Sunday, January 17, 2016

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 know you can too.

It won't get any better.

Wednesday, December 23, 2015

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.


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 increases the risk of cardiac events as much as rofecoxib (Vioxx) or high-dose celecoxib (Celebrex).  
   Strike causes more liver toxicity than most NSAIDs.  
   Strike 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.


Tuesday, September 08, 2015

Wisdom Teeth Are Proof Of Intelligent Design. Because God Had Every Reason To Give You Too Many Teeth To Fit In Your Mouth.

Not to mention tonsils and the appendix.

Psalm 139:14 -I praise you, for I am fearfully and wonderfully made. Wonderful are your works; my soul knows it very well.

Except for the fact that the openings of the esophagus and trachea are too close together. Easy to choke and die that way.

  Matthew 5:48  -You therefore must be perfect, as your heavenly Father is perfect.

And cholesterol that can build up in coronary arteries is then somehow an instrument of perfection, even though a guy working for General Motors who came up with a system like that would have been fired.

Hangnails. The fact that a little piece of snot can make it hard to breathe. Lenses in your eye that wear out and make it harder to focus on things up close. I'm on a roll now.

I see god in the fact that my testicles are hanging out there for anyone to take a whack at. A turtle has a friggin' shell over his whole body for chrissakes. Putting a little protection over the boys was too much?

Ever see a leopard with a twisted ankle? Then why the hell are ours made like that?

Menstrual cycles? Really? And tartar that builds up on the last set of teeth you're ever gonna get.

Not to mention my favorite. Who the fuck designed the prostate gland? WHO. THE FUCK. DESIGNED THE PROSTATE GLAND???? Let's take a thing that gets bigger with age and wrap it around the pee tube. THE PEE TUBE! What a great fucking idea. How do you get rid of a good chunk of your body's metabolic waste? YOU PEE IT OUT! How do you regulate the body's osmotic balance? BY BEING ABLE TO PEE OUT EXCESS WATER! WHICH MEANS IT'S KIND OF IMPORTANT TO BE ABLE TO PEE! YET YOU BIBLE THUMPING IDIOTS CLAIM PUTTING SOMETHING THAT'S GONNA SWELL AND GET BIGGER AROUND THE PEE TUBE IS A GRAND IDEA!


It's an interesting little catch-22 really. Belief that god made you prefect is evidence in itself of your imperfection. If this is what your little imaginary friend came up with when he went for perfect, I'm kinda glad it's us people who design airplanes.

Monday, September 07, 2015

Here's A Reason Why You Have to Be Reminded That Certain Lives Matter.

Kenneth Foster was no saint. He was once young and dumb and stupid and did some dumb and stupid things. Hung out with bad people. Committed crimes. No one disputes that.

Just like no one disputes that he didn't kill Michael LaHood. No one. Not even the man who prosecuted Foster for LaHood's murder. He freely admits that Foster did not pull the trigger. That he was 80 feet away in his car when his friend gunned LaHood down.

He never got out.

He never pulled the trigger.

He had to ask his friend what happened when his friend came running back to the car.

And he was convicted of murder and sent to Death Row. He came within three hours of being executed. I shit you not.

He was convicted under the Texas "law of parties" which holds that anyone who had any part in a crime can be held responsible for murder if they "should have anticipated" that one of their accomplice's actions would lead to someone's death.

Which means Kenneth Foster was basically set to be put to death for failing to be psychic. Had he not managed to attract the attention of the media he most likely would have been. Norman Evans Green was not so lucky. He was executed in 1999 for his part in a botched robbery. When another man was the actual shooter.

I'm not making any of this up.

Now let's go to Cleveland, where Michael Brelo was accused of firing 49 times through the windshield of a car in which, unsurprisingly, both driver and passenger died. For the last 15 shots  he climbed on top of the hood of the vehicle and was firing inside. This man had accomplices too, who also were firing. A total of 137 bullets were sent the victims way, and no one disputes this man was responsible for 49 of them.

