An Update On My Now Completely Normal Life. Plus Highlights From A Few Minutes Pill Counting Action.

Hola no one! Because I'm pretty sure that's who's left checking out my little blog garden after almost two and a half years of no posting. And what a two and a half years it's been! Trump's back! Now I know how much you guys loved my rants on politics, I could watch the number of hits here go down and down the more days in a row I talked about George The Formerly Worst Bush back in the day, but I just wanna throw out a reply I got on my old Twitter account when I was bitching the night of the 2024 election from a user by the name of @theNickNiti

 

 Replying to @drugmonkey
The Drama.. Ohh no you may have to suffer another 4 years of no wars, secure borders, and low inflation... What a curse!

 

BBBBBBBWWWWWWWAAAAAAHHHHHAHAAHHHHAAAHHHAAAAA!!!!!!!!!!!

I'll just say I've reached out to @theNickNiti several times since then, and have heard nothing back. Which says it all really. 

But you don't need me to tell you about Dorito Jesus. I know what you're really not interested in is what I've been up to, so I'll tell you. Just kinda livin' really. I read like a man possessed, bounce my radio waves around the world and off the amateur radio satellites as they whiz by, go to the coast often and to Mexico once to scout out a possible escape place, take naps, and once, against my better judgement, agreed to help the local non-profit pharmacy that a Mr. Moneybags had set up in this town to take my place. 

You see, it seems they were taking the non-profit part of their mission a little too seriously, as a pile of unreconciled  insurance rejects had piled up because the inexperienced pharmacist in charge was in over his head. To be fair, the computer system they were using sucks donkey balls. I know this because it was the same one I used back in the day, and this poor bastard didn't have any one to teach him. So what the hell, I'll go down there and do my good deed for the day. I sat down in the back with a pile of paper and started dialing PBM help desks for dollars. 

 It started out well when the first place said my call was very important to them. It went down hill from there. Prior auths, step therapy, mysterious codes that had to be put in mysterious places that didn't exist on the computer screen, which necessitated a call to the software vendor who I think I might have stiffed out of the last month's money I owed them. They were gracious about it though, because the first thing their little machine told me was that my call was very important to them. 

 I gotta hand it to Express Scripts though. They don't give you any of that important call bullshit. They make it pretty clear they don't want your goddamn call at all. 

Anyway, after a morning of this, the pharmacist asked if I would mind manning the counter while he grabbed lunch. Would I!! Hell yeah! A chance to get back in the saddle for old times sake and do some real phamacyn', returning to my position of community prominence, if only for half an hour. 

The other pharmacist left and the first customer through the door was a guy I used to call Mr. Norco. He came to the counter with a...wait for it...empty Norco bottle and immediately went into his story about why he needed it early. It was like he was picking up right where he left off three years ago. After a couple minutes he tried a tack he was never able to when I was the only drugslinger in town. 

"THE OTHER GUY ALWAYS LETS ME GET IT!!

 "You can take it up with him after one." I said, while seeing in his profile that the other guy did not, in fact, always let him get it. 

This was followed by a lady who gave me a prescription cash discount card and informed me in the way one informs a servant that this was her insurance from her husband's employer and the copay would be $10. She took the truth in the calm, sane rational way of an intelligent person who made a minor mistake. In my fantasy world. In reality she fought tooth and nail over a $14.76 bill in the way of  a mother fighting for the life of her only child. The prescription was for vitamin drops. 

The next person gave me a Medicare Part D card that was three years old. The one after that had an insurance plan that didn't cover promethazine DM. He took the explanation in the reasoned, logical way of an educated man who can understand that there is no shortage of DM products over the counter. 

Ha ha. Not really. he called me stupid and said he was going to Wal Mart. 

And then I realized, that old pharmacy feeling was back. The muscles tensing up in the back of the head, the jumpiness, the anxiety, being able to see your pulse in the flashes before your eyes. It was like the return of an old friend. A friend who wants to kick you in the nuts every time he sees you. I had been living a normal life so long I had forgotten what it feels like to man a house of drugs. 

The other pharmacist came back from lunch and I told him I had done about all I could for him. I made it to my car and felt the way of pharmacy drain from me like a flush making its way to the septic tank. I will, never, ever, set foot behind a pharmacy counter for as long as I live. 

And I didn't even tell you about the woman who got her eye pecked by a chicken.  At least I have another two and a half years of no wars, secure borders, and low inflation on the horizon.

This One's For The Kids.

Because you need to know what's waiting for you on the other side of a pharmacy degree, and no one else is gonna tell you.

Your professors aren't gonna tell you.

The corporate hacks you interview with aren't gonna tell you.

The American Pharmacists Association isn't gonna tell you. They're there to let you know provider status will create a world where every child gets a puppy and unicorns frolic in the pastures shitting rainbows all day long.

But you need to know. So when I saw this out on the internets I figured I'd put it here where some of you kids would see it. There's not one word in here that surprised me. As a matter of fact, I'd be surprised if you weren't treated to some variation of this if you make the mistake of slinging pills for the corporation. Read it and weep. Then figure out what you're gonna do about it.

This was around the point where back in the bad old days I would have put in some sort of joke about how it was too late for me, but you can still save yourselves.

But it wasn't too late for me. Which I guess means this post isn't just for the kids. I sure as shit didn't have any special entrepreneurial skills  when I set out on my own. I didn't even know what happened to the money after I dropped it off to the community college hack on my way out the door.

Yet here I am am. Three years now and counting. If it's too late for you to find another major I have every reason to believe you could do it too.

No one at CVS probably even read this letter. More people will see it here than at their corporate headquarters. Nothing will change there, but that doesn't mean it has to be this way.

It doesn't. You don't have to accept this.

The letter's long and maybe not of much interest to people outside the profession, but if you're thinking about your major, or if god forbid you're close to accepting a job with one of the chains, you need to read every word.

Then figure out how to keep this from happening to you.

__________________________________________________________________


To Whom It May Concern,

Please accept this letter as notice of my resignation from the position of pharmacist at CVS Health.

As per the terms of my employment contract, I will continue to work for the company for the next 2 weeks, completing my employment on February 26, 2016. If there are any areas in particular you would like me to focus on during my notice period, please let me know. As always, I will continue to give my best effort – I want to leave my team in the best possible situation, and I hope that the new pharmacy manager gets off to a good start.

Although this should be difficult decision to make, I have recently come to recognize that it is really the only decision left, largely due to what I feel is a serious deficit in my immediate supervisor's management abilities. I recognize that she is a strong pharmacist, and I have a lot of respect for her as such, but I have spent the last 3 years under her supervision becoming increasingly frustrated with the state of our district and the way it has been handled. I can no longer keep these feelings of frustration and hopelessness to myself, and will detail some of them below. I hope you will understand my reasons for moving on.


I will start with the broader issues, involving the company as a whole. Let me lead off by saying that I have worked for CVS for 10 years, from intern to pharmacy manager. I have worked in 3 different states, under different management teams, and weathered many storms with and for CVS. I had a colleague, who has about the same tenure, say to me the other day, “I used to recommend that all of my friends try to get jobs here. It was such a good company to work for. Now I tell them to stay far, far away.” I hear this sentiment echoed over and over again throughout the world of retail pharmacy, from those who were previously employed by CVS and from those of us who’ve stuck around, faithfully holding up our ends of the bargain and hoping CVS would see the error in their ways and do the same. The downfall of CVS as a desirable employer began when Tom Ryan retired. His philosophy was always people-driven. He wanted to run a healthcare company, one that took care of and did right by its patients. He wanted us to be able to provide the best possible patient care, and valued our customers as people, not as dollars. He valued his employees as individuals – raises were merit-based and people were recognized for their accomplishments, encouraged, and rewarded.


When Tom Ryan’s reign ended and Larry Merlo took over, it did not take long for their corporate philosophy differences to become apparent at the ground level. Technician hours were slashed; business metrics became the focus over patient satisfaction metrics; employee satisfaction declined and turnover went through the roof; employee benefits were cut, including the extension of the tenure required to achieve an extra week of vacation, stock options, and hiring everyone in at part-time employment to ensure that they didn’t have to be paid health insurance benefits; CVS acquired Caremark (not sure how the FTC allowed this) so that they could force their insurance recipients to use their own pharmacies and as such could lower their service standards to abominable levels, because patients had no choice but to use CVS. They no longer represent what ANYONE went to pharmacy school for, except maybe the paycheck. We are no longer healthcare providers – we have been relegated to being dispensing machines without regard to our own safety or that of our patients.


