It All Started With The Intern.

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

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

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

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

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

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

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

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

Always check your labels carefully my friends. 

You Were Wrong My Friend

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

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

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

-JOHN UPDIKE

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

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

Go buy a copy of Rabbit, Run right now. 

Maybe There Is Something To This Astrology Stuff.

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

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

 

BWWWWWAAAAHHHHHAAAAHHHAAAHAHAAAAAA!!!!!!! 

And so fitting.....

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

Because at work I like to keep things personal. 

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

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

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

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

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

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

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

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

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

Step 2) Sharpen the Drugmonkey claws. 

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

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

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

"I understand. Thank you for calling."

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

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

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

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

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

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

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

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

Do The Big Pharma Bashing Posts Get Easier To Write Because There's Better Material Available Or Because I'm Becoming A Better Writer?

So I'm doing my online travels today, which naturally lead me to the website of Allergan Inc. You know, because I'm a big fan of popular eye medicines and stuff.

Or maybe I was doing research on my secret project involving botulism toxin. I'll never admit which one it was. 

Allergan, you see, is the manufacturer of Botox™ A form of one of the most deadly poisons known to the human race. It has some medical use in the treatment of problematic eyelid spasms. It can also be injected into the skin of a cougar (an old horny woman, not the member of the cat family) to give her a better shot at landing a young piece of beefcake by making her skin look less wrinkly. There were rumors John Kerry used it during the 2004 presidential campaign as well. 

Anyway, guess which form of Botox Allergan cares far more about? Hint. Did you even know it had a legitimate medical use before I just told you? 

"So typical of Big Pharma" The cynical Drugmonkey thought to himself as the Allergan webpage loaded. I knew the score though. A Pharmaceutical Corporation's goal, like that of any corporation, is the accumulation of as many dollars as possible. 

But then I saw this, the opening paragraph of Allergan's homepage:

Allergan, Inc. is a multi-specialty health care company focused on discovering, developing and commercializing innovative pharmaceuticals, biologics and medical devices that enable people to live life to its greatest potential — to see more clearly, move more freely, express themselves more fully.

Gasp! Allergan had changed! Their focus, the very first thing they say, is enabling people to see more clearly! Move more freely! Express Themselves! A president who isn't dumb and a Pharmaceutical company committed to enabling people to live life to its greatest potential on two consecutive days! My God! It truly is a new world!

That paragraph was located right next to an ad for Allergan's new product, Latisse™, and I wondered if perhaps this Latisse™ was a miracle cure for Trachoma. After all, eliminating the world's leading cause of infectious blindness would definitely help people see more clearly, anyone who isn't blind could most assuredly move more freely without one of those guide dogs, and not having to wave around a red-tipped cane in front of you would probably let you express yourself better. A perfect fit for Allergans stated goals! Plus, a better plan to treat Trachoma, which has blinded 8 million people worldwide, than the current one, basically blanketing a town in azithromycin once an epidemic has taken hold, would give Allergan bragging rights over those cocky bastards over at Pfizer. A win-win for everyone!

Of course you can also stop Trachoma, which has infected 84 million people, by building a town a basic sewer system. But that's effective and cheap and doesn't lead to resistant strains of bacteria you can make more money off of later by inventing new antibiotics. Plus it makes people think about poop, and who wants to think about poop? Anyway, I was convinced this Latisse™ would just have to be something like a new, vastly improved treatment for Trachoma as I clicked on the ad to find out all the details:

You couldn't click on the ad. I had to use Mr. Google, which led me to The New York Times:

First it was frozen foreheads. Now it’s Betty Boop eyelashes.

Allergan, the company that turned an obscure muscle paralyzer for eyelid spasms, Botox, into a blockbuster wrinkle smoother, hopes to perform cosmetic alchemy yet again. At the end of the month, the company plans to introduce Latisse, the first federally approved prescription drug for growing longer, lusher lashes.

Longer, lusher, eyelashes. Which when you think about it really, might actually work against Allergan's stated goal of helping people see more clearly depending on how long and lush those lashes got. Drat. Big Pharma lied to me again. At least we still have a president who isn't dumb. 

"Drugmonkey, you corporate hating commie, you're not being fair!" I can hear some of you saying. Latisse™ is another version of Lumigan™, the glaucoma medicine, Allergan does have a commitment to help people see clearly!

Latisse will cost slightly more than Lumigan, which is $73 to $84 for a 2.5 milliliter bottle for patients who pay for it themselves.

Allergan plans on charging $120 for a 3 ml bottle of Lumigan with a different label. So yeah, I guess while they do have some sort of a commitment to helping some people who are rich or insured see clearly, they also have a commitment to ripping you off. What the New York Times calls "slightly more" is 37% higher per milliliter. For the same stuff.

