSTEM!! JOHN MCCAIN USED THIS MODEL, WHICH WILL LEAVE THE TAXPAYERS OF THIS COUNTRY STUCK WITH A TAB OF $700,000,000,000, AS AN EXAMPLE OF WHAT SHOULD BE DONE IN HEALTH CARE!!! JESUS CHRIST WHAT THE FUCK IS WRONG WITH ANYONE WHO WOULD VOTE FOR SOMEONE THAT PROPOSES SUCH A COCKAMAMIE IDEA?

Of course now McCain is backing away from the words he wrote the way someone who let out a smelly fart tries to make his way to the other side of a crowded cocktail party. But let there be no mistake, McCain let the fart. Make your decision as to what this says about his judgement. The fact he can't even make it to the bathroom to fart. Throw in the competence of his Vice-Presidential pick as well. Did you see the CBS interview? 



This woman is stoooooopid. Do the right thing in November.

In Case You Missed Friday's Debate

We're Against Cervical Cancer. When We Can Make Some Money Off Stopping It That Is. No Other Time Really.

    Lemmie ask you a question. Your answer will tell me a lot about what you do for a living. Let's say there's a disease that kills 274,000 women a year, 260 thousand of which are in the third world.  The disease is almost entirely preventable with routine medical care, which is precisely why almost everyone who dies from it is in a developing country.

   Now you have a vaccine for the disease. What do you do with it?

   You may think the right answer is to get the vaccine into the bodies of the people who are dying of the disease, and at first glance, it would seem that Merck, the maker of the cervical cancer vaccine Gardasil, would agree with you. This is what Merck says about themselves on their website:

Merck & Co., Inc. is a global research-driven pharmaceutical company dedicated to putting patients first. Established in 1891, Merck discovers, develops, manufactures and markets vaccines and medicines to address unmet medical needs. The company devotes extensive efforts to increase access to medicines through far-reaching programs that not only donate Merck medicines but help deliver them to the people who need them.

Those of you with business degrees though, and who work for Big Pharma in particular, understand full well "people who need them" means "people with money"

Whether they need them or not. 

Don't get me wrong. Cervical cancer is real and pretty scary. If you're in a place like Africa where your chances of ever seeing a doctor are pretty damn slim that is. If you're here in the land of the free™ (certain restrictions apply)  routine Pap smears will stop cervical cancer long before it gets to the scary stage. So what is Merck doing to get Gardasil to the people that need it?

A hell of a lot of lobbying to force girls in this country to get injected, that's what. 

“There was incredible pressure from industry and politics,” said Dr. Jon Abramson, a professor of pediatrics at Wake Forest University who was chairman of the committee of the Centers for Disease Control and Prevention that recommended the vaccine for all girls once they reached 11 or 12.

“Merck lobbied every opinion leader, women’s group, medical society, politicians, and went directly to the people — it created a sense of panic that says you have to have this vaccine now,” said Dr. Diane Harper, a professor of medicine at Dartmouth Medical School.

The result? 

In the United States, 41 states have passed or begun considering legislation on cervical cancer, according to the National Conference of State Legislatures, and 24 have considered proposals to mandate the vaccine for girls, generally in middle school.

Even the Bush Administration is in on the act:

BUSH ADMINISTRATION FORCING HPV VACCCINE ON IMMIGRANTS: In July, U.S. Citizenship and Immigration Services quietly amended its list of required vaccinations for immigrants applying to become citizens. One of the newest requirements was Gardasil

Sooooo.......one more time.....95% of cervical cancer deaths happen OUTSIDE the western world. Meaning it would make more sense to require people LEAVING the US to get vaccinated, not people who are moving to a place where access to preventative care is routine. 

"What else is new Drugmonkey?" some of you might be saying. "The Bush administration has quite a track record of getting things exactly backwards, and science really isn't their strong point." I'll have to give you that. Many of the 41 states that have a sudden interest in cervical cancer though, are probably run by competent executives, which makes me think the $162 per dose of Gardasil, most of which goes straight into Merck's pocket, just might have something to do with this sudden awareness of what should be a medium to low priority disease. 

Meanwhile a girl in Africa just felt a weird pain.  Merck seems to have no interest in her. 

Once Again The New York Times Follows My Lead. And By "Follows My Lead" I Mean "Rips Me Off."

From Tuesday's New York Times Op-Ed Page:

Talk about a shock to the system. Has anyone bothered to notice the radical changes that John McCain and Sarah Palin are planning for the nation’s health insurance system?

Uh, yeah. Me. Like 3 months ago when I wrote about it here. 