Now, these corporate changes began several years back. They are not my primary reason for leaving, despite the fact that they are significant. I came to terms with working for one of the corporate giants that was selfishly destroying our society by hurting employees and customers so that the upper echelons of management could bring in money hand over fist. I told myself that it was just the unfortunate way that capitalism in the US has gone, and that it was out of my control. My true reasons for leaving, now, after all this time, are more personal and immediate. Since my prior pharmacy supervisor, Sarah Freytag (the best manager I have ever had the pleasure of working for) moved into a corporate position a few years ago, my district has steadily declined under the management of [pharmacy supervisor name]. I have been underwhelmed with the quality of the management team we’ve had since her departure, and have become increasingly frustrated with the lack of response to the district’s decline.


It starts with respect. My current pharmacy supervisor treats her pharmacists and technicians with zero respect. As pharmacists, we are not even acknowledged as individuals with varying backgrounds and skill sets. Really, I think that it comes down to the fact that she does not spend enough time out in her district or talking to her pharmacists to know us as people, and doesn’t have the slightest inclination as to what we are individually capable of within our roles as retail pharmacists. As an example, a few months back I had text her to let her know that the website was down for our supplier, and I wasn’t able to place an order for the store I was filling in at. Her response was to call the store manager at home (after the order cutoff time had long passed) and ask her to call the store and talk me through how to place an order. I have worked for CVS for nearly 11 years – I have very successfully managed multiple pharmacies, and trained dozens of new technicians in the process. We have been ordering essentially the same way the entire time I’ve worked for the company. I thought to myself, “Does my immediate supervisor really think that I am that ignorant of the functions of my job? Would she really not know that sending an order is something that is well within my comfort zone, and not something that I need someone to talk me through? I can talk someone through just about any procedure in the CVS computer system with my eyes closed.” It really opened my eyes to the true lack of leadership that I was dealing with.


I’ve always felt like [pharmacy supervisor name] didn’t like me. I’ve never understood why, or what I was doing wrong. I’ve never had much feedback, positive or negative. In the 3 years I’ve worked under [pharmacy supervisor name], I’ve never even had the courtesy of having a review (which should be done annually, according to company policy). Last year, I received a very small percentage raise, much below the standard I had seen across my 10 years. I hadn’t had a review, so I checked my online personnel file where the written reviews are stored. I pulled up all of the reviews in there, 1 from Sarah and 2 from [pharmacy supervisor name]. The two from [pharmacy supervisor name] were both blank – all I could find was a rating of “Meets Expectations”. I emailed her to inquire about my raise amount since I had received an average rating, and asked if there was something I should be doing differently to improve my chances of getting a better raise next year. I never got a response.

Finally I called her, and she told me that she didn’t have anything for me to work on, but that my raise was low because my pay was high compared to other pharmacists in the company with the same title and tenure (PT Floater, 10 years of service). So now, my supervisor was telling me that it really didn’t matter what my performance level was or how hard I worked, that I was going to get a menial, ridiculous raise each year regardless, because I had worked very hard to move up earlier in my career and was now situated above some other people who hadn’t worked as hard. This year when I went to fill out my side of my review, my goals that [pharmacy supervisor name] had set for me revolved around “Manager Controlled Profits”, which involves script budgets and payroll management. Last year’s review was in March, and I had been floating since the previous September – the goals she had set for me weren’t even relevant to the job I was in. [pharmacy supervisor name] has so little respect for her pharmacists that she doesn’t even know who they are with respect to what positions they hold under her, and can’t even bother herself with writing out relevant reviews and goals for them.


But the lack of respect goes beyond that. Interns and technicians are essentially abused, and pharmacists are treated as pawns that should have no say or even opinion on their own career paths. I have seen technicians asked to take their day off to drive across town, pick up a cookie for a new pharmacist that was just licensed (and only one or two of the many, mind you) as congratulations, deliver said cookie to the pharmacist, and drive back home, all without pay.

I have seen countless interns on management rotations forced to work in stores as free labor, not to be shown a single thing about how to be an effective manager. I was even told by one intern that she was forced to personally deliver a narcotic prescription to an angry patient’s home – the patient’s regular pharmacy did not have her medication in stock, so the intern had to pick up her prescription hardcopy at the regular store, take it to another store to be filled, then drive it to the customer’s home. The patient was irate and somewhat unstable (I had spent over an hour on the phone with her myself a couple of days prior), and the intern was put in a very uncomfortable position where her personal safety was compromised so that the [pharmacy supervisor name] didn’t have to deal with the situation. Needless to say when [pharmacy supervisor name] asked her if she was interested in working for CVS, the answer was no.


As far as my personal situation goes, I have always been extremely flexible with CVS. I worked full-time until the birth of my daughter 4 years ago, and have since gone back and forth between full- and part- time, floater and pharmacy manager to meet the needs of my district. I have experienced swings from being told there are no hours for me to being asked to go back to full-time a couple of months later, and always taken it in stride and done whatever was asked of me. I have managed “challenged” pharmacies and turned them into “excellent” pharmacies,

I have been told by multiple pharmacy managers that I am the only floater they have ever had that will go above and beyond my daily duties of filling prescriptions to actually help them run their stores, and I have been told by technicians that I am the best boss they’ve ever had. I have a very strong urge to work my hardest and do my best regardless of whose store I’m in, whether the final outcome of how the store is doing is my responsibility or not, and I find my biggest frustration with floating was knowing that if I had more time at a store, I could make a bigger difference. This lead me to recently volunteer to manage a pharmacy that was really struggling, despite the fact that I have opened a small business and have a 4 year-old at home, and really want to be working part-time. I decided that for a while, I could sacrifice my personal needs to help my district succeed.


The back story on the situation at this store needs to be explained, as it is one of the major faults I see in [pharmacy supervisor name] management outlook. Since turnover has been so high under [pharmacy supervisor name], she has developed a habit of hiring the first person that walks in her door, regardless of their abilities as pharmacists or managers. She has also decided that the best way to get a pharmacy manager in a store that is in need is to force someone who doesn’t want the position and/or can’t handle the position to do it anyway. My biggest issue with this is with newly licensed pharmacists who have just graduated from school. They have no experience as a pharmacist, no experience being the one in charge of everything that’s going on that day, no experience handling being pulled in 8 different directions at the same time, and no experience managing people. They are not only being expected to magically become strong, fast pharmacists overnight, but they are expected to do so in very busy stores, and even as pharmacy managers.


In this particular store, 4 technicians were accepted into pharmacy schools at the same time. They were all scheduled to start their programs in August. The pharmacy manager was working on getting new technicians hired to replace them, and the staff pharmacist gave notice that he was moving away. The first terrible decision of a long series of terrible decisions was to, at the same time that the staff pharmacist and all the technicians were leaving, pull the pharmacy manager out and transfer him to another store. This left my store with no leadership, no permanent pharmacist, no technicians, and no one to follow through with the new hires. She decided to promote a staff pharmacist from another store (45 minutes away) and have him commute to my store to be the pharmacy manager, and put a newly licensed pharmacist in as the staff.

At the same time, the pharmacy manager at his original store gave his notice. [pharmacy supervisor name] decided that the best call was to let the transferring pharmacist remain at his original store as the pharmacy manager, and to force the newly licensed pharmacist to be the pharmacy manager at this store, with no steady partner for support. This was one of the worst decisions she could possibly have made, both for the pharmacist and the store.

Our district has plenty of experienced staff pharmacists who are plenty capable of being pharmacy managers. In this situation, I cannot understand why you would not take an experienced pharmacy manager from a slightly slower store and move them to this busy store, take an experienced staff pharmacist and promote them to a pharmacy manager at the slower store, and then take the newly licensed pharmacist and allow her to “get her feet wet” as a staff pharmacist. Dumping a new pharmacist into a management position is never a good idea. Dumping them into a super busy store is never a good idea. Combining the two is a terrible idea. Needless to say, the new pharmacist quit, leaving the store with no regular pharmacists and severely understaffed with technicians. I had been floating there some, and in an effort to keep the new pharmacist (who I had worked with when she was hired as an intern) I volunteered to take over as manager of that pharmacy, thinking that this would allow her to relieve some of her burden and be able to hang in there. I did eventually get put in as pharmacy manager, but not until a couple of weeks after the new pharmacist had left the company and the store continued to struggle, with no support from management.


About the time I was put in as the pharmacy manager at my store, [pharmacy supervisor name] went on maternity leave. I strongly believe that the only reason I was allowed to take the position was that she wasn’t there to say no – she had decided several months back that she would not staff me permanently in a store because she did not want to accommodate my schedule restrictions.