Of course he was charged too. With...voluntary manslaughter. And acquitted. No one disputes he shot at two people 49 times, and he was found not guilty. 

Norman Evans Green pulled no triggers, and he's rotting away today in his grave.

Kenneth Foster pulled no triggers, and is rotting away serving life in prison.

Michael Brelo pulled a trigger 49 times and for all we know could be screwing his wife right now and planning to go out to dinner afterwards.

Now take a wild-ass guess as to the respective races of Foster, Green, and Brelo. And maybe a guess as to what Brelo did for a living. I bet you'll get it.

Now ask yourself why these Black Lives Matter people seem to be so angry. Take a good look deep into yourself and ask that question.

I'm not as confident you'll get that one.

Sunday, September 06, 2015

A Bit Of Nazi History And An Insight Into My Mind.

Adolf Hitler came to power through a series of free and fair elections.

He worked his and his Nazi party's way through the German parliamentary system, gradually gaining votes and seats until his was the biggest bloc in the Reichstag, or German parliament.

But he wasn't quite where he wanted to be. There were still people who could legally tell Hitler to piss off, and Hitler didn't like that. Then came the Reichstag fire. Right during the runup to the next set of elections someone went and burned down the Reichstag building.

Now imagine the US Congress burned down right before a presidential election. Let's say it would have happened in 2004, right as W was trying for another term. Can you imagine how the feds would have reacted? Actually you don't have to if you just remember what happened after 9/11. I'm looking at you PATRIOT act, warrantless phone tapping, military detention without trial and Guantanamo.

Now imagine it wasn't W in charge during a time of national crisis but Hitler. You don't have to be a genius to see this Reichstag fire thing came at an awful convenient time for a power hungry fiend looking for a reason to consolidate his rule.

And you don't have to be much of a conspiracy theorist to speculate as to who might have set that fire.

Which is why every time I hear this song, I always imagine a scene in a Mel Brooks-like "History of The World" type movie. It would be  a kind of dance number thing, with uniformed Nazi's holding torches moving in perfect choreography as they set torch to the last speck of German democracy. The flames go up and the lights go out for Europe.

I can see it it my head. The whole dance number. Every time I hear this song. Tell me it isn't perfect.

Thursday, August 20, 2015

I Bestow A Roadmap For APhA to Follow

To: Thomas E. Menighan. CEO, American Pharmacists Association.

RE: Your ongoing public relations disaster.


Good Lord. I had no idea you would be so stupid about this.

I admit, when I first read the APhA Foundation's press release announcing the "Bowl of Hygeia" award given to Lloyd Duplantis, I thought it would be fun to sit back and chuckle as you scrambled around to do the right thing. But I never thought you would not know what the right thing was. Seriously, this is 2015, and a man who says the birth control pill leads to an increase in "effeminate men" and homosexuality now has a trophy with your name on it on his mantle.

And you're OK with that? Seriously? I haven't even mentioned his bizzaro theory about how gay Haitians contracted the AIDS virus in Africa and brought it to North America.

This is actually getting painful to watch. Have you noticed it's not just me giving you a hard time anymore? You are getting pummeled in the court of public opinion, and rightfully so.

But I'm here to help. I'm not quite sure why it's up to me to get you out of this mess of your own creation, but no one else seems to be lifting a finger. Thing is, putting all this in your rear view mirror really wouldn't be that hard. Here's your complimentary session with the Drugmonkey consulting service:

1) Make a statement. Now. Making it crystal clear that the views of Lloyd Duplantis do not in any way reflect the values of APhA. That your organization is for equality for all, and stands against all forms of discrimination and ignorant hatred.

2) Put in your legalese about not being responsible for making the decision to give him that award. BUT...follow this with an announcement of a change in your policy that will ensure this will never happen again. What those changes are I'll leave up to you. I can't solve all your problems after all.

3) Make a large donation to an organization that works for the advancement of the LGBT community. And I mean large. More money than you gave the Louisiana Pharmacists Association to award a bigot.

