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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    I do know for sure that lady found her firewood. 

    I really, really, hate this job sometimes. 

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

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

From the public relations press-release snore wire:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Better health awareness my ass.

I See A Bad Moon Rising

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

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

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

    "What is it Capt'n?"

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

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

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

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

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

    The boy started to weep softly. 

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

    Pray the bacteria do not come. 

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

A Tribute To Joseph, The Biggest Sucker In Biblical History. Or The Biggest Cuckold, Neither Of Which Is Anything To Be Proud Of Really.

     "My dear husband, I bring you good news! I am with child!" 

     "But how can that be? We have not lain with each other....unless.....you have lain with another man..."

     "Um...no....er....it is the child of God's...yes...God's child! I was seeded with no penis at all breaking the barrier of my outstretched legs. The inside of me was not filled in a way I can never imagine you filling it, thrusting deeply....hitting the magical G-spot again and again........leaving me on my hands and knees begging for more......literally begging...."

    "Um, no, that never happened at all. Totally God's child."

      "I see. Well that makes perfect sense. Why shouldn't I believe my wife is pregnant without having sex with another man. I mean, really, if you think about it, getting pregnant without the involvement of penis is way more likely to happen than a woman deciding she wants to do the nasty with a man other than the one she's committed to."

    "Blessed are we Joseph!"

    "Um, yes, blessed are we"

     Of course there is an alternate explanation: 

    "My dear husband, I bring you good news! I am with child!" 

     "How fabulous! This is the perfect sequence of events to cover for the fact I only lay with other men! What a glorious day! Does this robe make me look fat?"

     Either way, thanks Joseph. Thank you a whole fucking lot. Had you been not quite so dumb or maybe a little more psychologically comfortable with who you were, we would have had absolutely no need for The Crusades. All that Catholic/Protestant nastiness that killed so many people around the time of the Hundred Years War? Wouldn't have happened. We also wouldn't have then spent our time subjugating, colonizing, humiliating and killing every non-European on the planet in that bastard son of yours' name. We would have been too busy with the Roman orgies, feasts and toga parties. Yeah, I'd much rather have the Spanish Inquisition than an orgy. Thanks again there Joseph. You set off just a wonderful chain of events, didn't you? 

     Or Maybe Mary was just one hell of a lay and once you finally got a taste you just couldn't give it up for anything.  

It doesn't matter. Screw you Joseph. 

     

Dear Minnesota, This Fall, You Can Vote For One Of The Sharpest, Most Thought Provoking People Ever To Step Into The Public Arena.Or You Can Have This

That's Norm Coleman. He currently represents Minnesota in the United States Senate. Just in case you don't want to click on the vid, mnpublius.com was kind enough to provide a complete transcript:

Interviewer: I just want to know how you feel about the last eight years of George Bush.

Norm Coleman: Well, uh, belehduh belehdudeduh

I'm not kidding. That's the actual transcript. God if I lived in Minnesota I'd be so proud....

...and if I lived in Minnesota, I'd know what to do in November.

Back To The Drugs. You May Think The FDA Makes Big Pharma Prove Their Medicines Help Disease Or Suffering Before They Are Sold. You Would Be Wrong.

"Drugmonkey you've lost it" I can hear some of you saying. "Last night some cockamamie story about reporters getting arrested at the Republican National Convention, and now this. I know damn well the FDA requires a company to prove a new drug is effective!"

Well, several reporters have been arrested during the Republican convention:

There was a photographer right next to me who was also taken down pretty violently. He was screaming he was press, as well. He had credentials. He kept saying he was a photographer for the New York Post. And quite funnily, he said, “For Christ’s sake, it’s a Republican paper!” But that didn’t seem to matter.

And while the FDA indeed requires evidence of effectiveness for a new drug to be approved, there are times when it requires zero proof of effectiveness against an actual disease.

Meet our friend Mr. Surrogate Marker. He makes this possible. I think the best illustration of Mr. Surrogate Marker and how he can lead you off the path of the scientific method can be done with the help of a little time travel. So climb with me into the wayback machine to 16th century London, ground zero for culture and cutting edge medicine of the time:



The scene, The Academy of Smart Fellow Medicine, London's finest hospital:

Doctor wearing a wig: Zodooks and other curses! Another case of ill humored corpsucular spirits! It has been the leading cause of death in our fair city for a score of year now! Assistant! knock that rat off the table and prepare the leeches to suck a pint of blood from the patient immediately!

A scantily clad wench enters through the office door, carrying an armful of boxed lunches: My good doctor! I bring you tidings and wonderful news! A breakthrough in the treatment of ill humored corpsucular sririts (IHCS) from my superiors at the general meydicyne and surgical company!

Doctor Wig (staring at the wenches breasts): Tell me more of this breakthrough young lass!

Wench: We call it Warfarene. And it decreases the amount of time needed to bleed a pint of blood from an IHCS patient by over 50%! Here are many studies to prove this from the Royal Leeching Society. And many quill feathers you may use as pens.

Doctor Wig: Huzzah! Everyone knows decreasing the amount of time necessary to bleed a pint of blood helps in the treatment of IHCS!

Wench: It is a glorious day! Soon the future of IHCS patients will be long and prosperous!