New York Times, Tuesday:

For starters, the McCain health plan would treat employer-paid health benefits as income that employees would have to pay taxes on. "It means your employer is going to have to make an estimate on how much the employer is paying for health insurance on your behalf, and you are going to have to pay taxes on that money" 

Me, 3 months ago:

If you believe irony is the best medicine, than the McCain plan is for you. Why? Because it's actually a huge tax increase!.... I'll have to get a little wonky to explain how. Stay with me. First, McCain would end the tax break currently in place that lets you exclude the value of an employer-provided health care plan from your wages.

Wow. That just totally sounds like two different ways of saying the same thing. Except I said it first. And the guy who said it second gets paid a lot of money to type his words. And I type mine for free. And First.

Not that I'm bitter. Not that this is the first time the Times has taken their cues from me. I shall rise above it however, because there is a more important question. To quote one paragraph in the article that wasn't directly plagiarized from my work:

You may think this is a good move or a bad one — but it’s a monumental change in the way health coverage would be provided to scores of millions of Americans. Why not more attention?

Well duh. Because we haven't gotten to the bottom of the lipstick and pig issue yet. Not to mention moose field dressing.

So anyway, John McCain is proposing a huge tax increase to completely tear down the employer-based health-care system you probably rely on and replace it with something akin to the naked capitalism that served Lehman Brothers and AIG so well. I'd feel really secure if AIG was in charge of my health care right now. Especially if I were paying a lot more in taxes on top of AIG being in charge of my health care.

Not that you didn't already know this if you're one of my regular readers.  Look for the Associated Press to break the story sometime next month.

A Story I Really Wish I Couldn't Tell, But A Story That Makes Me Glad I Have A Place Where I Can.

    It started the way these things usually do. "Fucking dumbass doctor" I thought to myself. "Dumb son of a bitch is trying to get both our licenses pulled" 

    It progressed the way these things usually do. "Mr. Smith, has your doctor told you how he wanted you to take this stomach medicine he prescribed?"

     Couldn't talk to the doctor. One of the benefits of working the late shift. I was gonna have to milk Mr. Smith for a little info. 

    "Oh he just wrote that on there because he said it might be covered by my insurance if he did. I've been taking the over the counter Pepcid for a couple months now"

    I almost fainted. I tried to keep up outward appearances. "So.... did your doctor tell you to start taking the Pepcid OTC?" 

    "Oh no, I just take it a couple times a week when the heartburn acts up."

     My outward appearance effort must have slipped. "Why, is there a problem?"  

     Yes. There was a problem. The other prescription was for Reyataz. Some of you might have just now almost fainted. For those of you who didn't, I'll tell you Reyataz is used to treat HIV, and I'll let the drug interaction checker at drugstore.com give you an idea of the problem. Drugstore.com ought to be good for something:

PEPCID (FAMOTIDINE) and REYATAZ (ATAZANAVIR SULFATE)
Severity: Major

Description: Taking both an H2 blocker and atazanavir may cause your atazanavir to not work as well for you.
Using atazanavir together with a H2 blocker such as cimetidine, famotidine, nizatidine, or ranitidine is usually not recommended but may be required in some cases. Using both drugs may decrease how well atazanavir works.

That's the version you get. Here's what I see:

Atazanavir solubility decreases as gastric pH increases. The coadministration of atazanavir (400mg once daily) with famotidine (40mg twice daily) resulted in substantially decreased atazanavir plasma concentrations. Significant reductions in atazanavir serum concentrations may lead to therapeutic failure and the development of HIV resistance. 

     It goes on to say if you really, really, have to, you can combine these meds, but you have to be very careful, and it's a pain in the ass. Telling your doctor you take it a couple times a week when the heartburn acts up and the good doctor telling you he'll put in on your prescription blank to see if it's covered isn't being careful. There was a chance I was looking at a dead man. And I had to think of a way to tell him. Now. 

    I did the best I could. I probably sounded as bland as drugstore.com and I wanted to cry. He looked like a pretty decent man. The next lady in line demanded to know where we kept firewood. Welcome to my world. 

    I have no idea what happened next. The man got most of his meds from mail order and had only come to me in the first place because something got screwed up in the delivery process. I did the best I could, and really, I don't think I did anything wrong, but this whole thing really bugs me.  It's been awhile since it happened but I haven't been able to write about it until now. If it weren't for the little blog garden I probably would never mention it anywhere. You know Mr. Smith wasn't his real name, but I have no idea what happened to Mr. Smith.

    I do know for sure that lady found her firewood. 

    I really, really, hate this job sometimes. 

"And In Conclusion, I'd Like To Invite The Media To Grow A Pair, And If You Can't, I'll Lend You Mine"

It's Easy to Be The Pharmacy America Trusts™ When You Talk Out Of Both Sides Of Your Mouth.