I was told by the district manager and the interim pharmacy supervisor that, when I expressed concerns with the way things had been managed to this point, that, “We’ve been doing things the [pharmacy supervisor name] way for a while now, and it’s obviously not working. Now we’re going to do things my way.” I was under the impression that meant that I would be staying in this store for several months, allowing them time to hire a staff pharmacist for the store, get the technician staffing under control, hire a pharmacy manager, make sure the pharmacy manager was capable of handling a store of this volume, and then make a transition once the store was stabilized.

Unfortunately, as soon as [pharmacy supervisor name] came back from maternity leave, this plan went out the window. In my first conversation with her after she was back, I asked when she could get me transferred into this store permanently, so I could access all of the tools that are only available to pharmacy managers. Her response was, “Why would I transfer you there? You aren’t the pharmacy manager there. You aren’t going to be the pharmacy manager there. We’ve already got someone to replace you, and I just heard back today that he passed his drug test and background check.” Here we are back to respect, and treating people with some basic human decency.

I was shocked. I asked her about my pay, as the pharmacy manager position awards you a $1 per hour increase – she informed me that she would NOT be backdating my pay for the time I had been manager at the pharmacy, because despite the fact that I had power of attorney and was managing the pharmacy, I was not actually the manager there. All of this was completely sprung on me, in a completely tactless and inappropriate way, while I was in the middle of my shift. I felt the entire situation was extremely inappropriate, and I called the district manager. I was told that this was always the plan, despite the fact that one week earlier when she had been in my store, I had mentioned that I heard they had a partner for me, and she had acknowledged that and said she was excited that we were moving in the right direction. She and the interim supervisor had asked me to apply to the internal job posting for the manager position, and even had me spend my personal time writing a resume for the job. There are two options here – they were leading me on, lying to me about their intentions for me, or they lied more recently, informing me that this was always the plan.

Either way, I’m not satisfied with being treated that way. It’s not the decent way to treat anyone, and especially someone who has dedicated their professional life to CVS and volunteered to make personal sacrifices for the betterment of the district.


Now, my career is up in the air, my job in turmoil. No one has bothered to discuss with me what the plan is for my future, where I want to go and what I want to do. My store is in a state of unknown – under my guidance, turnover has stopped and my technicians are once again happy to come to work. We went from running consistently 500-700 scripts past due, to consistently running on time, and even occasionally getting some cleaning and organizing done, despite the fact that we are still understaffed by 60 technician hours a week.

Now, a pharmacist that is new to CVS is being sent in to manage the store. As has been described, throwing unknowns into this store hasn’t been very successful. It’s a tough store. It’s old, small, poorly laid out, and very fast-paced. We have recently grown by about 20% (just in the last few weeks) and have been able to maintain, but the technicians who have been through all of this just a few short months ago are terrified that a new pharmacist will not be able to handle the store and that it will return to how it was. I hope that’s not the case, but to be honest, no one knows.

One interview with someone isn’t going to show you that, and once again we are back to our old management tactics of putting all of our stock in one person to hold it all together. I even volunteered to stay on as the staff pharmacist, feeling that this would bring some stability to the store and that I could be an excellent supporting pharmacist to a new pharmacy manager that is not familiar with CVS’ system and the exact expectations and requirements of the job. This suggestion never even received a response beyond “We’ll talk…” which we never did.


I am not happy to be writing this letter. I had high hopes that a new district manager would bring real change, and that the district would no longer be subjected to the irresponsible and destructive management style that [pharmacy supervisor name] has brought with her.

Despite all of my frustrations, I still struggled with this – my professional career has only ever known CVS. I have made countless friends through this job, in technicians, pharmacists, front store staff, and patients. It’s difficult to walk away. But my hope is lost, my faith is gone. I hope for everyone else’s sake – all of those wonderful people who are still hanging in there, hoping for improvement – that I am wrong and change does come.


Thank you,
Lindsey Hoehn
PharmD

From The Mailbag. The Buckeye Board Of Pharmacy Figures It All Out. Way To Go Ohio.

Straight from the inbox. Complete and unedited:

Ever since CVS started their scorched earth policy regarding massive tech cuts the state board has received an increased percentage of complaints regarding prescription mis-fills. As the guardians of public safety(according to their mast head) they had no choice but to tackle this problem head on and come up with the appropriate solution; which of course they did.  From now on every pharmacist licensed in Ohio must now take  at least four(4) hours of continuing education consisting of "patient safety concerns when filling a prescription". 

This should definitely fix the problem of mis-fills.  We never practiced safety!  Who knew?

To be fair, this is only half of their safety solution. The other being the jailing of anyone guilty of making an error. Now that the second part of the plan is finally in place, you can breathe easily consumers of Ohio.

And by "consumers of Ohio" I of course mean "corporate bean counting assholes who are actually responsible for the problem." I doubt you had much worry they were going to inconvenience you in any way in order to keep people from experiencing preventable illness and death, but now you can rest assured you were right.

And to my friends left behind toiling for the chains, I'll say this is just the latest reason you need to get out. You know it as well as I do. I promise you you're not stuck there the way you feel you are. I made it out of that world and deep down.....you know you can too.

It won't get any better.

I Hope Some Doctor Somewhere Who's Written A Prescription For Cambia Reads This Post

Because I have a question for you I seriously would like to have answered.

Why?

Now don't get defensive, I'm sure you have your reasons, and I would honestly like to know what they are. I won't judge you. Think of this as like when a mistake happens in a hospital and the people investigating are more interested in finding out what went wrong than in assigning blame.

Because you made a stupid decision. And I mean that of course in a totally non-judgmental way.

It's diclofenac. I'm going to assume you know this, you're an educated professional and you fully understand diclofenac is one of maybe a dozen NSAIDS out there. Cambia is marketed to treat migraine headache, so the first thing you did when you wrote that prescription was decide that diclofenac was the most suitable option for treating your patient's migraines.

You'll see a bigger push to avoid ORAL diclofenac.  

   Think of it as a "three-strikes" NSAID.  

   Strike one...it increases the risk of cardiac events as much as rofecoxib (Vioxx) or high-dose celecoxib (Celebrex).  

   Strike two...it causes more liver toxicity than most NSAIDs.  

   Strike three...it causes more GI toxicity than celecoxib, etodolac, nabumetone, or meloxicam.  

   Recommend naproxen or ibuprofen if an oral NSAID is needed. 

That came from the Pharmacists Letter. A totally non obscure newsletter mailed to pretty much everyone who knows anything about drugs in this country. There's references in the article if you're interested.

Remember what they said there about ibuprofen also. It'll come up again later.

But it's OK to go with the NSAID that competes for both the highest liver and GI toxicity in its class. There are exceptions to every rule, and there can and will be perfectly good reasons to prescribe diclofenac to certain patients.

Assuming you knew Cambia is simply a form of diclofenac. Nothing more, nothing less. And at 50 milligrams, it's a strength less than that of the strongest tablet.

Hit that migraine hard, doctor.

Here's the thing I really want to know though. The thing that separates Cambia from the diclofenac we all know and love is the dosage form. Cambia is a powder. It's powdered diclofenac. Like diclofenac tablets after you crush them with the back of a spoon. That's what the Cambia is. Pre-crushed diclofenac.

So pulling together what we know so far, when you prescribe Cambia, you have decided to use the NSAID with the highest toxicity profile and that it would be a clinical advantage to have the drug pre-crushed at the factory.

"Yes" I hear you saying, good doctor. "Because of a superior pharmacokinetic profile"

That's a fancy way of saying that a powder should get absorbed faster than a tablet, and while that is certainly intuitive, I'll point out that the makers of Cambia offer no actual proof of that when they would have every incentive to do exactly that should any proof exist.

I'll also point out the existence of liquid ibuprofen, a dosage form that should be the most rapidly absorbed of all, in a drug with fewer cardiac and hepatic side effects.

But you are nothing but a creature of science, right doctor? And your decision to use Cambia would have nothing to do with the fact that at $450 to $500 for nine doses, it just must be better 'cause it costs more than the diclofenac tablets you can find for less than $20. I won't insult you by suggesting that, or that a smokin' hot sales rep is playing you for a tool.

But it's just that, if I don't go with any of those ridiculous explanations, I'm not left with a whole lot, which is why I'm hoping you can help me.

Why did you write that prescription that made you look so stupid? Not that there's anything wrong with being stupid. Unless you're a doctor maybe. Doctors probably should be smart.

Which I guess means I really am judging you.

Dumbass.

So Here's An Idea About This Whole APhA Awardgate Thing

Tell me what you think.

First, we get a bunch of the books where American Pharmacist's Association Foundation award winner Lloyd Duplantis espouses his theories that birth control pills lead to more gay men, which led to the whole Horny Haitian Homos bringing AIDS to North America thing.

If you're just tuning in, I'm not joking. Click here to get the scoop, or just keep reading the next few posts here.