As you can probably guess. The future of IHCS patients was in fact short and wracked with misery. That is because the good Dr. Wig fell into the trap of the surrogate marker. Surrogate markers are easy to identify. If you can fill in x and y in the following sentence:

"Everyone knows x helps in the treatment of y"

You've got yourself a surrogate marker. Let's try a few:

"Everyone knows lowering LDL cholesterol helps in the treatment of heart disease"

Vytorin and Zetia undeniably have been proven to lower LDL cholesterol. Six years after they came to market however, there is no proof that either lowers the risk of heart attack or helps heart patients live longer. In January, a study designed to show the drugs shrink arterial plaque was a failure.

"Everyone knows lowering a patients blood sugar helps in the treatment of diabetes"

Avandia unquestionably lowers a diabetic's blood sugar. It also might increase the risk for a heart attack. If your diabetes improves and your heart explodes, you're just as dead.

Surrogate markers aren't always bad. When other evidence is thin and not many options are on the table, knowing that a med has been proven to shrink your tumor (but not necessary lengthen your life) is a way better option than a bottle of shark cartilage. For diseases such as hypertension, high cholesterol, and diabetes though, where there are many proven disease-modifying treatments already available, approval based solely on surrogate marker evidence makes no sense. Let's see what happened when the FDA grew a pair and stood up to Big Pharma's surrogate marker play:

"Everyone knows raising HDL cholesterol helps in the treatment of heart disease, and our drug raises HDL, so it must be very helpful" said Pfizer.

"Prove it" said the FDA.

So Pfizer reluctantly did a large scale study measuring actual outcomes in actual patients, and found that its drug, torcetrapib, which did indeed raise HDL, also increased the risk of death by 60% Remember that the next time someone tells you about the evils of government regulation and the virtues of the free market.

Be careful out there friends. Don't stop taking anything without talking to your doctor first, but be careful.

Go here for the New York Times article I used as source info for this post.

This Is What Freedom Of The Press Looks Like In Bush/McCain's America.

If you were desperate to get some real coverage of the Democratic National Convention last week, you may very well have ended up at Democracy Now! What you would have seen if you did was hour after hour of hard-hitting interviews of the powerful. Tough questions asked of the people who pull the levers that make things happen in this country. Believe it or not, you also would have seen some thoughtful answers. Answers given in paragraph form for those so few of us left who do not suffer from news ADHD. It was awesome. You also would have seen some of this country's citizens who were spurred to action to try to hold what are supposed to be our representatives accountable for their actions in office. People like Ron Kovic, whose story you might be familiar with if you've ever seen the movie Born On The 4th Of July:

I did not give three-quarters of my body in Vietnam in 1968, forty years ago, to be put inside of a cage. I’m going to speak. I’m going to raise my voice against this war, and I refuse to be silenced. And we refuse to be silenced. We’re growing stronger every day. This is going to become one of the most powerful antiwar movements in the history of this country.

Ron was talking about freedom of speech during the convention being limited to pre-approved protest zones, and if you were watching Democracy Now! You would have seen it.

Like I said though, you probably would have had to have been desperate to find it. Most people watching the *cough* news from the DNC saw nothing but.....

well I just thought the speech was ammmmmaaaaaaazzzziinnnngggg.....

So here's what happens when someone dares to try and do real journalism in the United States in 2008:




That's Amy Goodman, host of Democracy Now!, being arrested hours ago at the Republican National Convention.

Goodman was arrested while attempting to free two Democracy Now! producers who were being unlawfully detained. They are Sharif Abdel Kouddous and Nicole Salazar. Kouddous and Salazar were arrested while they carried out their journalistic duties in covering street demonstrations at the Republican National Convention. Goodman’s crime appears to have been defending her colleagues and the freedom of the press.

Ramsey County Sheriff Bob Fletcher told Democracy Now! that Kouddous and Salazar were being arrested on suspicion of rioting. They are currently being held at the Ramsey County jail in St. Paul.

Suspicion of rioting???? Are you fucking kidding me? I could take the whole Democracy Now! staff in a fight with only my left hand. They are not scary people. On the other hand, they have never been scared of telling the truth, and evidently, that is now a crime.

Democracy Now! is calling on all journalists and concerned citizens to call the office of Mayor Chris Coleman and the Ramsey County Jail and demand the immediate release of Goodman, Kouddous and Salazar. These calls can be directed to: Chris Rider from Mayor Coleman’s office at 651-266-8535 and the Ramsey County Jail at 651-266-9350 (press extension 0).

That's all we have left now. The ability to make some phone calls. Otherwise we may be rioting.

I'm sorry Ron, but you may have indeed given three-quarters of your body to be put in a cage. I'm sorry.......

God Bless America.

Yeah, So, Like I Said, There's No Way Sarah Palin Could Have Faked Her Pregnancy.

Turns out the face of the American Taliban still has a daughter that is a shining example of what to expect when you think not giving kids condoms means that they'll never have sex, just not quite in the way the story looked to be gelling last night:

ST. PAUL, Minn. - John McCain's running mate Sarah Palin, said Monday her 17-year-old unmarried daughter is five months pregnant, an announcement stealing even more thunder from McCain and a Republican presidential convention already overshadowed by Hurricane Gustav.

Adding to the day's drama, McCain aides said the announcement was aimed at rebutting Internet rumors that Palin's youngest son, born in April, was actually her daughter's.

Good thing baby daddy was just packing some sperm, and not some herpes, or you know, the HIV.

At any rate, lesson learned. Drugmonkey keeps his mouth shut from now on until the whole story is in. If only others could learn about Trojans so easily....