There's no commitment whatsoever to the African villager looking for a decent place to shit however. No commitment from anyone. He'll take his dump the best he can and be blind someday. Enjoy your Big Pharma $120 a month body-altering mascara women of America, and remember always the reason prescriptions cost so much here: 

All that cutting edge research that keeps getting done. 

It Could Have Been Worse. I Mean, He Didn't Start A Nuclear War

"I don't know whether I'm going to win or not. I think I am. I do know I'm ready for the job. And, if not, that's just the way it goes."

-George W. Bush, Des Moines, Iowa August 21, 2000.

Yeah. That's just the way it goes. Kinda the way New Orleans just kinda went. Kinda the way the people who tried to blow up The World Trade Center just went right to jail.

Wait. That didn't happen on your watch. The person who did blow up The World Trade Center probably has more freedom right now than you'll ever have for the rest of your life, with those Secret Service folks and all following you around wherever you go.

Just the way it goes I guess.

Fuck it. You can't hurt us anymore. I just want to spend as little time as possible thinking about you from now on.

Keep walking assholes.

Some Things Karma Cannot Change, No Matter How Brightly She Smiles Upon You.

My friends, I have no idea what I have done to get on the right side of the forces that rule the universe. No idea. But like George Costanza the day he decided he needed to do the opposite of everything he'd been doing in his life, things have suddenly been breaking my way. This is how my New Year has gone so far.

I showed up for work on New Year's Day and there was a sign on the front window of the store saying the pharmacy was closed. Naturally, I beat it the fuck out of there. The corporates were mad, but there wasn't a damn thing they could do about it.

My mortgage payment went down. That's right, down. I have an adjustable rate mortgage tied to the interest rate paid on a 10 year T-note, which has fallen through the floor. Based strictly on economic criteria, I should totally be a Republican, and if I were some sort of selfish bastard fearful that I would somehow lose my status in society if I did not furiously beat down everyone below me on the socio-economic ladder, I probably would be. As it is though, I think It'd be kinda cool if your mortgage payment went down too.

My asshole neighbor moved away.

The person I wanted to be president when the campaign was in the "13 dudes and 1 dudette tromping around the snow in Iowa" phase will assume office tomorrow. My mind still has not fully comprehended this.

Thanks to the alert reader who sent in the e-card.

My creepy neighbor who used to call the store 5 times to ask if we were open moved away.

A check for a not insignificant amount of money magically showed up in my mailbox as settlement of a class action lawsuit against a former employer. I took down the man without even being aware I was doing so.

The people who lived next to the creepy neighbor also moved away, meaning I have almost an entire floor of the condo complex to myself at the moment.

"What does that say about what it's like living next to you?" asked my keystone tech when I told her this.

I even have the beginnings of a social life forming. I did things this weekend that didn't involve sitting alone in a dark room in the middle of the night sharpening my knives. Things with people. Real people.

And at work? I swear I'm not making this up. A customer asked me my opinion of generic Coumadin. And then, this is where it really gets weird.....he listened to what I said! Wait. It gets even weirder, he asked a relevant question! An actual conversation with a person about drugs who was treating me like I've spent the last 22 years of my life learning about drugs! On top of everything else, work had become like some sort of APhA wet dream!

It was around the time I said "The problem with warfarin is that most of the dose you take gets bound to blood proteins, meaning very little is left to work its effects on the body" someone walked by and shouted......

HEY! WHERE'S THE BATHROOM???!!!???

I wish I had a videotape of the asshole shouting for the bathroom in the middle of the one real counselling session I'll have this year. I'd send it to every pharmacy school in the country, and especially to this kid.

I just knocked on my neighbors door though, and no one answered. So that must not have been the moment I woke up from some sort of dream. Unless I fell back asleep and am typing this while actually lying in bed. I'll keep you posted.

The Drugmonkey looks over wearily at the alarm clock

A Student Seeks Out The Drugmonkey For Sound Advice, And Gets Back For The Most Part "Hell If I Know"

From the mailbag:

Hi. First I want to say that I love your site and ideas. With that in mind, I hope you can give me sound advice.

I'm a fifth year pharmacy student in New York with three more semesters left (2010) and I want to know if I should be starting to study for Naplex/MPJE at this time. I bought a book called Appleton & Lange's review of pharmacy but its 2001 edition and I haven't touched it yet.
· Which is the more important exam, Naplex or MPJE?
· What did you and your classmates study from when you took the Naplex/MPJE?
· When did you start to study for Naplex/MPJE?
· Is live prep. Courses like Kaplan good for Naplex/ MPJE review?
· How many times can I retake Naplex/MPJE?
· Am I within a set timeframe to take these exams?
· Are there different MPJE’s for different states? If so, which states have ‘easy’ MPJE’s?
· Is it true that you can retake the MPJE the next day or even the same day if you fail?