Then, we get the book's covers stamped with something like "By APhA Foundation award winning author Lloyd Duplantis." Like how Oprah stamps her book club picks.

Then we show up at the APhA convention and give 'em away for free, and let Lloyd's own words do the talking.

The only downers; this would involve Lloyd getting royalties, and I'd have to go to the APhA convention. I'm not sure which is worse.

I'm open to other suggestions.

Petition Started: Call APhA On Their Boneheaded Move To End All Boneheaded Moves

Click. Look. Sign. Spread around.

My Grown Up Letter To APhA

It's odd sometimes, the duality of the Drugmonkey/real life thing. You think Steven Colbert ever got confused as to which Steven he was? Probably not, but others sure as hell do over this type of thing. Rite Aid couldn't figure it out, and I will be forever grateful to them for it.

Anyway, this APhA/Lloyd Duplantis situation calls for more than the snarky Drugmonkey treatment. It's a serious problem that they seriously are gonna have to deal with. So this is the serious, grownup, not in character letter that I sent to CEO Thomas E. Menighan and the PR person who wrote the press release announcing the award.

Serious and grownup, posted at the home of the snarky Drugmonkey. You figure it out.

_________________


Mr. Menighan,

I am writing to you to express my utter dismay at the selection by the Louisiana Pharmacists Association of Lloyd Duplantis as that state's recipient of the APhA Foundation's "Bowl of Hygeia" award. While Mr. Duplantis has gained some notoriety as a member of a movement by pharmacists to refuse to dispense oral contraceptives to women, there is another, far more disturbing aspect to his work that I can only hope you are not aware of.

In 2010, Mr. Duplantis self-published a book entitled "The Pill, America's Sacred Cow" in which he outlines his opposition to hormonal birth control. While a complete debunking of the inaccuracies, use of pseudo-science to mask religious dogma, and flat out wrong statements presented as fact in this book is beyond the scope of this letter, there is a particular part of this work, which now has the tacit endorsement of APhA, that you need to hear. I start with the following quote:

"It is proposed by several researchers that the constant bathing of the female ovaries with exogenous female sex hormones affects the complex chromosome balance of the ovum while still in the ovary. This is hypothesized as a factor in the increased occurrence of effeminate men in the American population with the subsequent practice of homosexuality resulting in the rampant spread of HIV and AIDS infections."

Lest you think that was a quick statement of a fleeting thought. Later in the book there is an entire chapter espousing the bizarre theory that:

1) High dose estrogen contraceptives produce "effeminate men,"  which leads to an increase of the number of homosexuals in a given population.

2) These pills were tested in Haiti in the 1950s, leading to an above average number of gay men by the 1970s

3) A large group of Haitians traveled to the African nation of Zaire in the 70s, where errant vaccine experiments had led to the creation of the AIDS virus.

4) These Haitians then contracted the virus, brought the disease back to Haiti, and from there it spread throughout North America.

I can assure you Mr. Menighan, that is only the most egregious thing to be found in that book. There is plenty more where that came from. And now, through the APhA Foundation, these ideas have the implicit support of your organization. It would be one thing if you could claim lackluster vetting led to your foundation being unaware of this toxic work, but it is listed front and center on the press release announcing the award!!

Let me be clear. APhA has praised the notion that homosexuality is a medical disorder and lent credence to an incredulous "theory" about the start of the AIDS epidemic in the United States. You have no idea how much I wish I could go back to simply calling your organization ineffective.

I understand that you personally were most likely not involved in the decision to bestow this award on Mr. Duplantis, but that award has the name of the American Pharmacists Association on it, and as its Chief Executive Officer you are responsible and are to be held accountable for everything the organization does. It is up to you to limit the damage that has been done, and only a revocation of the honor given out in your name and complete repudiation of the repugnant ideas of Mr. Duplantis can begin to remedy this situation.

I look forward to hearing how you plan to act in this matter.

I will follow up this email with a certified letter to ensure you receive this important communication.

Lloyd Duplantis Of Gray, Louisiana Is Far Worse Than I Thought. That's Not The Problem Though. If APhA Is Capable Of Shame They Need To Bring It Out Right Now.

Fans of the blog know all about Lloyd Duplantis. For those of you that don't I'll tell you the condensed version. He was front and center in the movement a few years back of pharmacists that refused to dispense birth control prescriptions. What made Lloyd a little different though, was that it wasn't enough for him to say you couldn't have your Ortho-Novum because it went against his moral beliefs. He essentially ignored that part of his argument one night on national radio, saying he didn't dispense them "in the name of science," calling what's in your birth control pack "the most dangerous chemicals on the market."  He spewed forth bullshit and his bullshit got called here. That's old news.

There's more to Lloyd than we knew though. And thanks to the American Pharmacists Association, we all get to find out.

It seems that our friends at APhA, who seem to do nothing other than give out awards, build new headquarters, and shake hands while taking pictures,  saw fit to give out one of their awards to Lloyd. Specifically, a "Bowl of Hygeia," which is some sort of thing given out by each state association in the name of the APhA Foundation. I was gonna write me a little letter to that Foundation to ask them things like how honoring Lloyd fit in with one of their self-proclaimed values. I quote:

 "Respect for the patient’s role in managing their health is central to care."

Except when some slut wants to have a little control over her woman parts evidently, but I'm getting off track. I thought I could write a better letter if I had a copy of the book Lloyd wrote a few years back. Unfortunately I had to buy the damn thing. It isn't popular enough to be anywhere where you can borrow or steal it. Unlike mine, which can be acquired in all ways legal and otherwise.

Lloyd abandons all pretense of not basing his opposition to sexy pills on moral grounds in this page turner, but what immediately struck me was how he tried to have it both ways on the science stuff. Here's a quote from the introduction:

I have placed my own emotions and my own hypotheses here and those are based upon empirical and anecdotal observations. Since modern science and the politically correct establishment does not accept or rather has a general disdain for that type of science, I chose to call this compilation of my musings and articles that I have found interesting regarding "the Pill," a story rather than a scientific work. 

Got that? That fancy liberal science doesn't accept things like what some guy saw or thoughts he pulled out his rear end to be good enough, so this here type of science is called a story. A story about the type of science that isn't good enough for those eggheads. And a story that uses a lot of words like "empirical" and "clinical" and "hypotheses" to remind you it's just a story.

Just for kicks, let's take a look at a few of the places Lloyd's type of science leads to. These are just warm ups. The main one is coming:

-All contraceptive products have much more potential for harm rather than the possibility of benefit. 

Eh, no surprise there. We kinda figured he'd be saying stuff like this.

-In his practice, Lloyd says "every side effect listed on the package insert presented itself" 

That, my friends, is bullshit. No pharmacist has ever seen every side effect listed for any drug on the market, and every pharmacist reading this knows that as fact.

-"Oral contraceptives are steroid based chemicals and therefore create an immune-compromising situation which makes individuals more susceptible to infections of all kinds." 

Proof please. Oh I forgot. Wrong type of science.

-"I am very pleased to be able to share...some of the information I have garnered through my own personal research, clinical experience, and assessment of material done by others"

But remember, in no way am I trying to call this science.

-"The blood of women taking oral contraceptives often takes on a green color." 

Wha?

-"Any pharmacist practicing for any length of time has been approached and asked whether he has any outdated birth control pills for use on plants." 

OK this is just weird now. I've been at it 23 years and no one has ever asked me for birth control tablets for plants. So if you're interested in the world of reality you're gonna have to at least say "Every pharmacist except one..."

I could go on all night my friends, hell I could go on for a week. You wouldn't believe the amount of material in here. But that's not my point. Here's what I want you to take away from this book. I also want you to remember APhA gave this man an award

"It is proposed by several researchers that the constant bathing of the female ovaries with exogenous female sex hormones affects the complex chromosome balance of the ovum while still in the ovary. This is hypothesized as a factor in the increased occurrence of effeminate men in the American population with the subsequent practice of homosexuality resulting in the rampant spread of HIV and AIDS infections." 

Whoa. So, this guy is saying being gay is like some sort of birth defect. And APhA honored that.

"Well, APhA is incompetent remember" some of you are saying. "They probably had no idea about this book when they dished out that award."

Except it's listed front and center on their press release announcement. 

We're not done yet though. Hang with me and you'll find out how AIDS came to the United States. It's all covered in one of the last chapters, but you're gonna have to stick around for a bit. This is probably the most complex theory Lloyd comes up with. It goes like this.

1) The initial version of the birth control pill contained much more estrogen than the ones that eventually made it to market, which had much more estrogen than the ones on pharmacy shelves today. 

OK. That much is true.