From the public relations press-release snore wire:

Walgreens and Joslin Diabetes Center have formed an alliance to improve health outcomes for people with diabetes. Together, Walgreens and Joslin will develop and deliver awareness, wellness, prevention, and education programs nationally to reach the estimated 21 million Americans with diabetes and the additional 54 million Americans at risk for the disease.

You know what else Walgreens is gonna do? Make sure every diabetic in the city of San Francisco can get every last cigarette they want.

Drug store chain Walgreen Co. has sued the city of San Francisco over a law that will stop it from selling cigarettes and other tobacco.

San Francisco recently passed a law that will ban sales of tobacco at pharmacies. Walgreen (NYSE: WAG), based in Deerfield, Ill., says the law unfairly singles it out while other stores that aren’t pharmacies or which also sell groceries will still be able to sell cigarettes.

Awwwwww.......poor widdle Walgreens just can't figure out why they're being singled out. You know, maybe it has something to do with what they're trying to say about themselves in that press release, or this one:

The Walgreens Take Care Health Tour is on a 300-city, 12-month nationwide health screening tour that features 10 customized traveling education and health-screening vehicles. The program will travel more than 240,000 miles to offer six free screenings:

Total Cholesterol Levels
Blood Pressure
Bone Density
Glucose Levels
Waist Circumference
Body Mass Index
These services are worth more than $115 in value and no appointment is necessary.

The tour aims to bring free screening services and better health awareness to local communities throughout the United States and Puerto Rico.

So when it comes to the PR wire, Walgreens, you're more than happy to try to single yourself out as something different from the 7-11. But when a city actually expects you to act like you're something other than a Hapu's House of Jerky with drugs in the back, well, that's just not fair.

Wait. I forgot the main difference between a Walgreens and Hapu's House of Jerky. The Drive-through. And how professional that is. 

Let's be clear here. Walgreens hasn't just made a decision to sell cigarettes in their stores. They are actively fighting for the right to do so. Hiring lawyers and spending money and going to court for the right to sell cancer, emphysema, heart disease and stinky breath to the people who come through their doors.

“The incomparable reach of Walgreens and its deep commitment to the health of its customers make it our ideal alliance partner as Joslin strives to deliver our model of patient empowerment and the aggressive identification and prevention of complications across the country.”

"Not to mention all the cigarettes all those patients can possibly suck down" Joslin should have added. I think it's significant the only mention I could find of an actual Walgreens commitment to the health of its customers was on the website of its PR stunt partner. Walgreens itself only implies that it cares. 

Which tells me if you're a Walgreens pharmacist, it's only implied that you are a health care professional. At least until I can buy a pack of Marlboros at my Nurse Practitioners office. 

Better health awareness my ass.

I See A Bad Moon Rising

    The warmth surrounded the members of the White Blood Cell patrol the way a swarm of old people surround a pharmacy gate 5 minutes before it's scheduled to open. Surrounded just a little too much, thought the captain as they cleared the capillary pass and started to merge onto the vein highway. The captain could sense something was wrong. It was a little too warm. 

   "We might have to go into the lymph" He told the rest of the patrol. This captain could sense trouble the way a cat can sense that it should poop only in the littlerbox. 

   Two hours later they found it. Or rather, the confused private found it. Six months ago he was a stem cell back in the marrow and looked out over a future of limitless opprotunites. He decided to join The White Blood Cell Corps because he thought it would be a good way to get out and see the body. He also needed money to get into Nerve Cell University. He wanted to study music, but now he had a protein shell in his hands. 

    "What is it Capt'n?"

     "I was afraid of this, but I didn't want to scare you men. The viruses are shedding. We're gonna have a fight on our hands." 

    A stunned silence washed over the patrol. The Captain was the only one who could remember the last viral war. "Don't worry men. It won't be anything we can't handle. Just pray to your momma the bacteria don't get involved though. Things get ugly when the bacteria get involved."

    The first skirmish didn't go well. To the boy from Marrow it seemed almost as if the viruses were manufacturing themselves faster than they could be killed. The Captain said later that's exactly what they do. They hijack innocent cells and manufacture themselves.

    "Don't worry son. The antibodies are on the way. If it's just a fight with the viruses the antibioties will be all we need" 

    The boy was afraid to ask, but the Captain knew what was on his mind. "You have to be ready for the bacteria son. We might get chemical backup, but we might not. Surrounding these little specks of zombie protein is nothing compared to eating a bacteria alive.  You have to be ready for that."

    The boy started to weep softly. 

    That is the state of my immune system tonight my friends. I have a cold. 

    Pray the bacteria do not come. 

Everything You Really Need To Know About The Upcoming Presidential Election In The Form Of An E-Card.