Regarding state selection, is it easier if I get licensed in New Jersey than New York? I heard that the compounding exam is really hard in New York and I only worked in retail for a year and a half at CVS. The only compounding experience I have was in school back in fourth year. Would it be better to take New Jersey MPJE and reciprocate back to New York?

Regarding miscellaneous options,

· Are there states that will license RPh’s that have below 75 in Naplex or accept Naplex without MPJE? If so, which states and are there any special conditions (work in state for X years, take specific pharmacy courses after licensure, etc).
· Regarding California's licensure exam, is it easier than Naplex/MPJE?
· Can I use California's results to reciprocate back to New York if I pass it?
· I’m a US citizen and want to know if I need to take the FPGEC as well?
· Are there special licensure situations that require me to take all three Naplex, MPJE, and FPGEC?

Dear Letter Writer,

What the hell are you talking about? I have a feeling this FPGEC of which you speak is some sort of English proficiency test. I also have a feeling, based on my day to day work experience, it must be very easy to pass. 

MPJE? If I knew what the fuck that was I might be able to answer some questions about it. I bet Google knows what it is, but like you evidently, I don't really feel like looking up stuff about the MPJE on the Google right now. My future doesn't depend on knowing what the MPJE is though. Just sayin'

You seem to be forgetting letter writer, I'm old. Not old enough to have had to have taken a compounding test though. What the hell is up with that? When I took the NABPLEX, administering it was an event. You showed up at the same time in the same place with everyone else taking it and you took it using a pencil and paper. You were not allowed to use a calculator. I shit you not. The day I took the NABPLEX I spent a good 10 minutes trying to remember how to do long division involving decimal points by hand. 

By the way, The NABPLEX was given in a building that contained the Ohio Agricultural Hall Of Fame. Had I not seen it with my own eyes, I never would have believed someone took the time and effort to create an Ohio Agricultural Hall Of Fame. 

Eight years later I took California's exam, which was harder because it was geared towards PharmD's at a time when the rest of the country was still giving out BSPharms. There was an essay part, and I will never, ever forget that I missed a question about administering Plan B. I will never forget it because I had been a practicing pharmacist for eight years, and I had DISPENSED the fucking Plan B probably dozens of times in the last year and I still flubbed the question. Brain farts happen to the best of us my friend. 

All in all though, this Bachelor Of Science degree holder kicked the California test's ass. Scored a 92 on the multiple choice and an 87 on the essay. If you're a *cough cough* Doctor (snicker snicker) of Pharmacy and scored less, you pretty much wasted a year of your life and a few thousand in tuition money. There's also a good chance you do the exact same things during the workday that I do. Ha ha.  

Anyway Letter Writer, what I'm saying is that very little of what I went through would apply to you now. I'm sure a few alert readers, or um, Google, the company that built its empire on making the world's information easily accessible, will be able to help you out though. 

The comment floor is now open.  

Another Republican Wanders By, And Does Us The Favor Of Providing A Teachable Moment.

Republicans use a variety of tactics to cover for the fact that they are always wrong. Always wrong, yet somehow always more than eager to argue. Volume is one of their favorites. Maybe it's because they're hard of hearing. That would explain why they seem to just not understand a lot of things. I would like to see some sort of study corrolating the voting patterns of people with the percentage of hearing loss they may be suffering. 

That can't be the problem with this commenter though, who stopped by to use a very common Republican argument tactic:

You described Medicaid as a clusterfuck, yet think that somehow, MAGICALLY when EVERYONE has insurance through the gov't everything will be BETTER?

Notice how he tries to make up for the fact he can't shout on the internet by using more caps? Damn, what is it with Republicans and volume?

Not to mention I never described Medicaid as a clusterfuck. The tactic he's trying to use here is taking what you said,  changing it to something that kinda sounds like what you said, and then trying to pin those changed words on you. They do it a lot. Pretty much every night on the O'Reilly factor actually. 

What our friend here seems to forget is that while this may work when you're on the O'Reilly factor trying to run out the clock until the next commercial break, when you're in a place with written words, what you actually said sticks around, and can easily be re-posted. Here are the words I wrote that stuck the burr up our friends ass:

I have a feeling that fact will do a lot more to get us a solution to this problem than the fact Monique literally got screwed to death by the clusterfuck we call a health care system here.