2) The initial, experimental, versions of high-estrogen oral contraceptives were tested in the slums of Haiti, because there was a large, accessible population that was poor and wouldn't cause much trouble if things went wrong. 

Don't know about that, but certainly not implausible.

3) Remember, there's totally a link between high estrogen birth control and more "effeminate" men. And homos. 

That's what you said earlier. Yes I remember.

4) These experiments were done in the 50s, which means by the 70s there were more....

homos?

...than would be in the normal population. 

OK, I'm gonna quit commenting here and just let this thing play out to the end.

5) There were several vaccines being tested in the Belgian Congo in the 50s and 60s which "are offered as a catalyst for the beginning of HIV" 

6) In the 70s, which would be when the homos created in Haiti would be at peak horniness, a "unique population transfer" occurred as 47,000 Haitians were brought to Zaire to work on "health and welfare activities"  

7) Remember, there were more homos in this population than there would be normally.  

8) And they would do homo things. Because they would be at peak horniness.  

9) And so they would catch the AIDS, and bring it back to Haiti.  

10)  Then it spread throughout North America. 

OF COURSE!!!!!!!! IT MAKES TOTAL SENSE!!!!!!!!!! Big Pharma experimented on the poor people of Haiti, creating a pool of homos, who then grew up and got horny and went to Africa, where there was some sort of mad scientist or something who accidentally created the AIDS virus, and the horny Haitian homos picked up the virus and took it back to Haiti and then into our own country!!


THERE SIMPLY IS NO OTHER WAY!!!!!!!!!!!!!!!!!!!!!!!!!!


OK lets all laugh at that for awhile, and then remember something.

APhA gave that man an award.

And they knew about this book. It's featured in the press release announcing the award's presentation.

Which means whether they meant to or not, the American Pharmacists Association just gave a tacit endorsement to the theory that horny Haitian homos caused AIDS.

This goes way beyond birth control now.

This goes way beyond calling APhA ineffective.

They have some explaining to do.

Testify To Pharmacy Jesus My Friend......Testify......

I QUIT RITE AID!

And it was the best thing I could have ever done for myself.


Hello Mr Monkey, I asked advice from you a few years ago about leaving Walgreens for a Rite Aid position located where I wanted to live. I thought you would like to hear what happened.

It lasted 3 years. During that time, I was miserable. It got so bad, I was forced to flex my brain muscles more than I did in pharmacy school, to figure out how to get out. It is so pathetic, to spend $150k on student loans and pass classes that took all of my efforts for so many years, only to find myself equally pressured to get the fuck out of the very place I dedicated my life to be in.

I was threatened with trivial write ups over mentally ill customer complaints, sending a personal fax, putting a flu shot sign in the incorrect location, etc. These write ups, I was told, would lead to a final meeting that would possibly result in termination. I put my keys in the lock box, called the DPM and informed him I would never be back. They did not deserve a 2 week notice.


I started a home business with my wife, and all is well. I still Rph, doing some floating for the new Haggen stores. I now own my life again, sleep well at night, and wish the best for all of my pharmacy friends that are stuck in the corporate trenches.

I appreciate all of your thoughts and writings over the years, and they no doubt had a huge influence in my ultimate decision to leave and stand up for myself. For that, I thank you very much Mr. Monkey.

The Socialist Invasion Has Begun, And Rubber Bands Are The New Symbol of Surrender.

Big changes reportedly happening at the Pharmacy America used to trust my friends, first and foremost, that artificial corporate person is no longer an American citizen. Remember that vaguely patriotic Walgreen's logo that used to abound in the pill counting world?  Well it no longer fits the global monstrosity that is the new "Walgreens/Boots alliance," and has been relegated to the trash heap of history. Right wing Fox news types take note, the country's largest drug chain is no follower of the doctrine of American exceptionalism, as evidenced by the new logo scrubbed of every trace of red, white, and blue:

Holy crap that thing looks like some sort of campaign sign for the Green party. Could European pussies be replacing good old American corporate assholes? 

NEVER!!!! I hear the Fox newsies screaming. EUROPEANS ARE SOCIALISTS!!!! AMERICANS ARE THE FREE MARKET JOB CREATING BUSINESS CHAMPIONS!!!!! USA!! USA!!! USA!!

Let's break away from the Foxy type of reporting for a minute though and check in with reality. This comes from a source deep in the bowels of the new company who says:

As you’re probably aware, Walgreens “bought out” Alliance Boots. Bought out being the most vague of terms, as (Former Boots and now acting CEO of the new corporation) Stefano Pessina is a much, much smarter businessman that Gregory Wasson was, as the latter was a pharmacist who kissed asses all the way to the top. So Pessina outmaneuvered him at every turn, and now the “Walgreens Boots Alliance” still keeps the Walgreens name, but the upper level of finance is 85% people from the Boots dominion.

USA!!! US....wait....wha? But you thought any country with universal health care automatically had a system on the verge of collapse because evil bureaucrats didn't let anyone make a profit, didn't you? Well guess what dittohead, the land of the National Health Service produced a corporate asshole that just took your home grown one to the cleaners.

Perhaps those Europeans did overestimate American competence just a bit though:

As you also probably know, Walgreens as a company has pledged to cut some obnoxious amount of money.  This is because, when they were preparing for the merger, they were talking out of their ass as much as they could in order to inflate their expectations.  This fell pretty flat on its face, and I’m sure Pessina was thrilled to see the forecasts that he inherited.

Before you get too flustered though, you might be happy to know that some of the language of business is Universal. Mainly the stupid micro-managing bullshit part:

So the initial plan to recoup this billion dollars of loss was to minimize amber vial returns. Logic being that while we only get minimal credit for open stock bottles, we get no credit for pills that are in store prescription bottles. So make sure you use the pills that are in those vials (from return to stocks et. al) before anything out of the stock bottles. This makes sense, right? 

Except the fact that they literally paid someone 50,000 dollars to come up with the idea of.....

Get ready for this. This is great.....

  “rubber banding amber vials to the stock bottle it belongs to so technicians know to use it first” 

BBBBWWWWWWAAAAAHHHHAAAAHHHHHAAAHHAAAAAAAA!!!!!!! I seriously put this in contention for some sort of  "stupidest bullshit directive of all time" award, but upon reflection, I realized the current champion, Rite Aid's "no more than 5 labels printed at a time" rule, had absolutely zero impact on revenue, while this time-waster at least is grounded in an attempt to maximize credits. The rubber band thing will have to settle in at number two.

This part of the experience will be no surprise to those of you plugging away inside a corporate swamp though:

they’re so committed to the idea that I receive eight e-mails a week about making sure those rubber banded vials are all over your shelf, and I actually had a visit from a guy from Deerfield because my store was “a high risk store.”  

I wonder if they sent each store a supply of official rubber bands to be used in this program, in order to keep the risk as low as possible? My money says there's a good chance.

There's more than rubber bands afoot in the new order though. It seems the Europeans aren't too bad at good old American downsizing:

Now, obviously, unless 75% of your stores are completely inept (which, in all fairness, I have met some of my peers and walked away wondering that sometimes) they’re not wasting a billion dollars a year on drugs that the technician just doesn’t pick up off the shelf.  So they went to plan B, which is “firebomb every level above store level.”  This is honestly kind of nice, because it gives us the nice thought that maybe they realize they can’t cut any more from store level (I know this is a pipe dream). 

Walgreens initially had a position known as a community leader - this position was a front store manager somewhere that was also responsible for the six stores around them and making sure things ran smoothly.  Walgreens has “pumped up” this position to take the manager out of the store and responsible for about 15 stores instead of about 5, and is calling them the “District Manager” - based on my experiences with the former community leaders, they are going to have the basic pharmacy understanding of a technician school graduate on their first day.  They’re also slashing the “district manager / district pharmacy supervisor” positions in almost half - the half that doesn’t make it can step down to the new “district manager” position (at a pay cut), and the half that does make the cut is now responsible for twice as many stores.  They did the same trimming for the level above them, and cut out 4 markets, evenly dispersing them over the rest.

And now a war on District Managers, which actually.....makes sense. When I was at Rite Aid we went through an extended period where we were District Managerless, and during that time company emails consistently ranked "vacant" as the second or third best district in various company metrics. I'm pretty sure Vacant even kicked everybody's ass and came in first a few times.

Let's sum up:

So end-game here is a couple things:
1)  The suits who have been trying to make us do more with less now all the sudden have to cover more ground with less help, which is a nice twist on what we’ve had to do for a while. 

2)  Someone, somewhere in this merger has given me hope that someone might have a glimmer of the idea that “you can save as much money by cutting a middle-management paper-pusher who is making 150,000 a year as you can by cutting 15,000 tech hours in his spot, and the tech hours are more productive” 

3)  I’m going to have a whole new level of high school graduate telling me how a pharmacy should be run, and complaining that I’m overpaid.