There you go buddy, PR disaster dealt with. I solved your damn situation with about five minutes of thought while I was waiting for my wife to finish brushing her teeth. Now why the hell couldn't you, with your access to the best PR professionals in the country right there in your DC neighborhood, come up with something other than cowering in silence?

Unless...the values of Lloyd Duplantis really do in some way align with those of APhA. I guess that would explain it.

Until you open your mouth Tom, the world will never really know.

Do. Something.


Sign a petition calling  on APhA to do something about their boneheaded move here. 

Monday, August 17, 2015

Words APhA Has Honored. YouTube Edition.

You know, I'm just gonna step aside here, put away all the snark, and let this dramatic reading from the book The American Pharmacists Association chose to plug from the author they chose to honor speak for itself. This guy isn't Lloyd, but he's preaching right out of Lloyd's work.

Before you hit play, remember:

The American Pharmacists Association's Foundation gave this author an award. 

Since this book has been brought to their attention they have done nothing and said nothing

Without further ado, lets roll the tape. 

Sunday, August 16, 2015

Let's Have Some Fun With Lloyd Duplantis While We Wait For The Cat To Untie APhA's Tongue.

Here's where we stand on APhA "awardgate" as of this afternoon:

1) The APhA Foundation gives an award to our old friend Lloyd Duplantis, who, it turns out, is about more than keeping birth control pills away from people he feels aren't smart enough to know the risks. Turns out he's a horrible homophobe as well. Go here to catch up on the details if you're just tuning in. 

2) APhA cites Lloyd's homophobic book in the press release announcing their award.

3) The fact that they are supporting bigotry is brought to APhA's attention, whereupon they do...

...absolutely nothing. Not one word from them so far.

Go here to add your name to a petition asking APhA to take back their bone-headed move. 

4) I take that back. They are doing something. They are taking down critical comments posted on the blog of their CEO, Thomas Menighan. Go here, quickly, before they erase the comment field again. 

So to sum up, APhA makes stupid move, refuses to own up to it, and is now trying to erase online evidence of what they've done.

But you can't erase this Thomas Menighan. So today we'll start a new series I'll call "Words APhA Has Honored." We'll take an actual, real excerpt from the book APhA plugged in their press release and put it up here for all the world to see, followed by a little debunking, commentary, or maybe just uproarious laughter

Ready? Here we go:

Here is one sentence from a pill insert- a powerful, real statement which alone should cause many pharmacists to shy away and opt out of filling prescriptions for such dangerous chemicals.  
"The use of oral contraceptives is associated with increased risks...of myocardial infarction, thromboembolism, stroke, hepatic neo-plasia, gall bladder disease, and hypertension." 

Wow. That is scary. But wait, there's more:

Serious cardiovascular, cerebrovascular, and vascular events, including myocardial infarction, sudden cardiac death, ventricular arrhythmia, cerebrovascular hemorrhage, transient ischemic attack, hypertension, subarachnoid and intracerebral hemorrhages, and pulmonary hemorrhage have been reported post-marketing 

Holy crap I'm even more scared now. Except that second quote wasn't from Lloyd's book. I cut and pasted it from Viagra's "pill insert," more commonly known among real pharmacists as the prescribing information.

Because real pharmacists know you can find a a scary line in the "pill insert" of any drug on the market. I could write you up a description of aspirin that would scare your socks off.

APhA knows this too, but chose to honor this guy anyway.

There's plenty more where this came from Thomas Menighan. Enough material to literally keep this thread alive for years. And it'll keep coming, one by one, post after post in a place where you can't erase it, until your organization owns up to what it's done.

It's up to you how long this goes on.

A Quickie From The Morning's News.

We'll have more on APhA, Lloyd Duplantis, and "awardgate" later on, but Sunday mornings always start with the Sunday newspaper around the Drugmonkey household, which today contained this line:

"The county is budgeting about $14 million more for 2015-16 than this year's $45.3 budget. The mental health funds are from a California state tax on millionaires that voters approved in 2004."  

You have no idea how happy that makes me.

Today is a good day.

Carry on.

Tuesday, August 11, 2015

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.