A basic sentence diagram will show what I was calling a "clusterfuck" is what "we call a health care system here" The "healthcare system" where a person can be on Medicaid one month, a half-ass employer based plan with a $5000 deductable the next, and nothing at all the month after that. As a matter of fact, the whole point of that passage was that the person who died would have probably lived had she been able to keep her Medicaid coverage. It's pretty clear to anyone with basic reading comprehension skills thats what I was saying. If you're gonna try to argue with me, you're gonna have to do it using the points I'm actually making you dumb buttfuck. 

Do you understand it's you I called the dumb buttfuck and not the so-called health care system we have in this country? If so you're making progress. 

But wait, there's more:

Where have you been living?

Where have I been living? In the one civilized country that doesn't ensure it's citizens have healthcare coverage. The same country with healthcare outcomes inferior to its peers. The same country that pays almost twice as much for those inferior outcomes as anyone else. Again, that was kinda the whole point of the post you were responding to.

Always wrong, yet somehow always more than willing to argue. I don't understand it. Kinda the way this commenter didn't understand a word of what they read.  

Sadly, It Appears My Customers May Remain In Their Vegetative State For Quite Some Time

How the hell did anyone fall asleep before the advent of Ambien? I know if you're in the profession you have a keg of it on your shelf. I know you whip the Ambien around like snowflakes in a New England blizzard, and I know if the insurance doesn't cover it there are fewer ways to make a credit card appear more quickly. I believe the economist's term is inelastic demand. People love the Ambien. That's what I'm saying. 

By the way, am I the only person left on Earth who remembers when Ambien came with strict warnings in the prescribing information that it was not to be used for more than 7 consecutive days except under exceptional circumstances, or did I just show my age here? 

At any rate, a little over two years ago, I reported to you exciting news about that little white pill that has taken the country by storm. It seemed a doctor in South Africa inadvertently stumbled upon evidence that Ambien, the same sleep aid essential for millions of lawyers to get a good night's sleep after a hard day of screwing members of the general public, just might be of use in waking people from persistent vegetative states. You can just imagine what the response was from Big Pharma to the news that one of their meds soon to lose patient protection could have a dramatic impact on people undergoing an incredible amount of suffering:

The company that first developed zolpidem, Sanofi-Aventis, was contacted...but appears to have chosen not to become involved in the trials or the use of the drug on brain-damaged patients

Not to worry though, if Big Pharma's idea of medicine has nothing to do with the possibility of almost literally waking people from the dead, I'm sure Medium Pharma will step up to the plate. A company  like NovaDel Pharma for instance. I hear NovaDel Pharma is doing some research with zolpidem now that its patient is free and clear. Lets go take a look at their web page:

Zolpimist™ (zolpidem oral spray) uses NovaDel’s proprietary formulation technology to deliver zolpidem tartrate, which is currently marketed as Ambien®, the leading hypnotic for the treatment of insomnia. NovaDel has announced positive results from its clinical studies comparing zolpidem oral spray with Ambien® tablets. Zolpimist™ has been approved by the FDA for the short-term treatment of insomnia characterized by difficulties with sleep initiation.
Zolpimist™ offers the potential benefit of a faster rise in drug blood levels potentially leading to a faster onset of action, without having to take water.

I'll translate that for you. NovaDel's research involves a way to separate people from their money by promising to put them to sleep about 15 minutes faster. And without having to take water! If that sounds like the dude who's been lying in a coma for the last 15 years is getting screwed, that would be because he is. 

I contacted fictional Washington insider Vernon P. Carmichael to get his take on the coma screwing situation.  "In Washington it's all about power and influence" Carmichael explained to me in an interview that took place in my mind. "And to be honest, the coma lobby is among the least effective in the industry, outranking only APhA, an organization too inept to even manage to get all the letters in its name capitalized."

It's true. I called the fictional headquarters of the Association For The Advancement Of The Consciousness Impaired and the phone rang for half an hour before anyone picked up. And the person who finally did answer sounded really sleepy.

"Meanwhile we all know the influence of the 'more money than brains' demographic" Carmichael continued. "Bottled water for sale, need I say more? Spell 'evian' backwards. Hell, you can even mock them and they still line up to give you their dollars." 

"So I would advise any of my clients that the future for any company that can develop a sleepytime nose spray out of a dirt cheap product that already exists, and charge out the ass for that nose spray, as well as any company that cares for people expected to stay in vegetative comas for a long time is very bright indeed." Carmichael never said.

In America that is. I should add there is research being done on using zolpidem in comatose and other brain-damaged patients. In South Africa. By a British company, ReGen Therapeutics. 

Damn good thing we don't have socialized medicine like those Brits though. Otherwise important scientific research would be crippled.  Enjoy your sleepytime nose spray sucker. That sound you hear as you drift off is the rest of the industrialized world laughing their ass off at us.

Thanks to the alert reader who pointed me in the direction of the story.