 Time will tell how profitable the British socialists will be. In the meantime, I think I might buy stock in a rubber band company. Whichever one Fox News says will never succeed. 

A Quickie From The Mailbag.

Hi there,

My name is Judy and I'm with the American Recall Center. I came across your blog while researching health safety topics and wanted to say that, as a fellow advocate, I admire your passion for keeping your readers informed, and healthy.

With Patient Safety Awareness Week around the corner (Mar. 8 - Mar. 14), we want to bring attention to a hidden safety hazard found in all of our own homes, our medicine cabinet. It's so important that we understand the medications we take, how to store them securely, and dispose of them properly. That's why we're asking influential writers, like you, to share their thoughts and experiences in a post.

We want to highlight some important facts about medication safety and we're hoping you'd be willing to help us in doing so!

Please let me know if you'd interested,

Inspire,

Judy

Dear Judy,

Strike 1- Use of the word "passion." The new definition of "passion" is "empty buzzword thrown randomly into business jargon"

Strike 2- Exclamation point! Another trendy corporate grammar tool to show how "outside the box" we are!

Strike 3- "Inspire?" Really? What....the......? that is actually worth three strikes all by itself.

The answer is no. Please become very passionate about staying as far away from me as possible!

The word that goes here is sincerely.

DM

A Question Looking to Be Crowdsourced By You CVS Chain Slaves

This one showed up in today's mailbag, and here are those out there who know more about this than me:

I recently had to write about a CVS case that talks about the DUR system. After reading your blog, it seems like you are very familiar with it. I have one question for you: Are these “hard stops” exclusively managed by pharmacists? Or could some of them (the silly ones) be handled or “overwritten" by a trained technician? I mean, could some of them be managed by others and then the hard ones, only be handled by a pharmacist? That way pharmacist be more focused on the more important ones.

As a former Rite Aid chain slave, I know we had to override them all, and there was *something* to override on almost every prescription. (Caution using birth control in reproductive age women was my favorite.) Not sure if CVS is the same way.

Pharmacy Jesus Saves Another Pharmacy Soul

From today's mailbag:

It's been a year since I left CVS behind, in part due to your incisive, honest assessments of the debilitated state of our profession. I now work in a nursing home pharmacy with some of the best people you'd ever want to meet in a sweet little town in the scenic north Georgia mountains. My stress is gone, my arrhythmia is much better, I'm a better husband and father, and generally a better person for leaving that toxic environment. I think for all the complaining retail pharmacists do, I don't think they realize how bad it is until they get out and see how good life can be again. Thanks again and keep fighting the good fight.

Crucified and resurrected my friends. Curing stress and arrhythmias. Making you a better person with a happier life. That's what I do. I'm Pharmacy Jesus.

And I'm waiting for you, Mr. or Mrs. Walgreen's pharmacist just home from a 12 hour shift, your hands still shaking as you reach for the scotch and the Prozac, to come join us. It is doable. You do not have to live like this. 

Your liberation starts here

Oh, How I Have Been So Dreadfully Wrong About The American Pharmacists Association.

....and I'm a big enough man to admit it. Lo these many years I've been hurling mean adjectives at them; useless, incompetent, clueless, out of touch with the profession being some of the most frequent. Little did I know they've been working on a master plan for the pharmacist in the trenches. A cure-all elixir of happiness and harmony that will liberate at last those poor souls chained to the retail world of high volume, no breaks, no room for error and no time to pee.

It was unveiled on page 49 of this month's issue of Pharmacy Today  in case you missed it.

First we tackle the problem of stress. You have it, I had it when I was a chain slave, and it ain't getting any better unless you're able to buy your own place and finally do pharmacy right. Fear not though, as the story's appetizer is a stunningly simple solution to the problem:

In more than a decade working as both community staff pharmacist and manager, Jennifer Davis, PharmD, has found at least one solution for countering the stress that inevitably follows a tension-producing incident like a misfill or an encounter with an upset customer: she presses the pause button. 
 

“Those of you who were involved need to take a break,” Davis, who is now a Fred Meyer Pharmacy manager in Beaverton, OR, will tell her staff. “You need to get off the floor, because the chance of making an error right now is very high.” 


EUREKA!!!!! If only I would have thought of that the time I had to start my Sunday shift as the only person in the pharmacy by dealing with an emotionally fragile rape victim while foaming at the mouth barbarians were demanding their drugs.

My supervisor was disappointed, after 8 hours of playing catch up that day, that the controlled drug inventory wasn't completed. I never forgot their gratitude for my efforts to help that woman. Little did I know it all would have been better if I just would have hung out in the break room for awhile.

But we're just getting warmed up here folks, because The American Pharmacist's Association has been on the case of what ails the retail pharmacy world, and a solution is coming down the pike, baby:

...many pharmacists find it difficult to cope. And rather than promoting the challenges and professional rewards of community practice, many of them advise younger pharmacists to look elsewhere for career opportunities. That was what Mark A. Munger, PharmD, Senior Associate Dean and Professor of Pharmacology at the University of Utah College of Pharmacy, and colleagues discovered in a 2012 survey of more than 300 independent and community chain pharmacists

I just want to pause here and note that it took some egghead until 2012 to realize that pharmacists are likely to tell others to choose another career.

Steps are being taken, though, to reverse these discouraging attitudes, said Munger...

Awesome.

...who is scheduled to lead a discussion, Pharmacist Occupational Satisfaction and Coping with Stress, at the 2015 APhA Annual Meeting and Exposition in San Diego in March

YES!!!!!!!



A DISCUSSION!!!!!!!!!!!!!!!!



PROBLEM SOLVED!!!!!!!!!!!!!!!!


(cue Beethoven's "Ode To Joy" right here)



And what might such a discussion entail? The article goes on to give some tasty previews:

Munger said he had heard from both independent and chain pharmacies. Many of the chains, he said, “have developed internal oversight committees that handle their employee–pharmacist complaints or suggestions and then address them by building a culture that relates around appreciation for their individual work, the individual pharmacist’s ideas, and empowers them to make more individualized decisions.”


BBBBBBWWWWWAAAAAAAAAAAAHHAHHHHHAHAAAAAAAAAHHHHHHHAAAAAAAAAAHHHHHHHHHHHAAAAAAAAAAHHHHHHHHHHAAAAAAA!!!!!! BWWWAAAAAAAA HAAAAAAA HAAAAAAA......oh god...must breathe.......BWWWWWWAAAAAAAAAAAAAAHHHHHHHHHAAAAAAAAAAHHHHHHAAAAAAA........HAAA HAA HAAAH HAAAAA.....oh man......need air.......face is blue.....


BWWWWAAAHHAA!!!!


Ok, stop. Need to focus.


BWWWAAAAAAAAAAAAAAAAAAA!!!!!!


Stop, Drugmonkey. Try to forget what you just saw and move forward.

I just want to say I really want to hear from a chain pharmacist that works in a culture that relates around appreciation of their individual work and empowers them. At all. Any kind of empowerment. I'll put up a reward for anyone who can find me a member of that mythical species.

But wait......the bullshit ain't done being served:

Munger added that many of them are also “building clinical services into their labor projections, which will no doubt improve the workplace environment, as we suggested in the paper, empowering pharmacists to make more clinical decisions. We think that was really one of the major emphases that we got from our survey.” 


Yup, no doubt there, baby. I bet there's noooooooooooooo doubt at all among any of the drugstore schleps beating their brains in to meet their metrics right now.

Alright, one more round of this:

Davis has also learned that diplomacy works best when a patient with urgent needs demands time during a period when patients are lined up at the counter waiting for prescriptions or to be counseled. She will tell the patient: “I would love to spend time with you, but can’t right now. Could I look into this and call you back at a better time?” 
 

“Ninety-nine percent of the time, they’re totally fine with that,” she added.


Excuse me, Dr. Clueless? THERE'S NEVER A BETTER TIME!!!!!!!!! I cut my teeth at a 24 hour Walgreen's that did around a thousand prescriptions a day, and yeah, we might have been able to work a call like that in around 3 or 4 in the morning some nights. I have a feeling 95% of customers aren't gonna be fine with that, though.

"Um, Drugmlonkey?" some of you might be saying. "I thought you said you were wrong about APhA. It kinda looks like they're kinda clueless and out of touch, just like you've always been saying."

No, my friend, they are more than that. Even more than I imagined. Because the only thing worse than a clueless, incompetent oaf who is unwilling to do anything is a clueless, willing stooge who allows others to use them. It's called the American Pharmacist's Association, but it just gave the corporate pinheads who have taken over our profession a platform to tell lawmakers, regulators, public relations agencies, the media and anyone else in the world who will listen about the progressive changes for good they are making in the workplace. Serious decision makers will listen to them, see the APhA stamp on the statement and move on.

That was a knife you just found in your back my friend. Paid for with your dues.

And until today, I never thought APhA willing or competent enough to put it there.

I was very wrong.

At Last, The End To Our National Narcotic Nightmare

Leafing through this morning's edition of the delivered on dead tree news in a semi-awake caffeine craving state, little did I know the momentous moment that was in store. Not only for me my friend, but for my patients, for you, for the country, and hell, probably even the world. 

That's why I still get the dead tree news. Because if I let myself just pick and choose my news from the electronic information buffet, I would have missed this, and probably have spent the morning reading about how the latest cost projections from the Congressional Budget Office show Obamacare will be coming in at a 20 percent lower cost than previous estimates, then I would be writing a post rubbing that in your face right now.

You wouldn't have liked that, because you would have been torn away from a post about no-go zones in Europe where non-Muslims are not allowed to instead read some left wing slanted news story, when what you wanted was funny pharmacy material. Perhaps a return of the ever popular "Highlights From Today's Pill Counting Action" posts.

A left wing story that happens to be true by the way, unlike that no-go shit that Fox News pulled out of its ass.

So it's a good thing none of that is happening, and that I still force myself to have my news delivered to me like the Johnny Marzetti that was plopped down on my tray every week in elementary school. Or else neither one of us would have come across the breakthrough solution to the most vexing of modern problems.

I'm talking about painkiller addiction. You deal with it, I deal with it, everyone with a healthcare license deals with it, as well as the millions of Americans whose lives have been upended by this plague. Once we had a bright idea to reformulate the OxyContin thinking that would help. What happened was that drove people to heroin and dirty needles and product cut with rat-shit contaminated baking soda the local pusher had lying around his filthy soon to be condemned meth lab trailer out by the old Johnson farm.

Dammit!! What we thought was a great idea turned out to have zero effectiveness! What is the solution to this Rubik's Cube public health dilemma?  Well there it was right in front of me on the printed page.

First though, is a Johnny Marzetti served anywhere other than elementary school lunch trays? And what kind of life do you have to lead to be honored with a vaguely appleish food product?  

God, so many questions this night. But fortunately one big answer.

Because someone, you see, finally asked leading syndicated health columnist "Doctor K" what they could do to minimize the risk of becoming "hooked" on their newly prescribed painkillers.

And if you know one thing my friends, you know that once Doctor K is on the case, he'll get to the bottom of it.

After giving us the lowdown on the basics of opiate/opioids and their uses, the good doctor gets down to brass tacks. Unveiling after what I'm sure took months if not years of research, the key. That's right, now for all the world to see, we have tips from the National Institute on Drug Abuse that will help not only the letter writer, but everyone on god's green earth avoid the horrors of addiction.

But wait, do they really make tacks out of brass? I would think you'd go with a cheaper metal. And why would you say "god's green earth" when any picture from space clearly shows the planet to be blue? I suspect the answer to the latter has something to do with the religious types and their difficulty accepting what science shows to be true.

That's not why you're here though, let's free the people from their narcotic hell, and then we can move on to why the faithful can be so stupid. Here we go, the answer to how we can finally free ourselves from the chains of drug dependence and be free at last, free free free at last:

Keep your doctor informed about all the medications you take. This includes over-the-counter drugs. 

Take your medication only as prescribed. 

Read the information provided by your pharmacist before taking your medications. 

Discuss your medication with your doctor or pharmacist. Don’t hesitate to ask questions if you are unsure about its effects. 

Throw away any unused pills once your back pain improves.    

Jesus Fucking Christ. This is the last time I start a blogpost about something before actually reading the article I'm writing about. I saw the headline before work and was so excited....but now....I'm stuck trying to defend this bullshit as something other than a waste of space.

Really Doctor K? I trusted you, and you treat me like I'm too goddamn stupid to think that maybe I shouldn't take my fucking habit forming meds as prescribed. Thanks there buddy, because up to now I thought a good way to avoid ending up in a twelve step program would be to force Norco down my goddamn throat by the handful. I also figured that hiding the fact I got Vicodin from my dentist would be a great path to moderation as well.

You fuckhead.

It's more than a waste of space, thanks to this antiquated technology it's also a waste of ink and I probably just contributed to the deforestation of the Indian subcontinent. Fuck me.

And fuck you. Go back to your Fox News, because you're not getting anymore Highlights From The Day's Pill Counting Action. Because I don't hate my customers anymore. Because it's amazing how much more likable people become when you finally have the tools to deal with them as an actual pharmacist and not a cog in a goddamn pill mill trying to keep the numbers on your computer screen from turning red.

Jesus Christ I just wasted my whole night on this. Doctor K sucks ass.

'Tis The Season For Sticking It To Your Employer. Two Guys In The Trenches Simultaneously Inspire And Infuriate Me.

Tonight I feel I should turn in my MENSA card. I no longer deserve it.

We'll get back to that in a bit, but first a report on some chain drugstores who have been more naughty than nice when it comes to their dealings with taxpayer dollars. First we go to the smog-choked depths of Fresno. Home of the worst air quality you've never heard of, probably because to report it would mean admitting to having visited Fresno. While passing out the stacks of albuterol to the people of the San Joaquin valley though, it seems like Walgreen's was up to a bit of no good:

A federal judge in Fresno has reinstated a jury award of more than $1 million in punitive damages against Walgreens for firing a pharmacist who blew the whistle on alleged billing fraud...In August 2011, a jury awarded Fresno pharmacist Sami Mitri $88,000 in general damages and $1,155,000 in punitive damages. 

According to court documents, Mitri began working as a pharmacist for the company in 1996. He later was promoted to pharmacy manager in Walgreens’ Fresno district. The court documents say he first brought the billing fraud to the attention of Walgreens officials in the spring of 2009; Jones said Mitri learned of the illegal practice because he frequently filled in for Walgreens pharmacists throughout the Valley. 

After he was fired in January 2010, Mitri sued for wrongful termination under the whistle-blower statute that protects workers who report employer misconduct.
In a nine-day trial in August 2011, evidence revealed that more than 20 Walgreens stores from Atwater to Tulare and Coalinga to Porterville were found to have fraudulently billed the government involving Medicare and Medi-Cal patients, Jones said. 

For example, if a patient needed 30 pills, Walgreens would give them 10 and give them an IOU for the rest of the pills, Jones said. Walgreens would then bill the government for 30 pills, he said. 

This illegal practice also involved expensive and time-sensitive medication done by injections, he said.

This one baffles me. I did some time back in the day working for the pharmacy America trusts when they're too lazy to get out of their car, and it was very...very...clear how partial fills were to be handled. The company had just been busted for this exact thing not long before and had re-tooled its software to handle these "partial fills,"  billing only for the amount given to the customer at the time, and for the balance owed only when it was actually dispensed.

Furthermore, they were adamant to the point of crazyness that any new hires complete their computer-based training on this partial fill procedure RIGHT NOW!!!, and the documentation that they had done so was put in their permanent personnel records. So for them to get busted for the exact same thing, while firing the guy who brought it to their attention, seems incredible. I suspect the problem was an ignorant District Manager or two. Ignorant District Managers are about as rare as that smog over Fresnoville.

Anyway, whenever I hear a story like this my reaction is always the same. "Goddammit why couldn't that have been me." Cashing in while striking a blow against the corporate bastards that have ruined our profession, what a true win-win that would be. I had a set of standing orders for my keystone tech to periodically rake her memory for things the corporation could have done in the past, as well as keep her eyes out for anything in the present we might be able to cash in on. And until today, I figured we just weren't lucky enough to be in a location where any shenanigans were happening. If you're thinking the same way, prepare to read this one and weep:

Rite Aid Corp. recently agreed to pay $2.99 million to settle federal charges it used gift cards to entice Medicare and Medicaid beneficiaries to transfer their prescriptions to its pharmacies. 

According to the U.S. Department of Justice, from 2008 to 2010, Rite Aid “knowingly and improperly” influenced the decisions of Medicare and Medicaid beneficiaries to transfer their prescriptions by offering them gift cards.

Everyone who works in a chain pharmacy just gasped right now. I heard it. Every single one of you has gone through the gift card bullshit, and many of you noticed the fine print that says these cards were not to be given to Medicaid or Medicare beneficiaries. Those silly few who actually tried to enforce that restriction were universally....universally he said, meaning every time, by everyone, told to give them the cards anyway.

At least, I used to think those few attempted enforcers were silly wasters of time:

The case stemmed from allegations made by pharmacist Jack Chin. The Justice Department said that as a whistleblower, Chin is entitled to $508,300 of the funds recovered from Rite Aid.

GODDAMMIT!!!!!! GODMUTHERFUCKINGOFCHRISTDAMMITT!!!!! IT WAS IN FRONT OF MY FACE THE WHOLE TIME!!!!!! THE WHOLE GODDAMN TIME I WAS TOILING AWAY FOR THOSE ASSHOLES THE ABILITY TO KICK THEM IN THE NUTS WAS DANGLING RIGHT IN FRONT OF ME!!!!! EVERYONE KNEW ABOUT THE GIFT CARD SCAM!!!! EVERYONE!!!!!!!

Except......only one person was smart enough to do something about it. Sigh.

I'd like to blame my old keystone tech for the fact that 500 large isn't headed our way, I did issue those standing orders after all. but....no....the buck stops here. So instead of being able to hire a pharmacist to run my store so I can go into the mountains and hang out with the bears, I will be going in to my store tomorrow as usual.

Which still beats the shit out of working for them.

So the best I can do now my friends is to pass on a little advice.  The gift card thing will come around again, and when it does, there will be irate customers who don't understand why they can't have one. When that happens, it might not be a bad idea to ask your District Manager for guidance as to what to do. Ask him in writing. And keep his reply for future reference.

Because evidently getting busted for something, and putting procedures in place to keep from getting busted again, isn't always enough to overcome the power of ignorance when it rests with a District Manager type.

I know a good pharmacy lawyer. When the time comes drop me a line and I'll put you in touch.

Do You Know Why I Have Now Inherited The Title Of Best Pharmacy Columnist In The World Now That Jim Plagakis Is Gone? Because Neither One Of Us Ever Wrote A Paragraph Like This.

Look at it:

Clinical community pharmacist (CCP) has begun to appear recently in various venues. It was in the title of a continuing education (CE) session presented at the recent National Community Pharmacists Association convention. The CE session was presented by a panel of innovative community pharmacy practitioners who have been leaders in new direct patient care services.

I just want to point out a few things here:

1) That is the entire opening paragraph, complete and unchanged, of a column in the current issue of Pharmacy Times about, well...who the hell knows? Some character called Clinical Community Pharmacist evidently. Maybe some sort of superhero that can appear in multiple venues at once? If I want to learn about him I guess I'll have to take one of those CE lessons, because there sure isn't much who,what, when, where, or why in this sorry example of news reporting.

2) This was written by a college graduate. He claims to have a masters degree.

3) This illiterate still has a regular gig writing for a national pharmacy trade magazine and Jim Plagakis does not. Chew on that awhile.

4) This also presumably got past an editor at some point. If I ever sent her a turd like this my editor would probably fly out to California and make me eat a dictionary.

I have to go put some water in my eyeballs now, because that piece of work made them hurt and I'm afraid they are about to catch fire.

JP At Large Cut Loose. My Reflections On The First Great Pharmacy Writer.

There was a time when I hated Drug Topics, the pharmacy trade magazine pretty much everyone in the profession is familiar with. I mean seriously hated it. Every time it was delivered to my store it invariably ended up being leaved through, cussed at, and hurled towards the garbage. What burned my ass about the mag most during of the era of George Bush The Lesser was the incredible platform they had earned over the years, a magazine delivered to and read by almost every pharmacy employee in the country,  and how they were in the process of just blowing it. The magazine got smaller every year. It was printed less frequently. The writing....was bad. Really bad. Here's an actual example pulled from my little blog garden's archives. Keep in mind this was the lead paragraph of a news story:

Can metered-dose inhalers containing flunisolide, triamcinolone, metaproterenol, pirbuterol, albuterol and ipratropium in combination, cromolyn, and nedocromil be phased out because they harbor ozone-depleting substances? If there are alternate products that provide the same benefits as these drugs, they are nonessential and can be removed from the market by, say, Dec. 31, 2009, after a transition period. So proposed the FDA in the June 11 Federal Register. The agency said it would hold a public meeting to discuss this matter. For now, please send your comments to the FDA by Aug. 10.

Reading that hurts my eyes to this very day.

It wasn't only witnessing the self-destruction of what was once the main communication channel for pharmacy that stuck in my craw. It was knowing that I could improve it. If I could only get a shot at writing for those guys, I knew.... KNEW... I could be a part of its renaissance. But I also knew the chances of breaking into the world of actual paid print writing were long and hard. I had even sent Drug Topics a Viewpoint piece once and had heard nothing in reply. So I continued to seethe. Another dip into the archives:

Apparently Pharmacy Has A Code Of Ethics. Who Knew? 

Not me. But there it was in black and white in the latest issue of the trade magazine Drug Topics. The code of ethics by the way, was by far the most interesting thing in that rag, Jim Plagakis being the exception that proves the rule. Why Jim continues to do the clowns that think we'd be interested to read about drugstores in the suburbs on Atlanta putting in generators and publishes statements like "Tylenol was one of the top acetaminophen products suggested" the favor of writing for them baffles me.

Name another acetaminophen product.

Quick. C'mon. No Googling.

See my point? Drug Topics hurts my eyes, and if it weren't for Jim Plagakis and the curiosity aroused by seeing an alleged code of ethics that governs my profession, I might have had to try to gouge them out this Christmas Eve to stop the pain.

Jim had been writing a column for the magazine since I was a zit-faced frat boy who didn't know which end of a spatula to count with. He was the last echo of what they used to be. Kind of like Christiane Amanpour at CNN. And unbeknownst to me he had noticed this angry little monkey man and his blog. Drug Topics was looking for someone to write an op-ed for them, and Jim brought me to their attention. When they balked at the, how do we put it, periodic immaturity of what I was posting to the web, Jim assured them that I could write like a grownup when the situation called for it.

So one day I got an email from Jim Plagakis asking if I was interested in writing an article for the magazine. For those of you not in the profession I'll tell you this was the equivalent of Paul McCartney taking an interest in your garage band and asking if you'd be interested in signing to his record label. And so it began:

The idea came to me while I was waiting for my weekly Andy Rooney fix. I had long ago decided that I can't just tune into the last segment of 60 Minutes to catch the ruminations of the cranky old grandfather I never had. That would be cheating, like reading Drug Topics solely for "JP at Large."

That was the first paragraph of the first article I ever wrote for Drug Topics. I was so proud of myself for getting in that JP reference.

The rest my friends, is pharmacy wordsmithing history. I have proven both myself and Jim right. I got my shot, and I HAVE had a part in moving that magazine towards where it should be. Drug Topics is a  better read today than back when it was breaking the news that Tylenol is a popular brand of acetaminophen. And you know what? My awesome columns are part of the reason why.

This isn't a happy post though, because there is a sad ending to this for Jim. He has been let go from Drug Topics, and in a way that has left him hurt and feeling insulted. That breaks my heart, as he doesn't deserve to be made to feel that way. He carried that publication through the time it was...there is no other word, awful. And to not be given the chance to say goodbye to his many fans reminds me of how they cut off Frank Sinatra's speech when he was accepting a lifetime achievement Grammy.

Paul McCartney, Christiane Amanpour, Frank Sinatra. Have I made the way I feel about Jim clear?

It won't be the same next month when I'm struggling to find something to say before deadline the way I always do, and I can't imagine it ever will be. There'll be a tinge of sadness with every article zapped to the magazine from now on. A little emptiness you can't fill with words.

I wish it had ended better than this.

Sometimes, My Friends, The Jokes Just Write Themselves. That Won't Stop Me From Taking A Crack At It Though.

During the tour of CVS corporate headquarters, it was indeed obvious Foulkes takes her butts seriously.

"No one, and I mean no one, has assembled a bigger collection of assholes than we have right here in this building"  She gushed. "And not just in the drugstore industry. I'll go on the record right now in saying that I don't think there's a company in the history of commerce that has had more butt openings than you see in front of you right now"

UPDATE 1- So here's a real quote from the butt-stopping issue. (God why am I actually reading this magazine?)

After 22 years at CVS, and a multitude of different experiences throughout the organization, Foulkes has “gotten comfortable living in ambiguity,” she told DSN. “I’ve been thrust into situations where I just don’t know, and I have gotten comfortable not knowing."

I think what we just learned here is that the CVS President in charge of stores freely admits to, as many of her employees might put it, having her head up her ass.

Wow, I need to be breaking stories like this, These executives never seem to want to talk to me for some reason though.

Hey, Are You A Chain Pharmacist In/Around Boston? Wanna Talk To Someone About Your Working Conditions?

.....someone who can maybe do a little something about it? If so, drop me a line and I can put you in touch with someone.